Pacifiers, Diapers, and Diarrhea – PediaCast 088
- Getting Rid of the Pacifier
- The Diaper War: Plastic vs. Cloth
- Undigested Food in Poop
- PediaCast 41: Thinking Inside The Box (Pacifier discussion)
- Diapers: Plastic or Cloth – From The New Parents Guide
- Chordee Information (Penn State Children's Hospital)
Announcer 1: This is PediaCast.
Dr. Mike Patrick: Bandwidth for PediaCast is provided by: Nationwide Children's Hospital — For every child, for every reason.
Announcer 2: 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 is Episode 88, our Listener Edition, for Friday, November 30th, 2007 — Pacifiers, Diapers and Chordee. What is chordee? Well, stick around, we'll let you know.
Coming up also today, in our Listener Segment, we're going to talk about the diaper war — plastic versus cloth, how to get rid of the pacifier, undigested food in the poop. Someone asked.
Dr. Mike Patrick: I mentioned chordee. And then, we have a question about diarrhea as well, so we're going to focus on poop here for at least a couple of the questions. Well, I guess if you consider the diaper question, that one kind of involves poop, too.
All right, enough of that.
You know, in the office this week, I had a run, it seems, on parents who did not want children to receive shots. I mean, I can go like two or three months and not have anyone even question them. And this week, there's a couple of them. And honestly, we've had this conversation when Bob Sears was here to talk about The Vaccine Book. I don't kick people out of my practice if they don't want to give their kids shots. I'm all for parent choice, but come on folks, let's at least be a little educated about this stuff.
The parents this week who refused to have their kids get any shots, really, had no good reason except, "Well, I don't think we should be putting all those things into their bodies." Or, "Well there, we don't know enough about that. There's just not enough research." Again, I'm not making fun. It's just that if you're going to refuse vaccinations for your child, you could at least do a little research and have something to back you up.
But just to say, "I do not put that in their body." Because I can present data with thousands and thousands of kids. Or, there's the fact that I see a hundred well checkups every week and almost all of them get shots. And then, I see them back over and over and over again, and pretty much see the outcomes in relation to the shots. But no, they want to listen to this hole-in-the-wall website that uses poorly research scare tactics.
And honestly, I don't try as hard as I used to. I guess that's probably part of the problem. Most of these people give me ten minutes in the room with them. Unless, they had researched it well and then fine. But these ones just say, "Well, we shouldn't be doing that." Ten minutes in the room and they were signing for their kid's shots, because I presented the data and showed them. But as I practice longer, I don't know, you lose your motivation a little bit. Again, that's a problem and probably this is as much my fault as it is the parents', but yeah, I don't know.
I even had one mom recently that said she really prayed about this and then found this website — that I've never heard of before — that told her not to get shots. And then, couple of days later, she's in the office with me and I said, "You know, maybe I'm the messenger. Maybe, it's not the website." Yeah, I actually said that. But I didn't push any further and she left without shots.
Again, I had a few this week and it just seems like it's a run-on because I can go months and months without it. So, anyway, a little personal frustration there.
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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.
And with that in mind, we'll be back to answer your questions right after this break.
OK, listener question number uno comes from Rose in Omaha, Nebraska. And Rose says, "Dear Dr. Mike, hi there. I just figured out how to download podcasts to my MP3 player. As a result, I had become addicted to your show. Please pardon my grammar, spelling or lack of sense this morning. I work 12 hours a night and just got off a string of several nights in a row."
"OK, my question is, I have a beautiful two-year-old that is deeply attached to her pacifier. My husband and I have tried to break her of her bink, but it's easier to give in to her inconsolable crying by giving her pacifier back. My doctor suggested complete cold turkey for her and a strong stick to-your-guns for both my husband and I. Is there any suggestion you can give me to break her off her pacifier? She has a mouthful of teeth and I don't want a pacifier to ruin them."
"Thanks for all of your help. Love your podcast. Keep up the great work."
All right, well, thanks for your question, Rose. And thanks for adding some time in your day for PediaCast.
First, let me say that I do not believe that pacifiers will cause any type of permanent tooth problems in a two-year-old. Oral structure at that age is really determined genetically and not by sucking on a piece of plastic. And for an in-depth look at the science behind why I say that, I would refer you to Episode Number 41. Kind of a controversial episode, it was called "Thinking Inside the Box", and we actually used pacifiers, what they can do and thumb sucking as well — non-nutritive sucking we call it — and the effect that has on the mouths of toddlers and older babies. So we go into that in quite a bit of detail and really dissect the research on it. And again, that is in PediaCast Episode Number 41.
Now, having said that, if you still want to get rid of the pacifier at age two or three, that's fine, do it. I'm not saying it's wrong to get rid of them in young toddlers. I'm just saying they don't cause tooth problems in my informed opinion. So let's say you do want to get rid of it anyway, which again is fine, how do you approach getting rid of them?
Well, going cold turkey is certainly an option. And if you're going to do that, you have to get all of the pacifiers out of the house. That way, you won't be tempted to cave in. So I mean, if there's a pacifier in the house — as you said, they're inconsolable crying — if they cry loud enough and long enough and throw a big enough tantrum, you're going to cave in, give them the pacifier. And then, they'd learn that if they behave in that way, they get what they want, which is really not a good thing.
So, your best bet is remove all temptation of yourself giving in and just get rid of the pacifiers completely. And you can expect a terrible week. But you will get through it and a week or so later, the pacifier will be forgotten. And will this cause some sort of psychological meltdown down the road? Would they be, 24 years old and on a shrink's couch and suddenly, it's coming out? It's unlikely. It really is unlikely.
Now, there is another solution. And I think this one works best for older kids, like late two-year-olds or early three-year-olds even. And what you can do is this: identify a date that you're going to get rid of their binky — it could be their birthday, just some date that they can sort of comprehend — and make a chart or calendar. Show them which date you're going to get rid of the binky, "This is a binky-free day."
And you can make little X's.
And I, though, get it. They may not understand the concept of the calendar, but as you start marking days off and you get closer to it. And what you're going to let them know is that on that day, you are going to go to a toy store — or some other motivating place where merchandise can be purchased — and you are going to trade in the binkies for an item of your son or daughter's choice. And that's going to happen on this day on the calendar, and we're marking off days till we get there.
Now, well before that day, I would start to limit the use of the binky to only at night. That way, this isn't much of an issue during the day. So, you sort of start weaning them on it anyway. Now, when you get to the point where they're just taking at night, then, that's what you want as you get close to the day. And then, when the day arrives, you take the pacifiers to whatever store and trade them in for toy or a book or whatever that's going to motivate your child, and literally, leave all the binkies with the cashier. So you pay for the toy or book or whatever it is, but your kid thinks, "Hey, look, this is an even trade. You're going to get this toy, she's going to keep the pacifiers." They're out of the house and you've warned them ahead of time.
And the toy does help relieve some of the burden of the loss. They showed really upset, they don't have the pacifiers anymore, but "Hey, you got this cool new thing that you can play with." The first few days still may be rough, but rough days are part of being a parent.
All right, moving on to listener Number 2, this comes from Katie in Provo, Utah. She says, "We are having our first baby in February and I really enjoy listening to your show as a kind of prep for our new baby. We've been considering using cloth diapers instead of disposable diapers. Our main motivation is cost. But as I have been doing research, I've heard that cloth diapers are supposed to be easier on your baby's skin. I'm wondering if, as a doctor, you think there's a health benefit mostly less diaper rash to using cloth diapers. Thanks — Katie."
Well, there are several issues, Katie — and again, thanks for your question — when you look at the plastic versus cloth debate. Now, first I want to say that where I practice, I really never see cloth diapers. It seems like my entire patient population is still in plastic diapers.
Still in — cloth is the original, folks.
But anyway, I guess today's cloth diapers are nothing like yesterday's cloth diapers, from what I understand. But I don't live in the most progressive of communities and all of my patients are still in plastic diaper. So, I may not be the best person to answer this question, but let me still attempt to.
I guess one of the issues when you look at plastic versus cloth is the environmental issue. Plastic diapers take a long time to degrade in landfills. But then again, cloth diapers require use of soap and water and electricity and your septic system and public sewers. So I'm not sure where I stand on that one. I mean, they both have environmental issues. Of course, not using diapers at all is an entirely different environmental issue. So, you're going to have an environmental issue no matter which way you go.
In terms of diaper rash, I really think that depends on the kid. I see a lot of kids who seldom, if ever, have a diaper rash even with plastic diapers. And you see some kids who only will tolerate one brand of plastic diaper, or they just constantly have rashes no matter what brand the parents use. Cloth diapers, though, you could also get bad rashes there from contact dermatitis because the cloth diapers are not going to absorb poop and pee as much, and so those are going to be able to touch the skin a bit more. So you think there may be more of a contact dermatitis risk. Also, yeast infections, they can still happen with cloth diapers.
So I think the diaper rash issue really depends on the kid. Well, I could see where cloth diapers may have a little bit of an advantage, especially to the contact dermatitis or allergic reaction to the diapers. If you're undecided and your only issue is the rash, you could always try plastic disposables to start and then, switch to cloth if they do end up having a rash problem. So I think for most kids, from a health standpoint, it's not really going to matter but there will be a few kids who do better with cloth compared to plastic.
Now, I did find a really nice article on diapers cloth versus plastic. It takes an objective look, it doesn't try to convince you one way or the other. It's at the site called the New Parents Guide and this particular diaper article looks at rash concerns, cause, environmental impact, the convenience variables and all these things. It really was a good resource and I would encourage you to check it out. And, of course, we'll put a link in the Show Notes for you for that.
OK, listener number three, this comes from John in China. Really? He's in China — that just is bizarre for me, I don't know. The distribution of podcast on the Internet is pretty crazy.
John says, "Dr. Mike, my wife, daughter and myself work in China. This past week, our daughter Lucy has begun to have undigested food in her poop. Peanuts, raisins and spinach is what we have noticed. She's 19 months old. She currently has four new teeth coming in. I think I heard this can make them have loose stool. But we are curious, why is she having undigested food like this in her diaper. The peanuts, I can understand but the spinach and raisins concern us. Thanks for your help."
Well, thanks for your question, John in China.
Teething does not cause loose stool. Viruses are the most common cause of transient or loose stool that sort of comes and goes in babies. There are other things that can do it too, but viruses would be one of the more common ones. Of course, if diarrhea persists or it has blood in it or it's accompanied by fever, other sources other than viruses would need to be ruled out.
Now, when kids have loose stool for whatever reason, there's quicker bowel transport. The bowel's moving things through faster. That means there's less time for digestive enzymes to do their job. There's less time for proper absorption of the food material. And so, there's more opportunity for undigested food to make its way into the expelled stool, because it's moving through faster, there's less time for absorption, less time for digestive enzymes. So, if they have loose stool, for whatever reason — there's a virus or something else — you're more likely to see some undigested food in there.
Now, in the absence of loose stool or diarrhea, you may still see some undigested food in the diaper. And most likely, this is OK even with the spinach and the raisins. Think about when you eat corn when that goes through you. Fibrous food just take longer to break down. Babies have a relatively short intestinal link for the digestive processes to occur. So it really is not much of a concern. However, if your child has poor growth or unexplained fever or blood in the stool, then you do have to still entertain other causes. And as always, if you're concerned, call your doctor and let him or her take a peek.
OK, and question number four comes from Mel in Denver, Colorado — "My four-year-old was just diagnosed with a chordee, C-H-O-R-D-E-E, after seeing a specialist about his undescended testicle. Both operations will be done together. Could there be a link between the circumcision he had at birth and his chordee? I guess what I'm asking is, does scar tissue from the circumcision cause a chordee or is it something that appears by itself?"
OK, first, we have to describe what is a chordee. A chordee, again, C-H-O-R-D-E-E, is a congenital — meaning it's present from birth — downward curvature of the penis and this is due to a strand of connective tissue between the urethral opening and the glans or the tip of the penis. So from the bottom of the opening of the hole at the tip of the penis to the head of the penis, there is a piece of connective tissue that sort of arch and crosses the gap of the rim where the head turns into the shaft and that pulls the shaft downward. And that causes a little bit of a curvature to the penis itself, especially toward the tip.
Now, it's often associated with something called hypospadias, which is another congenital condition — so present at birth — where the urethral opening is not at the tip of the penis but further down and it can be somewhere along the bottom of the glans or even along the bottom of the shaft of the penis. It's possible too and they have to have surgery for that. Now, this is not always present with hypospadias, the chordee can also be present just by itself.
Now the defect is exaggerated during an erection. So, during an erection, the penis even more curved than it otherwise would be. And this can interfere with proper vaginal penetration, and then can also cause fertility issues as well. So, this is definitely something that if you find in infancy, you just want to get it taken care of then, because you don't want to wait till later, and then you got this other kind of problems that are of a personal nature. So you want to get this taken care of when they're babies, really, in my opinion.
Now, this is a congenital malformation, so kids are born with this. The exact cause is unknown. It's just something that happens during development and it is not associated with circumcision or scar tissue or any of these things.
So again, treatment surgery in infancy, although you should wait till after they're six months old, that's what most experts would say. Because they're going to be able to better tolerate the anesthesia at that point. And also, the structures are a little bit bigger and easier to work with as well.
In my opinion, this sort of thing should be treated at a children's hospital by a pediatric urologist. And these are the guys who — and gals, in some cases — who spend all day basically taking care of children's penises. So that's who I would think that you would want to take care of this.
Got a great information sheet about chordee from the Penn State Children's Hospital and you can link for link to that in the Show Notes at pediacast.org.
And finally, listener number five, this is Miranda in Dallas, Georgia. And Miranda says, "Hey, Dr. Mike. I have a twenty-month-old little princess and she has had diarrhea for the last couple of days. I called the doctor and they said there was nothing we could do for it and there was no reason to bring her in if she wasn't running a temperature or acting sick. Some general information, she isn't running a temperature, acting pretty normal other than sleeping a little more and she's eating pretty well, too. The diarrhea is mostly clear, if that is important at all. What are some things that can cause diarrhea and are there any at home remedies that we can use to try and help her out? Thanks so much for your great show. Keep up the great work. Long time listener — Miranda."
Miranda, thanks for writing in. So what causes diarrhea that lasts for a couple of days in a 20-month-old? More likely than not, a virus. So viruses, viruses, viruses — number one cause by far especially if the diarrhea is very short-lived. Now, there are a lot of other things that can cause diarrhea in kids. And this list I'm going to go through here is not exhaustive. We're just going to give some examples.
And, of course, if you're concerned, see your doctor. If your doctor won't see you because there's no fever, then get a new doctor. If you want to see your doctor and you can't get in and they tell you, you can not come in, then that's a bad sign. So, I mean, you should be able to go see your doctor regardless. And if they're so busy that they can't see you when you have a question or a concern, then that is an issue.
OK, so, viruses are going to be number one. Now, bacteria can cause diarrhea as well. Now, bacterial causes of diarrhea, often there's blood in the stool. Not always but often. Giardia is something that could cause a diarrhea. Usually, that comes from contaminated water.
And then, C-diff or clostridium difficile, this is a specific bacterial infection, and that come on from recent antibiotic use. So if you have a kid who's been on antibiotic, especially if they've had a series of antibiotics, then they get this diarrhea that's not going away and it's pretty severe, one of the things you could think about is c-diff or clostridium difficile.
Lactose intolerance, if you're missing the enzyme lactase that you need to break down lactose, the sugar. You can also get what we call post-infectious lactose intolerance where because of the diarrhea which is caused by a virus, the enzyme lactase is washed out of the intestine because of the diarrhea and so you become temporarily lactose intolerant. So first, the diarrhea is caused by a virus, but then it lasts longer because now, your child's lactose intolerant until they can build up that enzyme again. So we do see that a lot too. And just switching him to a formula that doesn't have any lactose in it usually will help with that. Or if they're an older, toddler kind of kid, then just avoid milk and dairy for a few days.
There's also malabsorption syndromes that can cause diarrhea. A cystic fibrosis can lead to sort of a greasy diarrhea because of poor fat digestion. Inflammatory bowel diseases such as Chron's disease and all sorts of colitis.
And actually, constipation can cause diarrhea. Typically, in the beginning stages of constipation, you have infrequent hard, difficult to pass bowel movements. But as the intestine fills with stool and there's no room to make normal turds anymore, then the new food coming from the small intestine just kind of slides around the bulk that's in there. There's no room to make normal turds and it comes out as liquid. So we can see diarrhea as sort of an in-stage constipations as well.
So these are all things that can cause diarrhea. But in a 20-month-old who's had a couple of days of diarrhea, most likely it's a virus and it's going to last a few days.
In terms of home remedies, lots of fluid. You want to keep them well-hydrated, Pedialyte is good. Avoid lactose, so no milk or dairy. Soy is OK. You don't want to use Kaopectate in kids, especially if they have a virus. You want them to have the diarrhea. You want them to still be hydrated so keep pushing fluids. But the diarrhea does help to get rid of the virus. So Kaopectate is a no-no in kids.
And then, probiotics, this is the idea of introducing the bacteria or re-introducing the bacteria that's supposed to live in your intestine in there to re-populate it. Because when you have the diarrhea, it does get rid of the bacteria that's supposed to live there and that can cause the diarrhea to last longer that way as well — so probiotics.
And this all done in conjunction with your doctor, not on your own. Your doctor can tell you how you get probiotics or the bacteria that's supposed to be in the intestine back in there to help the diarrhea not last quite as long. You definitely want to see your doctor if you have diarrhea that lasts more than a few days. If there are signs of dehydration, vomiting, fever, severe abdominal pain, blood in the stool, any of these things, any concern really, you'd want to call your doctor and let them know.
All right, so that wraps up our Listener Segment or Listener Show, I should say, for this Friday and we'll be back to wrap up the week right after this.
Dr. Mike Patrick: All right, thanks go out to Nationwide Children's Hospital for providing the bandwidth for this podcast. Also, to Vlad over at vladstudio.com for providing the artwork. Thanks to all the listeners out there, all of you, the reason we do. And thanks to my family for letting me do it for you.
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So, everybody have a great weekend. I'm going to say Go Oklahoma, beat Missouri. For obvious reasons, because the Ohio State Buckeyes are number three and that would get us to the National Championship game. Or go Pitt, beat West Virginia. I think that one's less likely though. So we'll see how the weekend goes and what kind of mood I'm in, depending on how those games go after the weekend.
So, until Monday, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids.
So long everybody!