Salad Bars in Schools, Toy Safety, Prescribing Honey – PediaCast 092

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Announcer 1: This is PediaCast.

Announcer 2: Bandwidth for PediaCast is provided by Nationwide Children's Hospital. For every child, for every reason.


Announcer 1: Welcome to PediaCast, a pediatric podcast for parents, the news edition. And now, direct from Birdhouse Studios, here is your host, Dr. Mike.

Dr. Mike Patrick: Hi, everyone, and welcome to PediaCast, its Monday morning. This is episode 92 for December 10, 2007, with Christmas is just creeping up on us, isn't it? I'm calling this one Salad Bars, Honey, and Alcoholism.

OK. You can guess it's probably a news show, perhaps, such a wide variety of topics. So, that's coming up along with some other news stories as well.


Before we get in to that though, you know, whenever I have an interesting thing happen to me at the office, I'd like to share with somebody. And it might as well be you guys. Now of course, you know, we keep the HIPAA rules on PediaCast. We never mentioned any names. And you know; most private stuff we don't talk about here.

And actually this one does not really involve an actual patient anyway. It has to do with mom's boyfriend; I assumed who it is. So what happen is, I was on-call recently and the next day after I was on-call we have kind of a crazy call system, where [01:41] what’s has been happening is, I think I've talked about this a little bit before.

But we worked in the evening, as well as the afternoon, seeing sick patients. So often times, we are there until 9:00 or 10:00 at night. This time in the year, more like 10:00 sometimes later. And so the next day, we just worked in the morning, and we have the afternoon off.


So, it was my afternoon off after I was on-call, and my cellphone rings, which is a little unusual, because most people don't call my cellphone except when I'm on-call, I wasn't. So, I answered. I just say, "Hello…. And this guy says, "Dude, I don't know who you are. But what were you doing calling my girl at 1:30 in the morning?“

And [laughing] OK I'm being confronted. Being called dude and this guy wants to know why I'm calling his girl at 1:30 in the morning and I said, “Well, your girl wanted to know the dose of Tylenol for her baby, this is Dr. Patrick.” And he said, "Oh! Sorry dude.“ And he hang up.

So, that was kind of interesting. You know, I'm sure my number showed up on her cellphone, I probably should have done the *67 thing but or have my cellphone blocked, but I just have never gotten around to doing that.


Anyway, kind of interesting little tidbit story for you. OK. We're going to go ahead and get in to our news topics here. When schools offer salad bars, kids eat more fruits and vegetables, concern over toy safety, and disappointed kids impact the holidays for parents. The FDA issues and alert on a bedwetting drug. Prescribing honey for childhood cough, and teaching kids the science of alcoholism. That's all coming up.

Don't forget if there's a topic that you would like us to discuss, just go to and click on the contact link. You can also email me at or call the voice line at 347-404-5437, which spell as KIDS. Also 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. So if you do 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 will be back with our News Parents Can Use, right after a short break.


I do have a new way for you to know whether we are recording live or not. And well, I mean, I guess we always record live, I mean, [laughing] I don't record dead.


But my point is, we are using a SHOUTcast server now so that you can listen to PediaCast as we make it by listening to our stream. And if you go to and click on the live link, there are directions there. You'll need Winamp or iTunes to listen to the stream, and all the directions are right there on the live page at

Now, we also…I have a cool graphic that has an on-air, off-air sign. So if you go to that page and the little sign says off air, then don't even bother try to listen to the stream. On the other hand, if the light says on-air, then you know there is something on the stream and you can listen to it. Now, I know, this doesn't help in terms of predictability.

I mean, it is Sunday evening now, 9:20, and I know in a perfect world we'll do this at the exact same time every day. But folks, this is not happening quite yet. So you know, if you happen to be at the website, click on the live tab or link and it will let you know whether we are doing anything live. Not just the shows. I've been doing the interviews on the SHOUTcast server as well.


And you know, any other little tidbits we do. You know, we may actually do at some point here a scheduled live show. There is a Meebo window there, so that you could shoot me questions live that might become a fun to do that sometimes. So to think about that gets some together and schedule it and then we'll see how that works out.

All right. Our news parents can use edition is brought to you in conjunction with the news partner, Medical News Today, the largest independent Health and Medical News website, and you can visit them online at The new UCLA study has found that elementary schools can significantly increase the frequency of fruit and vegetable consumption among low income students by providing a lunch salad bar.

The findings published in the December issue of the International Peer Review Journal Public Health Nutrition show that the frequency of students whose fruit and vegetable consumption increase significantly from 3 to 4 times daily, after a salad bar was introduced.


In addition, students has mean daily intake of energy, cholesterol, saturated fat, and total fat declined considerably. “One of the major contributing factors to the high rate of overweight children in the United States is that they do not consume the daily recommended servings of fruits and vegetables,” said lead author, Dr. Wendy Slusser, Assistant Professor of Pediatric Mattel Children's Hospital, UCLA and the UCLA School of Public Health. “Increasingly, availability and accessibility to healthy foods is one way to improve children's diet. In turn, this sets up opportunities for kids to have repeated exposure to healthy food and positively impact their choices.”

The UCLA pilot study was conducted at three Los Angeles unified school district elementary schools, participating in the salad bar program and the US Department of Agriculture reimbursable lunch program. Study participants included 337 children in Grades 2 through 5.


Children were interviewed using the 24 hour food recall questionnaire, but before and after the salad bar intervention in 1998 and 2000, respectively. The study was offered in conjunction with the Nutritional Education Component, including a school assembly to teach children about the proper etiquette of serving themselves salad. That's fun [laughing], and picking a well-balanced lunch, as well as an artwork project, and visits the farms or a farm markets. This salad bar program was developed together by LA Unified School District Food Services and Occidental College in LA.

“The results are clear, if we provide fresh fruits and vegetables in kid-friendly ways, we will increase consumption,” said school board member Marlene Canter [08:46], “I'm excited to see that our efforts to find new and creative ways to improve our students' nutrition and help reduced obesity are working.” Since the study, the Los Angeles Unified School District school board voted positively on a 2003 obesity prevention motion that includes recommending fruit and vegetable bars as a modification of the hot lunch program.


An important source of nutrition, fruits, and vegetables helps with weight management and can also be beneficial in reducing the risk of certain cancer, heart disease, stroke, and Type 2 diabetes. Eating a variety of fruits and vegetables can improve health by increasing amounts of vitamin C, phytonutrients, potassium, and fiber in the body, and displacing energy dense fatty foods.

The USDA has reported that only 36.4% of US children between the ages of 2 and 19 eat the recommended 3 to 5 servings of vegetables per day. And only 26% eat the 2 to 4 recommended daily servings of fruits. The salad bar program showed us that children will indeed eat more fruits and vegetables, if offered in an appetizing and accessible manner. Slusser said, "future study should evaluate parent education of school lunch menu changes as well as why boys are less likely to eat from the salad bar at lunch than girls.”


All right. You know, it sounds like a great idea, right? Salad bars at school. But there’s certainly some obstacles to this. I mean, we're talking 2nd through 5th graders here. I mean, how exactly, do you go about stocking a salad bar for 2nd graders. You know, I mean, there must be a learning curve, how much of what to put out.

And you know, what's the cost and how much is wasted? And I'm not trying to be too cynical here, OK. Maybe I am a little bit. But in theory, it's a good idea. But I have this feeling that elementary salad bars are not going to be coming to your kid's school anytime soon. But if I'm wrong, let me know.

You know, if your elementary school kid has a salad bar in their school, I'd like to know. I just don't see that happening. But I think it's a good idea, and hopefully this will get us started thinking in the right direction. All right. As they're searching the web for information about recalled toys and scanning store shows for toys they think are safe.


Now, parents have a new worry, what to do on Christmas morning when their kids are disappointed because the unsafe toy they really wanted is not under the tree. According to a new National survey sponsored by Cincinnati Children's Hospital Medical Center, a quarter of parents are already anticipating Christmas disappointment because their children have their hearts set on a toy that the parents will not buy due to safety concerns, and it's not just an issue for parents. More than three quarters of all adults agree that holiday purchases will be influenced by toy safety.

And at least 25% say they plan on omitting something on a child's Christmas list because they worry about safety. But while they're making these decisions, parent and non-parents alike are also concerned about unhappy faces on Christmas morning and would like some help. More than half of all adults say they would appreciate advice on how to help kids enjoy the holidays even if they don't get some of the toys they really want. “Fortunately, while the safety issues won't go away, there are ways to manage disappointed children, “[12:02] according to Dr. Daniel Nelson, a nationally recognized authority in counseling children and adolescents. Dr. Nelson is Medical Director of the Child Psychiatry Unit at Cincinnati Children's, and he says the worry is understandable but the situation can be managed if parents are prepared. There's no surprise that children can feel angry, sad, sulky or depressed when they don't receive what they want. But kids can resolve it pretty quickly, depending on the type of support they get.

The key is addressing this behavior quickly. If the behavior lasts for more than a day, there may be something more bothering the child than just a gift, or they may be using sadness to get what they want. Dr. Nelson suggests to parents to use this time to learn from their child.

He recommends saying something such as "I'm kind of surprise you're really sad that I can see how upset you are but not receiving this toy. Is there something else going on that I may not be aware of? By being reflective and exploratory while remaining empathetic, parents can show that they're interested in what the child is feeling and make it a clear answer about what may be going on.


Dr. Nelson also advises using direct communication and treating this situation as opportunities to teach children. “If someone else such as a grandparents or aunt, they didn't get them what they wanted, use that moment as a teaching moment to show how to react appropriately,” says Dr. Nelson.

He also suggests, parents can use this opportunities to explain to their children why they didn't get the toy, including a concern for their safety. Once children's concerns are met, it's best for parents to shift the focus away from the toys to other ways their child can enjoy the holidays like playing out on the snow or going to a loved one's house. So you know, these Chinese toy safety issues actually have a good side.

I mean, we've gone to the point where it's a crisis when kids don't get everything they want for Christmas. I mean, half of all the adults surveyed said that they would like some advice on how to handle their kid's disappointment when they don't get what they want for Christmas.


Now I have to ask you, "Did you get everything you wanted for Christmas when you're growing up? I mean, as adults do we get everything we want? No, OK. So, kids learn to deal with being upset when they're disappointed. And you know, they have to deal with it and it's a skill of the kids certainly need to learn for adulthood, right?

So, don't pass on this opportunity, moms and dads, it's an important lesson. Don't get me wrong, I don't like to see kids disappointed at Christmas. But you know, life is what it is and we have to take every opportunity. We have to teach even when our children are disappointed on Christmas. I mean, how else will they be prepared to teach their children when the time comes? OK, moving on.

The US Food and Drug Administration has asked the manufacturers to update drug labels and prescription information on Desmopressin available on tablet and nasal spray form, and used to treat bedwetting to include new information about severe hyponatremia which is a condition caused by insufficient sodium in the blood which can lead to seizures, and sometimes death.

The FDA announcement explained that certain patients taking Desmopressin, which is marketed as DDAVP nasal spray, DDAVP rhinal tube, DDAVP, DDVP, Minirin, and Stimate nasal spray were risk of developing severe hyponatremia that can result in seizures and death.


“Desmopressin reduces water elimination in the urine. Children treated with intranasal forms of Desmopressin for bedwetting for primary nocturnal enuresis are particularly susceptible to severe hyponatremia and seizures,” said the FDA. “The warnings and restrictions applied differently to the nasal spray and other formulations of Desmopressin. Nasal spray formulation that contains Desmopressin are no longer approved for the treatment of bedwetting,” said the FDA. “And it should not be used in patient with hyponatremia. Again, that's low blood sodium or who have a history of it.


“Doctors should consider other options for treating this condition,” said the alert announcement issued by FDA center for drug evaluation and research. “Tablet, rhinal tube, and injections forms of Desmopressin who also carry new information about the risk for hyponatremia, said the FDA.

Patient on a tablet form of Desmopressin for bedwetting, who developed illnesses with episodes of electrolyte or fluid imbalance characterized by fever, recurrent vomiting of diarrhea, should have their treatment interrupted. This also applies to patients who undertake vigorous exercise or who have other conditions linked with increase water consumption for 1 hour before and for 8 hours after taking Desmopressin tablet.

Patients whose fluid intake should be restricted said the FDA regardless whether it's a tablet, nasal spray or any other form. All Desmopressin formulations should be used cautiously in patients with habitual or psychogenic polydipsia, which is the abnormal ingestion of large amounts of fluid.


Similar caution is recommended when treating patients who are taking drug that may cause them to drink more fluids. For example, patients on tricyclic antidepressants,and selective serotonin reuptake inhibitors, or SSRI's. Those are drugs like Zoloft and Prozac, those kinds of things. According to the FDA, all patients taking Desmopressin and ingesting excessive fluids are the higher risk of developing hyponatremia, which again is low blood sodium.

The FDA has received 61 reports of patient experiencing hyponatremia related seizures linked to the use of Desmopressin including two, who died. You know, this is not news to me. When I was a resident, I actually, and this is we're talking with about 10 years ago now, 10 to 12 years ago. I saw a couple of kids in the intensive care unit with a severe hyponatremia that did lead to seizure and that they were being treated for bedwetting with Desmopressin.


And that, I mean these seizures are so bad, you can't even give them anti-seizure medicine to make them stop. Basically you got to get their sodium level backup very quickly in order to make them stop seizing. And in order to do that, you run the risk of them having a shift in the fluid balance in their brain, which can cause major problem we called herniation.

These things can happen when you're treating this. So, it's really a very dangerous situation, and you know, I personally have seen kids who have had this happened on a couple of occasions. So, I'll admit that in the last 10 years, I have been very, very limited in the number of times I've written for DDAVP.

I don't prescribe that very often. When I have, I made a very careful clear point of letting the parents know about the risk, and most of the time, the parents don't want to use it. So, if you child is taking Desmopressin or DDAVP for bedwetting, make sure you ask your doctor if this is still your best option.


OK, a new study by a Penn State College of Medicine research team found that honey may offer parents an effective and safe alternative to over-the-counter children's cough medicines. The study found that the small dose of buckwheat honey given before bedtime provided better relief of nighttime cough and sleep difficulty in children. Then no treatment or dextromethorphan or DM, a cough suppressant found in many over-the-counter cold medications.

Honey did a better job reducing this severity, frequency, and bothersome nature of nighttime cough from upper respiratory infection than DM, or no treatment. Honey also showed a positive effect on the sleep quality of both the coughing child and the child's parents. DM was not significantly better alleviating symptoms, compared to no treatment at all. These findings are especially notable since an FDA advisory board recently recommended that over-the-counter cough and cold medicines are not be given to children less than 6 years old because of their lack of effectiveness and potential for side effects.


The results are published by Penn State College of Medicine researchers led by Dr. Ian Paul in these months' archives of Pediatric and Adolescent Medicine. In a previous study published in 2004, Paul and colleagues, should neither DM nor diphenhydramine, another common component of cold medication, which is also what Benadryl is, performed better than the placebo at reducing nighttime cough or improving sleep quality. However, what am I saying here, I'll make sure I will say this right.

So neither DM nor diphenhydramine performed better than placebo. Because I made my little comments there, it made it sound like they performed better. But neither of them performed better than placebo at reducing nighttime cough or improving sleep quality. Sorry about that. I forget about the one I inject my own comments again sometimes I change how the sentence comes out.


However, honey has been used for centuries in some cultures to treat upper respiratory symptoms like cough, and is considered to be safe for children over 12 months old. Remember, we've talked about this before. Less than 12 months, you do worry about botulism toxin exposure in honey for kids that are less than a year old. Honey has a well-established anti-oxidant and anti-microbial effect, which could explain its contribution to wound healing.
Honey also soothes on contact, which may help explain its effect on cough as suggested by the World Health Organization. In the latest study, the researchers enrolled 105 children between the ages of 2 and 18 at a single university affiliated physician practice site. On the first night of the study, children received no treatment. Parents answered five questions about their child's cough and sleep quality, as well as about their own sleep quality. On the second night, children received either honey, artificial honey flavored DM or no treatment about half hour prior to going to bed, and then parents answered the same five questions the following morning.


The randomized study was partially double-blinded so medical staff did not know what treatment each participating family received, when distributing their sealed syringe containing envelopes. Parents of children who received honey or artificial honey flavored DM at a measured syringe or blinded that their treatment group. But parents of children in the no treatment group received an empty syringe, and therefore they were aware of their child's treatment group.

Across the board, parents rated honey as significantly better than DM or no treatment or symptomatic relief of their child's nighttime cough and sleep difficulty. In a few cases, parents did report mild side effects with the honey treatment, such as hyperactivity. “Our study adds to the growing literature questioning the use of the DM in children. But it also offers a legitimate and safe alternative for physicians and parents,” said Dr. Paul, a Pediatrician Researcher and Associate Professor of Pediatrics at Penn State College of Medicine and Penn State Children's Hospital.


“Additional study should certainly be considered, but we hope that medical professionals will consider the positive potential of honey as a treatment given the lack of proven efficacy, expense, and potential for adverse effects associated with the use of DM. Potentially dangers effects of DM in young children include dystonic reactions, which are severe involuntary muscle contractions and spasms.”

Further, DM is commonly used as a drug of abuse by adolescents. Cough is the reason for nearly 3%, I'm an amateur here folks, all right [laughing]. Cough is the reason for nearly 3% of all out-patient visits in the United States more than any other symptom. It is particularly bothersome at night because it disrupts sleep. Consumers spend billions of dollars each year on over-the-counter cough and cold medications, despite little evidence that these drugs provide significant relief.


Now folks, I've got to tell you, this is a tough one. I'm in a practice with five other doctors, and people come in like in any big medical practice, and any medical practice that sees kids. People going to come in with their children, and they have viral upper respiratory infections. They have runny nose; they have cough. They might have a little fever. And we've come a long way, and not prescribing antibiotics as a knee jerk reaction. But, I mean there was a time when parents came in wanting an antibiotic for these viral infections. And more often than not, that's what they got.

But we took the hard road finally, and we've taught parents that antibiotics aren't necessary when kids have viral infections. And so, now when parents come in, it's no longer the antibiotic they're looking for. Instead, they're looking for prescription cough medicine that's going to help their child's symptoms and help them to sleep. I mean, the parents still come in with their kids with these viral upper respiratory infections. But now, they expect cough medicine. And more often than not, that's what we give them.


Now, I am supposed to tell them to use honey. The only problem with this…OK, So let's say I keep up on the research, and I start telling parents to use honey while my partners are all still prescribing cough medicine. I mean, I'm going to get some dirty looks from moms and dads. And I don't even want to think about the names I'm going to get called when parents get their EOB from the insurance company in the mail and say, "he charged me how much, he tell me to give my kid a spoonful of honey…. [laughing] I'm not saying that it's not the right thing to do because it probably is.

You know, based on the study. But you know; this is some of the things we doctors have to consider. It's not always an easy job folks. Got to trust me on that, all right. Moving on to our final story, as adolescents get ready to attend holiday parties, it is time for parents to have to talk with them why they shouldn't to drink alcohol. Teens are constantly exercising their independence and individuality, and peer pressure is fierce. If their friends are drinking alcohol, chances are your teenager will too, even when parents are present at parties, there are no guarantees.


According to the study last year by the National Center on Addiction and Substance Abuse at Columbia University, one-third of the teen surveyed had attended the house parties where parents were present and teens were drinking. One-third. Fourteen year olds were three times more likely than 13-year olds to attend such parties. So, giving your young teen to talk is of course more important than ever. The Science Inside Alcohol Project and alcohol education effort from the American Association for the Advancement of Science suggest that parents try a new approach to curb teen drinking this holiday season.

Provide kids with scientific evidence behind why drinking alcohol can hurt them. Adolescents believe they are invincible, which is perfectly normal developmentally. So remember the link what you are saying is closely as possible to their personal experiences. And here are five questions parents can ask and answers to their kids to explain alcohol’s dangers.


Now I'm going to include the link to these in the show notes, so you'll be able to find that pretty easily. OK. So here are the questions that you should go through with your teenagers and the answers. So, are kids who begin drinking before the age of 21 more likely to become alcoholic? And the answer to that is yes. Almost half of all kids who begin drinking at the age 14 or younger become alcohol dependent at some point in their lives. Less than 10% of people who begin drinking over the age of 21 become alcoholics.

What are three important body organs that alcohol can harm? First is your liver. Alcohol can harm the liver's ability to remove poisons, germs, and bacteria from blood, as well as inhibited production of immune agents, which are needed to control infection. If you drink alcohol, it weakens your immune system, and you are more like really get sick over the holidays, also your brain. Kids’ brains are not fully developed, particularly the parts that stores memory.


So when you have 2 to 3 drinks you're less likely to remember things that happen to you, also your heart. Alcohol reduces blood flow to heart muscle causing weakness and deterioration. Of course, this is a long term process. But if you start drinking now, as you get older, it can cause problems.

Number three, can drinking alcohol hurt your sports performance? Absolutely. The recent ESPN report featuring Dr. Gary Wadler, a Professor at the New York University School of Medicine, stated that drinking alcohol after a practice or a game can impair your ability to play sports for up to 14 hours. Some of the effects are slowed reaction time, problems with balance and steadiness, dehydration, and a decline in fine and complex motor skills. Can deep drinking alcohol make you gain weight? Yes, drinking alcohol regularly can make you fatter, particularly in your stomach. Alcohol is classified as a food, not a drink because it contains calories.


The average alcoholic drink has about the same amount of calories as a large baked potato, but no nutritional value. So you don't get any vitamins from it. Number 5, can drinking coffee or other stimulant drinks help sober you up enough to drive? No, caffeine is a stimulant and it can wake you up, but it does not stop alcohol's effect on making smart decisions or controlling a car. Don't be fooled by people who say they are wide awake drunks.

"Most adolescents don't really understand how alcohol affects their bodies,” says Shirley Malcom, Head of the Education and Human Resources Directorate at the American Association for the Advancement of Science. “Teaching them the science behind the damage drinking alcohol causes will hopefully make them less likely to use and abuse it.” Then my question is, are they teaching this sort of stuff in school? I mean, I remember doing a story a few months back about a Ph.D. Chemist who went back to high school as a teacher, and really got kids interested in science by including this sort of teaching in the Chemistry curriculum. I mean, I think it's a good idea, and not just for parents, but for science class too.


And not just alcohol, but other drugs as well, both recreational and prescription. So, I did some checking and I found a really great resource on this, so check out the show notes. It's a link to the Parents and Teachers page at the National Institute on Drug Abuse. They have great and free age appropriate curriculum resources for parents and teachers of kindergarteners to 12th graders on the biology of addiction and the effects of drugs, both good and bad on the human body. I mean, it's your tax dollars at work here, people, you know…use it. You can find a link to it in the show notes. OK, we're going to take a quick break. And we'll come up to wrap up this episode of PediaCast right after this.



All right. Thanks.goes out to The Nationwide Children's Hospital, to Medical News Today, and also Vlad over for providing the artwork. And thanks to all of you for taking a little time of your day to join us here for the big show. I also would like to say, OK, for the little show. Sorry laughing]. Thanks to all of you who give us reviews in iTunes over the last few days. Last I check, we’re up to 160 reviews. If you haven't done yet, please do. My personal goal is 200 by the New Year. It's going to be tough, I know, it's going to be really tough. So, if you haven't done yet, please stop up to the plate and provide us a review in iTunes. I would really appreciate it. Pediascribe, Karen posted a blog post yesterday called "We're all in this together.”


Those of you who follow the show closely know that my daughter is in High School Musical, and it opened over the weekend in Columbus, and Karen has some pictures from the performance up on the blog. So if you want to see Katie, and Troy, and Gabriella, and Sharpay and Ryan, check out Pediascribe and I'll put a link to that post in the show note. If you have no idea who Troy, and Gabriella, and Sharpay, and Ryan are, then either you don't have twins at home or your family lives in a cave in the middle of nowhere. OK, maybe not a cave in the middle of nowhere [laughing].

I thought you're connected enough to be listening to a podcast, but you know what I mean, right? OK. All right. Next time, we're together which I think of probably Wednesday, it would be back to more of your questions and some answers. I've been working on those already over the weekend. So we should have that all ready to present to you on Wednesday. So check back then. And until then, this is Dr. Mike saying, stay safe, stay healthy, and stay involved with your kids. So long, everybody.


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