Toddler Eating Habits, Stinky Urine, Humidifiers – PediaCast 093

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  • Toddler Eating Habits
  • Stinky Urine
  • Umbilical Hernia
  • Humidifiers



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 1: Welcome to PediaCast, a pediatric podcast for parents, The Listener Edition. And now, direct from Birdhouse Studios, here is your host, Dr. Mike.

Dr. Mike Patrick: Hi, everyone, and welcome to PediaCast, it's Episode 93, for Wednesday, December 12th 2007. I'm calling this one No Veggies, Stinky Urine, and Humidifiers. So, it must be our listener edition, right? On order to have a group of topics that diverse. And actually you guys are lucky that there's a show on Wednesday and if I have to take more little micro breaks here, and here we sip it on some water.


You have to understand that I've got a little bit of a raw throat. I was sick enough that I actually on Monday, called in sick to work. No, it's not some of the doctors do very often. I mean, there are times when I definitely see kids who are sicker, but are not as sick as I am…

But you know, you just I hate calling and sick because it really makes a big stress on the schedule. I mean, you have to call and reschedule all those patients and all the other doctors have to take on the extra load. It's really tough. I mean it's really tough to call in sick as a doctor.

And I think the last time I did that was probably a year and a half to two years ago. I can't remember recently doing it. But you know I was sick when after I called in I went back to bed and slept till noon. I have not slept till noon since like college. It actually felt really good sleeping till noon. And then by 2:00 I was ready for a nap so I lay down and Karen woke me up around 5:30.


So I mean, I really was not feeling well. But I have a little more energy today, went to work and here I am. So, it's hard to keep me away from PediaCast though. ‘Cause I really like doing it. You probably figure that out. All right, so welcome. What we're going to talk about today, toddler eating habits, of course stinky urine.

Also we're going to chat a little about umbilical hernias and then we have a listener who asked a question about humidifiers versus vaporizers, so we're going to talk about that as well. Don't forget if there's a topic that you would like us to discuss, all you have to do is go to and click on the Contact link. You can also email or call the voice line at 347-404-KIDS.

Also don't forget the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you do have a concern about your child's health, make sure you call your doctor and arrange a face to face interview and hands on physical examination.

Also your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at And with that in mind, we'll be back with your comments and questions right after this short break.


OK. Listener number one is Eva, and Eva comes from San Bruno, California. Eva says, "Hi, Dr. Mike. I have a question regarding toddler eating habits. Our son is about two years and four months old. We got trouble getting him to eat vegetables for quite a while.


It's getting worst since he started preschool about four months ago. He refuses to eat anything green even though he loves yellow colored veggies like squash, yam and carrots. I've tried everything I can and fail terribly each time.

I get very frustrated and I'm afraid that he's not getting a balance nutrition which ultimately will affect his health. I'm a big fan of your program and hope you could give me some guidance. Thanks – an anxious mother….

All right, Eva. No need to be too anxious over this. I mean, the thing you got going for is at least he eats yellow and orange veggies, I mean I see a lot of kids who just flat out refused vegetables all together regardless of what color they are and as it turns out my son who's now 10 is one of those kids who's still, it is very difficult to get him to eat vegetables.

And really, I mean there's only so much you can do. You have to pick your battles. And you can't really force them very easily. It does become a big battle of the wills and usually just not go very well.


So I think as long as you have a kid, if they're really picky and they're not getting a lot of vegetables and the green vegetables they get iron from those and of course fiber. And there's other micronutrients that you get from green vegetables as well but you can get most of those in a multivitamin. So I think you know for kids who aren't eating a lot of green vegetables, a daily multivitamin is certainly something you want to do.

But those micronutrients, I mean they're important but if it's going to affect them, it's going to affect their current health status. Not necessarily too much for their end of the future because most of those micronutrients come and go pretty easier. I mean, you eat them, they're there, they do their job and they leave.

You don't have to like store them up over a long period time. So really their future health is going to really be more dependent on what their nutrition is like in the future. Not what is like now with regards to the micronutrients. Now you do want to make sure that your kids are growing OK.


Now if you have a kid, who let's say 10th percentile for height and weight, they're not eating their vegetables doesn't mean if they suddenly started eating a lot of vegetables, they're going to grow taller, and be bigger, and you know jump up to the 75th percentile? No, remember, your ultimate growth is dependent on genetics and total amount of calories that go in, Your metabolic rate, you know, these sort of things and not necessarily the amount of vitamins and minerals that you're getting.

Certainly, you don't want deficiencies on those things but really our foods are just so fortified these days that even, you don't have to do green leafy vegetables to get what you need. And so good balance diet with fortified foods and grains and a multivitamin – you're probably going to be fine.

So as long as your kids are healthy and growing well and growing as you would expect them to grow, giving the family pattern and the genetics of your family, then I wouldn't really be too anxious about it. Of course you want to keep offering them. You know, there's certainly nothing wrong with the "no thank you… helping. You know, where the kids going to take a bite of it.


‘Cause at some point, you know, they may decide it they're going to like it. But I can guarantee if shove it down their throat and make them eat it, they're going to grow up not liking those vegetables and probably not getting their kids to eat them either.

So, I wouldn't sweat it too much, worrying is not going to change your child's eating habits. But keep offering them, keep giving them a chance. Make sure that they're healthy and they're growing OK, and do a multivitamin that will help you out too. Don't give up on them. Keep offering it, but there are too many things in life to worry about.

OK. Listener number two. This comes from Tiffany in Arlington, Massachusetts. And Tiffany says, "Dear, Dr. Mike thank you for your podcast full of wonderful advised and insights. I have a four month old son, and discovered PediaCast last spring. I enjoyed listening to your show during my daily waddles on the last few months of my pregnancy. I've a question about urine odor. A few weeks ago I've noticed that my son's urine to come a strong smell. It's hard to describe, but it's somewhat sweet and musty smelling. I brought it up with his four month doctor visit.


His doctor noticed the smell and seemed interested but not too concerned. I asked about the Maple Syrup Urine Disease and she said that that was tested at birth. He's exclusively breastfed and this came on pretty suddenly. Do you have any advice or can think of reasons for this to happen? I don't think my diet has changed at all. Other than that, he seems to be a healthy little boy, and is meeting his milestones on time. Thanks again, Tiffany….

Well thanks Tiffany for your question. We have a four month old boy with the sort of sweet and musty smelling urine. Now before, we talked about this I want to read another question on the same topic from a different mom.

This one comes from Tammie in Columbus, Indiana. And Tammie says, "Hi, love the show. I've a 13-month-old daughter and she smells like maple syrup. Not all the time, just a few days a week. It's been this way since she was nine months old. Once people other than ourselves started noticing the smell, we bought her up to the doctor. He said that some kids just have certain smells. Well we did some research on our own because we were not comfortable with his explanation.


And we came out what Maple Syrup Urine Disease. We brought this to him and we're surprised that he was unfamiliar with the various forms of the disease. He didn't know how to go about testing. So he looked it up and we got her tested. Now, once we read about Maple Syrup Urine Disease, we drastically reduced her protein intake and the smell went away.

She was tested for the disease on a reduced protein diet. Her only protein was milk and occasional peas. One of the two tests came back normal, so we resumed normal protein consumption and the smell returned. Now question number one, should we pursue our gut feeling that there is something to this and go over our doctor's head so to speak and when does our judgment as parents override our doctors expertise?

And question number two, can you explain a bit about how some metabolic disorders are delayed onset? Maple Syrup Urine Disease is tested for before the baby leaves the hospital but only in the more severe cases which show up the other types show up later in life. Thanks and keep up the good work, Tammie….

All right. So, thanks to you too Tammie.


So we also have a 13-month-old girl with the similar problem. Now, there are several things that can cause urine odors and for the most common things that are going to cause it. One would be concentrated urine. So if you have a kid, who's in a period of time when they have some decreased fluid intake or increase fluid loss, so they have vomiting or diarrhea, or they have fever.

They're going to have more concentrated urine because they still have the same amount of waste products that their body has to get rid of. But the body is trying to hold on the water, so it puts less water into the urine and that makes it more concentrated and so it has a stronger odor to it. And it does not necessarily go along with the urinary tract infection. I hear that a lot.

You'll see kid who's running a little bit on the dry side, and they're concentrating their urine, has little bit of a smell to it. And a lot of parents will say, "I can smell this urine if you have urinary tract infection?… But urinary tract infections usually don't have a smell associated with them unless they're dehydrated because of the infection. May be they're vomiting with it or they have a fever and they're concentrating their urine.


And then it's been from the urine being concentrated not for the infection. Another one is medicines, if you think about amoxicillin. Their pee starts to smell funny because some of the amoxicillin is gotten rid of through the urine, and so has a smell associated with it. And those kind of things are much more common than the disease that these two listeners are bringing up.

But since that's the honest that's first in their minds, let talk about it. So we're going to talk about a little bit here about Maple Syrup Urine Disease. Now first I have to say, yes it's a real disease. So there really is a disease whose official name is Maple Syrup Urine Disease. It's a genetic moderated illness. So this is something that you inherit, not that you catch.

And basically, if you remember what's happening here if you remember from like I said I do this a lot, but just try and simplify things a little bit. If you remember back to high school biology class, if you remember proteins are made up of amino acids, right.


There's lot of different kinds of amino acids and you put a bunch of them together and those are the building blocks that makes proteins. Now there's a sub group of amino acid called the branched chain amino acids. And these are amino acids like leucine, isoleucine, and valine. So these are going to be the branched chain amino acid, leucine, isoleucine, and valine. OK, you don't have to remember that, there's not going to be a quiz at the end here.

The people who have Maple Syrup Urine Disease cannot break down those branched chain amino acids. They're just – they're missing a part of the pathway that the body uses to breakdown those amino acids and so those branched chain amino acids build up in their blood and are excreted in the urine and as it turns out actually, one of the byproducts of one of those amino acids.

So it doesn't get broke down like it supposed to but it does get broken down to some degree and it's that chemical that's excreted in the urine that actually gives the smell of maple syrup.


Basically if the urine is going to have sort of a sweet, musty, smell to it like maple syrup does because they have this build up in the blood of these branched chain amino acids and some by products from that are getting excreted in to the urine. The bigger problem because, if your urine smells like maple syrup I mean that end of itself is not necessarily a problem.

Well, the problem is that these high concentrations of these branched chain amino acids in the blood can cause brain damage. So that's significant and in its severest form these amino acids starts to build up right from birth because the normal baby formulas that we give the babies and breast milk have branched chain amino acids or proteins that contain those so it gets broken down and they get these branched chain amino acids.


So pretty quickly after birth whether you're breastfed or bottle fed, you're going to have a problem and that could lead to brain damage. Now there are forms of these disease however, they aren't quite as severe and the body's ability to breakdown those amino acids changes over time and often the ability to do that worsens during times of physical stress such as during an infection. So what ends up happening?

Well, when you have to build up of these branched chain amino acids and then you have that causing brain damage you start to see these kids have basically brain issues. So, they're going to have difficulty feeding, they can start to have vomitting, lethargies, seizures, coma and then finally death and these brain damage that occurs is permanent. Now, how do you test for this? Well part of the new born screening test is to look for a build-up of these amino acids in the blood stream. You can also check the urine.

So you basically, just do a test of serum blood, amino acids and urine amino acids and they usually check for the whole panel. So you look at all of these different ones and if you can see a spike and leucine, isoleucine, and valine then you know that you have this disease.


So it's pretty easy really to diagnose, you just have to do a blood amino acid test and a urine amino acids test. And you don't even have to order the individual one it's usually just order all the amino acid panel and look for those. Now in its mild or intermittent form, these may be normal if there's a diet low in branched chain amino acids or proteins that contain those or if the body's ability to break them down is currently OK.

So if you have those test and they're normal, but it's a kid has a mild intermittent form, you may not see it. Now, brain damage can still occur in kids with a mild or intermittent form if the blood levels of these amino acids reach a critical level for a critical length of time. So in kids who have this sort of on and off when you have these smell, that's definitely when you want to check the blood amino acids and the urine amino acids.

Now, how do you treat this? Well, there's a special diet that it's free of branched chain amino acids or proteins that contain branched chain amino acids and that should be started immediately and there's a special infant formula that's design that has low levels of those leucine, isoleucine, and valine amino acids and persons with this condition have to stick to a diet free of those particular amino acids their entire life

Now that requires close follow up with their doctor, frequent blood tests to make sure that they're not those things are arising in the diet that they are eating is definitely low on those things because of the fact that can it cause brain damage and usually a dietician gets involve an you need lots and lots of parental cooperation to make sure everything is adhered to. And even… sometimes in the light… in light of an acute crisis where you have a build-up of these and you're starting to see some CNS effects, like difficulty feeding, lethargy, and even vomiting.


Sometimes, even dialysis is necessary to get those amino acids out of the blood. Now in terms of prognosis or the long term outcome, with strict dietary treatment, many children with Maple Syrup Urine Disease have grown into healthy adults. On the other hand, even in its mild and intermittent form, these crisis episodes can occur again particularly at times of severe illness and these crisis episodes can lead to brain injury and death.

So it's really important even in a mild intermittent forms that you figure out that that is what's going on. So that's a little bit of a background of Maple Syrup Urine Disease. Now let's look at specific questions that our listener's had. One we talked about – they asked about should the test be repeated now that the smell is back?

I would say definitely. I mean, it's definitely prudent to test both serum and urine amino acids at the time when that smell is present because if the test are normal, and they were taken when the smell is there and the child has no central nervous system symptoms and they're developing normally then I'm reassured that we're not dealing with Maple Syrup Urine Disease.


But on the other hand, if they have the CNS symptoms and the smell is there, you definitely have to check. And even if the symptoms aren't there, the brain symptoms aren't present if they have that smell and the only normal test where when the smell wasn't there, I would say definitely when you get those tested when the smell is present.

And if your doctor won't repeat the tests when the smell is present, I'd find a new doctor and as soon as possible to get your child tested because it's important and you know when you look at the stakes that are involved and I think really the standard of care won't be to test that.

Then if you bring it up, I think your doctor will. And then one last thing Tammie asked why are some cases severe and seen immediately upon birth and others, are these mild intermittent formed with the delayed onset. Actually the answer to that is pretty easy. If you remember the problem is body's inability to breakdown branched chain amino acids.


This is not a one step process. They're multiple sort of chemical steps in the breakdown process of these amino acids. There's one particular critical step, this step, there's only one way the body can break it down and if that's realized by this thing, I'm not going to get too technical here but it's this thing called the BCKD complex and it's at the level of mitochondria and if that is missing, there's no alternative pathway for this conversion of the branched chain amino acids to take place.

And this is what results in the severe form of the disease that's seen almost immediately after birth. But there are other steps in the breakdown process of this branched chain amino acids that can also have a genetic type problem. But for these steps, there may be alternative pathways that the body can use to accomplish the same thing. However, there may be a limited capacity to do that.


So if the protein load is small and the alternative pathways are at their prime, then life is good. But if the protein load exceeds the capacity of these alternate pathways, think of them as like a little detour, a chemical detour, there's just a different chemical process that can do the same thing. But they just can't do it to the degree that the body's normal pathway that's supposed to be there can do it.

So if the protein load exceeds the capacity of these sort of smaller detour routes or if the capacity is diminished because of physical stress or infection or the body for some reason just loses its capacity and those other pathways, then the branched chain amino acids can start to accumulate and that's what room causes the mild and intermittent forms of the disease.

For more information of the Maple Syrup Urine Disease and just to prove that it really is a real life illness, you can go to the show notes at Look for the link from Medline Plus that has a nice job of discussing Maple Syrup Urine Disease in terms that parents can easily understand.


OK our next question is from Kris. And Kris is in Toronto. And I'm going to take a break here, real quick just to take a sip. Again, I warned you about that. But it's not worth it to do the post productions stuff and get that out of here. But with my throat feeling the way it does, it's important.

OK, so this comes from Kris in Toronto and Kris says, "Hi, Dr. Mike. I've been listening for about a month and I've enjoyed your podcast. I even like the tensions you make even if they stir the pot sometimes. I have a question regarding my seven week old daughter, she was born 5 weeks premature but it's doing fine.

We've noticed that her belly button sticks out about 3 cm from her abdomen. It doesn't hurt her when it's touched and it's not red, so I'm not worried. Our doctor told us it's an umbilical hernia. We have since been forwarded to a specialist to make a more in depth diagnosis. Could you provide some more information on this topic? Keep up the good work and I'll be submitting my iTunes review shortly, Kris….


Kris, are you waiting on me to answer your question before you submit the review? Is that how this works? See folks, he's holding my review hostage. So let's get to the discussion of umbilical hernias. I will say this from what you've told me, I'm sort of surprised really that your doctor is referring you to a specialist for this.

It's a common issue and generally, one that will go away by itself without any intervention being required at all. Let's talk a little bit first about how umbilical hernias in babies are formed. If you remember, the way you probably wouldn't remember ‘cause you didn't go to medical school. [Laughs] If I were talking to medical students I could say "Do you remember…?… I guess in this in this case, I can't.

Anyway the abdominal muscle wall during development it actually forms as a left side and a right side that gradually come toward the midline and then meet there and there's sort of a connective tissue layer that connects that two sides of the muscle together.


So the abdominal wall muscle, it's really two sides, a left and a right and they meet in the middle with a little bit of a connective tissue. Now the last place where these muscles end up meeting together are going to be right where the belly button is. And the reason for that is pretty easy or pretty simple, it's because the umbilical vessels so the artery and the vein… two arteries and a vein that connects the placenta… so mom's circulation to the baby's circulation.

They go down to the abdomen at the level of belly button. And if you had you know, a tight muscle layer there, it's going to pinch up those vessels so just part of normal development is that, you're not going to have a very strong muscle layer right there where the belly button is. Now for most kids after they're born, that sort of correct itself and the muscle sort of joins together with this connective tissue area and you know, life is good.


But in some kids this area at the belly button, the muscle walls fails to meet right away, but it will, in time and so because the muscle wall sort of weaker right at the level of the belly button, intestine can push up in to that area and sort of push up into the area of the belly button and you get this bulge right at the belly button that pushes upward.

Now for most of these kids, this is something that's going to go away on its own. So most of these kids, it's there by the time that they're two years old, it's much smaller and by the time that they're kindergarten age, it's pretty much gone. And that's going to be the natural course for most of these kids and no intervention at all is required.

Now, every now and then you're going to have a kid where it just keeps getting bigger and bigger even after they're one or two years old and those kids it's probably going to be need to be corrected surgically, or if it doesn't disappear completely by the time that they're about four or five years age, you know then there may be a reason to do it.


I say by the time that the kids see it's there and other kids were making fun of them for that bump that bulge being there, right time to get rid of it. And again, that's going to be you know, when they're about kindergarten, first grade something like that.

Now the other issue with this, is that whenever you have intestine going through a muscle layer there's always the risk of the muscle layer squeezing and the intestines sort of becoming trapped in the hole that's there and before bowel obstruction occurs, the blood supply to the bowel actually is the first thing that's compromised and so if the blood supply is compromised to the bowel then that part of the bowel can die and that's a medical emergency and we call that strangulation of the bowel. Now this is much ,much, much more common with other types of hernia particularly inguinal hernias, it's where the intestine travelling down the inguinal canal.


So in boys, that's the canal that leads to the scrotum and that strangulation of that kind of hernia is much more likely to occur than an umbilical hernia but you know, in my 10 years of practice, I have seen a couple of kids with umbilical hernias that started to get strangulated and they needed urgent surgery to correct that. So generally, what we tell parents is if you have a kid with an umbilical hernia, you know, once a day give a little push, your doctor can show you, how you do this.

When you push it then you make them go flat, you make the intestine go back inside the abdominal wall as long as it slip try it back inside. There is no pain associated with it. You let go and the intestine comes back out and the bulge is there again. If you do that once a day, it's not going to hurt the kid and you're convinced that it's not going to get strangulated. If there's ever time that it won't go back in or you push on it and kids screams and pain then that's an urgent medical situation, you want someone to look at that right away.


Now don't confuse what I'm telling you with that being a substitute for you asking your doctor about all of these because it's important ‘cause you want to make sure really is an umbilical hernia that you're dealing with and the best way to do that is to have your doctor look at it.

OK this is the… you know, look I got to limit my liability here folks. You have to see a doctor and get their advice for your specific child. Now let's contrast all of these with what I will call a secondary umbilical hernia. This is where in older kids and adults where the abdominal muscles have already come together and then you get a tear and then the intestines starts to come up through. Those kinds of umbilical hernias that you see in adulthood do need to be fixed because it's not a matter of development just not having completed yet.

It's really more of a matter of a tear on the muscle wall and so those do need to be usually surgically corrected. But for these babies where you just waiting on the muscle wall to come together and they're less than kindergarten age and it hasn't been getting bigger since they're one or two year old. A simple observation really is all that's warranted.

They do have an increase chance of ending up with an outie belly button, they've a little extra flap of skin there and that's something as they get older and you know if they wanted that surgically corrected, it's a lot easier than a hernia surgery.


And for more information on umbilical hernias I have a great site from the Mayo Clinic and it goes in the lots and lots of detail about umbilical hernias and what you do for them. Basically it's what I just said but you know if you don't believe me, go check it out for yourself. There's some link on the show notes for you to the Mayo Clinic on Umbilical Hernia.

OK, and finally we have Samantha in Scottsdale Arizona, and Samantha says, "Hi, Dr. Mike. I love your podcast. I've been an avid listener for quite a while now. I a mother of three boys and with cold and flu season upon us, I know I'll soon be chasing three little noses all over the house with the Kleenex. I've heard mix information regarding how to help kids at night who are stuffy, and sniffly and coughing.


My pediatrician has always said to use a humidifier but my primary care doctor has said it's a waste of effort and pediatricians just say that you should use them so parents feel they're doing something to make their kids feel better. So I guess I have a multitude question, is it worthwhile to use a humidifier? Other than concerns regarding burns, is there a reason to not use a hot mist vaporizer?

What's the difference between a humidifier and a vaporizer? Are there other home remedies that actually work and do you have any magic remedy for keeping the common cold from becoming something more serious such as an ear infection or a sinus infection? Thanks for your time and for your wonderful podcast, I love your no holds barred, no none sense approach….

Well, thanks for your question Samantha, let's just go ahead very quickly here and take them one at a time. Is it worthwhile to use a humidifier? Well it's not going to hurt. OK your primary care doctor makes a good point. It is something that's probably going to make parents like they're doing something. You know though I think for infants it probably is going to help a little bit.


When you think about infants the diameter of their nasal passages is very small and it didn't take much mucus to clog them up and the humidifier does help thin the mucus a little bit, you're basically increasing the water vapor and the air that the child's breathing and you think about wet mucus versus dry mucus – wet mucus you can sniff a little, little better, your mom and dad will be able to suck it out a little better. Kid will probably be able to deal with that a little better, whereas the dry or thicker mucus is they're going to be more a little more clogging.

So a humidifier does help thin the mucus a little bit and particularly in the little babies where you have a smaller diameter nasal passages, I think it does help a little bit. Does it help a lot? Probably not. It probably helps moms and dads feel like they're doing something more than it probably helps the babies, but did we use a humidifier and our kids' room when they're sick with colds in childhood? As a pediatrician, yeah we did. Did we do it ‘cause we felt like we're doing something? Maybe. OK.


Other than concerns regarding burns is there a reason not to use a hot mist vaporizer? No I think burns are really the only concern. Those hot ones don't get as hot as they use to. I mean most of them now requires salt to help lower the boiling temperature and burns are less likely than they were in the old days but they are still possible. On the other hand the cold mist humidifiers aren't without their own problems because bacteria and molds can grow in the water so if you use that kind the cold mist kind, it's best to switch them with some bleach water every day and then rinse them really thoroughly once a day, ‘cause you want to blow bacteria and mold into your kid's sick room you know what I mean.

In terms of which one is better, I get to ask that all the time, you know I think it's really only the safety issue; both of them are going to do the job adequately. You know the cold mist once probably are a little bit safer as long as you keep them clean and replace them, they don't last forever and the hot once though you don't worry about burns a little bit especially when you have toddlers running around.


OK what's the difference between a humidifier and a vaporizer? Well humidifier is going to be any device that adds water to the air so you're increasing humidity. Now vaporizer does this by turning liquid water into water vapor. So you're changing liquid water into water gas. And it takes heat in order to do that.

Now cool mist humidifier is blow out tiny droplets of liquid water so technically it's not a vapor, but you are increasing the water content of the air, you're just putting liquid water into the air instead of gas water into the air. So vaporizers are a type of humidifier, so all vaporizers are humidifiers but not all humidifiers are vaporizers.

You've had teachers for that game with you before, right? OK are there any home remedies that actually work? Well if you listen to PediaCast 92 our last episode according to one study, honey works but you can only use that for kids who are 12 months and older and that's just according to list that recent study.


So if you haven't heard Monday's show go back what the PediaCast 92 and listen to the new story about the honey research. So you may want to think about using honey especially for night time cough and kids again who are older than 12 months of age. And finally do you have any magic remedy from keeping your common cold from becoming something more serious such as an ear infection or a sinus infection?

No not really. I mean, what happens is that you get the viral infection first, you gets lots of mucus from the virus. The mucus clogs up the Eustachian tubes and the passage ways up into the sinuses and any normal mouth bacteria that had migrated to those locations, get trapped, can't get back down to the mouth. Start to reproduce on an area where they're not supposed to be and you get the sinus infection or the ear infection.

And you can't really get rid of mouth bacteria. So in order to avoid those complications, it's really best to avoid the initial cold virus to begin with. Also when you realize how ear infection and sinus infections usually get started then you realize that it takes some time for that whole process to happen, well first you have the virus, then the mucus then the bacteria getting trapped and then the bacteria overgrowing that area and then the body sending in white blood cells to clean up the bacteria and that's when you get the inflammation and the symptoms.


So if your kids had a cough and runny nose for a couple of days, it's really unlikely, it's going to be a sinus infection or an ear infection because if you look at how the whole process occurs, it's going to take a longer in a couple of days. So how long? Well 10 to 14 days, probably closer to the 14-day mark of constant symptoms certainly starts to make you suspicious about secondary bacterial infection on top of a virus.

And so does any new fever spikes especially if it's several days after the onset of the viral infection. So your kid have a fever for day or two and they have the virus, the cough, runny nose, congestion and then on day 10 they spike a new fever, that's definitely suspicious for a bacterial infection on top of it. But there's really no magic remedy for keeping that process from happening unless you can get rid of all the mucus which we know cough and cold medicines even don't do that.


And really do you want to get rid of all the mucus because that is how the body traps the virus and helps to clean that out and so it's hard to get rid of all the mucus, so that's not practical. And you can't get rid of the mouth bacteria cause they're supposed to be there and if you get rid of all the mouth bacteria then you end up with the yeast growing in there and you have thrush and all other kind of problems.

So, no magic remedy, sorry. All right.

Well, thanks for all of you for your questions this week and we'll go ahead and take a quick break here and we'll be back and wrap things up, right after this.



All right keep those iTunes reviews coming. Again, it's my personal goal to get to 200 by the New Year and I last count I think we're up to 164. So in the last couple of days we have four new ones. If you have not submitted an iTunes review and you've been thinking about doing it, please to it now as we try to get to 200 by the New Year.

I don't know, I feel like it's probably too lofty of a goal to be honest with you. I'm probably setting myself up for a failure. But if you guys want to pull through, please do. Please, I'm begging. I don't need a Christmas gift just give me a review on iTunes.

OK thanks go out to Nationwide Children's Hospital for providing the Bandwidth for this show. Also Vlad over for providing the artwork for the website and our feed and of course thanks to all of you for stopping by and listening and submitting your questions and participating in the program. It's definitely appreciated.


This week on Pediascribe, Karen's blog which is the blogging arm of PediaCast. We don't do the medical thing, you know the podcast is the medical thing, we want something that parents can relate to and Karen is a wonderful parent and a wonderful wife too.

So basically, she's in-charge of the blog and today's blog and actually yesterday ‘cause I'm recoding this on Tuesday but this is a Wednesday show and so Tuesday's blog entry was "Gas Station Rules…, now Karen doesn't rant too often but this time she does run about gas station pump rule breaker.

And often we aren't together when I pump gas and I have to tell you that one of the rules that she sort of rants about people breaking is using your cellphone when you're pumping gas and I have to admit, I'm guilty of this.


I have an iPhone and you know, you get an internet on the iPhone looks like a web browser you know and you're standing there pumping gas… I don't have anything else to do, they got to pump on auto click and lot of times grab my iPhone and, check out sports score see what's on drudge report you know that kind of thing, yeah I know.

But my question is this. Is this really an issue? I mean how many times is there an explosion because someone uses their cellphone by the pump? I think we need to submit this question to MythBusters, you know what I'm saying?

I mean, let's get a room with a lot of… how much gasoline… how much gas… not vapor, what do I want to say? Like I said it's vapor. The gas vapour – how much do you need and what sort of spark do you need to ignite it and will a cellphone do it? MythBusters I'm telling you.


All right. So check out Pediascribe, there'll be a link to that blog post in the show notes as well. OK our next show is going to be on Friday. I haven't decided if it's going to be a research show or we're going to answer more of your questions. It going to be one of those two.

I haven't started on the script yet so I'd better get busy. We don't have an interview this week but next week Cat Schwartz "Our Mommy Gadget Guru… plans to stop by the studio and of course that's always a fun show. So look for that one on the feed next week, but I'll be back on Friday 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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