Buckwheat Honey, Exercise Saucers, Nipple Confusion – PediaCast 096
- Difficulty Weaning from Breast
- What is Buckwheat Honey?
- Exercise Saucers
- Nipple Confusion
- Salad Bar Comment
- Flat Feet
- PediaCast 92: Honey and Salad Bars
- Monofloral Honey (Wikipedia)
- Flat Feet in Children (familydoctor.org)
- Flat Feet Info from Pediatric Advisor
- PediaScribe: Cast Photos
Announcer: This is PediaCast.
Dr. Mike Patrick: Bandwidth for PediaCast is provided by Nationwide Children's Hospital. For every
child. For every reason.
Announcer: Welcome to PediaCast, a pediatric podcast for parents — the Listener Edition. And
now direct from Birdhouse studios, here's your host, Dr. Mike.
Dr. Mike Patrick: Hi everyone and welcome to PediaCast. It is episode 96 for Wednesday, December
19, 2007, where we are flirting with Christmas, aren't we? Today's topics, among others,
exercise saucers, nipple confusion, and flat feet. It must be a listener's show to have such a wide
variety of topics, plus we have a couple more in there too. Before we get started though, I have
to tell you a little story about the power of suggestion.
I went to the eye doctor yesterday, and I found out that I have glaucoma; it's something that is very
strong in our family. I have not had any vision lost from it yet, and hopefully we keep it under
control, and I won't, but it's possible. But in any case I had to have surgery in one of my eyes a
couple of years ago, and my visual acuity became much worse right after the surgery and lasted
for quite a while.
So I had a new pair of glasses that were really much stronger in the one eye that I had to have
surgery in, and corrected it pretty well. I didn't quite get the 20/20, but maybe 20/30 or so. So I
went to the eye doctor yesterday and I find out that my vision in that eye is basically back to what
it was before the surgery.
OK that's great, except that now my glasses are over correcting and my vision's blurry in my left
eye. I knew it was, but it's always been a little blurry in that eye since I had the surgery, a little bit.
In any case, now I really noticed it. Once someone tells you, "oh, you're glasses aren't right", now
it's driving me baddy. I barely noticed it before I went to the eye doctor, but as soon as someone
tells you that, "oh, are you reading ok?"
Now all of a sudden I'm looking at my computer screen and the script is blurry, and it wouldn't
have been blurry if they hadn't told me that. And of course I can't get in to get the glasses
because I wore contacts before the surgery, and my doctor told me I could do that again, so I
have an appointment, but it's not after the new year, so anyway, I just feel like complaining.
I do want to thank all of you; we had a great outpouring of support in iTunes with the reviews over
the weekend. I think we left last week about 164, 165, something like that toward the end of the
week. And right now we're setting with a 173 iTunes reviews. So you guys really pulled through
during the weekend, and I'm going to clap [clapping] because I really appreciate that. Again my
personal goal is to try to get to 200 by the New Year. I didn't think we'd be able to, but now I'm
thinking, maybe we will.
At 173, we're not that far from it, and we have a week and a half or so until the New Year. So if
you haven't done the iTunes review yet, please stop by, I promise you there'll be a moratorium on
iTunes review's comments after the New Year, I promise if we hit 200. So don't do it for me, do it
for yourself too, then you don't have to hear about it. But the outpouring of support has been
great and I really thank you for the time and effort you put into that.
There've been some really nice comments; I think that really is going to help attract new listeners,
which we need to build the audience, so we can get some sponsors, so I can put more time in to
doing this. So what are we going to talk about today? I mentioned some of it, difficulty weaning
from the breast, what exactly is a buckwheat honey? Exercise saucers, and nipple confusion,
and flat feet I mentioned, and then a salad bar comment from a listener.
That's all coming up after the break. Don't forget if there's a topic you would like us to discuss, all
you have to do is go to pediacast.org and click on the contact link. You can also email
email@example.com. If you do that make sure you let us know where you're from and the voice
line is also available for you at 347-404-5437.
And finally the information presented in PediaCast is for general educational purposes only. We
do not diagnose medical conditions or formulate treatment plans for specific individuals.
If you have a concern about your child's health, call your doctor and arrange a face to face
interview and hands on physical examination. Also, your use of this audio program is subject to
mind, we will be back with your comments and questions right after this short break.
Dr. Mike Patrick: First up on our listeners segment is Heather, and Heather is in Singapore. And
Heather says, "Hi Dr. Mike, my baby is just over a year old, she eats very little in the way of
solids, and she is not sleeping through the night."
"She's a happy, active baby, and because her growth is off the top of the charts, doctors here are
not concerned about her disinterest in food. They don't care that all she eats in a day is ten
Cheerios and a few bites of avocado and sweet potatoes. I don't want to give up breast feeding,
unless I have to, since that is her main source of food, plus without her taking her bottle it would
be very traumatic for her. So here are my questions, how long can babies go on breast milk
alone nutritionally? And because she is breast fed only, is she able, physically to sleep through
"I hate to make her cry it out if she's truly hungry, but right now she'll only go three to four hours at
night between feedings. Here they say, starve her until she takes something else, but that seems
rather cruel. I've tried holding her off and then having someone else off her cup, but that didn't
work. Please help, I guess the bottom line is this, is she ok on the breast milk alone? I can keep
doing this, but at what point should I be concerned? One very tired mom, Heather."
I'll tell you, Heather, you ask for my opinion on this, so I'm going to give it to you, and I want to
preface this by saying that my opinion is not the only one that's out there, and you're going to get
different philosophies on this, and since it's my show, I get to share mine with you. So this may
not be the most well-received answer in some camps, but all I can do is to tell you what I think,
because you're asking me what I think. You aren't asking the breast milk Nazis that are out there,
so I'm not going to cave in to their views, sorry.
I think the first problem here that we're dealing with is it sounds to me like you are not making
enough breast milk anymore. She'd probably go more than three or four hours between feedings
if you could get more volume into her, then we have the second issue that we're dealing with, and
that is a stubborn baby who knows what she wants, and knows how to get what she wants.
You're not going to be able to get her, to get more volume into her, to help her go longer, as long
as you're exclusively breast feeding, because you can only make so much. So how are you going
to get more milk into her? Well, she's going to have to take it from a bottle or a sippy cup. Now
my vote personally would be from a bottle. Now I know she's just over a year old, and lots of
moms and dads want their babies off the bottle soon as possible after that first birthday, which
really does not make any scientific sense.
I think the bottle's going to be easier for her, and save the worry of that transition from the bottle to
a sippy cup for another day. Some would argue, you're making the transition, it's already going to
be tough, just go ahead and go to the cup and save yourself a step. But when you have a baby
that is this stubborn, you want to make the alternative to what she wants the easiest thing that it
can be, because you don't want another barrier to hold up this transition.
So my vote is you got to get her on the bottle. Now, you tried holding her off and having someone
else give her a cup, and it didn't work. Again I would have them use a bottle and not a cup, and I
would also have them use vitamin D whole milk, and not breast milk in the bottle. Again there's
going to be people out there who are going to really get upset at me over this. But, the reason for
that is, because when she tastes the breast milk she's going to just think about what she wants,
and that is to be nursing.
But we don't want her to nurse anymore because she's at the age where it's fine to wean her, and
you're not making enough, for her being so stubborn, you really need to get her mind on
something else, and what is offered in the bottle should be something that tastes a little bit
different so she does not associate it with nursing.
Now my guess is, even if you do these things, it's still not going to work and the reason why is
because your daughter is weaning. She knows that if she cries long enough and loud enough,
and puts up a fuss and a tantrum, she's going to get what she wants, and what she wants is to
nurse. And the reason that she knows she's going to get that is because you have given in.
When you say, "oh we tried this and it didn't work", that means you lost, that means that she
ended up getting what she wanted and you're not going to get anywhere until she figures out that
what she wants is not going to happen, there is no other choice here.
So you have to be the one to win. Now there will be tears, there'll be temper tantrums, there'll be
tears and temper tantrums for hours, and you have to be prepared for that. She's prepared for
that, she's going to do the tears and the temper tantrums for hours because that's how she's
getting her way, that's how she's learned to get what she wants.
I'm all for the so called starve her until she takes what you want her to take routine. Because
she's not really going to starve, she's going to get dehydrated long before she starves. And in
ten years of practice, I have never seen a kid get dehydrated from stubbornness, which is what
this boils down to. Again, I think you should stop nursing, switch to vitamin D whole milk, cold
turkey, no more breast milk, you could pump for relief, but that's it, or you're going to have a
miserable few days. But you're having miserable days now, right?
So I say it's best to turn up the heat and get this over with, because more volume is going to
equal more sugar, and more calories for feeding, and then she's going to be able to go longer
between feedings. I think this is your first step. The first step is to get her on bottle with vitamin D
whole milk, then we'll worry about getting her on the solids, because there's not a big rush here
from a growth stand point because she's growing well, she's off the chart.
She's obviously getting enough calories, but she can't do this much longer, and you're going to
have to get her on solid foods or she's going to develop an aversion to solid foods. Especially
being in Singapore, usually we send those kids to the occupational therapist to help them. But if
you wait much longer you're going to be dealing with even bigger problems. So I think it's time to
get her transitioned over. Letting her cry it out seems like a cruel thing to do, but you got to look at
the big picture, and where do you want to be six months from now.
And if you just let this go the way she wants it to go, are you going to be there? Part of being a
parent's making the tough decision, and that's not always what your kids want. But it starts now, It
starts when they're a year old, and it does not get any easier. Now again there are going to be
people that say "whaa, just supplement,… but I think in the kid that is this stubborn, you're going to
have to make the switch, because otherwise every time she gets a taste of breast milk, she's
going to remember nursing, and want that again, and you're just going to have more problems.
Once you have her off the breast, and on a bottle, and on whole milk with spaced out feedings,
then we'll deal with the problem of the solids. I'm not going to go there now because it's just going
to blur the picture. You need to give it a couple of weeks, get her on the bottle, on milk, spaced
out feedings and then get back to me and we'll go on from there with the solid issue, because
you can only tackle one problem at a time. You got to pick your battles, and right now I think the
battle has to be to get this transition taken care of.
OK, I think let's go ahead and move on here. Again there'll be those who argue my point, and
that's fine, but you know, you ask for my opinion, they're not going to change my mind. I've been
doing this too long, seen these sorts of things too many times, so I'm going to stick with that.
All right, this comes from Loraine. Loraine emailed and did not let us know where she was from,
so shame on you Loraine, but that's OK, we love you anyway, thank you for listening, and actually,
I love the question Loraine, because I learned something new. Loraine says, "Hi Dr. Mike, I love
the show and thought the story about prescribing honey for cough was very interesting, but I have
a question, is there a difference between a buckwheat honey and other types of honey? Also I
thought your comment about the ethical dilemma of prescribing honey very informative.
I recently took a health ethics class, and I appreciate your being so candid about the decisions
doctors have to make in their everyday practice. Thank you again for all the time and effort you
put into PediaCast, Loraine."
All right, well, what she's talking about is from PediaCast episode number 92, where we talked
about honey for coughs and we'll put a link to PediaCast 92 in the show notes. Now I have to
look this up, I had no idea what buckwheat honey was. What I learned is that there's this concept
out there of a monofloral honey. Now if there's any bee keeper in the audience you're going to
know exactly what I'm talking about.
Basically, monofloral honey is honey that is made by honey bees, which are collecting the nectar
and pollinating a single plant species. So these are going to be pure honeys with just one nectar,
one type of nectar in it, and those types of honeys apparently command a good price in the
market place because each one has a distinct flavour. And just to give you some examples of
some pure honeys or monofloral honeys made from honey bees that are just pollinating and
getting nectar from one single plant species.
Acacia, this is just a few, there're tons of them, acacia, alfalfa, apple blossom, avocado,
buckwheat, cherry blossom, heather lavender, manuka, mesquite, orange blossom, raspberry,
sage and sunflower, and again these are just small sampling of what's out there.
So, let's look a little bit more on buckwheat honey. Well according to Wikipedia, buckwheat
honey is primarily made in the United States, China, and Russia. Buckwheat was an important
crop in the United States from about 1930 to the 1960's, and it since faded from use, and
buckwheat honey has actually become scarce in the United States. However a wild buckwheat
plant which was a close relative, has become established in the US, and it's a naturally little bit
more mild of a taste, then they get traditional buckwheat and sometimes it's used to blend with
the classic old fashioned buckwheat or sold separately as a monofloral honey called Bamboo.
A recent study has shown a course of buckwheat honey to be more effective than over the
counter cough syrup at treating childhood coughs, so, see the results of that study already made
its way into Wikipedia. So why would the researchers use this buckwheat honey? Traditionally
monofloral honey also spot to have better medicinal value than mixed honey.
Now despite Wikipedia's stating it's scarce in the US, it must have been readily available to the
researchers at the time of the study, or they probably would've picked a different monofloral
honey. Now why do a monofloral honey? Well that at least then ensures that each kid in the
experimental group is getting the exact same composition of honey, so it helps you to know that
you're data is going to be intact, because it's not like, well half of the kids got one kind of honey,
and other half got a different kind, or just the regular honey that's out there, it's just the mixed
honey, it doesn't really matter which flowers the bees visited.
The gourmet honeys are the ones over these monofloral ones, the ones you find in the grocery
store are just going to be a mixed bag of honey. I suppose that in order to get better results, they
wanted to know that each kid was getting the exact same composition of honey, and there were
too many kids in there to get to give everyone a dose of honey from the exact same jar. By
picking a monofloral one you have a better idea that they're all getting the same honey.
And since researchers are prone to reporting every minute detail of the study, they let us know
which honey they used. Now can these results be extrapolated to other honeys, in particular,
honey that you find at the grocery store that's just a mixed plain honey? Of course to know for
sure that would take more studies. And if you're a medical student, or a pediatric resident, and
you're interested in research, now's your chance, do the honey thing because this is going to get
a lot of press I think in the end.
But certainly as a parent, if you can't find the buckwheat honey, which you probably won't be able
to, try whatever honey you come across at the grocery store and give it to your kid and see what
happens, because the most important result from a parent's point of view is, "does it help your
kids or not?" So I think I'll just give it a try, even though it's not buckwheat honey and see. Now
remember, no honey for kids under 12 months of age because you do worry about exposure to
botulism toxins, so avoid that.
Ok, listener number three, by the way, in the show notes I do have a link to the Wikipedia article
on monofloral honeys, so if you have an interest in honey, you can check that out.
Sandy in Round Lake, Illinois says, "I have two questions, what do you think about exercise
saucers? And what does it look like when a baby has nipple confusion? Thank you, love the
Sandra, you got right to the point, I'm not used to such pithy questions, but I'll take them, actually I
like them, most of the questions are pretty verbose, which is fine, keep them coming folks,
verbose, pithy, either way, it's all good.
You have some good questions, Sandra, let's tackle them. First, exercise saucers, they're
definitely safer than walkers since mobility is not an issue, because with walkers, you worry about
stair hazards, you worry about reaching hazards, because the babies are up a little taller, they're
mobile, they can reach some things you might not think about up on the shelves, and those sorts
Also in walkers, babies are learning to use a specific muscles to walk, but they're not the same
muscle groups that babies will need for real walking, so overuse of baby walkers can lead to a
delay in real walking, and so with this exercise saucers, all of these hazards are eliminated and
the potential for a delay in walking is also eliminated, as long as you don't overuse it. I mean you
still can overuse an exercise saucer; I would look at it as part of a baby's overall stimulation
It's not a baby sitter's substitute, they shouldn't be in the exercise saucer all day long, but babies
need some floor time, they need some time in their cribs, some time in a high chair, sometime in
the swing is fine, little time in the exercise saucer's fine, it's just part of the total package. I think
they're fine but in moderation, like everything else in life.
Nipple confusion, I don't believe in it, babies are smart, they may find one easier than the other,
and they may develop a preference, and they may become very stubborn about their preference,
which can cause problems. And moms often give in to that preference which reinforces the issue.
So there are a few babies, a very small number of them who would do better sticking with one or
the other, especially if the one you want them to have is different from the one that they want. In
that case you probably ought to just stick to your guns and give them the one that you want them
to have, otherwise when they get the one that they want, it's going to cause problems.
So for some babies, they're going to have a preference for the breast, others are going to have
preference for a specific type of nipple or specific bottle, and they're going to give you real
hassle if you try to switch them over. But the overwhelming majority of babies are going to do just
fine going back and forth as the need and the situation arises.
I don't think babies are confused about how to suck differently on one thing or another, but I think
that they might find one easier, they may develop a preference, and babies, just like adults are
very prone to being stubborn, and you have to learn how to deal with that.
Let's move on. Listener number four, this comes from Jamie in San Diego, and Jamie says,
"Hello Dr. Mike, I've been listening to your podcast for few months now, I was listening to show 92
about salad bars. My daughter is in the fourth grade, and ever since she was in kindergarten her
school has offered a salad bar. She switched schools in third grade, but it's the same school
district so they also have a salad bar. Fortunately my daughter likes salads. My wife and I always
offered her salad when she was younger, now she gets the main dish plus some salad on most
days. Anyway my daughter's school district is San Diego Unified. I believe all schools should
have salad bars, thank you for all you do."
Well thank you Jamie for the comment. The salad bar story was in the same episode as the
honey story, so if you're visiting PediaCast 92, check out the honey story, that's where you'll find
the salad bar story as well. And again there'll be a link back to PediaCast 92 in the show notes.
Ok we have one more listener; this is from Colette in Alaska. Colette says, "Hi Dr. Mike, first off,
I love the show, you do such a great job and I truly appreciate you and your family's time and effort
to get this information out. I love hearing your rant about fear mongers, and their attorney's
messing it up for everyone, I very much agree with you. My question is about flat feet, I have a
four year old that has her father's very flat feet, I noticed it quite a while ago, and I asked her
pediatrician, he said she'd probably outgrow it….
"We have moved since, and now have a pediatrician that has suggested taking round flat cotton
pads, folding them over and taping them into her shoes. That seems odd to me, I've been on a
mission to find out if I really need to force her to wear an arch, or will she be fine without one?
Will that cause problems for her later?…
"They don't seem to hurt her or bother her now, her feet. We mostly wear winter boots outside
and Crocs inside, orthotics are expensive, but most shoes for her age have no arches or
support. Is there a reason for that? I've tried to do some research online and have haven't found
much on the topic. Any advice, rant or other is definitely welcomed and appreciated by a manic
mommy of two daughters in Alaska, take care and thanks again, Colette."
All right, first let's talk about flat feet then it'll make a little bit more sense. What exactly is flat
feet? A flat feet is basically a condition in which the foot does not have a normal arch, now as it
turns out, all babies and toddlers have flat feet. Arches typically don't start to form until kids are
three to four years of age and then some kids, it can take even longer than that.
So why do babies and toddlers have flat feet? Well it's because they have really loose joint
connections made up of cartilage and baby fat between the foot bones that sort of spread
everything apart, so that when they put weight on their foot, because of these loose connections
between the bones and because of the fat that's between the bones and the cartilage instead of
solid bone, everything's going to just kind of smoosh flat and they're going to have a flat foot.
Now, as the skeleton matures, then the joint connections stiffen, the baby fat regresses, and the
way that the joint stiffen is in an arch shape, and this is going to happen during the elementary
school years. Now, if in some kids, it can take a little bit longer than that, now if the joints stiffen,
and in a flat pattern instead of an arch pattern, that's the kind of flat feet that can cause problems.
But you're not really going to see problems with that until they're an older child or a teenager.
And some people can live with flat feet, and without much of an arch, and not have any issue with
it at all. Now the next thing I want to say is that, this whole thing of the skeleton maturing and the
joints stiffening into an arch shape is going to be genetically mediated, so how your foot
develops depends on your background, your genetics, how your body is going to do this?
By putting cotton inside the shoe and folding it in half, cotton is not going to cause joints to stiffen
or changed the shape of bone; it's just not going to happen. And the reason that there's not a big
arch support in kid's shoes is because also, that's not how the arch forms. The arch forms as a
normal part of development during the elementary school years.
So, kid who's got flat feet as an infant or a toddler, it's supposed to look like that, they're not
supposed to have arches yet. Now let's say that you do have an older kid, and they have flat feet,
what do you do for that? You only have to do something if there's a problem, we have an old
saying in medicine, "if it's not broken, don't fix it", because what you may end up doing is, if there
was no problem to begin with, you fix it, and now you've got a problem. I mean you don't want to
create problems if things are going well, so as long as they don't have any difficulty ambulating, it
doesn't hurt when they walk, there's no pain, they're walking normally, they're functioning normally,
it doesn't matter.
Now for kids who have symptoms associated with persisting flat feet, as they get to be older,
then some shoe inserts or orthotics may help to put the foot in such a position that it relieves the
pain. Those things aren't going to make an arch; they're simply going to provide support to help
So what about surgery? Well it's not help for a need in the vast majority of kids with flat feet, but if
flat feet is caused by these abnormally fused bones, and it's flat, and it's a teenager, then surgery
may be indicated. But remember, most flat feet in kids is caused by the opposite, the foot joints
that are too laxed, and cartilage and this baby fat one, they're really little, and that they usually
corrects itself over time.
So the bottom line, babies are not born with arches, they're born with flat feet, as the foot
develops, baby fat is lost, the joints stiffen into an arch shape, and this process begins around
aged three or four, but it can take several years to complete, and all of this is normal as long as
there is no pain or functional problem. If there is pain, obviously, you need to see your doctor or if
there's a functional problem and the first thing to do, and by functional problem, we mean they're
delayed in walking, they can't run, jump skip, go up and down stairs, that sort of thing.
And then if they're having discomfort, shoe inserts may help provide support, but if the bones
fused and or stiffen into a flat shape, they're really more likely to develop chronic foot pain as a
teenager and young adult, and that's rare, but it might require surgery, but you want to hold off on
surgery as long as possible, and definitely best to wait until the skeleton is mature, which again is
going to be more in the late teenage years and into early adulthood.
Couple links in the show notes that you can trust on this flat feet information from
familydoctor.org, and also another one from Pediatric Adviser, they're two sources that I trust and
you should too, and you can check them out in the show notes at pediacast.org. All right we're
going to take a quick break, thank you to all of you for writing in as always caught up a little bit
this week on those listener questions, we'll be back to wrap up the show right after this.
Dr. Mike Patrick: Don't forget that you can listen to PediaCast live by going to pediacast.org and clicking
on the live page, and there's directions there on how exactly you can do that, it's easy, it's free
and if you'd like to listen to the show as it's recorded, you can do that. Usually the best time to
find us is going to be during the seven to eight o clock hour, Eastern Time during the week, so
check it out, and you might be able to catch us recording live, that's again at pediacast.org.
Thank you goes out to Nationwide Children's Hospital for providing the bandwidth for our show,
also Vlad over vladstudio.com, he's the artist that takes care of us, and we appreciate that.
And of course the show would be nothing at all without you, so thank you for taking a time out of
your day to join us and for participating by writing in with questions, I really do appreciate that.
The Pediascribe blog is done by my lovely wife Karen, and today's blog post, actually I always do
this, because I record the day before the show is released, so this would be yesterday's blog
post. We have some cast pictures from high school musical which my daughter Katy, just was in,
and also my son is playing Christopher Robin in Winnie the Pooh production, and we have some
cast photos at the blog.
So if you go to the show notes at pediacast.org, there's a link there and you can see what my
kids look like, because I'm a proud dad. Reminders, iTunes reviews, you know all about that, I
won't go there again, but please 200 by the first to the air please, also the PediaCast shop is
open for your shopping enjoyment, we don't make any mark up on any of the items there, we sell
them on cost, it's more about spreading the news.
And also we have a poster page, I know for a fact that there're a few family practiced doctors,
pediatricians, medical students, pediatric residents who listen to this show, and all of you, please
go to the poster page at pediacast.org and print out some posters, they're PDFs so you can
copy them freely, they're not copy righted and post them up in exam rooms, bulletin boards, that
sort of thing, I'd really appreciate it, and of course, word of mouth is the best way to tell other
people about the show. All right, our next one will be on Friday, and again, during this busy flu
season, we're doing the three shows a week thing; once it slows down on the Spring we'll
probably go back to five shows a week.
When I have more time to work on this, I can get five out, which is my goal, again which is why it'll
be nice to build the audience, get a good sponsor, and then I can cut my practice down to part
time, which would be lovely, because then we'd get one of this out every day and have lots of
special shows and do all kinds of cool stuff that I can't do now, because I just don't have the time.
So, anyway, where was I? See? I go off on these tangents. Friday, we're going to probably
answer more listener questions, because I got a backlog of them. Seeing the same question in a
couple of times, like, "did you hear me?", "did you get it?", I'm trying folks, I get inundated with
questions, and we try to pick good variety of them to cover all the age groups. All right, so until
Friday, this is Dr. Mike saying, stay safe, stay healthy, and stay involved with your kids, so long