Asthma Treatment Barriers, Stranger Anxiety – PediaCast 102
- Barriers In Asthma Treatment
- Effects On Teens From NOT Having Sex
- Stranger Anxiety
- Stomach "Flu"
- Testicular Temperature
- Children With Asthma Not Receiving Medicine Due To Lack Of Insurance
- Teen Benefits Of Not Having Sex Decline With Age
- Separation And Stranger Anxiety (Dr Greene)
- Infectious Forms Of Diarrhea (KidsHealth)
- Scrotal Temperature Is Increased In Disposable Plastic-Lined Nappies
- Critical Evaluation Of The Diaper Study (Dr Spock)
- PediaScribe: Someday They'll Be Cooking For Me
Announcer 1: Bandwidth for Pediacast is provided by Nationwide Children's Hospital, for every child, for every
Announcer 2: Welcome to Pediacast, a pediatric podcast for parents. And now, direct from Birdhouse studios, here
is your host, Dr. Mike.
Dr. Mike Patrick: Hello everyone, and welcome to Pediacast, a pediatric podcast for moms and dads. It's Dr. Mike and it is Pediacast episode 102 for Tuesday, January 2nd, 2008. Stranger anxiety, stomach flu and warm testicles. Yes, you heard me right.
We have a big show lined up for you. It's been a week since we have talked amongst ourselves and I have to tell you, I actually had this show prepared to do last week and my voice just could not take anymore. And those of you who are regular listeners of the program know I had this cold, yeah, about 2 to 3 weeks now. No fever with it, I feel pretty good and actually in the mornings my voice is doing pretty well but by the end of the afternoon it is shut. And if I could go 2 or 3 days without talking at all, you know, I think, I'd be pretty good. But as it is in my job, I have to talk all day long and that tickle [coughs] just will not go away. So there still may be a little bit of coughing but I do feel much better.
Alright, one thing, this is a little bit old news but, again, I had this show prepared for last week so I'm going to hitch up with it anyway.
Anyone out there watching American Idol? And I'm going to bring this around to parenting. The audition shows — okay you know, I like the entertainment field obviously, you know, I put together a show here at Pediacast and you know, so I kind of like watching American Idol because, you know, there's these amateur entertainers, kind of like myself and of course they can sing — well, some of them can sing. I don't pretend that I can sing. In fact, I know that I stink at it. I mean I recognize this fact. Nobody needs to tell me and if someone just came up to me and said, "Oh you're great, You shall audition for American Idol." I'd say, "What do you want from me?" You know, you're kissing up because you want something because, you know, I know that I can't sing, and if someone tells me that I can, you know, I know they're fooling me, or you know, maybe they're tone deaf. So my question is, how do some of these people come to believe that they actually have singing talent?
And when Randy and Paula and Simon have to do the dirty work, that their parents should have done years ago, it means poor people are crushed, like they really thought they had a chance and then as viewers, you know, you feel sorry for them, but we shouldn't [laughs]. I mean, they couldn’t sing to begin with. They didn’t have any business even trying out. Come on, people. Moms and dads, I think it’s okay to tell your kids that they aren’t amazing vocalists. You know, encourage them to sing for fun and for themselves, you know, be in a choir, that’s great, and of course, point out the talents that they do have. And you know, build them up for what it is that they can do well but please don’t set them up to make fools out for themselves on national TV by leading them to believe they can sing when they clearly can’t, and not everyone can sing. You can have all the vocal lessons in the world and it’s not going to happen. So, there, you know, we related American Idol to parenting 101. You like how we did that? Pretty sneaky [laughs].
Alright, what we're going to talk about today: barriers in asthma treatment, the effect of teens from not having sex, and that one we get a little bit descriptive so I'll give you a warning before we shoot into that news story so that if you have kids who are also listening you can fast forward, because that news article may not be appropriate for the younger set but we'll get to that.
We're also going to talk about stranger anxiety, the stomach "flu," this is not a video podcast but if it were, when I said "stomach flu" I would've held up both hands with my two fingers, you know, and made the little quotation sign. Then we're going to wrap things up with testicular temperature. It's going to be an interesting show.
Don't forget if there's a topic that you would like us to discuss, just go to Pediacast.org and click on the contact link. You can also go to firstname.lastname@example.org and click on the con — no, no wait [laughs], don't do anything there. You just write — just write out your email to email@example.com.
My ADHD is getting ahead of me. If you do the Gmail route, please include your name, location (where you are located because, yeah, we'd like to include that when we go through the questions) or you can call the voice line at 347-404-KIDS, that's 347-404-5437. And I should point out, we have had 2 or 3 more of those and we're going to those next week. So if you called recently on the Skype line and left a message, rest be assured, we're going to answer your questions but you have to wait about a week.
Our News Parents Can Use is brought to you in conjunction with news partner Medical News Today, the largest independent health and medical news website. You can visit them online at medicalnewstoday.com.
Each year, over 750,000 children with asthma may be at risk of a major asthma attack while they have no health insurance. About 30% of those families are more than twice the federal poverty level,
putting them above the threshold for public health insurance programs in most states.
"Too many children with this chronic condition are without insurance at some point during the year,… said Dr. Jill Halterman, associate professor of Pediatrics at the University of Rochester and lead author of the study as reported in the journal, Ambulatory Pediatrics. "These children need to have ongoing treatment from a primary care provider to avoid serious health complications. Without that, they are at increased risk for ongoing symptoms and even hospitalization….
About 13 percent of children with asthma were without insurance at some point during the year. That includes 2 percent… or 114,000 children… who were uninsured for the entire year. Those same children were 14 times more likely to have had an unmet need for medication than children with private insurance. Even those who gained insurance by the time of the survey were six times more likely to have missed out on needed medication.
The study also showed that many children with asthma were not seeing a regular physician often enough. Almost one-third of parents of uninsured children said they had no personal primary care doctor for their child. More than one-third of parents of children who had lost insurance and about half of parents of children with no insurance for a full year said their child hadn't seen a personal doctor for preventive care in the past year.
(And these are kids with asthma!)
"Healthy children should see a physician for preventive care at least once a year. Children with asthma need even more consistent care to prevent attacks and other related illnesses. No year should go by for a child with asthma without at least one, if not more, visits to their regular physician to update treatment plans and address ongoing health issues,… said Halterman. "We, as physicians, have very clear guidelines about how to effectively manage a child's asthma symptoms, but we can't help these children if we don't see them….
No differences were found between children with private and public insurance, when it came to unmet needs, discontinuity in care or poor access.
This suggests that consistency of coverage for children with asthma is more important than the source of insurance. Recent studies conducted by the University of Rochester Medical Center have shown that providing insurance to children with asthma through the State Child Health Insurance Program (SCHIP) reduces their unmet needs and reduces racial disparities in access to care.
"No child, especially one with a chronic health condition such as asthma, should go without health care because of situations over which they have no control. Insurance costs a lot to buy, and many people can't get approved because of past health problems. There will always be families who earn too much to qualify for private insurance yet too little to afford private insurance. It is hard to see children suffer with conditions like asthma, where we know what to do and we know that it helps… just because they cannot get health insurance…. said Dr. Laura Shone, an assistant professor of pediatrics at the University of Rochester Medical Center and another author of this study.
Let me grab a sip of water here and then we're going to talk about this. Alright, so we live in a country that at least according to this article does not take care of these kids. Now, I know this is a political issue, and I do try my best not to tread in political waters, but, hey, this is an election year, right?
The thing is this. In many cases, these kids do have access to care. Their parents just don't know how to navigate the system to get it. I have personally seen many kids, absolutely free, despite our high office overhead because they have no health coverage. And really, that is a burden that individual physicians should not have to shoulder. You know, I have also personally seen kids who qualify for public health coverage but don't have any, because their parents haven't navigated the system correctly and I've had to hold their hands and help them break through the red tape. Now, again, that is a burden that individual physicians should not have to bear. So what's the answer?
Well, I really don't know. I mean, I don't like seeing kids free because it does put a strain on cash flow, there's no question about that. And those of us in primary care already have to settle for nickels and dimes as it is from 3rd party payers, and we have lots of expenses that we have cover. And I don't like helping families with the red tape, not because I don't care, but I'd rather spend my time practicing medicine than navigating bureaucracy.
1But I do these things because I have to. I mean, turning my back on the problem on these kids who need help is not right either. At the same time as a doctor, do I want to be an employee of the government and they federally run healthcare system? Um, no. I mean, would you?
So, again, what's the answer? Well I do know this. The solution is going to take lots of thinking and creativity and it's going take true conviction on the part of our next president in congress to get it done. Now unfortunately, I'm not sure any of the candidates are really up to the task. You know, I know, that's a bit "glass is half empty" but, we'll see.
Now I don't think that they're not smart enough or creative enough to do it. I just don't think it's really in their heart a priority. So we'll hear what they say over the next few as the campaigns roll and go from there. I know this issue doesn't affect many of you personally. I mean, most podcast listeners aren't relying on public assistance or are without health insurance but it does affect a lot of people in this country. And I see families that it does affect every day. And when it comes down it how we take care of our kids as a society and what it costs in our tax dollars speaks volumes to how we are as a country, in terms of values and morals and where our money goes. So, in that sense it does affect all of us.
Alright this next news story is, again, going to put a bit of strain on our clean rating in iTunes. So, if you are driving in the care or you're listening where you're working around the house, if there's kids around and you want them to hear the S-E-X word over and over, you might want to skip ahead to the music and get out of the news section and get right to the listener part of the program because you'll be safe then.
At least until we talk about warm testicles at the very end of the show and then you might have to skip again. Alright so here we go, proceed at your own risk.
The percentage of teenagers who report solely positive benefits from not having sex declines precipitously with age, according to a new study by scientists at the University of California, San Francisco.
The finding suggests that adults should give teens guidance in coping with both the negative outcomes of engaging in sexual behaviors, and the negative experiences of refraining from them, the researchers say.
Now, remember these researchers are in San Francisco (a little progressive).
The study, reported in the January 2008 issue of the "American Journal of Public Health,… studied teens from the fall of their ninth-grade year through the spring of their tenth-grade year.
Among teens who remained sexually inexperienced during the study, the percentage reporting only positive experiences from refraining from sex fell from 46 percent to 24 percent.
Among teens who were sexually experienced at the outset of the study — by the way I love how they put that, "sexually experienced." Okay, folks, these are kids who had sex. The percentage of these sexually active teenagers reporting only positive experiences from refraining from sex later on fell from 37 percent to 8 percent.
The greatest change in attitudes was among teens who became sexually experienced during the study period. For those teens, the percentage who said that not having sex resulted in only positive experiences dropped from 40 percent to 6 percent.
A comparison between the groups was also illuminating. Those adolescents who were sexually experienced from the outset were more likely than those who remained sexually inexperienced to value refraining from sex. So the bottom line, because it gets a little confusing.
The ones who had sex wished they hadn't, and the ones that hadn't had sex wished they had. [Laughs] That's life, folks. Isn't it? It's not just sex that's that way, you know? You know you have something you wish you did and once you have it, maybe you wish you hadn't.
"When we encourage teens to abstain from sex or delay becoming sexually active, we frequently over-focus on the health risks, such as unintended pregnancy or sexually transmitted infections,… said senior study author Bonnie Halpern-Felsher, a professor of pediatrics in the Division of Adolescent Medicine at UCSF.
"Young teens are aware of the health risks, but this study shows that teens are assessing how they feel about refraining from sexual behaviors based upon how having sex makes them feel — and those feelings become increasingly influential over time,… Halpern-Felsher said.
While research has examined how teens feel about becoming sexually active, the current study is the first to examine how teens feel when they don't have sex, according to Dr. Sonya Brady, another researcher involved with the project.
The study examined the attitudes of approximately 600 Northern California high school students. Study participants were divided into three categories: those who were sexually experienced (or had had sex) at the outset of the study, in the fall quarter of the ninth grade; those who had become sexually experienced by the end of the spring quarter of the tenth grade; and those who remained sexually inexperienced (no sex) throughout the ninth and tenth grades.
The study data was collected between 2002 and 2004 from a racially and ethnically diverse group of high schoolers who were mostly 14 years old at the start of the study (14?). Fifty-eight percent of the teens were female. Forty percent were Caucasian, 22 percent were Asian and 17 percent were Hispanic, and the remainder being of other racial groups.
In the study, researchers asked participants to fill out survey questionnaires that asked about the positive and negative consequences of refraining from sexual activity.
Sexual activity was defined as having either oral or vaginal sexual relations. According to the teens, positive consequences of not having sex included "having a good reputation," "your friends were proud," and "you felt responsible." Negative consequences included "partner becoming angry," "felt regret," "felt left out" and "felt like you let your partner down." The participants were surveyed every six months.
Those who were sexually experienced were more likely than the other groups to value refraining from sex. So those who had wished they hadn't. By the spring of the tenth grade, these teens were twice as likely to report a positive outcome from not having sex, when compared with adolescents who became sexually experienced during the course of the study.
The researchers say, although more investigation is needed (it always is) to understand why that might be the case, it appears sexually experienced teens may reflect upon their past experiences and come to value selectivity about sexual partners or appropriate occasions for engaging in sex.
"Refraining from sexual behavior should feel rewarding, and engaging in sexual behavior should be based on maturity and readiness,… Brady said.
"We often focus on abstinence in sex education programs. It may be that, when we do this exclusively, we're not meeting the needs of those adolescents who choose to be sexually active, and may be failing to give them the tools to select the most caring partners for them, the right occasions for engaging in sex, and the best strategies for engaging in safer sexual behavior,… she said.
Alright, you know, this is Northern California we're talking about, okay? It's not the Corn Belt. I get that. But I'm telling you, moms and dads, no matter where you live, your teenagers at 13 and 14 years old (9th and 10th grades) are dealing with this stuff. Are you helping them deal with it? All I'm going to say.
Alright we're going to take a break. We have some questions from listeners that we're going to address and we will get to that right after this.
Alright, I realized that my voice is a little squeaky today, but hey, I'm not coughing as much, alright? So, that's the good news. Our first listener is Marcy from North Bellmore, New York and Marcy says, "Hi, Dr. Mike. I'm a new listener and love listening to your podcast. I even enjoy listening to the topics that I haven't faced yet. My question concerns my 6-month-old daughter who recently developed stranger anxiety relating to my mom whom she sees about once a week. The last two times we visited, she cried hysterically whenever my mind tried to hold her."
"This made my mom feel terrible since she sees her about once a week and has never happened before. Is there anything that I can do to help the situation?"
Oh boy. Stranger anxiety. It's a normal part of infant development and it begins around the time that babies develop a skill called object permanence, and this means they remember objects and people even when the object or person in question is not physically present, and this is a skill that shows up some time between 6 and 12 months of age but the exact age is highly variable from baby to baby.
Now, with this in mind, you know healthy babies form a close bond with a primary caregiver, usually a mother. And when mom is away, infants, once they get this object permanence, they remember, in fact, they strongly they remember and miss their mom. Now don't get me wrong. Babies know their mom for the first hours of life, but at this time, there's really more of an awakening of sorts.
And even when mom's not there, they remember mom and miss mom. And when they see others, whether it be strangers or the doctor or grandparents who they used to exchange smiles with, or sometimes even dad, they realize, hey, this is isn't mom and anxiety sets in and they fuss and cry. They think, you know, mom's going to leave them and this new person's going to be there, and they think, oh, I'm going to miss mom, they get anxious and they fuss and cry.
Now that's what we think happens. I mean, we don't know for certain, because you know, they can't tell us, right? But we think that's what happens and when you think about it makes sense. The good news is, it's common. Lots of grandparents are in the same situation and the other good news is it goes away with time. Now when? Well, that's highly variable, but usually between 15 and 18 months, it's starting to settle down. And I find in my own practice that babies who start early are usually the ones who end early than the babies who start the stranger anxiety stuff later are the ones who end a little bit later.
I mean, the prime time for this — I mean, it can be as early as 6 months but the prime time is probably like that. 12 to15 month-range. I mean, that's like when it's at its peak. And then 9 to 12 months, you know, that in — something like a bell-shaped curve. You know, 9 to 12 months is kind of bad for a lot of kids and between and 18 months is kind of bad. And then the kids that are less than 6 months is not so much of an issue. And once they get to be about 18 months to 2 years old, it's not really much of an issue anymore, either. Of course there are more and different issues that are popping up at that point. In the meantime, you know there's really not much you can do to make it better. I mean, even seeing grandmom more often probably won't help all that much. I mean all you can do is understand it, resign yourself to dealing with the frustration that it prevents and cling on to the promise that it's only going to last a few months.
Now I know a few months seems like an eternity when you are in the midst of it. I know and I've been there in my own house. You know, I'm a dad. And I see it every day at the office.
If you want to know more on stranger anxiety, and Marcy may want to forward this source to grandma so she can better understand it. Dr. Greene has a nice write up on separation anxiety and stranger anxiety at drgreene.com. And of course we'll have a link for you to that in the show notes.
Okay, question number 2 comes from Cezanne in Calabasas, California. "Hi, Dr. Mike. Over the weekend, my 13-month-old seemed to have caught what seems to be the stomach flu. It's been going around day care and they said diarrhea is the first sign. But when we searched Pediacast at 2 AM we could not find any past podcast on this topic."
By the way, I love, Cezanne, that you are going to Pediacast at 2 AM instead of the baby books. Okay, round of applause — woohoo! [Laughs] It's great! That's what we are after.
Cezanne goes on to say, "I was wondering if you could please address this topic. Is a case of diarrhea really the stomach flu? If so, what signs should parents look for such as diarrhea or loss of appetite, how to treat it, should baby have milk if you hear she has diarrhea."
"Luckily my daughter only had one instance of diarrhea and seem to be feeling better the next day except that she still doesn't have much of an appetite and wants a lot of extra TLC (that's tender loving care, for those might be outside the US). Thanks and I enjoy your podcast so much."
Alright, I'm going to take a sip here real quick. I apologize but I hate post-production. Let's get technical here for a moment. There's really no such thing as "stomach flu," okay? The influenza virus which is what we refer to with the term "flu" is a respiratory infection. So typical flu symptoms, the true flu [coughs] is a sudden onset of high fever — 103° – 104° F is common. The fever usually lasts 3 to 5 days. Sometimes it can last a little longer than that even.
You get upper respiratory symptoms, runny nose, cough, and then pneumonia is a common complication. So this is a respiratory illness. Now, winter time, vomiting and diarrhea is usually caused by a different bug altogether. So no, it's not really the stomach flu. In baby, people call it that. It's like a lay person's term. In babies and toddlers, one of the most frequent causes of vomiting and diarrhea is rotavirus. And with that one vomiting usually lasts anywhere from 3 to 5 days. Usually fever during that time, diarrhea then can last for 1 to 2 weeks afterwards and dehydration is common from all the vomiting and diarrhea but we do now have a good vaccine to protect against it. So hopefully, in the years to come, we'll see a lot less of rotavirus.
Now there are other viruses, too, that can cause diarrhea in kids including enteroviruses. Although you see those more in the summer time. Norwalk virus, think cruise ships with that one, but not just in cruise ships, day cares can have it run through as well, and that can cause vomiting and diarrhea.
Also, cytomegalovirus can cause diarrhea. Don't these have great names? But influenza is not one of them. So stomach flu is a misnomer. But we all know what that means, right? I mean if someone says, oh he's got the stomach flu, regardless of the name, you know, regardless of the name of the virus that's causing it, we know what you mean when you say that.
So what do you do for it? Well, you watch for dehydration. You want to push what we call isotonic fluids, and that just means it has the right amount of salts and sugars in the fluid. You don't want a plain water, because if you remember from high school chemistry class, you remember osmosis where fluid moves from where there is more particles to where there's less particles, you want the fluid that you give to have the same amount of particles as the blood has in it. Because you don't want fluid to be shifting to be shifting out of the blood or into the blood because that can cause imbalances in electrolytes. That's a bad thing. So, that's why Pedialyte is a good one to use because it's isotonic. I'm sure you remember that. I mean, think way back high school chemistry — isotonic, hypotonic, hypertonic, you learned it. Trust me you did at one point. [Laughs]
You may not remember it now, but you did learn it. So the goal is really to replace the fluid that was lost with the diarrhea and not necessarily to stop the diarrhea itself. So I usually don't recommend like Imodium A-D, you know, despite the people who make it, not ever wanting to sponsor Pediacast, and I would accept that, but it's true. You don't want to really stop the diarrhea because the diarrhea is getting rid of the virus, right? It's kind of flushing it out of the system so what you want to do is to replace the fluid with isotonic fluids such us Pedialyte, slowly advance to a BRAT diet. I would avoid dairy because the lactose — um, we've talked about this before. The enzyme that breaks down lactose is in the intestine in the intestinal wall and the diarrhea kind of washes that out. So, after you have diarrhea you become temporarily lactose intolerant and ingestion of lactose which is in regular milk will kind of perpetuate the diarrhea cycle because now you're having diarrhea from your lactose intolerance.
So it is a good idea to avoid dairy for a little while, while you have vomiting and diarrhea. Breast milk and soy milk products are fine. And then now, sort of the new trend is to consider giving kids pro-biotics and, you've heard of this before. The idea here is, also with the diarrhea, not only the enzyme that breaks down lactose is getting washed out but the normal good bacteria that live in your intestine that aid with digestion is also getting washed out. So the idea is if you replace the bacteria that's supposed to be there, what we call a pro-biotic — these are like the bacteria that's in yogurt but you can also get it in tablet form and crush them up and put them in, you know, like apple sauce and feed it to your kid that way. You can do that even in babies. But I would talk to your doctor before you do it. You know, so those are kind of strategies for dealing with diarrhea.
Now what else can it be if it's not a virus. Well if there's blood in the stool or if it has a prolonged course, especially greater than a couple of weeks, or it's particularly severe, then we have to think about the bacterial causes of diarrhea — things like salmonella, shigella, campylobacter, yersinia, E.coli 0157:H7 (that's the bad E. coli). So those you worry about. Also, giardia, cryptosporidium — these are protozoal. Now you got to think back to high school biology. Protozoal organisms that are often found in contaminated water. [Coughs]
And another bacterial cause is clostridium difficile or C. diff, that's the other one you have to worry about and of course then, there are — I'm just kind of going through what we'd call a differential diagnosis. There are non-infectious causes of diarrhea as well such as cystic fibrosis, which usually causes sort of a greasy diarrhea because they have problems with fat digestion. You know, that's kind of disgusting but that's the way it is but that's a chronic, greasy diarrhea. [Coughs]
Also, of course lactose intolerance, if you have that as a primary problem that could cause prolonged diarrhea. And then, another one is iatrogenic. What does that mean? Well, it's a fancy word that means, the doctor caused the diarrhea. And you know common cause of that would be antibiotics, you know, if kids get an ear infection, you give them an antibiotic, now they have diarrhea — our fault.
But hey, we got rid of the ear infection. So there's lots to consider. You definitely want to check with your doctor, keep in touch with your doctor when your child has vomiting and diarrhea. Certainly you want to make sure they're not getting dehydrated. If you like to know more about infectious forms of diarrhea, and I know you do, check out the show notes for a link to a good article from kidshealth.org and you'll find that at pediacast.org.
Alright, and finally, our listeners segment, we have Mica [Mee-ka], or maybe it’s [May-ka] — anyway from Kiev, in the Ukraine, and this by the way is our warm testicle bit, so just to warn you. Mica [Mee-ka] or Mica [May-ka], Mica [Mee-ka], Mica [May-ka] [coughs], hey, it reminds me of Laverne & Shirley, the opening of the song — okay, … Most of you probably are too young to remember.
[Mica] says, "Hi Dr. Mike, thanks for your podcast. I listen to it in the Ukraine (a bit far!) and discuss some of the interesting issues with my husband who is an orthopedic doctor. I'm going to have my first baby in a couple of weeks and I'm busy to prepare for baby stuff. I'd like to ask your opinion about the influence of heat on male organs. I heard that male organs shouldn't be heated for a long time. So our choice is using cloth diapers for our baby boy. I heard the temperature around his balls would rise when he wet a disposable diaper, also he won't cry immediately for a change because of the super comfortable function of recent artificial materials. I really appreciate if you could give me your opinion. Thanks!"
Well thanks for the interesting question, Mica. I think you're good either way, really. Really I do. Cloth, disposable.
At least with regard to testicular temperature, there may be different opinions out there with regard to comfort and convenience and environmental impact, but when it comes to testicular temperature, or ball temperature as you put it, I think you'll be fine either way, really. There was a study published in the archives of diseases in childhood in 2000 that did show that testicular temperature is warmer in babies using plastic disposables compared to those in cloth diapers, and I'll put a link to the abstract to that article for your science types in the show notes. And we do know that testicular temperature affects sperm production which leads to the whole boxers versus briefs debate, right?
But babies aren't making sperm. Now what about this. Does warmer testicular temperature in infancy affect sperm production later in life? And that's a good question and in fact, it really is Mica's question, and the answer is we don't know for sure, but it's unlikely.
There's a nice evaluation of this study by Dr. Robert Needleman. He's a pediatrician affiliated with drspock.com, and he brings up some good questions, such as: what brand of diapers were used, how tightly were they put on, did the cloth diaper kids wear plastic pans over the diaper, and if not, how would that affect the outcome, and were the study participants blind to the study details. If not, the plastic diaper moms, disposable diaper moms might wrap the diaper tighter and the cloth mom might make it looser, not on purpose, but you know, it's just human nature to sort of coax the results along if you know what you're testing. I mean, if you are in this test and you know that you're testing to see if it's warmer when you put on the plastic diapers, a mom, you might, you know, put it a little tighter because you know you're trying to show that it's warmer. So you definitely want the participants blinded into what it is that you are doing. We do have a link to the critical evaluation in the show notes as well as a link to the abstract of the article as itself.
So this study is questionable and it certainly does nothing to look at long-term effects of warmer testicles in baby boys. And to my search, there really has not been any further studies done on these topics since then. So what's a parent to do? Well, if I am the parent I wouldn't let this issue determine my decision, but that's my opinion, which is what she asked for. And thanks by the way for listening and contributing all the way from the Ukraine.
Okay, let's go ahead and take a break and we'll be back to wrap up the show right after this.
Alright as always, thanks go out to Nationwide Children's Hospital for providing the bandwidth for the show, Medical News Today for helping us out with News Parents Can Use, and Vlad over at vladstudio.com for helping us out with artwork on the site and in the feed. And of course, thanks to all of you for tuning in and participating in the show.
We always highlight something in the Pediascribe blog. And today's highlight is "Someday, They'll Be Cooking For Me." My wife and kids recently participated in a cooking class of whole foods and Karen writes about their experience and posts some really cool pictures in the Pediascribe blog. So be sure to check that out and as always we'll have a link in the show notes at Pediacast.org.
Don't forget, the Pediacast shop is open. If you like to buy a T-shirt, no mark-up there on our part. Also the poster page for hanging in the offices and bulletin boards to help spread the word, because that's how we get a bigger audience, bigger audience means more sponsors, more sponsor money means I can cut back on clinical practice and devote more time to this project.
And since you're getting it for free, you know, spreading the word helps. Alright, I did mention that I only did one show last week and part of it was my voice, but you know, this time of the year, you just have to bear with me a little bit. Our office is crazy. [Sighs] It's been really, really crazy. The flu starting to pop its head, RSV is cranking, and you know the regular rhinoviruses everybody's coming in with that too, even the ones who don't need to.
But you know, we always happy to see people. Don't get me wrong. Even when we say, you know, rest, fluids, motrin or tylenol, give it a few days.
Alright [laughs] so until next time, this is Dr. Mike saying — did I sound frustrated there? I really didn't mean to be. If you came in and saw me in the office today and I said that to you, I was sincere, really. I don't mind seeing folks. Until next time, this is Dr. Mike — oh, oh, oh, I should mention, next show is going to be Thursday. And it really will be because it's already done and will be produced and put together here with the next couple of hours, so on Thursday, January 24, Dr. Michelle from Hawaii, family practice resident, 3rd year, is going to join us. We're going to talk about Scarlet Fever so you don't want to miss out on that. It was a great conversation and we'll present that in our next episode which will be on Thursday.
So now, until next time, this is Dr. Mike saying, stay safe, stay healthy, and stay involved with your kids. So long everybody!