Cough and Cold Medicine, Bedwetting – PediaCast 105

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  • Cough And Cold Medication
  • Saline Nasal Wash
  • Gastroesophageal Reflux
  • Bedwetting
  • Caffeine and ADHD



Announcer 1: Bandwidth for Pediacast is provided by Nationwide Children's Hospital, for every child, for every reason.


Announcer 2: Welcome to Pediacast, a pediatric podcast for parents. And now, direct from  
Birdhouse studios, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone, and welcome to Pediacast. It is episode 105 for Thursday January 31st,  
2008. This is Dr. Mike coming to you from Birdhouse studio. I'd like to welcome everyone to the  


This is going to be what I would call "Pediatrics, Bread and Butter" kind of show. And the topics that we're going to talk about and they all stem from questions that you folks sent in. But all of them are  
repeat topics. I know we've discussed all of these things before. And it would be easy enough to  
just you know direct you to the old shows where we talked about them in the past. But the thing is,  
these are issues that come up often, and I know we have a bunch of new listeners out there since  
the last time we covered them and they come up so often. I think it's best just to go through these  
things again. And I did not, by the way, look back at my previous scripts or answers or take-a-
listens, so maybe there'll be a fresh spin on these topics.

So what are they? One is gastroesophageal reflux. So babies who spit up. We're going to talk  
about that. Also bed wetting, and discuss that again.


And there's a question someone had about ADHD or ADD. You know what, [laughs]
a little problem I'm talking about there so we're going to discuss that also.

Now before we move on, I want to mention, Karen, my lovely wife, who does Pediascribe, the blog,  
she's the blogging arm of Pediacast, she's celebrating her one year blogversary. Okay [laughs]. So, she's been doing Pediascribe now for a year and coming up at the end of the show we're going to  
tell you how you can enter a giveaway that we're having to celebrate the one year blogversary and  
you could win a $100 Amazon Gift Certificate. Yes you heard me right, $100 Amazon Gift  
Certificate but you have to hurry. We're getting this information out to you a little bit late and the  
reason– It was my fault. I should have mentioned it in the last show and I didn't.


But the other thing is, you know, the advantage for this contest, really should go to her regular  
readers and so they have been able to enter for the last few days but you do have a couple of more  
days here that you could enter if you are listening to this show on time. If you waited a week to listen  
to this one, then you're out of lock. Sorry. But again, we'll have information on how you can enter the  
$100 Amazon Gift Certificate coming up at the end of the show.

Okay so we're going to talk about reflux, bed wetting and ADHD, but before that we have our  
News Segment and we're going to talk about cough and cold medicine, some new information out  
from the FDA, and also a research study that was done on an alternative way to help clear out kids'  
noses, without the use of medicine by mouth. So we'll talk about that.

Don't forget if there is a topic you would like us to discuss. If you have a question, a comment, a  
concern, any of these things, it's really easy to get ahold of us.


Just go to and click on the contact link. You can also email If  
you go that route, make sure you let us know where you are from or you can call the voice line at  
347-404-5437, which spells KIDS.

Also, don't forget the information presented in every episode of our show 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 the Pediacast Terms of Use Agreement which you  
can easily find at, and with that in mind, we will be back with News Parents Can Use  
right after this break.



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, and you can visit them online at


The U.S. Food and Drug Administration issued an advisory, strongly recommending that over-the-
counter cough and cold medications not be given to infants and children under 2 years old because  
of the risk of life-threatening side effects. The American Academy of Pediatrics (AAP) supports this recommendation and urges parents to seek safer ways to soothe infants and young children  
suffering from coughs and colds.

Studies have shown cough and cold products are ineffective in treating symptoms of children under  
6 years old, and may pose serious risks. A variety of rare, serious health problems have been  
associated with use of these medications in children, including death, convulsions, rapid heart rates and decreased levels of consciousness. A review by the U.S. Centers for Disease Control and  
Prevention of national emergency department visits due to adverse drug events from cough and  
cold medications was published in the online version of the journal, Pediatrics, on Jan. 28.

"It is critically important for parents to receive clear information about the risks and lack of benefit  
from these drugs, and ways to help take care of children suffering from colds and coughs," said Dr.  
Renee Jenkins, president of the American Academy of Pediatrics.


"We urge FDA to continue its analysis of the existing data on these medicines intended for children  
over age 2 and take appropriate action, including initiation of immediate, rigorous scientific studies  
as needed to determine the drugs' safety and efficacy."

Children metabolize and react to medications differently than adults, often in unanticipated ways.  
For more than 30 years the AAP has emphasized the importance of studying medicine in pediatric  
populations. As part of the FDA's ongoing review of over-the-counter cough and cold medications,  
the AAP in October urged regulators to pursue further studies into whether these drugs have any  
benefit to children. The AAP also advised labeling that would inform parents that the products have  
been shown to be ineffective in children under 6 and could lead to serious adverse reactions.  
Thursday's advisory is an important first step. The FDA expects to announce its recommendation  
for children ages 2 to 11 in early spring.


(Oh sure, wait until cold and cough season's over.)

While annoying, cough and cold symptoms are usually benign and self-limiting. Over-the-counter  
cough and cold medications will not cure these illnesses nor shorten their duration. Parents should  
seek safer ways to nurse their children back to health, Dr. Jenkins said.

Although these medications have been in use for a long time, now we've learned they have some  
risks, especially because of the difficulty in determining a safe and accurate dose for small children.  
Instead of drugs, there are symptomatic interventions parents can do that are much safer for  

Dr. Jenkins recommended saline nose drops and suctioning bulbs to thin and clear mucus from a  
baby's nose, and using a cool-mist humidifier. Chest physical therapy can also loosen mucus and  
may help infants and young children expel mucus.


If a child under age 2 develops a fever, consult a doctor. And for more suggestions on treating  
children without over-the-counter cough and cold drugs, the American Academy of Pediatrics has a  
site with helpful hints and of course we'll put a link to that in the show notes at And  
our next story looks closely at one of these none-medicine alternatives.

If you have a child with a cold you may find that his/her symptoms improve with a nasal wash  
solution made from processed seawater — it may also help prevent respiratory infection from  
coming back, according to an article published in Archives of Otolaryngology, the January issue.

The researchers explain that upper-respiratory tract and sinus infections are common among kids.  
Nasal irrigation with isotonic (or balanced) saline solutions seems effective in such health  
conditions and is often used in a variety of indications as an adjunctive treatment. Although saline  
nasal wash is currently mentioned in several guidelines, scientific evidence of its efficacy is rather  


Ivo Slapak, M.D., Teaching Hospital Brno, in the Czech Republic, and his team randomly selected  
401 children who had a viral upper respiratory infection and divided them into two treatment groups.  
One group was given standard medication (cough and cold medicine) while the other received  
standard medication plus a nasal wash with a modified processed seawater solution, and these  
children were aged 6 to10.

Patients were observed for a total of 12 weeks, from January to April 2006, during which health  
status, symptoms and medications used were assessed at four visits over the course of the trial.  
Acute illness was evaluated during the first two visits (which were three weeks apart), and  
prevention of a subsequent viral disease was discussed during the following two visits which were  
completed sometime between weeks 4 and 12.
The nasal wash was administered six times per day during the first phase and three times daily  
during the prevention phase.


The children were given three strengths of the nasal solution — jet flow (or 9 milliliters per nostril),  
fine spray or 3 milliliters per nostril) and a dual eye/nose formula with fine spray (given at 3  
millimeters per nostril).

390 children completed the study, and the scientists found that the noses of the children in the nasal  
saline solution group were less stuffy (blocked) and runny. Eight weeks after the study began,  
during the prevention phase, the children in the saline solution group had substantially fewer sore  
throats, nasal obstructions and secretions, and coughs compared to the children in the standard  
treatment group who did not receive the saline solution.

The researchers also found that during the prevention phase fewer of the saline group children were using fever-reducing drugs, nasal decongestants, mucus-dissolving medications or antibiotics.  
Those in the saline group also experienced fewer days of illness and complications during the  
same period.


According to the authors, the nasal wash was well tolerated, and they reported that the kids  
preferred the fine spray formulation because of less discomfort. We did not hear substantial  
complaints about compliance, and good compliance seemed to be confirmed by the weight of  
returned empty bottles.

[Laughs] (Of course, if all the returned bottles were empty, you know, why weigh them? Okay.)

The authors believe that saline washes may reduce the production of inflammatory compounds.  
They may also create a better environment for cilia, the tiny hairs in the respiratory system. Cilia  
sweep away mucus and particles. It is not clear whether the effect is predominately mechanical,  
based on clearing mucus, or whether salts and trace elements in the seawater solutions play a  
significant role.

Now when they talk about a seawater solution here, I guess it really is seawater that they use. But  
how about a commercially available sterile .9% saline solution?


Like in the US, here, you can get non-medicated little noses or Baby Ayr that's spelled AYR or  
ocean, which is what all of us have access to, really, at our local pharmacy here in the US. I don't  
think I've seen a sterile seawater solution on the shelves in the United States. And remember this  
particular study was done in the Czech Republic. But stay tuned, you know, with the recent issues  
surrounding cold and cough medications, I have a feeling we're going to hear lots more about this  
sort of options very, very soon.

Alright we're going to take a quick break. We're going to come back to answer your questions.  
Again, we're going to have some bread and butter pediatric topics, things that pediatricians talk  
about often and on a daily basis. So that will be coming up right after this.



Alright first up is Peter from Arizona, and Peter says, "Dr. Mike, here's a tough one for you. We just  
had our second little one, a healthy baby boy. Everything is going well except that he has fairly  
significant reflux. "


"My wife is convinced that her diet has a significant impact on this. I, on the other hand, had done a  
fair amount of research looking for good randomized clinical trials on this and can't find anything.  
Even though La Leche League doesn't support this line of thought, I'd be interested to hear what  
you have to say on the subject. Thanks. Peter"

Well thanks for your question, Peter. Let me preface this discussion with the following. If as a  
breastfeeding mom, there is a certain food or a certain groups of foods that every time you eat  
them, they seem to make your baby fussy, spitty, gassy, whatever and if you avoid these same  
foods and your baby is happy, smiling, cooing, you get the picture [laughs], and then when you try  
these same foods again, the fussy, spitty, gassy returns, by all means, avoid those foods.

Now, if the list of foods that seem to do this can be divided into chapters, then at some point, I think  
you have to face the facts that maybe it's not the food.


Now, from a science standpoint, mom's diet affecting the baby's behavior does not really make a  
lot of sense to me. Food gets broken down into its core components in our intestine, so mom's  
intestinal tract is going to break down the food that she eats into its individual core components,  
and let's face it, breast milk is breast milk. The gland that makes milk, and there is not a direct tube  
that goes from mom's intestine to her breast. You know, things get processed and you know, for  
instance if mom eats dairy, the milk proteins are broken down into their individual amino acids and  
lactose is broken into simple sugars.

You know, really, the same sort of thing goes for any other food that you care to mention. So it  
doesn't make sense to me that mom's diet is really going to have a lot to do with how well the  
breast milk is or is not tolerated.


Having said that, I'm not going to argue who swears every time she eats broccoli that little Joey has  
fits. Okay, fine, avoid the broccoli. I'm not going to be convinced that that's really that the issue but  
that's my problem, not yours. And as a mom, you're the one with the screaming baby in the house  
so you know, if avoiding broccoli seems to help, then by all means, avoid it. Now, having said that  
too, let me back up here a minute. Some people would argue well, you know you give moms who  
are breastfeeding certain medications and those end up in the breast milk but the thing with that is  
those medications also aren't food and they don't get broken down into their individual components,  
they are actually, the medicine itself, is a molecule which goes into the bloodstream and then that  
can get distributed to some degree in the breast milk. So, medicines are a little bit different than  
food. Foods are much more complex, sort of, you know, compounds that get broken down into  
individual molecules.


And so my point with that is that, you know, I mean things do get in the breast milk but in terms of  
food our body does a pretty good job of digesting them and distributing them to the body and  
breast milk is breast milk. Okay you get my point with that.

And the other thing too is of course there are a lot of other things that make sense from a medicine  
and science standpoint that do make babies fussy, spitty, gassy. And in my experience, one of the  
more common things that does that is reflux. So gastroesophageal reflux. This is basically food that  
is coming from the stomach up the esophagus, and into the mouth and then they spit up. And what's  
happening here is really pretty simple. It comes down to their being sort of a loose valve on top of the  
stomach. So there are two valves in the stomach. Right, you've got two holes. You've got one on top  
that goes to the esophagus, right? And you've got a hole at the bottom that goes into the small  


You've got a valve at each of these holes and when the stomach squeezes, what's suppose to  
happen is the valve on top closes and the valve on the bottom opens so the food goes in one  
direction and that's down. And with reflux what happens is the valve on top is a little bit loose or  
leaky so when the stomach squeezes the valve on the bottom opens but the valve on the top opens  
up too so some of the foods goes up instead of down and some stomach acid goes up as well and  
this can cause some heart burn and fussiness sort of issues.

And again, this happens a lot and for most babies, as they mature, that valve on top of the stomach  
between the stomach and the esophagus tightens and the problem goes away. And usually that's  
going to be sometime between six months and a year of age, most commonly around 9 months of  
age or so. For some babies it's sooner than that. For some babies it's a little bit later than that. So  
what do you do about this?

Well, the first thing you want to do is make sure that it really is reflux that is causing this issue. You  
don't want to say it's reflux and then there's some life-threatening condition that it is instead.


And one of those life-threatening conditions would be a bowel obstruction and this is particularly  
true in young infants and things like pyloric stenosis, which is– It's just a thin– We've talked about  
this before. It's just a thick valve at the bottom of the stomach that does not open very easily and so  
the food can't get through and the food comes up, because it can't get through that bottom valve.  
Another one it would be duodenal atresia and this is when there is a narrowing of a part of the small  
intestine that prohibits food from getting through. There's is also this beast called malrotation, and you can get a mid-gut volvulous with that, and that basically is the intestine is not sort of tact down like it's supposed to be and so because it can move around too much it can sort of fold over on itself and can cause a bowel obstruction that way. So what do you see with bowel obstruction?


Well generally you see projectile vomiting so you got a lot of pressure build up because the food  
can't get through. And by projectile vomiting I'm not talking of vomiting where it comes out like a  
fountain or at arm's length. I mean, this literally is across the room hit in the wall on the other side of  
the room. I mean this is exorcist baby kind of stuff. I mean it really comes out with a lot of  
force. Also if there is bile in the vomit, green or yellow real fluorescent looking stuff, then you worry  
about bowel obstructions. Or if they are losing weight with their spitting up, they are not growing  
very well, they appear to be dehydrated, these are all things that can go wrong with bowel  
obstructions. So if any of those things are going on, you definitely have to take a close look and not  
just call it reflux without making sure that that's all that it is.

Also, you can have some anatomical problems. You can have a fistula or a little tube connecting the  
esophagus and the trachea. You can have some blood vessel issues where you'll have a vascular  
ring around the esophagus that's sort of constricting things.


And these can cause choking because food is coming up and then able to get down into the  
trachea easily. So if you have a kid who's spitting up and their choking on it, turning blue in the face  
or if they have episodes where they seem to gasp and not be breathing, you know, that's obviously  
a cause for alarm or concern. So how do you go about making sure it really is reflux?

Well if none of these warning signs and the kid's happy and smiling and spitting and growing fine,  
you may not need to do anything at all. But if you are concerned that there could be a bowel  
obstruction there, then we usually do some studies to look and see. One common study that we do  
is an upper GI, where you have a baby swallow some contrast material like barium, and they look at  
it, we take xrays, and then find out where the barium goes. And this is the way that you can make  
sure that there's not a connection between the esophagus and the trachea. You can visualize what  
the anatomy looks like to make sure that everything is normal.


And then also you might see reflux if you see some of this contrast material when the stomach  
squeezes leak back up into the esophagus, then you know you have reflux presents.

Now, just because you don't see it doesn't mean that there's not reflux there because you are  
looking at a snap shot in time so it doesn't really help you out too much. If it's negative, and there's  
not reflux seen on the upper GI, it still does not mean they don't have reflux, it just means they didn't  
reflux during the study, which, you know, so it may not help you out.

But it does let you know that there's not an anatomical issue and also, if you follow that contrast  
material with what we call a small-bowel-follow-through then you can make sure that everything is  
getting through in there. No obstructions in the small intestine or between the stomach and the small  

Also if you are worried about pyloric stenosis, you can do an ultrasound of that valve, that's called a  
pyloric ultrasound; that's something else you can do.


Also if you are still suspect there to be a reflux in a real fussy baby, another option that you have is  
what we call a sleep study with a pH probe, and basically they put a little wire down the esophagus  
and during the night they look to see if the pH of the lower part of the esophagus dips down real low  
then you know some stomach acid is leaking up into the esophagus. Now, obviously that's invasive.  
It's not the most comfortable thing for the baby so I mean you only do this if you have a real trouble  
kid and you're trying to figure out exactly what's going on. And usually that trouble is like apnea; the  
stomach acid is creeping up and making them choke and they're stopping their breathing but you  
don't think there's a bowel obstruction there, yet you don't necessarily want to go after their brain  
being the problem of why they are stopping their breathing. So this would be a sort of an indication  
where you do pH probe when you have a kid who's having significant symptoms and you think it's  
reflux but you want to make sure before you discount any other major thing that's going on.


Okay so let's say that you have a kid you're sure it's reflux, what do you do? Well, if they are happy  
and they are growing, the only problem is that they are spitting up, you don't necessarily have to do  

Because they are going to outgrow it. Now if they are really, really, really fussy with and this is  
common, and again, this is probably one of the more common things that kind of getting blamed on  
the formula being the problem, or what mom's eating is the problem. What the real problem is is the  
stomach acid is leaking up into the esophagus and causing heart burn and that's why they're fussy.  
So what do you do? Well you can try an anti-acid like Mylanta. They do make a calcium-rich Mylanta that used to be called Children's Mylanta, but I guess they wanted to appeal to a larger population of consumers and so they changed the name but it's still the same stuff. So that's one option.


Again, you don't want to do any of this without talking to your doctor first. This, again, in Pediacast,  
we are just talking what options doctors use. I'm not telling you to try this. If that doesn't work or you  
may just go ahead and bypass that step and try what we call and H2 blocker like Zantac would be  
an example; Tagamet's another example. And these are medicines that just decrease the  
stomach's ability to make acid. So you're not neutralizing the acid like you are with Mylanta. But  
what you are doing instead is just helping the stomach not make as much. Now they're still going to  
have stomach juices that leak up into the esophagus; they're still going to spit up. You're not going  
to affect that at all, but you you're going to have less acid coming up, so less heartburn and  
hopefully, less fussiness.

Now, you can also use, what we call a proton-pump inhibitor, and this does the same thing; only it's  
mechanism of action is a little different and it's a little better at decreasing the stomach's ability to  
make acid. So you really get rid of the acid with these medicines. And you've heard of them before:  
Prilosec, Prevacid, these sort of things.


They do have baby versions that can use of all these types of medicines. And again, the goal here  
is to make the baby a happy spitter instead of a fussy spitter. They're still going to spit up, Zantac,  
Prilosec, Prevacid, Mylanta — all these things don't really have much effect on the mechanical  
issue of the stomach squeezing, the valve on top popping open, and the food coming up. It's just  
going to make there'd be less acid so it doesn't hurt so much.

Now to lessen the actual spit-ups which you can do, probably the easiest way to do that is to give  
them smaller meals but more often — to do it more often. So, you're basically not overfilling the tank.  
So if the stomach isn't quite so full and stretched, when it squeezes, less of the food's going to  
come up. So you're just using physics to the mechanical situation, realizing what it is that's going on  
and giving them less volume but then you want them to have the same number of calories over the  
course of the day, so you have to feed them more often to make up for that.


Now another option that we used to use more than we do now, and that's to add some cereal to  
thicken the formula and the idea here is that if the formula is thicker and you keep them upright  
while they are eating, you're allowing gravity to help you out, so when the stomach squeezes more,  
the food is heavier so it's at the bottom part of the stomach and it's more likely to go down into the  
small intestine and then come back up. The problem with this is, one, do you weight gain, because  
you are increasing the number of calories that babies are getting and you really can get some rolly  
polly obese kids and honestly these kids have trouble, I find, right on through childhood, they just–  
right from infancy they start gaining weight and the weight issues continue for quite a while. And with  
the obesity and weight problems that we are seeing, and all issues with heart disease and  
teenagers and even younger kids and blood pressure issues, type 2 diabetes and even– You don't  
want them to gain weight unnecessarily.


Thickening the cereal can also lead to constipation and then that's an issue that you have to deal  
with and there are some suggestion that early exposure to cereals particularly less than 4 months of  
age can give it an increased risk of food allergies later in life. So that's another reason that you  
don't want to just run– You know, add the cereal without thinking twice about it.

But on the other hand if you have a kid who is gagging and choking every time that they spit up and  
you're sure there's not a bowel obstruction, there's not an anatomical reason for that, it's really just  
they're spitting up, then you do want to decrease the amount of spit-ups and so adding cereal then,  
the benefit of it, of them not choking, outweighs the risk of these other things we talked about — the  
weight gain, constipation, potential for food allergy. You know, you're always weighing benefit  
versus risk. And then that kind of situation, I think you're probably better off using something like  


There's also a medicine you can use to decrease the spitting up but these come definitely with a  
price. There was one that we used to use called Propulsid or Cisapride and we discovered that it  
causes some heart issues and that's now off the market. Reglan and metoclopramide is the drug  
name and Regland would be the brand name. And what it basically does is it helps the stomach  
empty a little bit faster so that things get pushed through into the small intestine more quickly so  
hopefully the stomach won't fill up quite so full. The problem with Reglan is that it can cause  
irritability so his babies were fussy before, well they're not fussy now because of the heart burn, now  
they're fussy from the side effect of the medicine on their brain. Also, it can cause some weird  
muscle spasm kind of things. So, I mean, again, it's reserved for cases where you really need it.


But if you have a child who's not fussy, they're gaining weight, it's not projectile, they are not choking  
on it, there's not blood or bile in it, then you don't worry about it so much. And you look at it more as  
a laundry problem, not a baby problem because they're going to outgrow it.

Okay let's move on, because we're definitely running over. Kailyn from Olympia, Washington says,  
"Dr. Mike, thank you so much for your show. I found it about two weeks ago and have listened to  
about 10 episodes so far, and I love it. My question for you is this. My son is 5 and a half years old  
and he's been potty trained since he was 3. He's still having problems staying dry at night. It upsets  
him and sometimes his friends will give him a hard time about it. I've tried leaving pull ups off him for a couple of weeks and have had no success. We don't let him have anything to drink after dinner  
and we make him use the bathroom before bed but he's only dry probably once a week. I'm not sure if I should worry about this being a medical issue, and should talk to his doctor or I should just wait it  


"Also, I'm not sure if this has any effect on the matter but he had surgery about two years ago to  
lower an undescended testicle. Dr. Mike, can you help us out? Thank you, Kailyn in Olympia  

Okay well, thanks for your question, Kailyn. You know this was common. If the idea of talking to your  
doctor crosses your mind, do it. I mean, you're a customer, okay? You or your insurance company is  
paying your doctor for a service and if you have a concern, bring it up. Okay? That, I think, is really  

Okay, now in terms of what my advice usually is for this. If you have a kid who is 5 years old and  
they're wetting the bed at night. The first thing I do is establish that this is only a night time problem  
so day time wetting is a different thing altogether and we'll save that discussion for another day. So  
let's say, this is just a night time problem.

I do like to see these kids and check their urine, and 99 times out of a hundred or more, urine's  
going to be just fine.


But I think it's a prudent start, you know, just to make sure the urine's normal, make sure they have a  
normal physical exam, and then get a little bit of history. Most of these kids are deep sleepers and  
their body relaxes, the bladder valve relaxes — see, we have another loose valve problem here. So  
these topics tie together. And then the kid urinates, because he's just so relaxed and the valve  
opens and the pee comes out. And this often follows a family pattern. It's more common in boys  
than girls and it can persist actually through the mid-teenage years; no other ways to stop it. There  
are, but the question then becomes, should you stop it? Traditionally, the medicines that we've used many years ago, the tricyclic antidepressant medicines, believe it or not, were used for this. But  
they have some toxicity and it can cause some heart issues and so they aren't really used for this  
much anymore.


And then the DDAVP or vasopressin came in to use and that's sort of falling out of favor now  
because it can cause some salt imbalances especially with sodium and that can lead to seizures,  
and so again it's one of those things where the benefit and risk, you go to look at weighing that and  
probably the risk of those medicines outweigh the benefits that you get. So, you know I think, most  
pediatricians and family practice docs are definitely stepping away from using medication to treat  
bed wetting.

Another thing that you can look into are these night time alarms. At the very first hint of moisture that  
basically buzz, and the idea is that it wakes the kid up and they realize that they have started to pee, they hold it and then they get to the bathroom. In my experience, they don't work very well.

I mean, the kid's a deep sleeper. And usually, the buzzer's going to wake up the rest of the family  
but not the bedwetter. You know it just alerts the rest of the house and the kid just wet the bed. But  
often times, it just doesn't work very well.


You can limit fluids before bed. You can try waking them up before they wet and making them go to  
the bathroom and these things have limited success. Generally, they end just being frustrated. And  
it might seem to work for a little while and then they're right back to their old patterns again. In my  
view, I think pull-ups are just fine. You know, they're better than they ever were before. They look  
more like regular underwear, they're pretty absorbent and personally, I would just go with the pull-
ups and just use those instead of regular underwear, put a plastic liner between the mattress and  
the sheet. You can also get those checks pads if they're leaking out of the pull-up.

But, Kailyn, in terms of your 5-year-old's friends giving him a hard time about it, my question then  
becomes, how do they know? I mean, the kids don't have to discuss this amongst their friends. If he  
wears his pull-ups to bed, his friends don't need to know. Now if he spends the night at a friend's  
house, you know, you just discreetly put the pull-ups on when you get changed into your pajamas  
and discreetly dispose of them in the morning and you may have to enlist the friend's mom or dad to help you out.


And again, you know, it's something that then maybe the friend can be talked– You know, maybe  
the parents need to talk to the friend and let them know this is something common. There's probably other kids in the class room who have the same issue. You just don't know about it because they  
don't talk about it and they're not the one spending the night at your house. So, you know, I think  
there are ways to deal with this directly and discreetly, and so, that's just my two cents. Again, if it  
crosses your mind to talk to your doctor about this please do it.

Okay and finally we have Shanna in Georgia, a regular listener and contributor to the program and  
Shanna says, "Dr. Mike, I've heard you mention several times that caffeine helps with ADD. Can  
you explain how or why this works. Thanks, Shanna."

Okay we're going to go through this really quickly. Caffeine has many effects on the body, and one  
of these effects is to increase the amount of the neurotransmitter dopamine in the brain.


And nerve pathways in the brain use neurotransmitters to talk to one another and dopamine is one  
of the more common ones and so if you're a kid and you work on a math problem, your math  
pathway is working so the neurons are in the brain, the nerve cells are talking to one another in the  
brain in the math area of the brain and they're using dopamine as a messenger between individual  
nerve cells. If the brain is running low of dopamine and there's not enough dopamine in the pathway,  
then this communication halts. So let's take this into the classroom. You got a child working on a  
math test. Things start out well. Their math neurons are firing. There's lots of dopamine in the  
pathway and then the dopamine starts to dwindle, and so it's harder for the nerves in the math area  
of the brain to communicate with one another. Now there's a noise in the hall or out the window, and  
the "hey, what's going on out there pathway" it has plenty of dopamine and so it becomes the  
dominant pathway that's firing in the brain and so from the kid's point of view, they forget about the  
math test.


And they watch what's happening in the hall or out the window until the dopamine in that pathway  
dwindles and then you remember that you have the math test or the teacher reminds you or the time  
is up. And by this time the dopamine in the math pathway has recovered and so you start working  
on the problem usually from the beginning but not for long, because the dopamine dwindles again  
and another pathway in the brain takes over and so it's this frustration.

You got this kid who starts the problem, they're doing fine, they get distracted and then they start working on it again from the beginning and if they could just keep the dopamine in that math pathway, they could keep their focus on the problem that they are working on. And so what caffeine does is it just helps to preserve dopamine in the brain so that more is available.


And that's what the ADHD medications do, too — Adderall, Concerta, Ritalyn, Metadate, Vivand, Daytrana — all of these things they increase dopamine availability in the brain. That's how they work.  
But they are better than caffeine because their effect is longer, you have more of a control in terms  
of how much milligram-wise that their getting. It's more socially acceptable delivery system  
by being in a pill at least for kids. In caffeine, the half life of it is just too short. It doesn't work long  
enough. I mean they'd have to keep recharging themselves with pills and you want something to just  
take in the morning before they go to school and it lasts all day.

By the way, Strattera is a little bit different. It doesn't work on the dopamine system. It works on a  
different neurotransmitter called norepinephrine just in case you are wondering, that's the advanced  
version [laughs], okay.

More information about caffeine in the show notes. I found a site called How Stuff Works that's very  
interesting and they have a nice caffeine article on exactly what other effects that caffeine has in  
your body so you may want to check that out in the show notes at


Okay we're going to move on and wrap up the show including information on how you can win a  
$100 Amazon Gift Certificate. If you're quick, you got to what I tell you, very quickly though, and we'll  
let you know what that is, right after this.



Alright, of course, as always, thanks go out to Nationwide Children's Hospital for providing the  
bandwidth for our show. Also Medical News Today for helping us out with the news department and  
Vlad over at for contributing with the art work at the website and on the feed. And of  
course, thanks go out to all of you for joining us and participating in the show week after week. We  
really do appreciate that.

Okay, so Karen's blog, it is Pediascribe, and you can find it at or You can also go to and click on the link to get there that way too.  
And Karen did a post called "Happy Blogversary to Me," where she looks back at the past year of  
working on the Pediascribe blog.


And we'll put a link to that post in the show notes. And in order to celebrate, Karen's giving away a  
$100 Amazon gift certificate. There's a link in the show notes with the details on how you do this. It's  
really easy. You just find a post about the $100 Amazon gift certificate giveaway and then you  
comment to that. Make a comment to that post and in your comment, just give us an idea of how  
you would spend the money. It doesn't mean you have to spend it that way, but yes for some you've  
been looking at it Amazon, just let us know what kind of thing you are looking at and then we'll have  
a random drawing of all the people who comment to that post and who include what they are  
interested in getting and by the way the reason that we did that is because these kind of giveaways  
get around the internet and the blogosphere pretty quickly and you get people who just comment  
real quick with the high and they're gone because all they want to do is win the prize, but not really  
interested in the blog.


So we want to make sure people follow directions. And so in order to qualify you do have to  
mention in your comment what you would use the gift certificate for. It doesn't mean we're going to  
hold you to that. Okay so there's a link in the show notes to get to the post that you have to comment  
on. Now here's the deal. It's Thursday. You got to do it by this Sunday. So you have three days,  
because this is going to close out on Sunday, February 2nd. So you have to enter by Sunday in  
order to qualify, so hurry. And if you are listening to this show after Sunday, well you are too late.  
But if you are a regular reader of Karen's blog, you have known about it anyway and so, you know,  
just start reading it and maybe you'll be able to enter for her two-year blogversary next year.

Alright, don't forget the Pediacast shop is available for you. We have t-shirts and tote bags and  
those kind of things with the Pediacast logo to help you spread the word and as always, I have  
mentioned this before, there's no markup on our part so if you do that, we're not making any money  
off the t-shirts.


They are a little more expensive than like Cafe Press but the quality is very good. iTunes reviews  
are most helpful. We also have a poster page so you can print out posters to hang up on bulletin  
boards and the like and of course please help us by continuing to spread the word about the show.

So another week's in the bag. I'll tell you what, I just have to get through influenza and RSV season  
here and then all will be good again. Because in the office it has just been crazy busy and so it's all I  
can do to get a couple of shows out a week. So I'll be happy when the virus season slows down. I  
hope all of you have a great weekend, and of course we'll see you on the other side of the weekend  
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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