Hostile Caregivers, Sports Training, Teen Drivers – PediaCast 117

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  • Hostile Caregivers
  • Sports Training For Parents
  • Teen Drivers
  • Picky Eater
  • Potty Training (number 2)
  • Low Testosterone
  • Breast Feeding Trouble




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 Bird House Studios, here's your host Dr. Mike.


Dr. Mike Patrick: Hello everyone and welcome to this week's edition of PediaCast, a pediatric podcast for moms and dads. This is Dr. Mike coming to you from Bird House Studio. And as always I'd like to welcome everyone to the program. It is episode 117 for Thursday, March 27th, 2008. And this one is Teen Drivers, Potty Training, and Breastfeeding. Now those of you who are regulars of the show now that we'll cover lots more than just those 3 topics during the course of the program.


But that'll at least give us a little bit of a start and an idea for you of what we're going to talk about today. Before we get into the meet of the program, I want to mention Skeeda bags one more time. Now what in the world is that? You know when you think about it plastic and paper bags at the store contribute to a large degree of the land field use. And basically just general clutter you get, you go shopping, you get plastic bag just stick them under the sink and pretty soon you're just overflowing with them and then you grab a big arm load of them, sticking them in the trash can. And they're not the greatest for the environment.


So Skeeda is a company that makes a very sturdy, reusable bag that you can take shopping with you and of course they have designer colors as well. And you can find that more about them at Now Karen had a really fantastic response to her Skeeda contest on the Pediascribe blog. And she did announce the winners of the free bags. And so many people use the coupon code to purchase their own Skeeda bag that she is creating a part 2 for this contest. If you buy a Skeeda bag using her coupon code which is good through April 13th.


And if you submit a picture of the bag out and about and being used by April 18, and she's going to do a random drawing of those who submit pictures. You don't even have to be in the picture, just a picture of your bag with some stuff in it out of the store. That's all you need to do. And then the winner will get a free Skeeda bag so another one.


Again if you don't know what I'm talking about check out you know our grandparents give us the paper bag. Our parents gave us plastic. But now it's our turn to show our kids a better alternative. And Skeeda is a great choice for that. So check out the links in the show notes. You can find out more about the bags at and the details on the Skeeda contest part 2 are in the show notes and on Karen's Pediascribe blog.


Last night Katie and I went to see Jim Trestle speak. Now those of you who don't know who Jim Trestle is the coach of the Ohio State University Football Buckeyes. And I was worried taking my daughter to a speech basically that she might find it a little bit boring. But Katie and I go to all of the Ohio State football games together, all of the home games and sometimes away games. And Nick on the other hand, my son, he's the basketball guy and we go to all of the basketball games together.


So these tickets to the speech that he was going to give in a small town in the western part of Ohio, that kind of fell into my hands and Katie was the natural one to invite. So we went for it and it was a good time and even though he spoke for over an hour and there was some dry parts of his speech all in all it was good. And it was a good time taking my 13-year old daughter to a motivational speech. So he's a college football coach.& It was still fun and I just wanted to point out that this is something that when life gets busy, your kids when they're teenagers. They've got their own activities that they're involved with and sometimes it's easy to forget to do some fun things with them.


And here was an opportunity to do something that ended up being fun for my daughter and me. It was about a 45-minute drive to get there and we had dinner out then we listened to the speech and then we had a 45-minute drive home and it was a time for dad and daughter to talk and it was a good time. So I would encourage parents out there. You know you get busy. You've got your own things going on. Your teenagers have their things going on. But make time for each other.


Alright and you know we don't do that enough. So I'm not up on a pedestal here talking down to you and say oh you need to spend more time with your kids. Because we get busy too and my kids are involved in so many things but it is important to take time out and do some things together so something to think about.


Alright so what else are we going to talk about today? A hustle care givers and sports training for parents also teen drivers that are all coming up in the news segment. And then we're going to go to the Skype line today for our listeners segment. We got lots of good Skype calls so we're going to discuss those.


And in the course of that we'll talk about picky eaters, potty training, particularly with regard to number 2, also a child with a low testosterone and some breastfeeding troubles. We're going to talk about that. Don't forget the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. 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 find at And with all that in mind we will be back with news parents can use right after this short 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. You can visit them online at A new study in the general family process reveals that caregivers with moderate to severe depression symptoms showed greater hostility and less warmth. The study focused on caregivers of low income children with persistent asthma.


Researchers lead by Dr. Marian Solano of Emmer University School of Medicine in Atlanta, utilized data from project star support for treatment of asthma research, a longitudinal study examining treatment adherence among low income children with asthma. This investigation used data from 100 low income families whose children we're prescribed medicine for their wising.


Researchers videotaped family members in the clinic during structured tasks and later related care givers; I'm sorry rated caregivers on warmth, hostility and disciplinary skill. Researchers rated each task separately. Caregivers with higher levels of depression symptoms exhibited lower levels of warmth and higher levels of hostility during both lost and conflict tasks.


Then the lost task, the child shared with family members his or her experience of a previously identified sad event such as a death or an injury. In the conflict task parent and child resolved the disagreement previously identified by each of them and separate interviews such as a disagreement about chores, sibling conflicts or privileges. As expected, caregivers tended to show more hostility and less warmth during the conflict task than Dearing the laws task.


However caregivers with moderate to severe depression symptoms showed a greater rise in hostility from the lost task to the conflict task. Then caregivers with minimal to mild depression symptoms by including a task designed to at least in warmth. The study allowed them of more valid exploration of how caregivers respond to children's need for support and nurturance expanding upon traditional procedures for collecting observational data.


The study provides a better test of models for understanding how parenting behaviors associated with caregiver depression may lead to child maladjustment. The present findings provided initial step in a pre-intervention research program investigating the contribution of caregiver depression symptoms and associated parenting styles the authors conclude. Our data may help mental health clinicians in identifying specific family interaction patterns which may promote optimal asthma management.


So here's another reason for moms and dads to recognize symptoms of their own mood disorders and get them taken care of. As Christ of play ball ring out the spring they undoubtedly be followed by complains of anxiety and stress from young athletes wanting to quit sports. Parents and coaches can make youth sports a fun learning experience or a nightmare according to sports psychologist of the University of Washington. But to achieve the former, sports officials and organizations must provide more training programs especially for parents, according to Frank Small and Ran Smith who have been studying the youth sport experience and designing programs to improve it for a coder of the century.


There's no problem in getting coaches to attend educational workshops. The challenge is convincing organizations to offer parent workshops and getting parents to come, said Small. Many youth sports organizations are saying yes we are interested in offering these programs but that's it. They're not delivering them to parents. There's been a drive in the last 20 years to teach coaches how to create a healthy psychological environment for young athletes.


A culture has been created and there's an expectation that coaches will receive this training. Unfortunately too many moms and pops are all too willing to assume they don't have a role in youth sports. However they should support what trained coaches are trying to do. Parents and coaches working together are a powerful combination.


The University of Washington researchers recently demonstrated the effectiveness of this approach in a study of 151 boys and girls playing in 2 different basketball leagues. The average age of the athletes was 11.6 years. Coaches in 1 league participated in a training workshop emphasizing a mastery approach to coaching developed by Dr. Small and Smith. This method emphasizes teaching youngsters about personal improvement, giving maximum effort, having fun, sportsmanship and supporting their teammates rather than winning at all cost approach.


Parents participated in a companion mastery approach to parenting and sports workshop that explained how they apply the mastery principles and how they can reduce performance anxiety in their children. Coaches and parents in the second or control league were not offered the workshops. Pre-season questionnaires showed little difference in levels of performance anxiety among the boys and girls in the 2 leagues. However by the end of the season athletes playing for train coaches and whose parents attended the workshop reported their levels of physical stress, worry and concentration difficulties on the court had decreased.


Players in the other league however reported their anxiety had increased over the course of the season. This combined approach helps both parents and coaches to create a mastery oriented climate, said small. We don't ignore the importance of winning because it is an important objective in all sports but we place winning in its proper perspective.


As a result young athletes exposed to the mastery climate were able to concentrate more and they had less worries about their performance. Their bodies also reacted more positively. They were less tense, had fewer queasy stomachs and they didn't experience feeling tight muscles. Fear of failure is an athlete's worst enemy and the sports situation can easily create this type of anxiety said Dr. Smith. The encouraging thing is that brief one time workshops for coaches and parents can give them the keys to decreasing pressure and increasing enjoyment. And an added bonus is the athletes were not fearful of failure typically performed better given a few key guidelines coaches and parents can be a winning combination for kids.


So what is this program for parents what's called coach-effectiveness training program. And there is a book by these two guys, Small and Smith, called Way To Go Coach and really it's a must have book for parents of athletes and also for coaches of young athletes too. I mean it really is it's a great book it goes. It subscribes all of these different topics that are important. So if you are a parent with a child at home that's involved in youth sports, I would highly recommend this book. Again it's called Way to Go Coach.


And we'll put a link to it to Amazon. I mean you go wherever you want and get the book. If you want a convenient way to pick up the book you can go to there's a copy of it there. And if you go to the show notes at we do have a link over 2 Amazon for you so you can pick up the book.


Alright and finally in our news department, the spreading out of city's residential, commercial, recreational and public spaces otherwise known as urban sprawl poses a special risk for teen drivers according to a new University of Virginia Health System Study. Dr. Mathew Trobrij , emergency medicine, physician and leader of researcher found that the sprawl results in more& miles driven by teens who have a higher fatality rate per mile driven than adults.


His results appear in the March 2008 issue of the American Journal of Preventive medicine. Well sprawl has been examined for its public health risk including the driving hazards of precincts for adults. No one has ever studied its specific impact on teen drivers said Trobrij. Over 3,500 teen drivers are killed each year in the United States. Teen driver fatality rate are 4-8 times higher than adult. Drivers, they are for the environmental characteristics that increase daily miles driven by teens, increased of risk of being killed in a motor vehicle crash.


This makes it particularly important to study how environment affects the driving behavior of this age group. Trobrij and Dr. Noreen Mcdonald, assistant professor in the department of city and regional planning at the University of North Carolina at Chapel hill gathered driving and demographic data from the national household transportation survey. They developed an algorithm to measure sprawl, daily miles driven by teens, demographic characteristics and the probability of teens driving more than 20 miles each day and counties with a varying degrees of sprawl.


Of the 4,528 teens surveyed, 48% reported they didn't drive. 20% drove less than 20 miles, and 25% drove greater than 20 miles. More pronounced sprawl was associated with increase daily mileage. Teens in more sprawling counties were more likely to drive more than 20 miles per day than similar teens living in more compact areas said Trobrij. Moreover this association was stronger among the youngest and least experience drivers.


Maybe that's because they don't know the shortcuts yet. Trobrij and McDonald conclude by saying increased efforts to understand and modify the effects of urban sprawl are necessary to improve teen driving safety. They say certain teenage characteristics like the tendency to take risks are not going to change. This makes health behavior modification in this age group very difficult. However our results suggest that changing the way we develop in youth land in order to minimize our dependents on vehicles can be an effective method of reducing the risk of serious injury or death among teen drivers in the United States.


Change the way we develop in youth land in order to minimize our dependents on vehicles. You know it's also an answer to increase oil consumption, rising fuel cost, green house emissions but in the worst of Mr. Mosby of the sweet life of Zack Concody. Good luck with that!


Alright let's take a quick break and I'll be back to answer some of your questions hot-off the Skype line right after this.



Heather: Hi Dr. Mike this is Heather from Bangkok. I wanted to call and say thank you for do continuing to do fantastic podcast. I do have a question. It's kind of a continuation of the question that I have previously asked. My 15-month old continues to be a very picky-eater. She has improved a bit but the question is, she will eat about 4 foods independent. Cereal,& Cheerios, wheat bread, sweet potatoes and avocados – that is it. And last I put yogurt on it. She's lactose intolerant. But if I put yogurt on mashed up vegetables – a few, broccoli, carrots, cauliflower and squash or pumpkin, she will eat it.& As well as if I make wheat, well it's a brown rice and a bean mixture that I grind up and then cook like a cereal. And if I put yogurt on that she will eat that as well. That's the only thing that she will eat. I have tried everything. I have tried baby cereals. I have tried every baby food on the market I can find. I've tried giving a table food. She's not interested in any of those things. So, my question is, is it OK that I put yogurt on the things to get her to eat them so that she's getting a more balanced diet or not? She does have blue stools because of it and she does have a kind of a rash because she has milk allergy. But it's the only way to balance her. I talked to the doctors here and they seemed to be fine with it because it's balancing her diet a little bit better but I wanted a second opinion.


Heather: Also, because she won't eat any type of protein and stuff maybe at that little bit of bean that I get her in the morning, that's next with the rice, I'm curious as to what that means. If your child will not eat any meat, any egg, anything along those lines – long term you know hopefully got into a registry will. She won't eat anything new. She will not eat any like I said table foods so I'm just trying to do my best to make sure I can get a balance of a diet as I can for her.& The other thing is, I worry about like her iron intake. I'm trying to give her a supplement when I can when I can put in her but because she only drinks breast milk still, she will not take any cup or bottle of anything else. I do my best to get a supplement and try to get her some iron. And I had to test it a year and she was fine in terms of anemia. But I was wondering when you would recommend another test just to check on that. So my very mother way hopefully came across about the lactose intolerance and giving yogurt it's about one container full of yogurt& today she eats, and if that's OK? She seems to be handling it OK and it does like it balanced her diet. I appreciate everything you do and I noticed it's a bit long winded,& but thank you very much and keep up the good work. Thanks for a great show. Bye.


Dr. Mike Patrick: Alright Heather in Bangkok thanks so much for your call, always appreciate it. So this sort of some, Heather has a 15 month old daughter at home who's a picky eater. Her 4 favorite foods are Cheerios, wheat breads, wheat potatoes and avocados. And if mom puts yogurt on some smashed up food like broccoli, carrots, cauliflower, squash, pumpkin and a brown rice bean mixture. And she puts yogurt on that, were in good shape. But your child won't eat baby food or baby cereal and the problem with the yogurt is that she's lactose intolerant and so the yogurt makes her have lost stool and a diaper rash.


And then she's also worried about protein. Is she getting enough? And iron, is she getting enough of that? There is no anemia at 12 months so when should she test her again? OK so let's get right to the answers. First in terms of the yogurt and in of itself, using& that to coat the foods, or use as a dip like a vegetable dip for kids in this age group it's not a problem at all. If you're able to help flavor the food and sneak some good nutrition type things in that way I don't think that is an issue in the least.


Now the lactose intolerance, actually there is an easy answer for that. And that would be to try lactose free yogurt. These are typically going to be soy yogurts and there are several companies that make them. And I have some links in the show notes for you. Whole Soy and Company is one example. Silk, the people who makes silk milk which is soy milk. They also make a yogurt called silk soy yogurt and then there's one from Stony Field Farm called O soy and that is also a soy yogurt as well. So I do have a link in the show notes to all three of those companies.


Now being in Bangkok in Thailand you might not have those brands available. But I would look in the grocery store and see if they do have a soy yogurt because you're not going to have the issue with the lactose and soy yogurt products. Now they can taste different so your daughter might not like the taste and here I'm back at square one, you won't need it with the soy yogurt; she only wants the regular yogurt.


So here's another idea or if you can't find the soy yogurt in your area another idea would be to look for lactate tablets. Now lactate tablets just contain the enzyme lactase that helps to break down lactose which is the sugar. It's called lactate. I would look for the original strength. They also have something called fast act which is a higher strength one which you shouldn't use. But if you get the original strength and just use one of them, the adult dose of the regular one is three of them.


So one is going to be fine for a kid between one and two years of age and then crush it up and sprinkle it into the yogurt and it will not change the taste of the yogurt much at all. It might make it little greedy but I don't think you're child won't even notice to be honest with you and in that way as they digest the yogurt then they get the enzyme that they need to break down the lactose. Something else that I find is that a lot of these kids who are really, really, really picky eaters they learned pretty quickly what foods give them an upset stomach.


So if you're lactose intolerant and you're a baby and you're starting to learn what foods do to you, you start to get picky because it's not just a taste issue, it's also that they sort of start to put 2 on 2 together and it's like, "When they eat this I get a belly ache or I may not want to try something new because it might give me a belly ache…. So if you're able to get this lactose issue under control ‘cause you could crush up and sprinkle it into other dairy products as well.


And so then they don't get that association between an upset stomach and different foods and the farther you get out from their last experience of having the upset stomach then the less of a fear it will be for them and then their pickiness may get a little bit better because they sort of forget about that association between eating and an upset stomach. It's not going to help if it's a taste or texture issue but if it is that they're getting some lactose in, some dairy in, and then get the upset stomach because they're lactose intolerance. Babies are smart and they can form associations pretty quickly.


So the other thing too of course, talk to your doctor. Bounce it off them because I'm not supposed to be giving out medical advice in the show. But if for my kid who is 15 months old and they were lactose intolerant and we put yogurt and that really helped him to get a really better balance diet. But the yogurt was giving them diarrhea, upset stomach because they're lactose intolerant. I will try the soy yogurt or I would try the lactate tablets crushed them up and see if you can help out that way.


OK now in terms of protein, we see picky eaters all the time. And I would say just keep trying, keep offering, keep trying a wide variety of foods cause you never know when it's going to change and then they start to like something and take it. High protein foods of course are usually going to be your meats and your dairy. But other things you may not think of. Of course you don't think about beans and there are other variety of beans too black, petal beans, lintels, even soy beans.


Split peas are also high in protein and tofu. I bet your daughter would like tofu given the other things that she eats. And that also has high protein. But I wouldn't drive you crazy with this. I mean the most important thing is to watch her growth, watch her health. If she's growing fine and he's healthy, there's no sign of protein deficiencies then you're good. And if not, if she's not growing well, she's not having other health issues then you do have to look for other causes of low protein.


You can't automatically blame diet because there are some kidney diseases that can be an issue with protein. So I would make sure that you see your doctor, if she's growing well, and she's healthy, I wouldn't go crazy with this. Some kids do end up needing a supplement like PediaSure, some dietary prevention to help them get more protein but these kids are not usually just your picky eaters. I mean usually there's other medical things going on that's making them not grow and be small and not get enough protein in.


Maybe they're not absorbing protein from their gut or their kidneys are wasting protein, these kind of things. So definitely talk to your doctor about it. But if your child's growing well and healthy even if they're really, really picky they're probably getting enough protein.


And then with the iron and anemia, as it turns out high protein foods tends to also be foods that are high in iron as well. So meats, and beans, and tofu, these are all high in irons. Also iron-fortified grains including infant's cereal, which I know your daughter won't eat by itself but maybe you could mix some iron fortified infant cereal. The dry cereal mixed it in with some yogurt and crush up a lactate tablet, sprinkle that in there, add little fresh fruit, and you have yourself a parfait.


You know what I'm saying? If you do the yogurt, you're still getting the milk fats and you should get the milk sugar too. You're just giving it a lactate to digest it better and then you're getting the cereal, getting some fruit in there – that sounds good. That's not fresh fruit parfait. You know instead of the granola, you're using some infant cereal and yogurt. Boy, that sounds good.


You know your daughter may not eat, I don't know though with what she said what she does like. I think she probably do well with vegetables. Green leafy vegetables like spinach, you have to be careful that choking hazard with that. But that's high in iron. Also broccoli, asparagus and Brussels sprouts are also high in iron as well. So then corolla broccoli with some yogurt you might be in business. Again if your child's growing well, they're healthy, they're not anemic, I wouldn't worry so much about all these.


And if they are a little bit anemic then iron supplementation might be needed. If they're mildly, I'm sorry; if there's severely anemic then you got to check for their health conditions that might be contributing to the problem. In terms of when to check again in our practice we usually check their hemoglobin to look for anemia when they're a year old and when they're two. But in your case, if you're worried about it and she's really, really picky, I might be inclined to recheck it again at about 18 months so 6 months after you checked it the first time.


Incidentally I have a great resource for picky eaters. That's a hand-out that's in PDF form. It's called Building Blocks to Helping Toddlers Eat Well and we'll have a link to that in the show notes at Alright let's get to call number 2.


Jennifer: Hi Dr. Mike this is Jennifer from Detroit. I'm a little behind. I was just listening to last episode of February that said that your Skype box was empty so I got insulate with that question on your favorite topic and everyone favorite topic, poop. I have a 3 1/2 year old son who has been potty trained for number 1 for several months now. He's been wearing under pants pretty consistently accept it bad. And he pretty much refuses to go number 2 on the potty. He has done it a couple of times but it's pretty consistent that he resists it at all on the potty. He is pretty regular and predictable and we know where he has to go and then often complains that his bum hurts. But he just downright refuses through all the fit and likewise on the potty. This has been going on for 3 months. We stopped fighting it and we just put a pull upon him when he had to go. We knew we had to go because we don't want him to hold it in. But it's getting to a point now where he'll be 3 and a half in May and I just think that he knows. He's an intelligent kid. He makes smart connections in my opinion.


Jennifer: And I think he gets it. It's not like he doesn't understand but want to have to go you should put in the potty. So I'm just wondering if you have any tips or persuasion that we can use we're pretty frustrated and just want to get him out of the pull-ups. We also have a one year old daughter and another baby on the way on September. So, the less diapers in the house, the better. Your help is greatly appreciated. Love the show. Keep it going. Thanks a lot Dr. Mike.


Dr. Mike Patrick: Alright thanks to Jennifer from Detroit. So let's sum up. We have a 3 1/2 year old who is potty trained pretty well for number 1 but who refuses to do number 2 on the potty. And he do pull-ups on when he has to go, so he let you know in when he's got to go, you put the pull-ups on. But mom wants him out of the pull-ups plus she has a one year old daughter and another baby on the way. And just really be nice to get this 3 and a half year old potty trained.


Now we've talked about this before in previous shows but it's an important topic and one that comes up very often if you have a child that sage at home. So let's go ahead and review it here. The first thing is you want to make sure that your child really is ready to be potty trained for poop. I mean they have to be physically developed to the point that they have some control over the bottle function. And most kids by the time they are 3 and a half this is not going to be an issue with it physically being a problem.


But still there is that potential so I would talk to your doctor about it you want to make sure that there's not some medical reason why they're not potty trained yet for poop. But there are some kids that are just normal development for them. They're going to be a late 3 and even on early 4 before they are potty trained for poops. Now that's the rare kid. Most of them are going to be potty trained by about 3 and a half. And if they're not again you want to talk to your doctor, have them take a look at your child to make sure there's not something medically wrong with them that would be causing this.


Now I would say for your 3 and a half year old Jennifer. I would say that for your 3 and a half year old it sounds like he's ready. Because he knows when he has to go he's getting the signals and he can hold it until you get the pull-up on and then he goes, he wants to be changed. So I think he knows when and he can hold it and he can release it when he wants to release it. So to me it sounds like he could do it if he wanted to do it. But he's not.


So I don't think for him it's likely to be a medical issue. I think it's more that he's ready to do it and you just got to figure out a way to encourage him to do it. But again not putting my hands on him and seeing him, and examining him, and knowing the ins and outs of his medical history. Really do when you talk to your doctor and make sure that they agree. OK so once you've made sure that your child is ready, they know when they got to go, they can tell you, they can anticipate, they can hold it, they can go on command when they got the pull-up on then you're set to proceed.


And the first thing is I would be consistent with a short term reward. Make it some kind of food, candy, M&M's you don't want to be something that they can choke on. But you wanted to be some kind of short term reward that they only get when they poop on the potty. And then I would also say if you have a jar of M & M's and you know they poop and you know they get a couple of M & M's. Now you know some are going to say rewards of foods or you're going to cause eating disorders OK. You know, chill out.


I don't think that's going to cause an eating disorder. If they like vegetables, it's got to be something they like. There are some kids that don't like candy. And whatever it is that you're going to use as your reward for a little while or get over this little hump, the only time they get that is when they poop on the potty. That's it. OK and then I would also consider a longer term reward program. So you basically take him to the toy store, buy something that they really want and if it has different parts, that's even better cause it'll last you longer.


For my daughter when she was 2 and want to get out of bed every half an hour we did this but we bought a big Polly Pocket set that had lots of different Polly pocket houses in it so that we could do this what I'm going to describe with this behavior modification technique. And then we had a different house so you could last longer. So what you do is they know that it's in the house OK. But they can't play with it until they earn it.


And then I would make a sticker chart and every time that he goes potty that he poops in the potty and not in the pull-up then he gets to put a sticker on the chart. And once he gets a certain number of stickers, he gets part of what you bought. So in our case if we bought a whole bunch of whole Polly Pocket set with some different little houses in it then she got to pick-up out house after she had 5 stickers.


Now you don't want it to be so long that they aren't put into together. You might even want to say OK you poop in the potty one time, you got to put a sticker on the chart and you get a matchbox car or whatever something new that you've bought. And then the next time well now that they put 2 into together that this is related then you can say OK. Now you don't get it with just your one sticker now you've got to get 3 stickers. You've got to go potty 3 times to do it.


And then after that you got to go five times to do it. Then after that you got to go seven times to do it. And then pretty soon you know they're going in the potty and then they forget all about the pull-up. So this usually works well. The other thing is I would praise, praise, praise success. Make it a party. Jump up and down "yay!… When they poop in that potty make it a big deal. And I would downplay failure. Just add a positive spin to it. Well OK didn't work out this time but don't forget.


If instead of doing it this way, if you do it on the potty you get a sticker and an M & M or whatever this going to be and you get a pick out. You know the toy that we bought, it's in the closet waiting for you to get right now if you poop. But I wouldn't make a big deal about your disappointment and this is terrible. You know just put a little positive spin on it but really just praise the heck out of success.


And the last thing is avoid melt down. I mean sometimes you just have to stop trying. You got to give it a rest for a month and then try again. Because if it gets into a big power struggle and it's always a big argument, you just have to walk away from that. It's like rebooting a computer. You just got to give it a month, look the whole situation and reboot and you'll be good. OK let's go ahead and move on to question number 3.


Kim: Hi, Dr. Mike. This is Kim here in Dallas Texas. I'm a big fan of your show. I got an iPod for Christmas and I‘ve been listen to it ever since trying to catch up on past shows. I have two questions. I have a 10-month old and I've two dilemmas. He has a testosterone deficiency and he's recently been going through some other shots and the tests. They just recently had another test and try to figure out why he has but he can't make testosterone or it's his brain just not sending a signal to the testes. Pretty much they told me either way he's going to get hormone shots monthly.


Kim: My question is because they have not been able to explain it to me, I guess sufficiently is if he's going to possibly make him normal? Right now he looks like a normal but he didn't look 10 months. He looks six or seven months even for the six month's clothing, 14 pounds off the chart. So I would just ask about that. Also, I was going to ask you, I've had a really hard time, I've have been breastfeeding him and lost a lot of my supply recently and it's just& been decreasing the past several months. But now it's to the point where I get to combine amount of two ounces during two 15-minutes palm sessions at work during the day. And now I only have enough to nurse him at night.


Kim: So normally I used to be able to nurse him in the morning and at night and pump enough for two bottles while I was gone during the day and he would have a third bottle just of formula. But now he's having mostly formula with maybe one breast milk bottle a day. So I was going to ask if you have any tips for getting my supply back up. I do want to keep trying to nurse him for another few months. He just seems so vulnerable to me. And I've already tried to give a break of a Blessed Thistle and I have way-up of my water intake so I don't know what's going on with that. If you have an advice, I would greatly appreciate it. Thanks' so much Dr. Mike.


Dr. Mike Patrick: Alright so Kim in Dallas. Thanks for calling the Skype line and also I think it's really cool the whole Christmas iPod thing. You know I think I've gotten several e-mails regarding that or people have started listening to PediaCast after they got an iPod for Christmas. So there's one way you can help spread the word about the show, next Christmas or whatever the holiday is, Mother's day buy mom an iPod and let her know about this show.


Alright so we have a 10-month old who has been diagnosed with testosterone deficiency and has to get hormone shots every month and mom wants to know when he'll be normal with the shots. They're still trying to figure out what's going on. And then the second question mom has been breastfeeding but her supply is slow. She gets two ounces twice daily by pumping. She still nurses once at night. He also gets a breast milk bottle during the day. That's what she's been pumping and otherwise he's drinking formula. Mom really wants to keep nursing him. What can she do to increase her supply?


Alright so let's talk about these things separately. First the testosterone deficiency this is actually a big, big topic. Cause there's so many things that can cause low testosterone production which is also known as male hypogonadism. So you do have to go sort of on a big hunt to find out exactly why they're low on testosterone. Now the treatment of low testosterone by itself is as easy as testosterone replacement therapy like you're doing.


And the success on that program, that therapy program depends to some degree on what the underlying problem is that's causing this low testosterone. This basically we can divide it up into 2 categories of what causes this. One will be called primary which happens at the level of the testicles and this or you can also have secondary low testosterone which happens at the level of the brain if you remember back too. I don't know I always say this. But if you remember back to high school biology class, in the brain you got the hypothalamus and the pituitary which regulate the whole endocrine system.


If you have a problem in the brain with the hypothalamus and pituitary, they may not be telling the testicle to produce testosterone like it's supposed to. So the problem can be at 1 of 2 levels and you got to figure out at which level it is. Now I'm going to run through some examples of things that can cause each of these. So primary examples and secondary examples but we're going to limit it just naming them. Because exploring all of these possibilities and then talking about that disease process is something that really would require going into a depth that is beyond the scope of what I can do here today.


So examples of primary, primary hypogonadism or the low testosterone at the level of the testicle some examples would be Klinefelter syndrome. This is where a baby boy, XX if you remember again high school biology. XX is for girls, XY is for boys. If you have a genetic issue where a boy has 2 X's, so XXY or even more, XXXY this is klinefelter syndrome and that can cause a problem with the testicles. Also in older kids if you have an undecided testicle that's not been dealt what they can, it can produce less testosterone because it is undecided so kids later in childhood this maybe an issue.


A rare cause would be mumps that can cause testicular injury that could result in a low testosterone also hemochromatosis which is an iron storage disease. Testicular injury and then also affects from previous chemotherapy and radiation therapies such as from a kid who had leukemia or cancer that can also cause production problems of testosterone in the testicle. Now in terms of secondary examples so things that could affect the hypothalamus and pituitary, one is common syndrome which is abnormal hypothalamus development. Those kids are interestingly enough. Also have an impaired ability to smell.


They do not, their skin smelling like we've talked about before. But I mean the sense of smell so they have an impaired ability to sniff things and tell what they are. You know what I'm saying. Also brain tumors can affect the hypothalamus and the pituitary glands so these kids definitely need a scan of the head to make sure there are no tumors there. Other infections of the brain, encephalitis, histories of meningitis, other inflammatory diseases, HIV and effects of medication can also affect the pituitary and hypothalamus.


So when you have a kid with low testosterone you really have to explore lots of things, do lots of testing, it's a big differential diagnosis to try to figure out what's going on. I will point you do a great resource on the subject of low testosterone and male hypogonadism from the male clinic and we'll have a link to that on the show notes at and click on that link and explore to your heart's content with the information at the male clinic.


Alright now in terms of breastfeeding, your best bet of increasing your supply is to nurse more often. So you're only nursing once a day and a baby sucking at the breast is more efficient than a pump. So& your baby is going to be able most likely to get more than two ounces. If you're getting 2 ounces out of with the pump your baby is probably going to be able to get more than 2 ounces out when they are actually at the breast sucking. Cause a baby's mouth, I mean that's what God made, the baby's mouth to be efficient with this. And so it's like two pieces of a puzzle going together. You know it's a baby's mouth going to be better than a plastic pump.


Also the typo stimulation that a baby's sucking at the breast gives you that stimulation often boosts production. So at a minimum I would try to increase your nursing to three times a day with the baby at the breast. So in the morning before you go to work, when you get home from work, in the evening, four times a day would be even better if you can add a middle of the night feeding or if someone can actually bring the baby to you at work to nurse when you're at work.


And so if you do both of those and you get the five breastfeedings a day I'll bet your production will really increase and you'll be successful at this so increased feedings with the baby at the breast should boost your production. Now I understand the problem here is going to be than you're not going to have a chance to pump cause the more your baby sucking at the breast the less opportunity you have to pump. So then you can store it you won't have the supply on hand and you may need the supplement with some formula particularly when you're at work and especially if your baby can't come visit you at work for you to nurse.


So overtime though if your production boost because your baby is nursing more often then you may be able, a month down the road to add back in some pumping times to get your supply in terms of your stored supply back up. But to get to that point I think you're going to have to sacrifice your supply you know that you pumped and stored and just nurse more and pump less to get there.


Now if you try this and it doesn't work or it's just not possible, you can't find the time to do it, I'm still going to say don't feel guilty about switching the formula if you must do it. Ignore the breast militants, I've used the word breast Nazi before and it's got me in trouble, OK I understand you know. But you got to line up here a little bit folks. I mean if Hogan's Heroes can poke fun at the Nazis you know I can too but and there are. There are breast militants out there. There are moms out there who make you feel like you are the worst mom in the world if you stop breastfeeding and that's ridiculous. You have to take a moderate stance on this because everyone's situation is a little bit different and you have to look at the whole story.


Everyone's individual circumstance, we can maximize your success and the things I've talked about would do that. But it doesn't always work and if you do have to switch to formula and these are good tips even if you continue to breastfeed. Avoid cigarette smoke around your baby. Avoid crowded day care centers and avoid baby sitters with snotty nose toddlers and school age children running around because those are the things that make your kid sick much more than breastfeeding will keep them healthy.


So avoiding those things is really, really important. Again I'm not anti breastfeeding. I've given you a plan that I think will really help to boost production. In my office I tell people these things all the time but we have to be realistic. There are some moms it's just not going to work and we have to be sensitive to them as well. So I hope that helps. We're going to go ahead and take a quick break here and we'll be back to wrap up the show right after this.



Alright as always thanks goes out to Nationwide Children's Hospital for helping us out with the bandwidth for today's program. Also Medical News Today, Vlad over at and of course a great big thank you to all of you for participating in the show. Taking your time to listen, download, and tell your friends and family about it, all those things.


Don't forget on the Pediascribe blog we have listed our Skeeda winners and there's another chance for you to win a free Skeeda bag if you use the code at by April 13th and submit a picture of yourself, not of yourself, or at least of your bag full of stuff at the store and you can win another bag free. And there's detail on the Skeeda bag on the contest available via links at in today's show notes.


I do want to remind you I haven't talked about this in a long time. We have an audience survey available at the websites. In the side bar over the top it's just says survey and you click on that and that'll take you there. If you have a few minutes and could do that for me then that'll be great. It does help with the demographics of our audience in terms of helping us out with sponsors and advertising and that sort of thing.


And then it also gives you a chance to tell me what you like and don't like about the show. You know it's a private forum so you're not like if you'd do an iTunes and you do a review and you say I hate this about the show. Then people don't get turned off and don't even give us a try. But this gives you an opportunity to let us know what you like and what you'd don't like and it helps us to make the best show possible for you.


ITunes reviews are also helpful too. Sometimes you get good ones. Most of the times is that we really get good ones and I appreciate that from all of you. I really do. Just love the love you know. And then sometimes we get some bad ones and usually its people have different opinions than I do. But you know I tried to look at both sides as much as I can. But at the end of the day you want to know what I think right? And so I tell you.


And I'm not sorry for that and I'll continue to do that even though there are people who don't like it. Alright I hope all of you have a great rest of the week and a great weekend. And until next time this is Dr. Mike saying, "Stay safe, stay healthy, and stay involved with your kids…. So long everybody.


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