Talking To Yourself, Chocolate Milk, Soft Spots – PediaCast 119

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Topics

• MMR Doctor Faces Disciplinary Panel
• Talking To Yourself
• Chocolate-Flavored Milk
• Bowlegged Baby
• Community Bed
• Soft Spots

Links

• MMR Doctor Denies Submitting Kids To Painful Tests Just To Prove His Theories
• Encouraging Preschool Kids To Talk To Themselves
• Children Benefit From Drinking Chocolate-Flavored Milk According To New Study
• The Abnormal Fontanel (American Family Physician)

Pediascribe

• Have I Taught Them Nothing About Nutrition?

Transcription

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

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now direct from Birdhouse Studios here's your host, Dr. Mike.

0:00:45

Dr. Mike Patrick: Hello everyone and welcome to PediaCast. It is episode 119 for Monday, April 7th, 2008. Talking to Yourself, Bow Legs and Soft Spots and of course lots more coming your way a little bit later in the show. A quick follow-up, we had a great, great, great response for our listener rants and raves show. Several more comments are ready and we are actually well on our way to having enough material for our second show. And really it was a lot of fun and all of you got a chance to meet Karen and find out a little bit more about the blog.

0:01:32

I also want to mention we're going to be away on vacation which is much needed. Our spring vacation is really important to my mental health because after a winter of seeing kids with the flu and RSV, and Rotavirus, it's just getting so crazy in the office in the winter that our two weeks spring vacation that we take every year is just as required for my sanity. But even though we're going to be gone for a couple of weeks I still have plans to have shows even while we're gone, that's the plan anyway.

0:02:06

So I have been working pretty hard at getting things ready for you. And I think one of those shows at least in the early part of May there'll probably be another Listener Rants and Raves Show Call Up Part 2. We haven't recorded it yet so if you do have a comment that you've been dying to share good or bad, write soon so we can include it with the next round of listener feedback which will then be coming to your way about a month from now give or take.

0:02:35

Alright I do, one of the thing before we start, I have a funny little thing story for you. You know Karen gets the blog about the crazy things that we do. You know me and the kids and other people in her life but you don't get to hear about the stuff she pulls until now. I'm going to share this one with you, last week there was a night that she went to bed early and my son Nick and I watched an Ohio State basketball game. It was the semi-final of the NIT.

0:03:05

And then we went to bed. Nick woke up early and see we have this agreement between the two of us. Whoever wakes up first wakes the other one up. I don't know why, we've done this for a while now. And then I get up, he plays on his computer, I work on the show in the studio, were together and we you know rest each other back and forth and this just kind of a fun father son bonding time in the early morning.

0:03:31

So, the point is I was up and went out of bed before Karen was awake so she went to bed by herself and woke up by herself. Now I did go in and say goodnight. You know when I went to bed I give her a kiss and said good night the whole 9 yards she just didn't remember it , remember it happening so Nick and I are down in the studio right? I'm supposed to be working on the show but actually at that point we're both playing up whale's master match on his computer instead.

0:04:00

And then I get a text message and I still have the sequence of the text messages on my iPhone so here it is:
Karen says, "Hello….
Mike: "Good morning!…
Karen: "Are you still up or are you already up?…
Mike: "You don't remember me coming to bed last night?…
Karen: "Not really….
Mike: "Ha! Nick and I went to bed at 11:30. Buckeyes won big, playing championship game on Thursday, CNIT….
Karen says, "Oh just making sure you weren't dead….
Mike: "Spitting coffee. Were you really worried I might be dead?…

0:04:36

Karen: "Yeah and I can't get my iPod to sync….
Dr. Mike:& OK see folks she only keeps me around for my technical skills. That's great! Just great! Alright so what do we have in store for you today? The MMR doctor, Dr. Wakefield Faces a Disciplinary Panel, Talking to Yourself. Chocolate Flavored Milk, we're also going to discuss Bow Legged Baby, a bow legged baby anyway with a listener question.

0:05:05

We're going to talk about the Community Bed; Should You Sleep With Your Kids? And then Infant Soft Spots. That's all coming up. Don't forget if there's a topic that you would like us to discuss on the show sure you would always get a hold of me. Just go to Pediacast.org and click on the contact link. You can also go to Pediacast@gmail.com and send us an e-mail. Or call the Skype line at 347-404-KIDS.

0:05:32

I also want to remind you that 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 Pediacast.org. And with that in mind we will be back with news parents can use right after this short break.

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0:06:33

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.
Dr. Andrew Wakefield told a general medical council disciplinary panel he did not submit young children to painful tests just to further his theories linking vaccinations to autism. He stressed that the tests were clinically necessary to diagnose and treat the young children.

0:07:00

He said the kids had autistic like symptoms as well as debilitating bowel diseases. A decade ago Dr. Wakefield's said the MMR vaccine may cause autism. Professor John Walker Smith, the doctor of the young children had ordered all the tests. According to Wakefield, the investigations including colonoscopy limber punctures also known as spinal taps. Brain scans, blood tests and urine tests were stopped when they could not reveal a link to the children's problems.

0:07:29

He insisted that the well-being of the children was our foremost consideration. Dr. Wakefield is not a practicing clinician he's an academic doctor and he's accused of ordering tests against the children's best interest in order to further his own research and by doing so breaking ethic rules. However he says he played no role whatsoever in deciding whether the test should or should not take place. According to Wakefield all the parents were very keen for their children to be included in the test and knew about the research program.

0:07:59

He said parents had told him about their quote normal children who developed autism after receiving the MMR vaccine and started investigating the potential link in 1995. He had previously investigated a possible link between the MMR vaccine and crone's disease. Dr. Wakefield says quote parents were telling me what turned out to be a remarkably consistent story of a normal child who they had lost. One who lost speech, communication, play, interaction with siblings had sometimes become in continent, was bloated off their food, was losing weight and was feeling to thrive in quote.

0:08:35

While answering the panel's questions during the hearing several supporters were gathered outside with banners indicating support for Wakefield, Professor Walker Smith, Professor Simon Murch and Dr. Wakefield all deny serious professional misconduct. According to the Daily Mail, Dr. Wakefield charged over $300 per hour to a law firm that had planned to sue the vaccines manufacturer. He invoiced Richard Bar a lawyer the hourly rate for investigating alleged dangerous side effects of the MMR vaccine.

0:09:08

Two years later Wakefield published his research paper alleging a link between MMR and autism in young children. However he did not disclosed that he was being paid as an expert adviser for Mr. Bar who is in legal proceedings against the manufacturers of the MMR vaccine. A clear conflict of interest most of the children who are examined were represented by Mr. Bar when Dr. Wakefield's report came out it led to a dramatic drop in the number of children receiving the MMR vaccine and a subsequent rise in the number of children developing measles.

0:09:42

According to the Daily Mail Dr. Wakefield was also accused of dishonesty in applying for over $100,000 of legal aid money for his research even though this is cause had already been met by the National Health Service. According to Wakefield he needed two funding sources for two separate investigations. Wakefield told the panel that the Royal Free hospital ethics committee had fully approved the invasive test on the children.

0:10:08

Dr. Michael Peg who was the committee's chairman at that time said this was not true. Wakefield's suggested that Dr. Peg's memory was at fault and the hearing continues. OK so all the evidence regarding MMR and autism comes from the research of this one man. And you know conducting research on the relationship between MMR and autism is not the problem nor or the invasive test, of course with a parental approval. I mean how else do we ask questions and find answers in advanced science. Certainly this was a good question to ask.

0:10:40

Thus the MMR vaccine cause a rise in autism and if it did we would want to know to understand how which could help us understand the disease better and to change the vaccine in some way to prevent this. But to be a higher gun for a lawyer planning to sue the vaccine manufacturer based on the research and for the tests subjects to be the very kids these lawyers represents and then not to disclose this minor tilt and his minor details.

0:11:06

And then to pronounce to the world that the MMR causes autisms based on the poorly done study funded by the lawyer of the kids in the study. A lawyer planning to sue the vaccines manufacturer, this guy calls himself a scientist. Look he is a medical thug and if you ask me history should hold him responsible for the years of destruction he has caused. Destruction which has left well children unvaccinated and in danger of needlessly suffering from a potentially fatal disease.

0:11:36

Destruction which has caused us millions of dollars and needless research to refute his bogus findings and distraction which has hindered and delayed our search for the true cause of autism.

Parents should not worry when their kids talk to themselves. In fact they should encourage it, says Adam Winstler, an associate professor of Psychology at George Mason University. His recent study published in Early Childhood Research Quarterly showed five year olds do better on motor tasks when they talk to themselves out loud either spontaneously or when told to do so by an adult than when they are silent.

0:12:11

Young children often talk to themselves as they go about their daily activities. And parents and teachers shouldn't think of this as weird or bad, says Winstler. On the contrary they should listen to the private minds and speech of kids because it's a fantastic window into the lives of their children. The study found 78% of children performed either to same or better on performance tasks when speaking to themselves than when they were silent.

0:12:36

The study also showed children with behavioral problems such as those diagnosed with attention deficit hyperactivity disorder or ADHD tend to talk to them more often than children without signs of behavioral problems given kids with behavioral concerns need more direction and control from adults. Teachers may unnecessarily ask children to be quiet in classrooms. Out of fears such speech coming from difficult to manage kids will lead to problem behavior says Winstler.

0:13:05

Yet non-disruptive private speech would actually help these children as they develop. Therefore teacher training and professional development efforts should teach teachers to increase their tolerance level for this kind of private out loud speech. Winstler says private speech is very common and perfectly normal among children between the ages of two and five as children begin talking to them, their communication skills with the outside world improved.

0:13:31

This is when language comes inside says Winstler as these two communication processes merge children use private speech in the transition period. It's a critical period for children and defines us as human beings. Winstler also conducted the first ever study looking at private speech in children with autism. He found high functioning autistic children talk to themselves often and in the same ways that non-autistic children do.

0:13:57

Talking out loud also improved their performance on tasks. Children with autism have problems with their external social speech so psychologist assumed their private speech would also be impaired says Winstler. But this study shows it is not the case. Autistic children used their private speech very effectively as a tool to help them with tasks. So it appears once again my grandma birth was correct. It's OK to talk to yourself, just don't answer back.

0:14:25

Alright children who drink chocolate flavored milk may actually benefit. A new study released in the journal of the American Dietetic Association found that children who drink flavored or plain milk consumed more nutrients and have a lower or comparable body mass index in children who don't drink milk. The authors say milk contains many nutrients that are important for children and children who drink milk including plain and flavored milk have high intakes of many nutrients in comparable or lower BMI's compared to children who don't drink milk

0:14:59

So limiting access in flavored milk in schools where may have the undesirable effect of further reducing the intake of many essential nutrients provided by milk. The study compared nutrient intakes and BMI's among 7,557 US children and adolescents ages 2-18 years. One group drank flavored milk, another drank plain milk and the third group had no milk. Result showed both milk drinking groups had significantly higher intakes of Vitamin A, calcium, phosphorus, magnesium and potassium than the non-milk group.

0:15:33

In addition BMI measures of milk drinkers comparable to or lower than measures of non-milk drinkers. Intake of added sugars did not differ between flavored milk drinkers and non-milk drinkers. Among females 12-18 years of age averaged calcium intakes by the flavored milk drinkers and plain milk drinkers were nearly doubled the calcium intake of the non-milk drinkers.

0:15:56

Dr. Retail Johnson, dean of the College of Agriculture and Life Sciences and Professor of Nutrition at University of Vermont, a co-author of the study, noted intakes of added sugar were comparable between flavored milk drinkers and non-milk drinkers confirming that the inclusion of flavored milk in the diet does not lead to significantly highly added sugar intakes by children and adolescents. The 2005 dietary guidelines for Americans encourages children to enjoy 3-age appropriate servings of low fat or fat free milk, cheese, or yogurt each day.

0:16:28

Currently less than half of children ages 2-8 and only about 1 corder of children ages 9-19 meet the recommended daily intake of dairy. Flavored milks can provide part of the solution for meeting this recommendation. According to the dietary guidelines, small amounts of sugar added to nutrient rich foods such as low fat and fat free dairy products may increase a person's intake of such foods by enhancing the taste of the products thus improving nutrient intake without contributing excessive calories.

0:16:59

In addition the school milk pilot test found that school milk consumption increase by 37% through specific improvements such as plastic packaging, one or more additional flavors and better refrigeration and merchandising. Child health is a top priority for the dairy industry and this research shows both flavored and plain milk can be an important part of a child's daily diet said Karen Caifer, Vice President of Nutrition Affairs at the National Dairy Council.

0:17:27

She said flavored milk is a great thing. Nutrient rich beverage taste great and that make it easy for consumers of all ages to meet the recommended servings of dairy each day. So moms and dads, if your kids aren't getting enough milk, try flavoring it. And if your soda offering school is failing or offer flavored milk be the squeaky wheel and ask them why? Alright we're going to get to your questions and we'll be back with that right after this.

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0:18:22
First up is Kate from Cherry Hill New Jersey and Kate says, "Our four month old daughter loves to hold on to your fingers and walk. Our neighbor insists that doing so cause dyslexia. I think there may be a correlation but is this really a cause and effect, what do you think, the nurse practitioner which was not my choice to see at her appointment last week that it was because her legs to go bow legged. But a jumper would be fine. We will ask not to see her again by the way. The last time we were in the doctor's office, they said it was no problem.

0:18:51

Is there a difference between standing and walking and using a jumper? She does tummy time everyday but prefers standing. Thanks for your help. Love the show, Kate….
Alright let's just, let me first point out that there is no known correlation between letting your infants stand and dyslexia. OK or any other learning issue for that matter. And I did do an exhaustive search of the PubMed data based which is a collection that the government keeps on all the medical research that's been done around the world.

0:19:23

And there was absolutely I mean really zero results when I look for any correlation, any research studies showing a correlation between standing infants and dyslexia. And you know from that how does that happened? In a standpoint, a correlation between infants standing and dyslexia really doesn't make any sense. But of course just because something doesn't make sense or is not in the medical literature, does it mean it's impossible?

0:19:50

It shows that nobody has asked the question and designed a study to prove or disprove the hypothesis. But let's pretend that we wanted to do that. You know how you could design a stud while you could take a large group of identical twins and identical twins are nice because they're genetics and other environmental factors are going to be similar. And you can have one twins stand frequently holding on into your fingers perhaps to some pre-assigned schedule.

0:20:15

And don't do it with the other twin. And then you could do a survey maybe you know when they're children, when they're school age and then again maybe when they're teenagers looking for learning issues and then determine if there's a statistically significant difference in the occurrence of learning issues when you compared the group who stood and the group who did not stand.

0:20:36

And I would predict that there would be no difference that would be my hypothesis. But to know for sure you would have to design a study and test it. Let me also point out that one problem with the study that I just described is that you are assuming that having them stand is what causes the dyslexia. You know it could be that kids who prefer to stand maybe more likely to have learning issues later on down the road. But I suspect that even a study where you took 2 groups of kids. One who preferred to stand and one who didn't and still tried your best to control for environmental factors that most likely there would be no connection.

0:21:17

But again that's just a hypothesis. You'd have to do the study to know for sure and no one has. Now on the bowed legs, now this is one I hear all the time. I have never heard the dyslexia one before. But the bow legs and standing in babies I hear this quite a bit. And once again there is nothing about it in the medical literature. So this is just a notion that's in grandma's head but there's never been a study to look at the question.

0:21:41

This one though might make some sense. I mean what is the average four month old weigh? Maybe 15 pounds or so and we know a four month's old a leg bones are comprised mostly of cartilage which is somewhat pliable. We also know a baby's skull may flat and if she lies in a given position in all the time. So if the weight of the head can flatten the skull could the weight of the entire baby because the leg bones to bow if they stand too much. I mean that seems plausible right?

0:22:10

And of course you could just design a study and see this as well no one has but you could. You know you could have two groups, one group stands a lot the other doesn't then you measure their leg bowing and see if there's a difference between the two groups. Now there are still two issues to contend with here though. Slightly bowed bones in the legs are normal in infants. That's their normal shape and the degree of bowing can be very quite a bit from kid to kid.

0:22:36

So in this case once again identical twins would be a good choice to see if lots of standing causes more bowing than you would otherwise predict. But there's another big, big, big issue and that is does it matter? So what if standing does increase leg bowing? The more important question is does increased leg bowing because functional problems for the child down the road. In other words let's say standing thus cause some increase leg bowing. I'm not saying it does but let's just says, let's say it does.

0:23:09

Does that result in more problems of function? In other words do these kids have delayed onset of walking or do they have chronic leg injuries, or chronic leg pain? Are they more prone to sports injuries? Are they more clumsy? I mean those are the important questions. And personally my hypothesis based on facts you know that I already know would be this, if a baby stood for hours each day it might result in more bowing than you would otherwise expect to find.

0:23:35

But in the end I don't think that would matter. I mean our bones have a tremendous ability to remodel themselves into the correct shape. Flat skull bones fix themselves and leg bones straightened. And it makes sense that our leg bones will eventually straightened despite the weight of our bodies because after all we are designed to stand. Now let me say this, you will find sites out there that say no way standing your infant absolutely, positively does not cause significant leg bowing.

0:24:04

But I will point out this pronouncement does not base on any research because there isn't any research out there on this topic. It's an opinion based on a person's experience and education, it's a hypothesis which in the end is fine especially if that hypothesis is based on known facts and is coming from someone whose judgment you trust. So the doctor and your practice who said standing your baby is not a problem and then you have the nurse practitioners saying oh what cause your baby's to have bowed legs OK fine.

0:24:31

The next one question for the nurse practitioner is, so what? Is that a problem? If so, what problem will these bowed legs create and what will you have to do about it? And I would also ask her how many babies she has seen in the scope of her practice who had bowing that caused the problem and what problems specifically did the bowed legs cause and what was done to fix them? See I would ask to see the nurse practitioner again because I'd get a kick to ask her those questions.

0:24:58

But you know that's me and I'm kind of smart aleck in that way. One last thing to point out, severe leg bowing can be caused by some disease processes for instance Vitamin D deficiency leading to rickets is a prime example. So if your baby's legs seem accessibly bowed to you, be sure to ask your doctor about it.

0:25:19

Oh so what would I do if I had a four month old baby at home especially one who likes to hold on to my fingers and stand, personally I'd let him do it. I'm glad you're enjoying interacting with your baby in a fashion and I bet there are a lot of smiles all around when you're standing there and holding on to your fingers.

Alright next up is Kelly from Columbus Ohio. "Dr. Mike I recently discovered your podcast and I become a huge fan. I'm telling all my friends about PediaCast and I'm particularly excited that you are a fellow Buckeye.

0:25:46

My question is this; I'm a single mother of a beautiful 9-month old little girl. Recently I've begun a practice that several people have advised me to discontinue immediately. I begun to put my daughter to sleep in my bed and began on a recent trip to Jamaica. She knew she was unfamiliar with surroundings and was quite uneasy so I let her sleep with me. It worked very well on vacation and I love waking up to her smiling face.

0:26:10

Now that we are home, I've continued this ritual. Many of my friends have told me that I will regret doing this. One friend even advised me that the Columbus Dispatch did an article last spring on the perils of this very practice. What is your opinion of having a community bed? I would like to add that I have what I believe to be a very good reason for having her sleep with me. I live in a cape cod style house. My bedroom is in the finished attic. If I put my daughter in her own bedroom, she would be downstairs.

0:26:38

I feel safer with her right next to me. If someone were to break in I'm afraid that even with the monitor I wouldn't hear them as I am a heavy sleeper. So I'm curious as to what your opinion is as well as what the research on this subject states. Thanks for the awesome podcast. Look forward to each new show. Keep up the great work….

0:26:55

Alright, well there is research out there on this one. There was a study done in 2005 and published in the Journal Pediatrics and it did show that there is an increase risk of infant death associated with bed sharing. And this makes sense I mean there's lots of suffocation potential for a baby in an adult's bed. The mattress is soft. The pillows are something their head can get caught in. The sheet, the blanket i mean there's lot of ways for babies to get suffocated and in adult bed.

0:27:27

And adult body can rule against your on top or over your baby. Now I know moms always say that would never happen. I don't rule in my sleep or I'll fill my baby's squirm, or I hear her cry, or I'm a lazy person who couldn't happen but it does happen. And in 10 years of practice I've personally seen it happen twice. And both times the parents woke up on top of the baby and the baby was dead. Now if I had those two sets of parents on my show right now what would they tell you, Kelly?

0:27:58

On the other hand how many parents bed share with babies and will ever, ever have a problem? Lots, but the potential is there for disaster and the question is, are you willing to take that risk? I wouldn't but ultimately you have to decide. You know Kelly here's another option, you could move your baby's crib to your room if you want to be together at night. And I do understand this desire by the way. I mean you're a single mom; it's nice to have a warm body next to you.& I get that.

0:28:26

But you should think twice before you put your desire above your baby's safety. So pull the crib up next to the bed so you can see each other. Put the fingers through the slats if you want. But I wouldn't bed share with your infant unless you're willing to accept the risk and consequences with a clear conscious. And by the way your baby won't like any new arrangement. She's going to cry and she might cry hard for a long time because that's how she communicates her desire and her disappointment.

0:28:52

She wants to be in bed with you. She's going to cry and try to get her way. But remember you are in-charge. It breaks your heart to see your child upset and disappointed but its part of being a parent. You have to make tough choices and trust me there are many more to come.

0:29:07

Alright, next up is Elena in Camp Pendleton California. Elena says, "Hi, Dr. Mike I have a question about my 18-month old boy. He still has a soft spot opening the size of a quarter on his head. Is this normal? When is a child's soft spot supposed to close up? I have ask his doctor and they can't seem to give me any information except will check him again in a couple of months. Thanks for your time, Elena….
Well thanks for the question Elena.

0:29:33

I assume you're talking about the anterior fontanel which is the most prominent soft spot located in the front center of the head. There's also one in the back center which is smaller and they are formed more which are very small and difficult to feel. And babies are born with these and they are important. They allow flexibility of the head which of course is important during childhood birth and they also allow the skull to grow rapidly. And then they act as a shock absorber when kids are learning to stand and walk.

0:30:01

So contrary to popular belief they don't make a kid's head more vulnerable to injury. They actually give babies added protection from falls by acting as a shock absorber. Now grant are the sharp object could broke more easily than it would through bone but penetration with a pointy object is not a common scenario. In terms of protection from everyday events, the soft spot is not a weak link. It's covered with a tough strong fibrous cover membrane and it's strong.

0:30:30

So when does it close? When does the anterior fontanel close? Well the correct answer is sometime during the second year of life. Normal ranges from an early close at 12 months to a late close at 24 months with around 18 months being average so that's why your doctor says he'll just keep watching it. Now the next question is what does it mean if there is delayed closure of the fontanel? That's what you're worried about right? I mean what does it mean if it takes too long to close?

0:30:56

You could also ask what if it's too big. What if it's too small? What if it closes early? And actually the list of answers is rather large and if you have an inquiring mind and you want to explore the possibilities I do have an excellent resource for you. It comes from the June 2003 edition of the magazine American Family Physician and it's an article entitled the Abnormal Fontanel. It's well written and it's thorough without getting too technical so if you're interested learning more about it check out the show notes at Pediacast.org and we'll have a link there for you.

0:31:28

Alright we're going to go ahead and take a break and we'll be back and wrap up the show right after this.

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0:32:03

As always thanks goes out to Nationwide Children's Hospital for providing the bandwidth for our show. Also Medical News Today for helping out with the news department and Vlad at Vladstudio.com for providing the art work for the website in the feed and most of all a great big thank you to all of you for tuning in, participating in the show, listening and supporting us. We really, really do appreciate it.

0:32:26

What happens when your tween kids are in-charge of making dinner? I mean the whole Kitten Kaboodle; from planning the menu, to cooking and serving, and cleaning up. And what if you only give them five minutes notice like, "Hey kids you're doing dinner tonight…. OK what do you get? Well if your kids are like mine the results will be interesting to say the least. And for more on that, including pictures check out the Pediascribe blog at Pediascribe.org and we'll also have a link in the show notes to the post Have I Taught Them Nothing about Nutrition.

0:32:57

Don't forget iTunes reviews are very helpful. How many of you found the show by looking around the ITunes directory and you clicked on PediaCast, you've read the reviews and you decided to check it out for yourself. And now you're here! So please if you have not done an ITunes review, they're very helpful and much appreciated. There's also a Poster Page at the website if you go to Pediacast.org. There are PDF files you can download, print, and hang up on bulletin boards and the like.

0:33:26

And then once again, I've mentioned this before, if you get a T-shirt at the PediaCast shop which by the way there's no mark up on that at all, we just, at our cost those T-shirts. If you get a T-shirt and wear it on vacation and snap a picture of you wearing your PediaCast T-shirt near a famous landmark, I will put some pictures up on the website and then in the fall we have a random drawing of all the people who submitted their pictures and we'll give you a $100 Amazon gift certificate.

0:33:57

So think about that. There's only going to be one show per week through mid May. In that way I can work ahead and keep the shows coming even while we're gone on vacation. But hopefully from mid May through fall we'll be able to ramp up the schedule again and get two to three shows out each week. That's the plan anyway. And remember if you have a comment for the next rant and rave show, send it along because we'll be recording another one in the next of couple of weeks and that one will be out probably a month from now.

0:34:24

Alright I hope everyone has a great week 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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