Teen Tanning, Gymnastics Injuries, Backpack Dangers – PediaCast 121
- Teen Tanning
- Gymnastics Injuries
- Backpack Dangers
- Online Gaming
- Lead Exposure
- Singulair Warning
- The Skin Cancer Foundation
- A Tan To Die For
- Pediatric Gymnastics Related Injuries A Concern
- Backpack Straps Can Cause Problems
- Link Between Online Gaming And Violence Killed Off
- Breath-Holding Info Sheet (Pediatric Advisor)
- Standard Lead Questionnaire
- Can Singulair Cause Depression?
Announcer: Bandwidth for PediaCast is provided by Nationwide Children's Hospital. For every child. For every
Announcer: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from Birdhouse Studios, here is
your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone, and welcome to PediaCast, a Pediatric podcast for moms and dads. This is Dr.
Mike coming to your from Birdhouse Studio. I'd like to welcome everyone to the show. It is Monday, April 21, 2008.
And the show is Breath-holding, Lead, and Singulair. Of course, we'll cover lots more topic than just those three.
Those are the ones that listeners wrote in and have some questions about.
So we will get to those a little bit later on the show. Of course, News parents Can Use will come up before. Before we
get started though I have a couple of serious things to talk to you about. The first one is we have a new component to
the PediaCast show.
Now you've heard, of course we have a Bandwidth sponsor every week and right now that is Nationwide Children's
Hospital that provides the Bandwidth for our show, and of course we thank them for that. We also, we're going to start
having an episode sponsor which will be a different sponsor each show and you know in a perfect world, you know
money which has grown in the tree and I could spend my time doing this.
And still be able to pay the mortgage, and you know, and not have to worry about anything, but unfortunately, as you
are aware these things cause both in terms of actual dollars and the time consumed.
So, it has become necessary to add a sponsor and we'll try to keep it as seamless as possible. So, this is our first
time our episode sponsor is actually The Minute Pie Mold Company, they're makers of great camping cookware. I
don't know if you go camping or if you ever gone camping, or you know someone who does.
The Pie Irons, basically it is a real sturdy cookware that you put a piece of bread and then you put the filling
in and you put another piece of bread, little butter on the bread, toast it together, put it in the fire for a couple minutes,
take it out at the camp fire, open it up and you got yourself, a yummy sandwich.
So this is something actually that is not new to me because we do go camping on occasion. We don't have all the
equipment but my wife's parents are avid campers and that they go camping quite often and so sometimes we shack
up with them. And Karen as it turns out is the pie mold queen.
And she makes the best Pie Molds and has her own recipes and can make them quickly too. So this is kind of near
and dear to our hearts, because when we go on camping trips, we used this and they make yummy pie molds.
Now if you have no idea what I'm talking about, you want to go to minutepiemold.com and we'll have a link for you in
the show note. They actually been around since 1962, and they've had an online stores since the mid 90s. So you can
visit them online at minutepiemold.com. They only sell like six products and they're all pie molds, so you have to check
All right. Moving on along here, in New South Wales, Australia. Have you heard about this? They actually ban the use
of tanning beds, although they call them solariums. For those people who are under the age of 18, so minors now can't& smoke, can't drink alcohol and can't tan.
But this is seemed extreme to you but before you answer consider this facts from the Skin Cancer Foundation. Skin
cancer is the most common form of cancer in the United States with more than 1 million cases diagnose annually, one
in five Americans and one in three Caucasian who develop skin cancer in the course of a lifetime.
Also a person's risk for skin cancer doubles if he or she has had five or more sunburns. Approximately 60,000
melanomas will be diagnosed in the US this year with over 8000 resulting in death.
Exposure to tanning beds before the age 35 increases melanoma risk by 75%. Let me say that again, exposure to
tanning beds before the age 35 increases melanoma, which is a skin cancer risk by 75%. On an average day in the
United States, more than 1 million people used tanning beds and 70% of them are Caucasian women who are
between the ages 16 and 49.
Even occasional use of tanning beds almost triples the chances of developing melanoma. And melanoma isn't the
only skin cancer associated with tanning, people who use tanning beds are 2-1/2 times more likely to develop
squamous cell carcinoma, and 1-1/2 times likely to develop basal cell carcinoma.
And it's no wonder tanning lambs can emit doses of UV radiation that can be as much as 15 times greater than that of the sun and despite this facts,& tanning popularity is on the rise in the US with the annual industry revenue exceeding 5
And I have to apologize for having an episode sponsor. With numbers like that, we can expect the industry is not going
to regulate itself. I mean, do you really think that a 5 billion dollar industry is going to say "hmp,… nope. Minor shouldn't
Is tanning, is dangerous to the health of our children, as a smoking or alcohol consumption? I say it is. And perhaps the idea of a ban on teenage tanning isn't such a bad idea after all. For more information on skin cancer you can visit The
Skin Cancer Foundation's website, there'll be link for that in the show notes.
So, what prompted the ban in New South Wales? Well, they were strongly influenced by the death of Claire Oliver. She was a 26-year-old up and coming Australian journalist. She's been an avid teenage tanner and in her 20s she
developed malignant melanoma and after that became an anti-tanning crusader.
Unfortunately, her crusade was short lived. She died last August. And she wrote her final piece for the Herald Sun in
Australia just three weeks before she died. There was an article called "A tan to die for…. And I'm going to read to you
an excerpt of this.
She says "I am at peace. But if I could go back and talk to myself when I was 19 I would tell that girl not to use a
solarium — that melanoma is not a small cancer, you just have cut out and you will be fine.
My mum told me it was abnormal to get in a box and fry myself, but I told her it was cool and everyone was doing it. I
was 22 when diagnosed. I had just finished a Bachelor of Media and Communication and a Master of Cinema at the
University of Melbourne and started work as a sports journalist at SBS. I was on top of the world. But I only got to work
for three weeks and then I found out about my cancer.
It was 2004 when they found a tumor under my left armpit, which they treated with immunotherapy. In July 2005, it came
back and this time they treated me with radiotherapy.
I was cancer-free for a year and seven months, and then in April I found a lump in my neck. I thought they could just cut
it out, but it turns out there were seven tumors in my chest and one in my lung. Now they have stopped counting how
many there are.
Young girls need to go out and educate themselves about solariums before they make any decisions. Melanoma is no
joke. And I will keep championing this cause till the day I take my last breath…. Which is it turns out, which is three
weeks later. So, look for the link to her entire story on the show notes and if you have a teenager at home who tans, I
strongly urge you to take a look at her story. And I would also ask you to reconsider your views on the safety of tanning
and to share those views with your children.
All right, so coming up in the news section a little bit later here in the show after we take a break, we're going to talk
about gymnastics injuries, also backpack dangers, and online gaming. And then as I mentioned before in the listener
portion of the program, we're going to talk about breath-holding, lead exposure, and a warning about Singulair.
Don't forget if there's a topic that you would like us to discuss, all you have to do is go to pediacast.org, click on the
contact link and you can get a hold on me that way. You can also email email@example.com or call the voice line at
The information presented in PediaCast is for general educational purposes only. We do not diagnose medical
conditions or formulate treatment plans for specific individuals. So if you do have a concern about your child's health,
call your doctor and arrange a face to face interview and hands on physical examination.
pediacast.org. And with that in mind, we will be back with News Parents Can Use right after a 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 website. You can visit them online at medicalnewstoday.com. More than 600,000
children produced a pay in school sponsored and club level gymnastics competitions annually in the United States.
A gymnastics continuous to be overlooked in terms of potential for injury, despite having one of the highest injury rates
of all girl sports. A study conducted by researchers in the Center for Injury Research and Policy and Nationwide
Children's Hospital and published in the April electronic issue of pediatrics, examined data on children's 6 to 17 years of age who are treated in the Hospital Emergency Departments for gymnastic related injuries between 1990 and
According to the findings, on average, there were 27,000 injuries reported each year and nearly half a million injuries
during the 16-year period. "Many parents do not typically think of gymnastics as a dangerous sports,… said study
leader Dr. Laura McKenzie. In fact many parents consider it an activity yet gymnastics has the same clinical incidence
of catastrophic injuries as ice hockey.
The majority of gymnastic injuries 40% according to school or a recreational sports venue. And girls are more likely
than boys to sustain upper extremity injuries. While boys have more incidence involving head and neck. Fractures and
dislocations were most common for children's 6 to 11 years of age.
And strains and sprains were more frequent in the 12 to 17 age group. "Our study suggests prevention and reduction
of gymnastic injuries may be achieved by the Establishment and Universal Enforcement of Rules and Regulations for
gymnast, coaches and spotters… said Dr. McKenzie who is also an Assistant Professor at the Ohio State University
College of Medicine. Data for the study was obtained from the National Electronic Injury Surveillance System.
The analysis included cases of gymnastics-related injuries treated at Emergency Departments across the country
during the 16 year. Wow! As many significant gymnastic injuries as there are in kids participating in ice hockey.
That's something to think about. All right, more than 92% of US children carry backpacks, typically the backpacks are
loaded with one quarter of the child's body weight and worn it with only one strap. Last year a team of physician
researchers examined effect of heavy loaded backpack straps can have on children.
They found that straps can significantly increase pressure when the load is 10% or more of the child's body weight.
They also found strap pressures with loads as well as 10% of body weight can obstruct localized blood flow and
contribute to shoulder fatigue.
This year the team has examined a pack straps in adults, in some profession such as the military, firefighting and
mountain rescue the packs may equal as much as 60% of adult body weight. The findings of the most recent study
indicate that even light loads of 26 pounds can decrease upper extremity blood flow and may result in loss of fine
motor control and increase fatigue.
Backpack straps typically rest on an area of the body where they may compress the axillary vein which causes
abnormally high blood pressure inside the veins and a subsequent decrease of blood flow in the shoulders and arms.
The researchers speculated that blood of the large and small vessels of the upper extremity area will decrease in an
individual all wearing a backpack.
To test their theory they examined eight healthy volunteers' six men and two women between the ages of 18 and 30.
The right brachial artery was measured using ultrasound and the index finger pulp microvascular flow was measured
using a photo optical device. Baseline flows were measured immediately before and 10 minutes after donning a 26
A 10-minute testing period was chosen because people typically wear backpack for at least 10 minutes. This amount
of time is also sufficient to measure blood flow. After wearing the pack for 10 minutes brachial artery blood flow
decrease from 2.66 to 1.52 mL/sec and index finger microvascular flow decrease from 100% to 46%, and both of
these reduction were statistically significant.
The researchers conclude that backpack loads of just 26 pounds decrease upper extremity macrovascular and
microvascular blood flows and may result on loss of fine motor control and increase fatigue. They wrap up by saying
"Which reminds that mechanism of diminished blood flow is likely due to strap compression of the axillary vein and we
think backpack straps may benefit from a redesign that skirts the vein leading from the upper extremity to the heart….
And you know what else would benefit from a redesign those thick heavy, glossy page textbooks? I mean, c'mon,
they're so 20th century.& You know, the thing is with that too… you know, you hear a lot of people say, "Oh, we're just
doing too much online stuff, and you know when you have textbooks online or having a digital copy of a textbook is not
the same as having the actual book.
But those books play a lot. And you know, I do see a lot of kids with back and shoulder pain and issues in my office
because of backpacks. So, something else to think about. We just got all kinds of things to think about today, totally.
All right, People, and this is definitely another one. You have to think long and hard about this one. People who play
violent games online actually feel more relax and less angry after they have played. This is the finding of Ms. Jane
Barnett and her colleagues at Middlesex University.
There was also presented at the British Psychological Societies Annual Conference in Dublin earlier this month. The
psychologist recruited 292 male and female online gamers, playing the game World of War Craft.
The players aged between 12 and 83 years, yes I said 83 years were asked to complete a questionnaire on anger, a
question in personality, and then play the game for two hours after this time they were asked to complete the test
again. The psychologist found overall the gamers were more likely to feel calm after playing.
But there were differences depending on sex, age and personality. Ms. Barnett said "there were actually higher levels
of relaxation after playing the game as supposed to experiencing anger but this did very much depend on personality
This will help us to develop an emotion and gaming questionnaire to help distinguish the type of gamer who is likely to
transfer their online aggression into everyday life…. You know, I bet this was not the result Ms. Barnett expected to find
when she embarked on the study. But that's the thing about research, you don't hypothesis with a proven hypothesis and sometimes you're thinking it's turned upside down.
We're going to take another break and we will be back to answer your questions, right after this.
All right. First stop is Char in Victoria, Idaho and Char says, "We're currently learning about breath-holding with our 14
-month-old little girl, Isabella. It has been a scary experienced that my husband and I have never heard of.
As we talked to friends, family and doctors about it, we're learning, it is not rare. In fact, my mother told me I have
similar occurrences as a young tot.
What can you tell us and your listeners about it? All right. First, let's just go kid of a typical case of breath-
holding. So you have an upset infant-toddler young child. They're very upset of something, they're crying frantically and
then in the course of crying, they hold their breath.
And then usually they take a great big deep breath in and just hold it and then their face turns red. The mom panics,
you know wonders if they're going to breathe again. She might blow in the face, pat on him on the back but in any
case, then he does finally start breathing again, here is she.
Now in a more, that's a typical case of it. In a more severe case, they might not start breathing again and their face
goes from red to more of a dusky color, they get a little blue around their lips and then they pass out. As soon as they
pass out they start breathing again cause the reason that they are holding their breath it's voluntary.
So the autonomic nervous system takes over as soon as they pass out. They start breathing again, their blood gets
oxygenated and they have a normal return of color. The recovery phase of this when they wake up, the child wakes up
and there's no, what we call post-ictal state.
This is what happens after seizure, when you wake up but you're still kind of out of it. You may not know who you are or
where you are and you're just a sort as you know, very calm and quiet for, you know, many, many minutes to a couple
of hours. Afterwards, you do not see that with a breath holding spells.
They basically just wake up and they might be calmer at that point or they may remember that they were upset and the
cycle kind of repeats all over again. Now, some important considerations here, there are plenty of bad things that can
make a child cry, make their face turn red and the blue and then they pass out.
So, you don't want to see a kid who does this. You don't want to immediately think, Oh, it's a breath-holding spell. That
should not be the first thing that comes to your mind because they're lots of bad things that can start to mimic this. For
example, a heart problem especially with an arrhythmia can cause this sort of thing to happen.
You know, the kid feels their chest feels funny or they might have some chest pain. They start to cry, you know, and
then their face turns blue, they pass out and they can die because it's really a heart problem and not a breath-holding
Other brain problems that can also mimic this, so you could have an infection encephalitis, meningitis, brain tumors,
hydrocephalus, head injury, seizures, you know, can sure to mimic this except for the difference with this post-ictal
state. From the doctor's mind, something that has to cross the doctor's mind is an abuse problem.
When you have this, a mom who's coming and explains that this has happened but she didn't necessarily see the
beginning of the event. Was there a mom's boyfriend, who may be shot the baby? Many terrible things to think about
but something has to cross the doctor's mind. So the bottom line here, if you just can't assume it a breath-holding
You want to make sure that you hold everything else out first. The bottom line here too is that there has to be… in order
that even consider breath-holding really, there should be initiating event something that upsets the child. So, they want
something they can't have, or they want out of the crib, you know, there's something that they want or you know, they
either want to do or want to have.
And when that is the initiating thing, you have to be careful because kids quickly learn that if their reaction is extreme,
they get what they want. And even young babies are smart and can put two and two together. And they can learn. "Hey!
If I cry to the point of vomiting or holding my breath until I pass out, I get what I want.
Now, I'm not saying that all breath-holding spells are done on purpose in fact most aren't. But if you hold your breath
enough you will pass out and some kids do learn to use this as a tool not many but some do. So you do have to be
careful, you don't want to give in to once when reactions are extreme, otherwise you allow the reaction to become
effective and it'll soon be more difficult to extinguish.
Now, in addition to wanting something or wanting to do something or wanting to be somewhere else, and that's what's
making the kid upset. Another very common initiating event is pain. So you have kids who fall down, they may scrape
themselves, have a head injury, or in the doctor's office getting their shots and they can get their breath-holding spell
and pass out.
And you have to be careful with this scenario particularly following a head injury because are they having a typical
breath-holding spell or they bunk their head and they have a brain bleed and that's the reason that they have turned
blue and pass out.
So, you know again, you have to be kind of careful with this. My advice is the first time it happens go see your doctor
for a full exam, no matter what. Next time it happens if it's a similar situation, call your doctor and touch base. Third
time it happens as long as it's… you know, the same typical pattern. There's an initiating event.
Yeah, keep a diary and next time you go in to your doctor's office let him know how many times and how often this sort
of things happening. That's what I would have someone do. Your doctor may want you to approach it differently. So I'll
make sure you talk to them about it.
You know, in doing that if there's ever a change in typical the pattern, if you know, suddenly they have a spell and there
wasn't something that they were upset about that initiated it where it last longer it's a different in anyway, I would
definitely touch base with your doctor because kids were prone to breath-holding could also have an arrhythmia.
And you don't want them to have pass-out because they have some heart condition and you're just blaming it on their
breath-holding spells. So when it's different than its usual pattern wherein particularly if there's not an initiating event,
then you want to be really careful and make sure you talk to your doctor.
So again, breath-holding spells ended up themselves as long as that is the true diagnosis are not dangerous. They
don't result in brain damage of any kind. They can certainly be scary to witness. But they aren't really a problem and
kids are going to outgrow them.
But other things that it can seem like breath-holding spells can be very serious and life threatening and you don't want
to kid yourself that breath-holding is to blame if the true explanation is something more sinister. I do have any
information sheet for you on breath-holding from pediatric adviser and we have a link to that in the show notes.
Next stop is Emily in Chicago. Emily says, "Hi Dr. Mike. I've been listening to your podcast since my commute has
been extended to an hour and a half last fall. I've greatly enjoyed it and then amazed that you have time to do your
podcast after you busy day at the office. I am a teacher, and although I loved my job, I don't want to do a podcast about it when I get home….
See for me though, it's not wanting to do the podcast, it's not wanting to go in to the office. "My question is I recently
took my daughter to her 12-month-old well check-up. I had to fill other form asking questions about her exposure to
lead. One question asked if we had lived in a home that was built prior to 1960, we had. So I checked yes.
And when I went in to see the doctor, she said my daughter would need a lead screening. As I research what was
involved in the lead screening, I was not happy to found out it included a blood drop. I do not think my daughter would
handle this well. From birth to 7 months we lived in the older home but my daughter wasn't really mobile enough to get
near paint, let alone scrape it and we are not doing any remodeling where any paint flakes or dust would be in the
We currently live in a newer home and it was right after we moved here that are daughter started really crawling and is
now walking. Am I out of line by not wanting her to have the screening? I don't really think she is at risk. I would love to
know what your take is on this.
Thanks, Emily in Chicago. P.S. I loved your podcast, the month or so ago about weaning children from breast milk at
11 months. My daughter was just that age when the podcast aired and that was the question I also had. I did wean her
starting at 11 months and we and she had no problems…. All right, so lead exposure.
I'll be honest with you Emily. I don't even use that lead questionnaire. I checked every child's lead level at 12 months, 2
years and 5 years period. Every child gets a lead test that I see for well check-up, when they're a year old, 2 years old
and 5. Why several reasons? There's potential for lead exposure that is not on the lead questionnaires.
Such as do you have anything in your house with a label that reads Made in China? In my mind that should be on the
questionnaire but it's not. I have seen kids who live in homes. Most of the lead questionnaires end up saying about
after 1978, is when most of the new codes went in to effect with regard to lead paint in terms of getting rid of those.
So, generally, if you live in a house built after 1978, the paint at least should be safe. But I have seen kids who live in
homes built after 1978 who have lived in a newer house their entire life who didn't go to an old daycare, who didn't frequently visit their grandma who lives in an old house whose mother doesn't make jewelry and whose dad is not a plumber, who have come back with high lead levels.
And I mentioned those about mom and dad making jewelry or being a plumber because that's on the questionnaire. So, in any care I've seen kids without any of these respecters who have come back with high lead levels, high enough to
be dangerous and high enough to need to be hospitalized for what we call chelation therapy.
So you know, I checked the questionnaire and I just checked everybody. What exactly is on the standard lead
questionnaire, I put a link on the show notes to once, so you can take a look at it for yourself. But you know, I checked
for anemia at 12 months, 2 years and 5 years as well, which is pretty standard as far as childhood screening tests go.
So you know, you're getting a blood draw anyway, you might as well throw in the lead test as well. And now, there was one
issue. There's two ways to get blood out of the kid. A capillary stick, you know like a finger poker, you'll poke versus a
venipuncture, where you're getting it out of the vein like on the inside of the elbow.
The problem with the capillary stick is that lead particles on the skin aren't necessarily dangerous but they can
contaminate a capillary samples. So as you kind of squeeze and you're getting the blood out and you're collecting it,
the blood touches the skin.
And if there is any lead particles on the skin. They can make the blood level of lead seem like it's higher than what
really is, where a venipuncture the needle goes directly into the vein. Blood goes in to the needle. Blood doesn't touch
the skin, then that's the more accurate reading of what the blood lead level really is.
So, if you do a capillary stick, and you get a high lead result, you should recheck it with a venipuncture. So you know, I
just start out what the venipuncture in every kid. In that way, you have a result, you can trust and you don't have to put
anybody through a second blood draw. Unless it comes back really out of line or really hide.
If I check another one, make sure that the test wasn't mess up. The folks in our lab draw blood from babies and young
children all the time. They're good at what they do and from most of the experienced is not as traumatic as one thinks