Baby Obesity, MMR Advice, Acne – PediaCast 123

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  • Baby Obesity
  • MMR Advice
  • Acne
  • Teething Tablets
  • Abnormal Uvula
  • Motion Sickness




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


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 mums and dads. It's episode 123 for Monday May 5, 2008. Teething Tablets, Cleft Palate and Motion Sickness.


I would like to thank our episode sponsor this week it is the Minute Pie Mold Company makers of great camping cookware. Including Pie Irons at a round, square and linear shape. And they have the same quality they have since 1962. Be sure to visit them online at

You know, one of the questions that I am often asked is what other podcast do I listen too? And as I thought I've shared some of those with you today. And if you're new to podcasting these are some great shows to check out or if you've been listening to podcast for a while and you're looking for something different you know, maybe there's one or two in here, you haven't heard off before.

So I thought I'm sharing with you. Well, you can find all of this in iTunes and of course in the show notes. We got a links up to each of this podcast website as well. So, you know, in the kids and family section, I have to admit, I listened to this types of podcast least often I'm immerse in pediatric and family issues all day at the office and in putting together PediaCast and when I get home from work, at home.


So the kids and family tight podcast, I don't listen to a lot. My favorites without… no question about it. My favorites are going to be PediaCast. No I'm just teasing. Manic mommies just fantastic. Erin and Kristin do a great job over there. So I do keep a subscription to their show on my iPad and listen to them frequently.

I was also at Jumping Monkeys I'm a big Leo Laporte fan and Megan does a great job as well and jumping monkeys always has some interesting things. So they're not a good one in the Kids and Family John Russell. Manic Mommies and Jumping Monkeys excellent shows if you haven't check them out. I supposed you have checked them out because you're listening to PediaCast, we're in the same category and you probably explored other shows.


So what else do I listen too? Well, those of you who've listen long know that I'm kind of a tech geek like a Mac. I'm a Mac guy. All right, not the PC dude, I'm the Mac guy. And of course if I'm a Leo Laporte fan and I like Mac. You know, MacBreak Weekly, it's got to be in there, really a great show. Kind of long but PediaCast could be long sometimes too. Merlin, gotta love Merlin.

So it's a great show Mac very quickly. Also if you want to keep up to date on your Mac News and you just have 10 to 50 minutes a day Mac OS Ken is a great podcast as well. Check out MacBreak Weekly and Mac OS Ken if you are a Mac tech person. If you're interested in doing your own podcast, there some great resources for podcasters and I do keep active subscriptions to this podcast on my iPad as well. Podcast 411 where Rob interviews podcasters although he's never interview me.


But that's OK. Rob does a great job interviewing different podcasters. C.C. Chapman does managing the gray, where it talks about new media and economics and getting sponsors and basically making a living doing podcast and blogs. And then Jason Van Orden at Podcasting Underground does a great job teaching you how to put a podcast together if you listen that serious from the beginning, you can learn a lot.

So those are some great ones on podcasting. And then my favorite category I call it just for fun. Redboy podcast, Matt and his wife Amy, Absolute Amy do their podcast from the corn fields of Central Illinois and they do a fabulous job if you've not check out the Redboy podcast, you must.


I love and some of you won't like this one but I love hometown tales. These are two guys who basically feature each episode a different hometown tale. You know mostly like folkloric type stuffs, so you know it talk about big foot and zombies and UFOs and you know, it's fun.  And I know, like I said some of you won't get into it, but it's a good podcast.

And then if you got the kids around and you want some good ones with the kids but that's also entertaining for grown-ups as well because you know, the ones are just for the little kids, I don't listen to those, I'm too busy. So if I'm going to listen to someone with my kids I want to be entertained too.

And the radio adventures of Dr. Floyd, griddle cakes which he stops for a while but I'm really glad his back. Griddle cakes and comedy forecast are great ones to listen with your kids. And again you can find all of these in iTunes and look for links to the individual websites in the show notes.


So I have a question many times, I just thought I'd go ahead and share it with you. So there you have it. That's what I listened too. All right, what are we going to talk about today on PediaCast, Baby Obesity, MMR advice and Acne… MMR advice is one, acne is another.

Teething tablets, abnormal uvulas and  a particular type of cleft palate, we're going to discuss that, also motion sickness. So lots coming your way. Don't forget if there's a topic that you would like to discuss or hear us discuss or you have a question or comment, go to click the contact link, you can get a hold on me that way.

You can also email make sure you'll let us know where you from.  Or call the voice line at 347-404-KIDS. Also if you haven't had a chance to stop by the website and complete the survey it will take you all of 30 seconds. It is much quicker survey than what used to be there.


It just gets demographic information and that's it. And I would ask you if you haven't done that please do. And even if you did the old survey which was the Podtrac survey that had page after page after page of questions. This one is quick and easy, I promise. So if you could do that for me I'd really appreciate it. All right, the information presented in this show 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.

Also your use of this audio program is subject to the PediaCast terms of use agreement which you can find at And with that in mind, we will be back with News Parents Can Use right after the 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

Know that scientist took part in a symposium at the American Society for Nutrition's Annual Meeting and discuss new infant feeding studies which used methodology such as randomized clinical trials, involving breast feeding promotion as well as sibling, peers analysis.

These studies may offer new insights on the possible associations between infant feeding and health outcomes such as obesity. The symposium infant feeding and the development of obesity, what does the science tell us brought together International experts in the field of infant nutrition to present their recent findings.


Featured researchers included Dr. David Barker, Professor of Clinical Epidemiology at the University of Southampton, UK who soon to be published study examines breastfeeding in a large group of sibling pairs that were followed in to their late 60s. This type of study design controls from maternal factors, according to Dr. Barker, differences in the long term effects of breast and bottle feeding may reflect differences in the mothers rather than the effects of the feeding itself.

Maternal factors include mother's mental status, her caregiving, mother-child interactions or other health related behaviors of the mother that may interfere with determining the association of infant feeding and health outcomes in the strength of any possible associations.

Our study designs such as the randomized clinical trial on breastfeeding and health outcomes in infants in Bellerose recently conducted by Michael Kramer, a Pediatrician and Perinatal Epidemiologist at McGill University in Montreal, provide evidence that research design can have a significant impact on infant feeding study results.


In a randomized infant feeding clinical trial, noticed the Gold Standard in Research. Infant's would be randomly assigned to be breastfeed or formula feed. However, such trials are generally not feasible in infant feeding research since mum wants to determine their infants feeding method.

Dr. Kramer randomly assigned hospitals to two groups instead, one implementing new breastfeeding promotion practices and the other continuing their usual standards of care for education. A total of 14,000 kids around 17,000 from each group participated in the study.

He found that despite the substantial increase and prolonged and exclusive breastfeeding among mothers receiving the intervention, there were no differences between their children and the children of mothers from the control hospitals. The once that did not implement breastfeeding promotion practices on several measures of body fat at 6-1/2 years of age.


These findings challenge the concept that breastfeeding reduces the risk of obesity in childhood as some other studies have found. Dr. Kramer spoke to the strength of his study design and pointed out the fact that other studies may have been flood due too to inherent bias in their design. Dr. Kramer said previously reported beneficial effects linking increase breastfeeding to decrease obesity may be the result of uncontrolled confounding and selection bias.

The study performed by Dr. Kramer represents the largest randomized trial done today in the area of human lactation. Other researchers at the symposium presented the outcomes in more traditional epidemiologic studies that were based on observational designs and does have limitations such as not being able to control subject's behavior. Br. Beth Mayer Davis, a Professor of Nutrition and Diabetes Researcher had University of North Carolina at Chapel Hill, discussed findings from her research on Infant Feeding and Diabetes in ethnic groups in the United States.


In her observational study of less than 300 subjects, mothers of children with diabetes were asked to recall if and for how long they breast feed their infant. Dr. Mayer Davis reported that breastfeeding appeared to reduce the risk for development of type II diabetes in youth, possibly mediated in part by weigh status in childhood.

And Dr. Nancy Butte, Professor of Pediatrics of the Children's Nutrition Research Center at Bailer College of Medicine, discussed the early infant feeding practices and that effect on obesity. Dr. Butte presented their work her work from the Viva la Familia Study, an observational project with a cohort of more than 1000 Hispanic children.

Dr. Butte noted that although breastfeeding appeared to have a small protected effect against childhood obesity. Other factors such as genetics and environmental variables far superseded infant feeding practices as risk factors for childhood obesity.


Alright, so why do I include this information in Pediacast? Is it to say: "hey it's ok to feed your babies formula…. Or to say, "Breast feeding does not protect your child against obesity,… No, you know, I still think breast feeding is best when it works. My point here is to show you something very encouraging in the scientific community.

We have a meeting of the American Society for Nutrition inviting scientists to present findings that clash with popular nutrition wisdom. The scientists are invited because of the quality of their research and not the content of their message.

The American Society for Nutrition puts a premium on evidence based material and it's a refreshing quality you simply won't find at an alternative medicine symposium. Here's more good news, stories about an alleged harmful link between the MMR vaccine and the onset of autism had little effect on whether US parents immunized their children.


"According to a review of the immunization records and news stories, parent's decisions were more likely influenced by recommendations from their child's pediatrician,… the researchers said. This study comes from the Children's Hospital of Philadelphia and the University of Louisville School of Medicine and was reported in the April issue of the journal pediatrics.

Data was collected from public use files of the National Immunization Survey from 1995 to 2004. A compared immunization records of 215,643 children ages 19 months to 35 months with spikes in new stories about the MMR vaccine and autism.

The news accounts were gathered from a database known as LexisNexis which tracks newspaper, television and radio news. The number of children not receiving the MMR vaccine increased after February 1998 when a scientific study proposing a link between the MMR vaccine and autism appeared in the British Journal of the Lancet.


After two years the US numbers of unvaccinated children then declined and did not rebound when the MMR autism link started to receive widespread coverage in the mainstream press suggesting a limited influence of news media on MMR immunization rates in the US. "The providers become more cautious during a period of controversy then public health officials should ensure providers are given timely advisories and access to credible recommendations'… said Dr. Michael Smith, lead author of the study and a Pediatric Infectious Disease specialist at the University of Louisville School of Medicine.

Our findings suggest that physicians may have been an important buffer against the potential negative impact of media coverage of immunization controversies. The Lancet study led by Dr. Andrew Wakefield was flawed and later discredited although widely publicized in the United Kingdom. National rates of MMR immunization in Britain fell from 92% to 73% following publication resulting in measles outbreaks and the first measles death in the UK in more than a decade.


The Children's Hospital study set out to provide the first population estimates of MMR vaccine rates in the US following publication of the Wakefield study and its subsequent media coverage. According to the data nearly 1 in 50 fifty US children miss the opportunity for MMR immunization in the two years following the Wakefield publication in private physician practices non immunization rose as high as one in 40 children.

Significant mainstream media coverage of the MMR autism controversy did not begin in the US until almost two years after the Lancet paper. By that time the number of children not receiving their MMR vaccinations was returning to the pre-Wakefield study level. Children were identified as intentionally missing MMR vaccines if they were up to date for other childhood immunizations including Hepatitis B, polio, diphtheria, tetanus proteases and homophiles influenza but not the MMR.


The current study looked to immunization rates through 2004. The decision to immunize children is influenced by three things: the parent's willingness, the health care provider's attitude and input toward guiding the decision and the vaccine's availability. Since there was no supply shortage during the study period, the decline can only be attributed to either the parent's or the health care provider's reluctance to vaccinate.

"Some medical providers made aware of the Wakefield study may initially have become hesitant to administer the MMR vaccine,… said the authors. "The lesson for the public health community may be that the willingness to immunize the children is a story played out in the examination room during private conversation between the doctor and family… said Smith.

Updating the doctor with the most credible information and with strategies for discussing vaccine safety with parents may be the most efficient way to guarantee successful immunization practices in the face of increasing amounts of often unreliable and misleading information.


OK. Dr. Smith here on Pediacast, you sir are preaching to the choir. And finally a message from the acne skin guide at More than forty years ago children watch films with an animated character named Jiminy Cricket. He represented the conscience of the film's main character. He was a little voice saying do this or do that.

Self-esteem can be viewed as a little voice. A person's self-esteem tells him or her "you're a person who had something to the world…. When that voice becomes stilled then the self-esteem disappears and the person without it starts to pay attention to all of the unkind comments that might be made about him or her.

Parents should start to build a child's self-esteem in the early childhood years because the social pressures invading a teenager's life can be handled more effectively with a strong foundation of confidence. Unfortunately many teens frequently lack self-confidence when they suffer repeated acne flare ups.


They fell like they will never look good which explains why the effects of acne can… e… into and possibly destroy growing layers of a teens self-esteem.  Think about the activities that fill the life of the average teenager. After school, here she might take part in sports rather extracurricular activities and almost all of these activities involve socializing. A student with that mean might shy away from socializing with others and thereby refrain from taking part.

And think about the magazines teenagers read, magazines with sport stars and Hollywood celebrities, the pages are filled with acne free faces and this sends the message that no one with acne is up to enjoy celebrity status and teens with acne problems begin to feel they lack all prospects for an exciting and rewarding life.

The result is a rapid loss of self-esteem and study show kids with low self-esteem tend to take part in destructive activities and have an increased risk of crime and low productivity as adults. This underlines the importance and benefit of tackling acne related psychological problems head on. So parents take acne seriously.


Visit your child's doctor for help. Over-the-counter medication is often ineffective and severe cases can lead to life-long scarring. By the way, the vast majority of acne cases do not require a referral to a dermatologist because pediatricians and family doctors are well experienced in dealing with acne.

Again, there's great information of the acne skin guide, and we'll have a link there for you in the show notes. All right. We're going to take a quick break and we'll be back to answer your questions, right after this.



All right. First up in our listener's segment today is Barbara in Folsom, California. Barbara says, "Hi Dr. Mike. I really enjoy your show. I have a question about teething tablets. I've heard a mixed review on them some people swear by them and other people say, it's an opiate and you are essentially drugging your child when you give it to them and other say it's poison and can cause serious reactions.

I bought them for my son as he seems to be in a lot of pain with his eye teeth coming in, but I'm scared to give them to him. What is your take? Thanks, keep up the good work, Barbara…. All right Barbara, well, I wouldn't be scared to give teething tablets to your baby but I wouldn't put too much talk in them working either.

I've divided my discussion on teething tablets into two parts: safety and efficacy. Are they safe and do they work. But before we get into that I've a critical question for you. Does teething really cause pain?


The answer is we don't know for sure. You know, babies have an immature nervous system and they can be naturally cranky. They may be fuzzy from acid reflux because they have heart burn. They can have ear infections, they can be too warm, they can be too cold they could be hungry. They can have a dirty diaper.

I mean there's lot of reasons for babies to be fuzzy. And teething is a convenient answer because it seems like it something that would hurt. And maybe it does but we don't know for certain because the babies aren't talking and telling us. We do know that there are molars that erupt through fresh gum after kids have started talking.

You know, you get your 2-year molars, you get your 5-year molars or 6- year molar right around there. I know there are plenty of times that I have pointed those newly erupting molars of the parents at well check-up, and I get the response, "Oh! I didn't know those were coming in…. And why did they know, because their kids were complaining about mouth pain. You've know they have this new teeth coming in and they were old enough to talk.


Other times, I see a kid who is 2 or 3 who is messing with an ear and they say their ear hurts. The exam reveals a normal ear, normal ear canal, normal tonsils, normal mouth. In fact the only significant finding is a new molar erupting on that same side. Now then the question becomes is it really pain? Or is it simply an annoying tingle radiating to the ear.

And I think the truth is that it's a variable , I think teething probably affect some kids more adversely than others, I think other kids tolerate it just fine.  You know, so it's hard to say. You know, I would say that I doubt that it causes severe pain.

And if your kid is, you know irritable and crying, and difficult to console it's probably not their teeth that's doing it. OK now. Does teething cause runny nose and fever? There are many good studies looking at that but it's doubtful. Runny nose and fever are usually caused by viruses.


And I hear people say, "Oh every time my kid gets a tooth, they get a runny nose and a fever…. But you know, they can easily… I could just as easily say "you know what every time my kid gets a cold, the tooth pops out…. You know, so infants guilt lots of bonuses differs two years of life because their immune system is a blank slay.

You have to get sick to make protection for the next time that virus comes around. And at the same time infants are constantly having new teeter up during the same time period. But just because two things are happening at the same time does not mean there is a cause and effect.

So I mean, you can't say that just because they haven't at the same time that teething causes runny nose and fever any more than you can say having a runny nose and fever causes the tooth to pop out.

OK, I've stated that here, back to teething tablets. OK. First word about safety, I'm going to use Hyland's teething tablets as an example because they've been run a long time.  And this information that I'm going to share with you comes directly from their safety information page and you can look for a link to that in the show notes.


And in their page according to their site, they say "first and foremost homeopathic medicines are regulated as drugs by the Food and Drug Administration as required in the Food, Drug and Cosmetic Act. The production of Hyland's homeopathic medicines occurs within a validated process as with any FDA regulated drug to ensure an accepted level of consistency in product output.

OK, that's reassuring. Now, the pain reducing ingredient in Hyland's teething tablets is Belladonna, which comes from a plant atropa belladonna which is also known by the botanists as deadly nightshade. No, I'm not kidding, it really is. Now, atropa belladonna is also the subject to folklore. The story is claiming that the devil has the exclusive right to plant and harvest belladonna hence any one eating it, has visited and killed by the devil himself. OK, that's not so reassuring.


But Hylands safety sheet goes on to say, the amount of belladonna in teething tablet is miniscule especially when compared to conventional medicine. Conventional medicine typically uses 0.2 to 5 mg of belladonna per tablet as an antispasmodic roughly 1000 to 25,000 times larger than the quantities used in Hyland's teething tablets.

The side effects sometimes caused the conventional medicines delivering more than 0.2 mg of belladonna such as dry mouth, blurred vision and urinary retention are not associated with homeopathic medicines because of their minute dosage. The homeopathic dosages in perspective typically a 10 pound child  will need to ingest 1000 Hyland's teething tablets or at least six bottles of 125 tablets each to exhibit even the first possible side effect of belladonna, OK, that's according to the company's website.


Now, that makes me reassured again. OK, but this pegs the question was such a tiny sprinkle of the stuff and you feel does it really work? Now there aren't any placebo control double blind studies to tell us. So you have go with your own experience on this one. You know, if it seems like it works, use it. Just don't give your 10 pound child 723 tablets in one sitting.

Because that according to Hylands, the amount you need to get the first side effect. All right, if you need that many tablets to get the first possible side effect, will one of those tablets do anything at all. I'll let you be the judge but probably not. I do have an excellent teething source for you from the British Dental Journal and it's an article from 2002 and it's called teething troubles? I leave a link for you in the show notes.


Another words, it's questioning, does teething really even cause trouble? So, anyway I'll check that out. Include some interesting historical perspectives. For example, don't you know that doctors used to slice open the gums in a crisscross pattern above each tooth to help it erupt? Did you know that long time ago, stroke? See medicine changes. Thank goodness.

All right, next up is Katie from Phoenix, Arizona. Katie says, "Hi Dr. Mike I've been listening to your podcast for the last few months and I am happy to found it as a hissing answers, so many questions that will come up on a daily basis. I have a question for you regarding my son. Today was his 6-month well check-up and his pediatrician noticed that he has a bifid uvula were actually split.

So it looks like W. this is not a terrible surprise because my husband was born with a full cleft palate. The doctor informed me that for now there are no reasons to worry. But if my son never had throat surgery such as having his tonsils removed it may become an issue.


In your opinion, is there something I should be worried about now? In other words, shall I take my son to see a specialist? I've heard that in cleft palate cases if an operation is needed it's best to do so before the child is one, so that it doesn't interfere with speech development. I've also read online that children with bifid uvula have more ear infections and possible hearing loss. What do you think of this and are there other problems that I should be aware of.

Thank you for all your work toward putting together this podcast/ I look forward to hearing your response…. Well thanks for your question Katie.  For those who aren't following what we're talking about here, the uvula is the dangly thing in the back of the throat. You know, hanging down from the middle.

And a bifid uvula is one with a split going partway up the middle. So instead of being shaped like a single finger hanging down in the back of your throat is more like two legs hanging down back there. Now technically, this is a cleft palate because the uvula is part of the palate and there's a cleft in it. There's a division.


But you're in good company because it's present in the whole 2% of the US population. So, 4 million fellow US citizens have bifid uvulas. And the good news is that by itself this condition is functionally inconsequential. So it won't be a problem at all other than looking a little different when your child's opens wide and says, "ah!…. But noticed I said by itself there is no problem. Here's the thing, a bifid uvula maybe associated with the presence of a submucosal cleft palate.

OK, what's that? Well, just to be real basic, you know the palate is to refer the mouth, the hard palates in the front, the soft palate in the back. The bifid uvula is sort of the mildest degree of cleft palate you can have. Now think of that split in the uvula travelling further forward so that it involves the portion of the soft palate.


There's a wide opening now connecting the oral cavity to the nasal cavity, that's your typical cleft palate and there can be a varying degree of severity. Now, what if that split in the soft palate. OK, now like tripping all over my words now.

What if the split in the soft palate is small? And it isn't a true connection between the mouth and the nose because there's a thin membrane still separating the two cavities that is a submucosal cleft palate. So, you have a mucous membrane still separating the mouth and the nose but you don't have the layer of muscle in the soft palate that supposed to be there.

Now again, not all bifid uvulas are associated with a submucosal cleft palate. Some of them aren't and some of them are. So although Katie in your case, I think it's more likely with dad having a history of a significant full cleft palate, it's more likely that your child's bifid uvula is going to be associated with the submucosal cleft palate.


If a bifid uvula, I hope I'm not confused. I feel like I'm confusing everyone. The bifid uvula, you got a split and the dangling thing at the back of the throat. If it's not associated with submucosal cleft palate then it's not an issue, it's never going to be an issue even with tonsils and or adenoid surgery down the road.

However, if the bifid uvula is associated with the submucosal cleft then it could be an issue down the road because there's a risk you could open that connection between the mouth and nose and of course of throat surgery particularly if you're working on the adenoid. And then that would open up the whole new set of problems which are beyond the scope of our present discussion. So, let's say you discover a submucosal cleft in the child.


OK, let's say, you have the bifid uvula, you got to look in to a little bit further and the doctor decides, "Yeah you do have a submucosal cleft…. So there is a split in the soft palate but there's a membrane still separating the mouth from the nose. What do you do? Do you get it fix? I think really, that is what Katie is asking.

That's the decision you ultimately have to make in consultation with your child's doctor. But I will say this, I generally subscribe to the notion of "If it's not broken, don't fix it…. And 90% of kids with submucosal cleft palate will have no obvious symptoms at all. And if you try to fix them, you may create problems in the process.

So I will personally take a conservative approach if it was my kid and only intervene if definite problem arises which is unlikely. Now, on the other hand, 10% of kids with the submucosal cleft will have some problems with it.


These are usually mild problems but they include the following: the most common is going to be increase nasal resonance when speaking. Because this membrane between the mouth and the nose acts kind of like a drum and you're going to get some reverberations and so you going to have a little bit more nasal tone to your voice.

Now, if that's the only problem a person has is fixing it worth the risk of surgical complications. It's a tough call. You know, it's not an easy answer to that. Now, less commonly with the submucosal cleft palate you can have a speech articulation and swallowing problems because you're missing the portion of the muscle that supposed to be in the soft palate.

And these muscles are important for proper speech and swallowing. Now the good news in the majority of cases, the amount missing is inconsequential and speech and swallowing are not significantly affected.


But if they are significantly affected then the decision to fix the submucosal cleft is a little easier. Now, one final thing to consider: let say an infant has no swallowing problem but they do sound more nasally when they cry but they're not speaking yet. Will they end up having speech problems?

I mean, that's the million dollar question, right. Cause you don't want to do unnecessary surgery and open up unnecessary risk, but at the same time it's better to prevent speech problems than to try to fix pathological patterns after the facts. So this is dicey and the right answer is not the same for everyone. There's going to be some kid, you decide not to fix who end up having problems and you wished you have fix them.

And there's going to be some kids who you fix that may have complications from the fix who never would have had a single problem if you just left them alone. You know we don't have crystal balls to predict this stuff. So what do I think you should do Katie? Well, here's what I would do. Especially given your family history, I would ask for referral to a cleft palate team at a Children's Hospital just to get their opinion.


You know it's going to be a multidisciplinary approach involving the Pediatric Ear, Nose and Throat specialist, the plastic surgery folks, the dentist, the speech pathologist, the audiologist, and a psychological support services. I mean, they're going to give your son the best assessment and be able to tell you their experiences with kids in similar situations and the usual rush in the surgery if it's not necessary.

What I want to do, is I would and go, see an EENT outside of the dedicated cleft palate clinic. I would want a team. And I witness too, about whether you're stepping on you primary care doctor's toes or asking for the referral. I mean, you and your child's best advocate and sometimes you have to step on toes to take the best care of your kids. So, it's a good question Katie.

Really, thanks for it. It's a good one. So that's what I would do. I would have at least looked into. You know, the decision whether they actually have a fix or not if the submucosal cleft exist with the bifid uvula.

You know, what we do is fix or not fix it, that's the tough question and I think a cleft palate team would be in the best position to give you the right answer. If it's a bifid uvula and there is no associated submucosal cleft with it. Yeah, just leave it alone. I do have a link in the show notes on submucosal cleft palate from the cleft palate foundation and just look on the show notes for the link to that.

OK, one more listener question here. Erika in Portland, Connecticut, says "Hi Dr. Mike, I discover your podcast about a year and really enjoy listening. I slowly working my way to the back episodes, I haven't yet come across wanted to address my issue. My question is about motion sickness. Basically are there any options out there that actually work other than avoiding travel in a car?…

My daughters 4-1/2 and 7 get car sick throw up intermittently. We know what happens when they try to read and discover it also happens when the older one tries to do her homework in the car but otherwise, there's no real pattern. Could be in a long trip, could be short trip.


We're driving from Connecticut, the Prince Edward Island in Canada this summer and we'd loved any advice on how to minimize this issue that we are well stuck on buckets, paper towels and fiber. Thank so much for a great show.

All right. Well, first, what causes motion sickness? The real cause is the brain receiving mixed signals regarding the body's position and movement through space. And this is why reading and doing homework makes it worse. Remember the semi-circular canals in the inner ear going to make you think back to high school biology again.

You basically have three semicircular tubes filled with fluid or partially filled with fluid, I should say. And receptor cells and these three semi-circular tubes are in the inner ear and they're aligned in different directions. So when you move the fluid moves and it activates the receptor cells and your brain gets the signal which it interprets and has able to tell which way you're going.


And what position your body is in as relates to gravity. Spinning on an axis, you know, spinning around in a circle causes problems because the fluid is slashing around activating receptors and all the canals and the brain as no idea what that's going on. And you get motion sick.

Now in a car, you're brain knows you're moving forward through space because of signals from the semi-circular canals in the inner ear. But if you're reading or doing homework, your eye is or telling, or playing a video game or watching a DVD on screen. Your eyes tell your brain that you are still.

So, you have a mismatch. You've got your semi-circular canals telling your brain one thing and your eyes telling the brain something different. And in motion sick prone individuals, the brains response with a typical set of symptoms. Symptoms which may require bucket, paper towels and fiber.


So there's two ways you can deal with this. 1. You can minimize the conflicting signals or you can blunt the brains response to the conflicting signals. So let's look at each one of these options. In terms of minimizing the conflicting signals, watching out the front window so that your eyes see what the body is feeling is the best way to prevent motion sickness in a car.

And this is why drivers rarely get motion sick because they're paying attention to where they're going. You want to minimize looking down, looking at the side windows, looking at video games, DVD players, you know all those kind of things. Now of course this is going to bore the heck at the kids grown up in the 21st century.

You know, they're going to be ask, are we there yet. They're going to be fighting with their siblings. You know, it going to be like when I was a kid most in the car but it is less likely if they're going to get sick. So you know, there's a good time for games. You know, have them watch out the front window and play. I'm thinking of something, I spy 20 questions, you got the picture.


You could also consider travelling at night because there's going to be decrease visual signals going to the brain then may be your kids will sleep. You know, traffics off and better, but you may have trouble staying away. And then you'll be tired when you get to where you're going. And your kids will be ready to go. So, that's not always the best solution.

OK, in addition to minimizing this mismatch of signals the next option is go ahead and let that conflicting signals be there but blunt the brains response to those signals and that's going to require a chemical cause your brain response to chemicals.  One chemical that is often times thought about in helping with motion sickness is ginger. And my nurse at work swears by ginger ale when she takes cruises. And mid posture actually did try on an episode and it did seem to work.


So you could try sipping ginger ale during the car ride, but the ginger ale actually has to have ginger in it to work. Cadbury Schweppes actually has a corner on the market when it comes to ginger ale. They make Canada Dry, Verners and Schweppes. I don't think Coke or Pepsi make ginger ale products. So I looked up the ingredients and they're basically, Canada Dry, Verners and Schweppes they're all the same probably the proportions are a lot different to make them taste a little different.

But basically, they're made up of carbonated water, high fructose corn syrup (bad stuff) and/or sugar. So they don't tell you which it is. Citric acid and natural flavors, sodium benzoate as a preservative and caramel color except for Vernerswhich doesn't. Oh no, it does. Verners does have caramel color.  So they all have this the same set of ingredients. Ginger probably comes in the play under the category natural flavors but, you know, it doesn't say for certain.


You know, how much ginger really is in there. So, you know, is factory-made ginger ale really going to help this? I have enough ginger in it to do anything.  I don't know. There are recipes for homemade ginger ale in the internet but I'm not sure I would drink that myself, let alone give it to my kids.

So anyway, commercially prepared ginger ale is something you could try and if doesn't work, well you have the fiber candies to cover up partially digested ginger ale smell. All right. While the verdict on ginger is still out, we know for certain that antihistamine blunts the brain reaction to the conflicting signals of motion sickness.

The tried and true antihistamine in this case is Benadryl or diphenhydramine is the drug name and one brand of diphenhydramine is Benadryl. Has an excellent safety record in kids. You have to ask you doctors about dosing, it is likely to make you child sleepy and you do have to watch out because a few kids have opposite reaction.


So, it doesn't make them sleepy. The opposite happens they are motion sick but they turn in to who again. So you have to be careful with that. The original Dramamine is another example, the drug name there is dimenhydrinate and it does have dosing approval down to age two. So you can ask your doctor about using Dramamine as well.

They are the lesser drowsy antihistamines Bonine, and Dramamine too. The active ingredient in this is meclizine, which is the same antihistamine that is an Antivert which is given to people who are having dizzy spells. That dosage is approved down to age 12.

Now, when we talk about dosing approval you have to keep in mind that, that means the drug company has tested it down to that age and has said it's safe. So if you use it at lower age, it's off label but it doesn't mean using something off labeled does not mean it's not the standard of care for instance using Albuterol in a 4-month-old  who's wheezing is the standard of care but technically it's off labeled cause it's not approve for use under the age of two.


OK. So in pediatrics we deal with this all the time. So, just because something says it's approved for use down the age 12. Your doctor may give you advice on using it or not using it and what dose and you have to take that up with your doctor because if I'll tell you what medicine and what dose that I'm practicing medicine, which is not inappropriate in the context of a podcast.

So those are some of your option. By the way the non-drowsy anti-histamine and I only mention this because you may be thinking, "Hey! Antihistamine, it's going to work…. Loratadine which is the active ingredients in Claritin and cetirizine which is the active ingredient in Zyrtec, these are the non-drowsy antihistamines. They are not likely to work because they don't cross the blood-brain barrier very well. That's why they're non-drowsy. They don't make it into the brain.


However, in some people they do get into the brain and these are the few individuals who get sleepy with Claritin and Zyrtec and that's why they're so called non-drowsy antihistamines because they're non-drowsy in most people but not everybody. In some people the drug is able to cross the blood-brain barrier, get in to the brain, causes drowsiness.

So if you're one of these people or your kids are one of these people who get sleepy with Claritin or Zyrtec then they might help you with motion sickness to some extent. Now, keep in mind that any of these drugs that help with motion sickness are going to have other side effects beside sleepiness including dry mouth, anxiety, urinary retention and blurry vision.

So always ask your doctor before using and always use the lowest dose that works. So I hope that helps, Erika. At least I give you a few options to think about and hopefully, you'll find a plan that works, and have fun and safe trip.

All right we're going to take a break and we'll wrap up the show right after this.



You know it takes a lot of help to make a podcast happen and I would like to thank Nationwide Children's Hospital, The Minute Pie Mold Company, Vlad Studio, Medical News Today, and listeners like you for helping make it all happen. As you're listening to this show, as long as everything goes according to plan. I am actually on vacation in Florida. We'll be at Disneyworld at Wilderness Lodge when this episode post.


And for today's highlighted Pediascribe post on digging back in to the archives a bit and featuring the post "I'll be going to Disneyworld…. Karen wrote this back in November during National blog writing month. Reader had asked Karen about her favorite Disney sites and community boards and since we are members of Disney vacation club and we visit the mouse often.

Karen has lots of good resources to share. So if you're interested in taking a Disney vacation be sure check out the post "I'll be going to Disneyworld… and I have a link to that for you in the show notes. Don't forget the PediaCast shop is open, so you can get a t-shirt.

And also don't forget if you're going to a vacation somewhere like Disneyworld or another recognizable place, be sure to get a PediaCast t-shirt where there's snap of picture, send it in. We'll upload it to the site and in Fall, we'll put everybody's name in a hot drawn name. The winner's going to get $100 Amazon gift certificate. So and you know what is it do for us?


Well, you know, you're out and about where in a PediaCast shirt to help spread the word. iTunes reviews are helpful also posters are available for download at the poster page for putting up on bulletin boards. And again I want to mention if you haven't filled out the new listener's survey provided by Wizard Media it's in the side bar of the website at If you filled out the old survey from Podtrac that was a really long survey. This one is quick, easy, take you 30 seconds. So please do that even if you filled out the old one once upon a time.

All right. I hope everybody 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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