Plastic Bottles, Cradle Cap, Peanut Butter – Pediacast 125
- Type I Diabetes
- Plastic Bottles
- Cradle Cap
- Peanut Butter
- Evidence Discovered For Suspected Cause Of Type 1 Diabetes
- Comfort For Bespectacled Kids – Eyeglasses Make Them Look Smart
- Depressed Teenagers Making Themselves Worse With Marijuana
- Bisphenol A (Wikipedia)
- Bisphenol A (American Chemistry Council)
- Mixing Plastic And Food: An Urban Legend? (WebMD)
Announcer 1: Bandwidth for PediaCast is provided by Nationwide Children's Hospital. For every child. For every reason.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from Birdhouse Studios, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone, and welcome to PediaCast, a pediatric podcast for moms and dads. It's Episode 125 for Monday, May 19, 2008. Plastic Bottles, Cradle Cap, and Peanut Butter. So we're back from vacation definitely rested and we're in to go although you can probably tell from my voice that I've got a little cold.
It's from touching handrails, you know and lines at Disneyworld and doorknobs and I'm sure actually the family both Karen, Katie and Nick they also underwent through it while we were on vacation and of course I have to open my mouth and say "Oh, it's probably something I have a few times before because I feel fine.
And then of course, you get me home and within a day or two I got congestion and cough and all that and so. OK, you don't have to feel too bad for me. I just spent two weeks and one week on a cruise and one week in Florida.
So I know I'm not getting your sympathy at the moment but anyway, I'll try to make it to this entire podcast without my voice cracking up but too much and we will see how that goes. We had a great time on vacation. I have to tell you, the weather in Florida this time of the year is spectacular and compared to Ohio weather, we got back.
Well, when we were there I think we saw a sprinkle-like may be one day and you know blue skies, white fluffy clouds the rest of the time we're again there. Now I know that it's not necessarily good for them. You know to have that kind of weather day after day, after day because then you get the threat of getting too dry and the wild fires.
But you know, when you're just going there for a couple of weeks on vacation, I'm glad it was a nice weather for us. Although I do feel for you now with some of the wild fires that are going on. But anyway, the weather was nice, you know blue skies and then we get back to Ohio.& And then we started, this was on Mother's day.
And we start descending through this wall of dark clouds and it's just like, "Welcome back to Ohio…. You know typically Ohio weather for this time of year. Well it turns out there was a tornado like five miles to the North where our plane was landing. And I believe that because it was such a rocky landing and I did notice that our plane was the last one to land in that direction.
Every other plane that came in after us will approach from the opposite side and came in that way, so the way to the clouds that we went right through. But we were coming initially over grass and then it seem like wind blew us into the runway and then we landed. We were all OK but there was a tornado reported at touch down at the time we were landing just like five miles away.
But I'm here in one piece just a little shaken from that experience, but we'll fly again ‘cause driving to Florida is not fun. So we did have a great time, a little bit changed in plan here. I've mentioned before we left for vacation that I was going to bump up the production schedule and try to get out two or three shows a week like I was doing there for a while, shorter shows.
Hang on to your horses; we're going to stick with one show per week for now. But stay tuned for some exciting announcements of new projects that I'm working on that will be of great benefit to all of you in the future. You just have to trust me on this one and there will be of course much, much more to come.
All right, so we're going to talk about today type I diabetes, eye glasses and marijuana are all in the news segment. And we'll answer some of your questions. We're going to talk about plastic bottles and chemicals leaching out of plastic bottles. We talked about this way back in Episode 35 but here recently I've got a bunch of questions about it.
So we're going to re-visit that topic. Also question about cradle cap and how you get rid of that in babies, and when is the right time to introduced peanut butter? We're going to talk about that as well.
Don't forget if there's a topic that you would like us to discuss on PediaCast, it's really easy to get hold of this. Just go to pediacast.org, click on the contact link. You could also email firstname.lastname@example.org if you get to us that way make sure you'll let us know your name and where you from in addition to your question.
Also the voice line is available at 347-404-KIDS. Let me also 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 do have a concern about your child's health, call your doctor and arrange a face to face interview and hands on physical examination.
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.
Scientist at Washington University School of Medicine in St. Louis working with diabetic mice have examined and unprecedented detail, the immune cells long thought to be responsible for type I diabetes.
Researchers were able to examine the immune cells from isolated insulin making structures in the pancreas know as islets of Langerhans. They cut the immune cells known as dendritic cells, right handed carrying insulin and fragments of insulin producing cells known as beta cells
This could be the first step towards starting a misdirected immune system attack that destroys the beta cells preventing the body from making insulin and causing type I diabetes. The results reported online in the proceeding's of the National Academy of Sciences push scientist to step closer to finding ways to treat this condition.
Now that we've isolated dendritic cells we can look at why they get in to the pancreas and determine their role in causing this form of diabetes says senior author Dr. Emil Unanue, Paul & Ellen Lacy Professor of Pathology that may allow us to find ways to inhibit dendritic cell function in order to block the disorder.
The American Diabetes Association estimates that one million to two million American suffer from type I diabetes which is also called Juvenile Diabetes because it frequently develops in children. Patient's required insulin injections to survive because the immune system is destroyed. The islets of Langerhans which contains the body's only beta cells. The insulin in these cells make us required for the critical task relating blood sugar levels.
Scientist detected dendritic cells in the Islets years ago. Dendritic another antigen presenting cells are the signals of the immune system that pick up bets of protein from around the body and present them to lymphocytes to initiate an immune system reaction.
The lymphocytes lead immunotax against foreign invaders like bacteria and viruses and eliminate them clearing the infections. An interaction between an antigen presenting cell and a lymphocytes leads to a part of the body being mistakenly identified as alien. The resulting attack harms the body causing autoimmune diseases.
Although dendritic cells present in the islet and their ability to summon immunotax made them likely suspects in type I diabetes. They were challenging to isolate from the pancreas for closer examination. The very tiny and there are only about 5 to 10 of them per islet.
Each of which contain approximately a thousand cells explains Unanue. So the senior postdoctoral researcher in the lab who did this work, Boris Cauldron had to develop some sophisticated cellular assays to pick them up.
Dr. Cauldron found indications that dendritic cells were carrying granules of insulin and pieces of proteins from beta cells. To test whether this cargo had the potential to trigger immune attack on beta cells.
Cauldron expose the dendritic cells to lymphocytes taken from diabetic mice. The lymphocytes were activated by the dendritic cells and switch into attack mode. In a separate line of research Unanue's lab has learned that dendritic cells in the pancreas may normally have beneficial effects on the health of beta cells.
They've shown that when dendritic cells are absent from the pancreas, the beta cells are smaller an indication that they're not as healthy. We think these dendritic cells are in the pancreas by accident says Unanue.
We believe in the normal individual they help maintain the help of beta cells. But in the person with autoimmune diabetes, they appear to start the problems that destroy the beta cells.
The key distinction likely lies in the group of proteins called the major histocompatibility complex, two decades ago Unanue and Dr. Paul Allen, Robert L. Kroc professor of Pathology and Immunology show that the major histocompatibility complex provides a stage in which antigen presenting cells show bits of protein or peptides to other immune system cells.
Scientist believes autoimmune conditions like type I diabetes are caused by differences in what the major histocompatibility complex binds to and how it presents that material to immune attack cells.
In support of this theory Unanue's laboratory and Dr. Michael Gross Washington University Professor of Chemistry have collaboratively shown the genes including the major histocompatibility complex proteins in the diabetic mice are unique and bind to a set of very characteristic peptides.
In addition, the study what protein fragments carried by dendritic cells are essential for causing type I diabetes Unanue and others are working to learn how genetic variations in the major histocompatibility complex all to have a chances that the immune system will mistakenly attack the body.
OK, there was a lot of science in that story, I understand. So to balance a bit or to provide a bit of balance, here is a later topic. Young children tend to think that other kids with glasses look smarter than kids who don't wear glasses according to a new study.
Children between the ages of 6 and 10 who were surveyed for the study also thought that kids wearing glasses look more honest than children who don't wear glasses. Otherwise, the survey suggested that children don't tend to judge the attractiveness of their peers who wear glasses when asked about their appearance, potential as a playmate, or likely athletic abilities.
The findings might give children some comfort when they are fitted with the first pair of eye glasses that leads study author Jeffrey Walline, Assistant Professor of Optometry at the Ohio State University. If the impression of looking smarter will appeal to a child, I will use that information and tell the child this is based on research, Walline said. Most kids getting glasses for the first time are sensitive about how they're getting to look.
Some kids simply refuse to wear glasses because they think they look ugly. The study is published in the May issue of the Journal Ophthalmic and Physiologic Optics. Walline surveyed children in this age range because they are more likely to be prescribed eye glasses than contact lenses.
Generally, children with near sightedness are diagnosed with myopia and receive their first corrected lenses at around age 8. Teenagers were not surveyed because they are routinely fitted with contact lenses if they want them. For the study Walline and colleagues has simple to series of 24 pairs of pictures of children for comparison.
The children in each paired differed by gender and ethnicity and each pair included with one child with glasses and one child without glasses. An 80 young children, 42 girls and 38 boys were surveyed of those 30 kids or 38% wore glasses themselves, 34 had at least one siblings with glasses, and almost 2/3 had at least one parent who wore glasses.
The questionnaire featured six questions, many base on similar studies on adults when presented with each pair of photos the participants were asked which of the two children picture, which you rather played with, which looks smarter, which of the two looks better at playing sports.
Which do you is better looking, which one looks more shy and which one looks more honest? On the average two-thirds of the participating children said they thought that kids wearing smarter than kids not wearing glasses. And 57% of the participants said that they thought kids with glasses appeared to be more honest.
Both kids with and without glasses thought other kids wearing glasses looks smarter. Walline said the finding suggest the media portrayal associating spectacles with intelligence may be reinforcing a stereotype that even young children accept.
In the case of the other four questions in the survey, the answers were not consistent enough to suggest that glasses made a difference and how the kids feel about the pictures, they were examining. Other trend emerge however, they have nothing to do with whether the kids in the pictures were wearing glasses in which supported conventional wisdom about kids opinions.
But boys and girls said they thought that boys appear to be better at playing sports. Boys indicated that they would rather play with boys and girls said they would prefer playing with girls. Both boys and girls thought the opposite gender look more shy.
Girls also were more likely than boys to pick their own gender when ask which child look more honest? "The fact that the question of attractiveness yielded no significantly different answers for children with or without glasses suggest that kids don't automatically consider kids with glasses to be unattractive,… Walline said. "The concern about attractiveness with glasses seems to be more internal to a particular child rather than an indicator of how do I feel about other people who wore glasses,…& Walline said.
Walline conducted a study with students at the Ohio State University and the Southern California College of Optometry. And from school age kids to teenagers, a new Whitehouse report says, many American Teenagers were depressed and used marijuana to alleviate their condition or more likely to make it worst and even risk developing more serious mental health problems such as schizophrenia, anxiety and even suicide.
The report which came out last week is from the Whitehouse Office of National Drug Control Policy and says millions of American teenagers said they experience feelings of hopelessness and loss of interest in the activities of normal daily life both signs of depression and many of these depressed youths are using marijuana and other substances.
The report says some teenagers are self-medicating their symptoms of depression with marijuana and don't realize they could actually be making them worst. May is a Mental Health Awareness Month hence the timely release of the report which estimates there are 2 million American teenagers who have felt depressed at some point over the last 12 months.
The report also suggest that depressed use are more than twice as likely to have used marijuana and have used it or become dependent on it. And nearly twice as likely to abuse the legal substances over the same 12 months as non-depressed youths. Director of the National Drug Control Policy, John P. Walters told the press that marijuana is not the answer.
Too many young people are making a bad situation worse by using marijuana and a misguided effort to relieve their symptoms of depression and he urged parents not dismiss teen moodiness as a passing face. Look closely at your teens behavior because it could be a sign of something more serious.
There is some good news since 2001, 25% fewer teenagers are using marijuana, however, they still out numbered the combined total of teens who use other drugs. The report makes the following key points: teenagers who smoke marijuana at least once a month are three times to have more likely suicidal thoughts than those who never use it.
Marijuana use can lead to depression and other mental health disorders. Well the proportion of depressed teens is about the same as the proportion of depressed adults. They're more likely than adults to use marijuana another illegal substances. Teenage girls who use marijuana are more likely to develop depression than teenage girls who never use it.
Teenagers who are depressed are more likely to practice other risky behaviors like daily use of cigarettes and heavy us of alcohol than non-depressed teenagers whose VH1 popular celebrity rehab program and addiction expert Dr. Drew Pinsky said "Don't be fooled into thinking that pot is harmless….
Marijuana is an addictive drug and teens who are already depressed and use marijuana may increase rods from suffering from even more serious mental health problems. Another aspect to consider is this, marijuana has become more prone over the last 20 or 30 years which makes it more likely that users may suffer Mental Health Problems, said the report which points the research showing that higher potency marijuana may be behind the rise and American used seeking help for dependence on the drug.
Long term users of marijuana are more likely to develop schizophrenia, other forms of psychosis and even become suicidal. As the director of the National Institute on drug abuse Dr. Nora Volkow explained not only our adolescence are great risk for drug abuse, but they may suffer more consequences. There are also some evidence that in vulnerable teens because of genetic factors, the abuse of marijuana can even trigger schizophrenia
Again parents should not assume mood swings or just the passing face and they should keep an eye out for carelessness with grooming, change in friends. Lacks of interest in the normal daily life's activities and withdrawing from family suggest the report.
They should also be more involve with their teenage children, ask them how they spend their time and give them clear rules about drug use and the consequences if they break them. All right, that concludes Our News Parents Can Use. We'll be back with your questions right after this short break.
All right, on to your questions. Now, you've probably noticed that here in the last few minutes my voice has been cracking a little bit. So, I got some water here and as we go to this listener questions you may have to hear me take a couple of sips because my throat's pretty purge in this cold virus that I have.
You know, and it's doing its thing but I'll be over it soon. And I didn't want to delay getting the show out because the next topic that we are going to address is one that I have gotten a lot of questions about and I picked four of the questions to read.
Normally I just read one of them and then say, some more people wrote. But this topic is so important to some people. I wanted to have a few different people get their voice heard.
So first up is Wendy in Lao, Massachusetts. She says, "Hi, Dr. Mike. Love the show and I recommend it to all my friends with kids. What are your thoughts on the recent announcement of Bisphenol A leaching out plastic bottles? Is it the heat from dishwashing that makes it worst. and should I invest a new baby bottles as I'm expecting.
And should I invest a new baby bottles as I'm expecting number 2 in two months? I thought maybe you'd be privy to more research than me. Thanks for dedicated hard work on this podcast. Kudos! Wendy in Lao, Massachusetts….
And then Deb in Jessup Maryland says, "Hello I'm a first time mom I've a wonderful 10-month-old Ian. I've a question for you about BPA Bisphenol A issues that have been going on. Can you please clarify this for me.
I'm confused as whether the BPA is truly a concern or not? Do I need to return the plastic bottles I have? We've been using them this whole time and we do not heat them in the microwave but we do wash them in the dishwasher. This is still an issue, I'm just confused and the info I can find just makes me more confused. Thanks, and you have a great show here. Keep up the great work….
Listener number three, is Sarah in Las Vegas, Nevada. She says, "Please do a show on BPA and its effects. I stopped using our plastic bottles when our son was 11 months old and I'd like to hear your opinion on the research regarding BPA long term effects. Thank you….
And finally, Bryan in Sherbrook, Quebec says, "I was just wondering what your thoughts are on the studies they are doing on plastic baby bottles and is there a risk while using them or it is another attack from ‘parental terrorists?'…
You know, let's talk a little bit about Bisphenol A and I did this. I looked back it was clear back on PediaCast number 35, so back in the early days. So, it's been long enough now, I thought, now let's go ahead and tackle this again plus have had so many questions about this. So the chemical that we're talking about here is Bisphenol A, and it's part of the physical make up of many plastics.
In fact it's been used in plastics for decades and we do know that heating plastic breaks chemical bonds.& So does lead to the possibility of molecules from the plastic entering food that contacts it.
Now this of course then has wide implications of plastic containers of many types including bottles and sippy cups but the question becomes, is this a problem? Well the current thinking is that the amount we're exposed to on a normal basis has remained steady over the years and this includes maternal use of plastic during pregnancy and plastic exposure by infants. So 40 years of ubiquitous plastic use in all age group would suggest that this is a safe exposure.
However, a couple of years ago there was some Habab in California. If there's going to be Habab, it's probably going to be in California an independent laboratory study in conjunction with the environmental California Research and Policy center.
Basically, did some test on five popular baby bottle brands and this included Avent, Dr. Browns, Evenflo, Gerber and Playtex. And they found that all five leach Bisphenol A at levels that were "found to cause harm in numerous laboratory animal studies.
High levels of Bisphenol A have been linked to other studies by the way to cancers, impaired immune function, early onset of puberty, obesity, diabetes and hyperactivity. No because of these findings environmental California recommends that consumers choose glass or safer plastic baby bottles.
In other words, plastic without Bisphenol A in it. They also advice against heating food or drink in plastic containers and against using harsh dishwashing soap and hot water for cleaning plastics.
And so with this recommendations has led some legislative bodies and various states to consider banning the use of plastics containing Bisphenol A now on the flip side, the American Plastics Council says "the Bisphenol A is one of the most extensively tested materials and use today….
The way of scientific evidence clearly supports the safety of BPA and provide strong reassurance that there's no basis for human health concern from exposure to BPA. Now, OK. That may be a bit bias coming from the American Plastics Council but they make a good point because many of the studies showing relationships between Bisphenol A and disease in laboratory animals have not had statistically significant results and were not published in peer reviewed journals.
Plus are the levels that harm mice the same as the levels that could potentially harm humans? Environmental California claims it does but that's probably a bit of the stretch. As we move to a safer plastic one without Bisphenol A, my question is what harmful effects we find from the supposedly safer plastic in another 40 years?
The other thing to consider is what does the FDA have to say about all this? Well generally speaking, any food that you buy in a plastic container with the directions to put in a microwave has been tested and approved for safe use said George Pauli, Associate Director of Science and Policy at the FDA Center for Food and Safety and Applied Nutrition.
What the industry does and runs bias for approval is simulate the testing to determine what could come out of the container says Pauli. We assume there will always be something that will leach out of the container into the food. So we looked at how much someone could consume over a lifetime and compare that with what we know about the toxicity of the substance. So, whether if it's Bisphenol A or any other chemical, the FDAs job is to monitor the amount we're exposed too.
Including the amount known to leach out a plastic and make sure it's a safe level. And so far, they say that it is. Now could they be wrong? Well sure, and research is on-going to test the validity of their position if that research ends up showing a danger, the FDA will pull the products including infant bottles and sippy cups from consumer shelves. Until that time, if I had to make the decision for my own children, I'd stick with using the bottles and cups we've been using for the last 40 years.
Looked I've said that before, leaving is risky; there are dangerous lurking around every corner. We can minimize risk but we cannot eliminate it from our lives. I mean, you can switch to different plastic or use glass.
But new plastics may improve to have currently unknown risk and glass is subject to chipping and chattering which can lead to serious lacerations and glass ingestion. I think as a parent it's really more important to encourage well balance diet and exercise. Keep your kids away from cigarette smoke.
Avoid over crowded daycare centers and encourage lots of stimulation of all the senses in all aspects of life. Am I going to worry about the safety of Evenflo bottles and Playtex sippy cups At this point?
No, of course I could change as we find out more through on-going research. Should you as a parent be concerned? That of course is up to you. This is a gray area and you have to look at both sides and come up with a decision you can live with. In that spirit I do present some interesting links in the show notes for you.
I give each one a good looking over and I think it's a fair and balance approach. Bisphenol A from Wikipedia just has a brief history of the chemical that I thought was interesting. There's also a link to the American Chemistry Council with more detailed information with the slant towards improving Bisphenol A is safe.
I also have a link to the National Geographic Green Guide and it's slanted more toward caution about Bisphenol A and baby bottles without going so far to claim that the sky is falling and then a nice overview, sort of a moderate stance comes from WebMD, it's an article called "Mixing Plastic and Food in Urban Legend so look for those in the show notes at Pediacast.org.
All right I'm going to grab sip water here really quick and then we're going to talk about cradle cap. So give me just a second. I apologize for that, and I know, you know how I feel about post production. So, OK, everybody's cool.
Helen in Vancouver, British Columbia says, "Hi Dr. Mike, my husband and I are new listeners to your podcast. We listen to it at night before we fall asleep. We are parents of an 8-month-old daughter who's had cradle cap since she was born. Our baby constantly scratches her head especially during the night.
We've tried the Olive oil, Glaxal cream and hydrocortisone cream but of no long term success. A friend recommended to try a dandruff shampoo. When I went to the drug store, the pharmacist didn't recommend it for a baby. Any thought on this issue? Your new fans from Vancouver, British Columbia, Alan and Helen….
OK, Alan and Helen.& I laugh because I think of, what was that in that movie or the show with a riser and what was that? Mad About You. Helen Hunt – that's right Helen Hunt. I just think Mad About You, you know, they're laying in bed listening, I don't like that in comes to mind, I don't know maybe because Helen Hunt, I don't know.
OK. I'm like way going up on tangent here.& I'm swear it's water I'm sipping on. Let's talk about cradle cap. Technically cradle cap is a seborrheic dermatitis of the scalp. OK so what is that mean? Seborrheic dermatitis, dermatitis is easy, dermatitis means skin rash.
Seborrheic pertains to the oil producing glands of the body which makes an oily sweat called sebum. So this is a skin rash of the scalp that involves oil producing glands. So what causes that? Well, you know the body is constantly making new skin and as new skin comes on board the old skin falls off.
In fact, you may want to think about it this way but a large portion of dust around your house is actually slipped off human skin. Now in babies with cradle cap the bodies making new skin cells on the scalp at a very fast rate. The dead skin sheds but the rate is so rapid it accumulates resulting in dry scales.
The dry scales blocked the outlet of the sebaceous glands causing sebum to build up inside the gland. The body response with inflammation to try to dissolve that extra dead skin and unplug the glands. Now once there's enough pressure from build up of the sebum it oozes out anyway, but now there's too much of it of the skin.
It's sticky oil which makes the dead shed skin form even more scales that stick to the scalp with the sebum acting like glue. So really we have a vicious cycle of play. And then to make matters worse Mom's hormones that cross the placenta into the baby's body, you know so they're in new first 2 or 3 months of life.
Those hormones stimulate the sebaceous gland to make even more sebum. So as the dead skin cells get slip off and they accumulate this extra sebum oozes around them, glues in to the skin which causes more blockage, which causes more back of sebum and then the sebum oozes out causes you know you see this is a vicious cycle and it's common in young babies. And so which ends up is a scaly scalp with inflammation kind of oozy looking wet, oily, and itchy.
And then as a complication of all this. Yeast often grows in this field of dead scaly skin which leads to more inflammation and irritation. And the presence of yeast also contributes the faster skin production and these causes more scaling and more sebaceous gland obstruction.
And then you can also get abrasions and secondary bacterial skin infections as babies scratch the itchy skin. They cut their fingers in their mouth. Their fingernails are well too long.
Mom's afraid to cut them or close and then the baby scratches her head and get the abrasions and then you can get bacterial infections on top of that. So what do you do about this? Well first you have to decrease the scaling and you really can decrease the ray of skin turn over.
So, you have to get rid of the skin that the scalp is trying to shed. Baby oil works well for this such as slippery oil rather than a sticky oil and it helps loosen the sebum and the scales and makes them easier to brush up.
So, daily application of baby oil and brushing with a soft bristle brush will help to eliminate the scales. Now my wife and I, especially my daughter had this. My son didn't have quite a big of a problem with it. But my daughter did. And I remember we used to use a vegetable brush.
I mean, a square plastic brush that had like a sponge on one side and little plastic bristles on the other but they're really soft, flexible bristles and that worked very well for us. So, you know we give her the rub with the baby well then use the vegetable brush to get the scales off.
Now, we did not use that to clean vegetables in between. OK, it was dedicated cradle cap brush. So getting rid of the scales helps to get rid of the sebaceous gland obstruction which decreases the buildup of sebum on the scalp.
Which further reduces scale formation. So you're basically, breaking the cycle if you can help these glands not get plugged up because they can just release their normal amount of sebum a little tiny bit at a time rather than oozing a whole bunch of it out at once. So, by controlling scaling with baby oil and brushing you help the scalp break the cycle.
Now what about the yeast? Well if there's lots of yeast over growth your efforts may not work because the yeast will stimulate skill build up faster than you can get rid of it. So you also have to control yeast growth if it's present and it usually is.
Yeast is also involved with older child and adult dry scalp known as dandruff and so dandruff shampoos like as Selsun blue for example contain a chemical called selenium which kills yeast. So dandruff shampoos are an effective addition to the treatment regimen.
They've been used in very young babies for many years with an excellent safety profiles.so in my practice I do use them for very young babies with cradle cap. The biggest issue you faced with the dandruff shampoos is that they aren't no more tears.
They will cause eye burning, stinging irritation. So you have to be careful with that otherwise your baby will grow to hate bedtime ‘cause they think you're going to get to shampoo in their eyes. They're going to scream and yell and be upset.
Another form of treatment is to control inflammation, so you want the body not to make the inflammation that is going to unplug the glands because of the presence of the yeast. So, sometimes we use various strings of hydrocortisone creams for short periods to control the inflammation present with cradle cap.
So you know, overall treatment, you know, first you did a mineral oil or baby oil and the brushing. Sometimes we use some hydrocortisone cream as well and sometimes we use the dandruff shampoo too.
If your child never get cradle cap, fine there's no reason to do any of these things but if they are prone to getting it in terms of once you got it treated and you wanted to stay away then daily baby oil application and brushing will help and may be even once or twice weekly use of the dandruff shampoo may help to prevent cradle cap in a kid who's prone to it.
But always ask your doctor which by the way Helen you failed to mention you took the advice of your friend, you took the advice of your pharmacist but you didn't mention asking your doctor which is always an important thing to do. OK. One more question and one more sip here. I'll be better next time we're together, I promise. My voice will be well rested.
This one is Mary in Chicago. And Mary says, "Hi Dr. Mike, I've been listening to you since my son was about six weeks old. First I would just listen to the segments that pertain to infants. Now I listen to everything and I'm going back to listen to old episode.
I feel more prepared to deal with each future stage of my sons' life. I want to thank you for all your hard work and all the information that you provide your listeners. Now, my question I'm a stay at home Mom to a 20-month-old and have become an occasional baby sitter to many family and friends children.
I was really surprised when one friend drops off her 2 ½ year old with peanut butter and jelly sandwich recently. I was in the impression that you should wait until the child is three to give them peanut butter. Her mother said, she has been giving it to her since she was my sons' age.
I've been asking other parents when they started to give their children peanut butter and I've heard everything from 12 months to 4 years. So, when do you suggest giving a child peanut butter for the first time? Thanks again for the podcast, you're the best, Mary….
OK, Mary there's two issues of peanut butter that you have to worry about. The first is choking and the second is allergic reactions because the peanut protein. Peanut butter, you know, is thick and sticky. So you want to make sure your child is not going to choke on it.
The ability to handle peanut butter from that perspective were very widely from kid to kid. But in general, sometime between 12 and 24 months of age, kids will be able to handle the texture of peanut butter just fine and as a parent, you know, best exactly when that's going to be.
Now, under the allergic component, here I don't have an easy answer for you Mary and I'm sorry. I was like to have definitive answers for people but this is one that is a great area and continues to be a great area. I mean, ideally to know what is safe, you'd like to see the study scenario. You like take large groups of babies.
Thousands in each group. Take them from the time that they're born and make sure that they have absolutely no exposure to peanut protein of any kind from the time that they're born until their group setting says that they will be exposed. So, you're going to start exposing each group to peanut protein at a different age.
So a hypothetical example: group one, you're going to expose into it starting at 12 months. Group 2 at 15 months. Group three at 18 months. Group 4 at two years. Group 5 at 2 1/2 years. Group 6 at three years. And group 7 you're never going to expose them to peanut protein intentionally ever. You want this group to be as similar as you can get them with regard the boys versus girls.
With regard the cultural diversity, with regards to food allergies in the family and then you start checking for the presence of allergic reaction to peanut protein at a wide range of ages and all the groups and follow the groups for many years.
OK, and here where it gets dicey, what exactly constitutes an allergic reaction? Is it a positive blood test showing that they have evidence of peanut protein allergy because of a blood test? Is it a positive skin test? Or is it a symptomatic clinical reaction.
This is important because you can have positive blood and skin test and not have clinical reactions and you can have clinical reactions with a negative blood and skin test.
So for our study, we're going to use clinical reaction or symptoms to say yes or no if peanut allergy is present or not because that's really what we want to know, right? We want to know, you know, if I first expose my kid at 15 months versus waiting until they're 3 years of age is he or she more likely to have a symptomatic allergic reaction down the road.
And is the difference between doing at least different ways statistically significant. If you do a study like this and you show me that first exposure at 15 months causes statistically significant more allergic reactions down the road compared to first exposure at age 3, then I'm a believer.
In that case definitely wait until age 3 the first to expose your kids to peanuts. So what are the results of these study? Well, I don't know because the study is never been done. And why not? So why has no one done this kind of study.
Well, you known large pharmaceutical company with big box has an interest in the topic. And also you and I care immensely about this topic. The people in-charge of research grant per strings aren't likely to share our curiosity. Thirdly allergic reaction to peanut protein often present itself in a form of a severe life threatening anaphylactic reaction with hives and wheezing, and difficulty breathing.
So how many Moms and dads are going to volunteer their babies for this one? I mean, the consent form will help parents running away faster than you can say all our peanut butter sandwiches. I know OK, it's a little Sesame Street humor there for you.
So what is the right advice and where does it come from? Traditionally, we've said and continue to say that parents should avoid high allergy foods until 12 months of age and it's included a peanut-protein containing foods. There was a recent study done by the Division of Pulmonary Medicine at the Children's Hospital at Pittsburgh in 2007 that showed over the past decade, the average first exposure to peanuts change from 19 months to 12 months.
So parents seem to be giving peanuts earlier than 10 years ago and the average first clinical reaction to peanuts has gone from 20 months to 14 months, so kids are reacting to peanuts at a younger age. So there was this out-cry, the earlier exposure is a problem following this report even among a well-meaning doctors.
But when you think about it, the study doesn't say that. I mean the study really is not even all that helpful. I mean the first off, it's a survey analysis. It's not prospective case control clinical trial. And the second, this is an allergy clinic, OK all the kids had peanut allergies.
OK, says that all kids with peanut allergies and basically they give the parents survey and when to first give him peanuts and when do they first have their reaction? So you know, so what, 10 years ago, parents were giving kids peanuts at 19 months and they're reacting at 21 months. And now they're giving kids peanuts at 12 months and they're reacting at 14 months.
I don't care what if they've waited until age 2 or 3? That's the question would they then react at 2 1/2 or 3 1/2? Or would they not have reacted at all. But actually, we want to know. Well, actually we wouldn't really know because if they had waited and they didn't react then they wouldn't be in the allergy clinic and they wouldn't be included in the study.
So this sort of thing is not really helpful at all in predicting who will and who won't be allergic to peanuts, but I'll tell you after that came out there was this big, Oh, you got a way, you got a way. All this says, for those who are allergic, the earlier you give peanuts, the earlier they're going to have a reaction.
I mean, no kidding. That's not or shuttering news here folks. Now, please don't mistake my flippancy here. Peanut allergy here is serious. It's potentially life-threatening; they make no mistake about that, but this idea out there that delaying exposure until age 3 is the safest way to go is not based on any known scientific principle.
Three has not been shown to be some magical age. So what do you do, well you definitely want to wait until it's no longer choking hazard. And speaking of that, we are talking about peanut butter here. You have to be particularly careful about peanuts and cashews and nuts themselves because they've a perfect size to get stuck in a child's airway.
So you really want to be careful with the choking hazard. And then with regard to allergies, if you have a family history of severe food allergies, I would dread carefully here. You know I would wait until a child is older and say 3 years old is not a bad age to wait until.
And it's not so much to prevent the allergy form occurring but because it's easier to rescue a 3 year old from a life-threatening anaphylactic episode than it's a 15 month old. And when you finally do introduce peanut protein especially when you get to the third, fourth, or fifth exposure, I wouldn't do it when you're on vacation or when you're visiting relatives who live three hours from civilization because if your child breaks that on hives, or as wheezing or difficulty breathing. You want to get them immediate medical attention.
And notice, I did say, especially when you get to the third, fourth or fifth exposure cause remember the way your body's immune system works is first you're expose to something for in the body. Recognizes such as foreign and makes antibodies against it, so that the next time I sees it, it can make a stronger reaction.
So it usually not the very first time that they're exposed to peanut protein. if this is going to be an issue, it's after they've been exposed to it a few times down the road. So keep that in mind. Also if there's a strong family history of severe food allergies, I would also avoid peanuts in the third trimester of pregnancy as well.
For those without the positive family history, you should still be careful and you should closely watch your children the first few times that here she has peanut products regardless of what age you decide to start.
By the way, there's lot more to say about peanut allergies which is beyond the scope of this discussion today. But stay tuned we may have more about that in an upcoming episode.
Incidentally, when did I first give my kids peanut protein products, we've waited till about age 12 months. That's me, my family. OK, we do each one. OK, we're going to take quick break and we will be back, to wrap up the show right after this.
All right. Thanks to all the Nationwide Children's Hospital, Audiblekids.com, Vlad over at Vlad Studio, Medical News Today, my family and of course listener's like you. Speaking of my family, in the Pediascribe blog, Karen did a post called Summarizing Two Weeks In One Post and if you want to know more about our family vacation, see some pictures of the family and action, hop on over to the blog at Pediascribe.com or you can look for the link in the show notes at pediacast.org.
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