Heat Rash, Microwaves, Penis Skin – PediaCast 129


  • Gastroschisis
  • Teenage Pregnancy / Reality Show
  • Traffic Pollution
  • Heat Rash
  • Whole Milk
  • Microwaves
  • Penis Skin



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 podcasts for moms and dads. It's Episode 129 and this one is called "Heat Rash, Microwaves, and Penis Skin".

Now, it's eclectic mix of topics, to say the least. And all I can say is you guys are responsible for this. I just answer your questions. And so, when you ask questions about heat rash and microwaves and penis skin, you're going to get the answers. So, I don't pick the topics here, folks. You do, and I'm going to blame you for this one.

How's everybody doing this week? And the show is out a little bit late this week compared to when I usually get it out it. I had hoped to get it out Monday or Tuesday and we're looking now at a Thursday, June 26th, 2008. I'm finally getting around to getting it done.

But we had a busy weekend. We went to the Parade of Homes. Now, I don't know about your area but we have, in Central Ohio, a builders association. And each year, they have a Parade of Homes, where it's big houses with all the bells and whistles and you pay six bucks and then get two or three the homes and see what& the latest trends are. Mostly dream because most years, the homes are completely out of most of our price ranges, including me.

This year, though, because of the economy, there were smaller houses. They were less expensive and that also meant there were fewer sort of cool features. And there were fewer houses too; there were just seven of them rather than the usual 12 to 15 or so.


Number-wise, I thought it was better because seven is doable. After about looking at seven houses, room to room, up and down the stairs, you're pretty much done. And when you get to be forty-some, your legs get sore when you're going up and down the stairs. The rooms start to look alike. So, seven was a good number. I remember the nearest pass we had gone and you get to House Number 14 and you're just about ready to die. So, we had a good time though.

Some of the workers at the houses we were looking at were kind of like car salesmen, really pushing their houses' features. For instance, one of the houses, the newer ones, the last couple of years now, they put butler pantries in between the kitchen and the formal dining room. And then, Karen mentioned that in this one particular house, there wasn't a butler pantry. And the lady said, the lady representing the builders, "Oh, those butler pantries are just overrated. Without it, you get more kitchen space, you get more cabinet space." Karen made the point if the house had a butler pantry like some of the other plans from that same builder, the lady working there will be praising the butler pantry and I think she's probably right about that.

So, what are favorite features touring these new homes? I'm really liking the third car garage separate from the two-car-garage. You know, like you got a two-car-garage and then, sort of on the other end of the house you have – maybe, at the different angle or different orientation – just a one-car garage. And I think that's great for clutter control.


Because our cars right now, we can't get any cars in our garage because we're kind of going through this decluttering process and that's the holding zone for our junk and so there's no room at all for cars. So, I mean, if you can have a dedicated two-car garage for both your cars and the third space used for junk, I think that would be cool.

The bath tub television, you got to love that. I mean, if you lay down in a jet tub and watch TV, I mean, that is the bomb, right? So, that was a cool feature. Got to love that.

I like the open plans. Karen likes the bonus room so you got more floor space but I kind of like it when you have sort of openness. The high windows that are horizontal and long, and if you've seen those, they let the light in, they still give you some wall space, you get more privacy and no need for window treatments. So, I kind of like that.

And then, of course, my all-time favorite feature of any house is an upstairs balcony. Just you feel like you're in vacation when you have one of those. And there was one particular floor plan that had an upstairs balcony off the master bedroom. Again, folks, I'm dreaming here. OK? But sometimes it's good to dream.

So, if you've haven't gone to one of those Parade of Homes before, even if you're not in the housing market, they're fun. They're fun just to tour around it. It's good exercises after about seven houses, though, you're done.

We saw a lot of worthless features too like cabinets up above washers and dryers that were way out of reach. You have to get a stool to get your laundries out. I guess you could store things you don't need very often up there but I'm not a big fan of shelves that you can't reach very easily.

One house had a dedicated dog wash. I mean, it was an elaborate thing, all tiled and in the utility room, and I guess you got to have a dog to appreciate that.

How about the water spa above the stove? I guess it's good to fill the pots, but then the pots – if you're worried that it's too heavy to get it back to the stove once you fill it, how are you going to get it back to the sink to dump out the water? So that, I mean, I guess it's kind of cool but I'm not sure how practical. Or do you really need to have a faucet over the stove area? Not sure about that.


OK, this one was way too much – the self-cleaning toilet. Now, I know it does not clean itself. It cleans yourself and I'm not talking about a simple bidet here, folks. I mean, this toilet had a front-cleaning cycle, a rear-cleaning cycle, an extra rinse cycle, a heated dryer with this nasty looking high power sprayers all around. And the bathroom had no toilet paper holder at all in it. I don't think so, OK. And that wasn't even in the green house.

The green house, the environmentally-friendly house, actually had a dual-flush toilet which I like where you one flush for pee, the other one for number two, and the first one uses less water. It featured one-foot thick concrete black walls, got to love that, strategically placed windows based on the lot. So, you have lots of sunlight and coming in to windows and solid walls but not many windows where the wind exposure occurred. Timers on the fans. All light fixtures would take compact fluorescent bulbs or no can lights that required incandescent bulbs, direct venting fireplaces.

OK, I did have trouble in the green home, though, with the big honking hot water tank. I thought instant hot water devices were more energy-efficient. But they had one of the old fashion big hot water tank that just constantly keeps hot water at the ready which didn't seem very environmentally-friendly to me. But what do I know, I'm a pediatrician.

And then, of course, many of these homes, there are leaky basements. There are quite a few wet basements. If you're going to parade the homes, clean up the basements.


One last story for you and this is more related to pediatrics. We are at one house looking at on upstairs windows and there was a young girl climbing on a high rock retaining wall. And the mom is sitting next to her texting on her cell phone. And this little girl, I mean, she must have been like three years old. She's crawling on top of these high wall and I…& OK, you see a scenario like that; you know what's going happen next, right?

So we go downstairs, we're touring this house. And by the time we get downstairs, the girl is crying. She's got a scuff on the knee and the dad is wiping tears out of her eyes. We didn't see the dad before but he came to the rescue and mom, still texting.


Dr. Mike Patrick:& Don't you hate that though? When you see a dangerous situation with a& kid – they're climbing this rock wall, they're standing up in the shopping cart, they're all over the car and not on a car seat – what do you do? What do you say? And it's a tough call for a pediatrician. I'm all for parental rights and privacy, but at the same time, is it my fault when I keep my mouth shut? If they're not my patients…


Dr. Mike Patrick: I probably should be more vocal at times like that.

All right. So what are we discussing today? Yes, this is not a home building podcast. But I'd like to chat. This kind of the beginning of the show is like my own little blog. So, but it's easier to talk than to write.

So welcome, everyone, one and all, to Pediacast. Today's topics: gastroschisis. That's a big word. It's in the news actually. We're going to talk a little bit about what gastroschisis is.

Teenage pregnancy reality show. Now, I'm not making that up, teenage pregnancy reality show. That's coming up in The News department.

Also, we're going to talk about traffic pollution. And then, we'll get to your questions: heat rash, whole milk, microwaves, and penis skin. That's all coming up.

And actually we're going to the Skype line today. So we're going to have Our Listener Questions – are actually calls to the Skype line, not just me reading email.


All right. Don't forget if there is a topic that you would like us to discuss, all you have to do is give us a holler. Go to Pediacast.org, you can click on the Contact link there. You can also email us at pediacast@gmail.com or call the voice line at 347-404-KIDS . That's 347-404-5437.

Let me also remind you that the information presented in every episode of Pediacast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, call your doctor and arrange a face-to-face interview and hands-on physical examination.

Also, your use of this audio program is subject to the Pediacast Terms Of Use Agreement which you can find at Pediacast.org.

And with that all mind, we'll be back with News Parents Can Use right after the short break.


Dr. Mike Patrick: 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.

Women who reported having both a sexually transmitted disease and urinary tract infection just before or during early pregnancy were four times more likely to have babies with gastroschisis – a severe birth defect in which an infant is born with their intestines and other internal organs outside the abdomen through a hole. This comes from a University of Utah report published on the online edition of the British Medical Journal.

The study which the investigators caution must be verified with further investigation may explain in par a global increase in gastroschisis, according to lead investigation Dr. Marcia Feldkamp, assistant professor of pediatrics at the University of Utah School of Medicine and director of the Utah Birth Defect Network. The National Center on Birth Defects and Developmental Disabilities, the US Centers for Disease Control and Prevention, and the Utah Birth Defect Network were partners in the study.


"Gastroschisis is a public health issue worldwide and the prevalence is on the rise in Utah," Feldkamp said. "We don't understand why this is occurring but the incidents of STDs, or Sexual Transmitted Diseases, is also increasing and there may be a connection. A study conducted by others in Utah found a ten-fold increase in gastroschisis from 1971 to 2002," according to Feldkamp.

The causes and mechanisms of gastroschisis are not known but researchers suspect environmental and maternal factors may be related to the birth defect. The age of a woman giving birth also appears to play a strong role. Women less than 20 years old are 11 times more likely to have& babies with gastroschisis compared with women older than 25. Nationally, one in every 2,700 babies is born with gastroschisis. The prevalence of gastroschisis is estimated at about one in 570 births in Utah when the woman is less than 20 years old.

Feldkamp and colleagues from the University of Utah Pediatrics Department, the Utah Department of Health, and the National Center on Birth Defects and Developmental Disabilities conducted their studies as part of the National Birth Defects Prevention Study. This study is a multi-site national investigation using birth defect surveillance systems in Utah and nine other states. The researchers compared data on mothers of 505 babies with gastroschisis and a control group of 4,924 babies without the birth defect in the ten states.


Mothers of babies in both groups were questioned through a computer-assisted telephone interview and asked whether they had kidney, bladder or urinary tract infections or sexually transmitted diseases before or during pregnancy. About 70% of the women in each group contacted agreed to take part in the study.

Woman who reported having both an STD and UTI immediately before or early in pregnancy were four times more likely to have a child with gastroschisis and that number increase to five times more likely if the mother had both an STD and UTI and was under the age of 25. No woman in the 25 or older group reported having both types of infection and mothers and all groups reported having more urinary tract infections than sexually transmitted diseases.

Although the association between having both an STD and UTI and the risk for gastroschisis needs more study, it's possible the link might be even stronger than the study suggests, according to Feldkamp. That's because STDs and UTIs often go undiagnosed.

"One of the problems especially with Chlamydia is these infections are subclinical and go unreported because the woman doesn't know she has it," Feldkamp said. "We probably have many cases that go undiagnosed." This is a particularly important issue in under 20 age group because STDs are increasing in this demographic.

Chlamydia, in particular, is on the rise and can cause both a sexually transmitted disease and the urinary tract infection. If teens are having sex and getting pregnant, they are at risk for sexually transmitted diseases. They're not thinking about the consequences, so that's a huge problem with this age group.

Babies born with gastroschisis have a much better chance of survival now than several decades ago with about a 90% survival rate. Surgeons will place the intestines back in the abdomen but this is a slow process often resulting in complications.

And the reason for that is you can't stuff all of the intestines back inside at once because there's no room. So basically you have to put the intestines in this device called a silo, which is hung vertically above the defect in the abdominal wall and then you push the intestines out of the silo into the abdomen but you do it really slowly, kind of like you'd push toothpaste out of a tube folding the top down as you go. It's a very slow process that takes several days. And while the intestines are in that silo, there is risk for infection, perforation or rapture of the intestine bleeding and other complications.


So, I bet most of you have never heard about gastroschisis before, but now you can say you have.

There's a new NBC reality show in the works called the "Baby Borrowers" that aims to deter teenagers from becoming pregnant. NBC worked with the National Campaign to prevent teen and unplanned pregnancy on the show, scheduled to debut this week. The National Campaign which often works with the entertainment industry to highlight teen pregnancy issues has created a special discussion guide based on the program.

The show will feature five 18 to 20-year old couples, task with taking care of babies and young children on camera. Amy Kramer, senior manager of the National Campaign says, "The show sends a clear message for adolescents not to get pregnant." She went on to say the non-scripted series is a format teenagers are used to. It looks like other shows teens watched but they also get this incredible message.

After NBC announced it would produce the show, Jan Hunt, Director of the Natural Child Project posted an open letter on the group's website that criticize the network. Her quote, "The present and future emotional health of the babies and young children whose lives will be so strongly affected. Sudden removal from their parents and placement with strangers for long periods of times is from a baby and young child's point of view no different than a kidnapping. In fact, it has been well established that babies who suddenly lose their primary caregiver can quickly go to in the mourning and emotional depression."


In response to this criticism, the National Campaign says parents of the children were allowed to watch and intervene during the 18-day taping of the show and the homes were quote baby proof. Trained paramedics and nannies were also on the set and all participants underwent background checks and psychological testing.

So OK, here's my question: Is watching this really going to prevent teenagers from having unprotected sex? I mean, come on, what do you think? OK, maybe during the run of the show, they're watching it, it's fresh on their mind. OK, maybe. But a few weeks later, little alcohol, little time alone. Come on, it's like saying the death penalty deters murders in the heat of passion. I mean, the guy's not thinking about the death penalty when he pulls the trigger. And in a similar moment of passion, I don't think a teenager is going to think about this show.

Look, it's the money. It's a novel concept, more viewers equals more sales and ads. That in my mind is the bottom line. And, since it's my show, I'm allowed to express that. OK, let's move on. Although it does sometimes get me in trouble, as some of you may know.

New evidence blames traffic-related pollution for increasing the risk of allergy and atopic diseases among children by more than 50%. What's more, the closer children live to roads, the higher their risk.

Children living very close to a major road are likely to be exposed not only to a higher amount of traffic derived particles and gases, but also to more freshly emitted aerosols which maybe more toxic. This is according to lead author of the study, Dr. Joachim Heinrich of the German Research Center for Environment and Health at the Institute of Epidemiology in Munich. "Our findings provide strong evidence for the adverse effects of traffic related air pollutants on atopic diseases, as well as on allergic sensitization" wrote Dr. Heinrich.

The results appeared in the second issue for June of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine. The study examined nearly 2,900 children at age four and more than 3,000 at age six to determine the rates of doctor diagnosed asthma and/or allergy with relation to long-term exposure to traffic-related pollution. Both the four-year-old and the six-year-old groups of children came from prospective cohort studies and were enrolled at birth in the Metropolitan Munich area. Their exposure to traffic pollutants was calculated as a function of the distance of their home for major roads at birth and at age two, three and six years of age.


Parents were given questionnaires about their child's respiratory diagnoses and symptoms and their children were assessed for asthma wheezing, sneezing and eczema. At six years of age, the children were tested for food allergies. Air was tested for particulate matter like soot and nitrogen dioxide at each of 40 identified points near high traffic areas at regular intervals between March, 1999 and July of 2000.

And then, after controlling for variables – like history of allergies and parents, pet ownership, number of siblings – researchers found significant positive associations between distance to the nearest road and asthmatic bronchitis, hay fever, eczema and allergic sensitization. They also found a distant-dependent relationship between proximity to the road and risk of allergic sensitization with those living closest to major roads having a nearly 50% greater risk of allergies.

Previous studies have found that pollutants and allergic sensitization are linked, but using distance from major roads as a proxy per pollutant exposure has been confused by the socioeconomic factors that are often closely linked to such locales. However, in Munich as with other older European cities, the roads and buildings are structured so that economic advantages are not necessarily correlated with living farther from the main thoroughfares. In this study, it was possible to determine that economic factors were not a confounding variable in the analysis, but there was a clear difference in the children's allergic development with relation to their proximity to a road.


"We consistently found strong associations between the distance to the nearest main road and the allergic disease outcomes," wrote Dr. Heinrich. "Children living closer than 50 meters to a busy street had the highest probability of getting allergic symptoms compared to children living further away."

Interesting. So, think about that next time you're shopping for a house or the next time you're the next time you're trying to sell yours.

All right, that concludes our News Parents Can Use and we will be back with your questions from the Skype line right after this.


Katie:& Hi, Dr. Mike. This is Katie from Birmingham, Michigan. I had some questions about heat rash. We have a four-and-a-half-year-old and one-and-a-half-year-old and they both have very sensitive skin and they suffer from heat rash in the summer time. They get their rash on their necks and it moves up their head and down their back. And after they wake up from sleeping or naps, they have it on their face and behind their ears.

We get a lot of strange look when we take our rash-ridden kids to the swimming pool because they're covered in their rash and the chlorine seems to make it worst.

So my questions are: what exactly is heat rash? Is there anything we can do to prevent or treat it? And does the humidity make it worst? Along with the humidity, they both sweat a lot and if that that contribute to the rash as well. And how common is it? Because our kids seem to be only one blocking around half the summer covered in a rash.

Thank you for PediaCast. We are all listening. Bye.

Dr. Mike Patrick: All right, so, Katie in Birmingham, Michigan has a four-and-a-half-year and one-and-a-half-year-old. They have sensitive skin. It's worse after waking up from sleeping and most noticeable on the face, neck, and behind the ears. They also sweat a good deal and wants to know if this contribute to that and how common is this problem.


So, let's talk a little bit about so called heat rash. Lots of rashes in the warm weather months get called heat rash and there's no specific medical diagnosis of heat rash. I mean, heat by itself does not cause rashes. Now, heat can make the blood vessels in your skin dilate, kind of like a radiator effect to help cool your body temperature and you get some blushing, some redness to the skin. But that's not really a rash.

So, what is heat rash if it's not from heat? Well, what it really ends up being is a contact dermatitis. So, something is touching the skin and you are having either an allergic reaction to it or I guess a milder form of allergic reaction, so there's sensitivity to it. So, the question becomes what is touching the skin and what is causing the reaction?

Now in the summer, there are lot of possibilities for the cause of so called heat rash. You can have poison ivy, other plant oils. You can have allergic reactions to sunscreen, bug sprays, yard chemicals, pool chemicals, lots of possibilities. But none of these seem to fit your situation, Katie.

In your case, I'll bet that the culprit is your laundry detergent or fabric softener especially as it relates to sheets and pillow cases. Because if there's a trace of these chemicals on clothing or sheets or pillow cases that touch the skin and then if your child sweats, then the sweat will dissolve these trace chemicals out of the cloth and the trace chemical then come into contact with the skin. And then, allergic reaction may result. Actually, this is a very common occurrence.


So first, you have to treat what's there, OK? And then you have to eliminate the chemical contact. Now for the treatment part, I'm going to refer you back to your doctor. The options, depending on the rash severity and its location, it could include over-the-counter strength and prescription strengths steroid creams, oral steroids, steroid shots, antihistamine medicines. But even with this treatment, the process is going to repeat itself if you don't eliminate contact with the chemical in the first place.  

So again, the treatment part, talk to your doctor. But now let's talk more about eliminating contact with chemicals and clothing and bed sheets.

In your case, Katie, how do you do that? Well first, if you've recently changed laundry products, I would go back to what you were using before. If you haven't changed laundry soaps, make sure whatever you are using is hypoallergenic. So Dreft is a good bet even for older kids and teens and even adults with sensitive skin. Dye and fragrance-free detergents are also good idea. Tide for instance makes a hypo-allergenic detergent. And other brands do as well, so look for those.

Whatever detergent you do choose, use a small amount. Don't overload the water. I'm sorry, don't overload the washer and be sure to double rinse, OK? So small amount of detergent, don't overdo it on the load size and do a double-rinse to try to get all the chemical out of the clothing.

Also, just during the times of the year when your kids are having these reactions, forget the fabric softener. Both the washer kind and the dryer kinds, the liquid that you put on the washer to dry your sheets, don't do them. Because fabric softener is designed to leave a trace of chemical on the clothes after the wash and dry cycle to prevent static clean. But if that trace of chemical is causing the rash, you have to stop using it.

You could try using a different brand of fabric softener.& Or try the liquid kind in the washer if you're using sheets in the dryer or vice versa. But my experience has been you have to get rid of the fabric softener completely.

OK, I hope that helps Katie and be sure to let us know. So wash the bed sheets and pillow cases with a hypo-allergenic detergent, use a very small amount of the soap, don't overload the washer, double-rinse, don't use fabric softener. See if that helps.

OK. Let's move on. Next stop is Jennifer from Detroit.


Jennifer: Hi, Dr. Mike. This is Jennifer from Detroit. A few episodes ago, you touched on changing over from Vitamin D milk to 2% or even skimmed once a baby turned two. And I think in that episode, you even mentioned that you could do it earlier than that. I was just wondering if you could explain the differences in the milks and the fat contents and protein and what your recommendation is, specifically if you can, for an 18-month-old.

I have a three-and-a-half-year-old who's on 2%. The rest of the family drink skimmed and having three gallons of milk in my refrigerator is a little overbearing.& So we changed her to 2%, but when I took her for her 18-month-old baby, the doctor seemed a little bit concerned about that and thought that she needed the… She's larger than average 18-month-old, but still within the growth charts. And I'm just looking for a little bit more on your comments you made a couple weeks ago. Thanks a lot.

Dr. Mike Patrick: OK, so Jennifer, changing over from Vitamin D whole milk to 2% or skimmed milk. So what's the difference between them in terms of fat and protein and why do you wait until two years of age to change and what do you do for an 18-month old?

Mom has whole milk for the baby, 2% for the kids, skimmed milk for the adults and doesn't like buying three kinds of milk. So, I don't really blame her.

OK, so first, let's talk about the differences. Now we're going to be talking here about 8 oz servings. So 8 oz of skimmed milk has 0.6 grams of fat and 8.7 grams of protein, 1% milk has 2.4 grams of fat and 8.5 grams of protein, 2% milk has 4.8 grams of fat and 8.1 grams of protein; and whole milk which is 3.25%, has 7.9 grams of fat and 7.9 grams of protein.


So, skimmed milk has at least amount of fat and the most amount of protein, and whole milk has the most amount of fat and the least amount of protein. And that make sense, all right, or at least the fat part makes sense. Whole milk has got the most fat; skimmed milk has got the least amount of fat in it.

Now, you will notice that skimmed milk is not really completely fat free. There is 0.6 grams of fat per 8 oz of servings. So there's a little bit of fat still in skimmed milk. And if you think about why, it's just because when they skimmed off the fat, a little get lefts behind. It's not a perfect process. So, that makes sense.

With regard to the protein, the difference is not too drastic. The skimmed milk had 8.7 grams and the whole milk has 7.9 grams. Now, why? Why would that be? Well, it's simply because if you have less fat taking up that 8oz volume, then you have more of the non-fat portion of milk taking up space in that 8 oz and that non-fat portion of milk contains proteins. So skimmed milk has the most protein because they are so very little fat taking up space in that 8 oz servings. But again, the difference is small, 8.7 grams in skimmed milk, 7.9 grams in whole or 3.25% milk.

And what you see for protein, you're also going to see for calcium, potassium, and the milk sugars. Skimmed milk will have the most because you don't have fat taking up space.

OK. So, let's focus on that fat now. Skimmed milk has 0.6 grams of fat; whole milk has 7.9 grams of fat. So, this is a big difference. Now why do you want whole milk until the age of two? Well, as it turns out, it's not really a growth issue. The answer actually lies in the brain. I guess it is growth, but it's not growth of the whole body we're talking about. It's brain growth. So, there are a lot of brain growth happening in the second year of life. New neurons are forming and old ones are growing and these neurons have long tails called axons, which are covered with a fatty sheet called myelin.


Now I know I'm making you stretch your brain all the way back to Biology class again, but I'm sure you've learned this way back when at some point or so. You just might not remember learning it.

To make the myelin, the body needs fat-based building blocks and milk fat is an excellent source for this. So the theory goes like this. More fat available during rapid brain growth equals better myelinization which equals a better brain, which equals better development and intelligence.

Now, notice I said "the theory goes like this." Because nobody's actually tested this; there's never been a prospective study where you take a group of kids, put them on a whole milk, take another group of kids, put them on skimmed milk, follow them into childhood and teenage years, control for other variables, and then see which group is smarter, which group has more problems with development, which group is more athletic and whatever other brain nerve, muscle test you want to do.

And why don't they do this test? Well, would you want your child on that study? No. "Hi, Jennifer. We're going to put your child on a random group. They might get a type of milk which we think will hinder her development and lower her IQ points, OK? What do you say?" It's not going to happen.

So the traditional advice based on the science of it, but not really on the evidence, has been to use whole milk until the age of two. And then, after two, when brain growth starts to slow, then it's fine to switch to 2% milk. But the traditional thought there has been stick with 2% until school age because there's still a little bit of brain growth yet to come and 2% still has some fat for you.


Now, the issue in recent years has become the childhood obesity problem. And not all of that milk fat gets made in to myelin for brain growth, lots of it does get laid down as fat elsewhere in the body. So in some respect, it's become a judgment call made by the parent and doctor. Together you have to balance the need for good theoretical brain growth against the need to minimize obesity.

So, you have to look at the child's growth pattern and you have to look at the volume of milk a child drinks. So for most kids, I still go with whole milk until age two, 2% milk until school age, skimmed milk after that. But if you have a very obese child or one who drinks lots and lots of milk, you may want to accelerate those transitions a bit and if you have a kid who's not thriving or drinks very little milk, then you may want to delay the transition.

So without knowing your child complete history, it's hard to give you a specific advice, Jennifer. But, hopefully, this discussion has helped you understand why the recommendations are in place and when and why there might be deviations from them.& Again, I don't blame you for not wanting three different kinds of milk in your refrigerator, so just make some judgment calls along with your doctor based on some of this information.

OK, let's move on to our final caller for this week.

Lavana: Hi, Dr. Mike. I love your show. I was just calling in to say that I was curious. When I was pregnant, my mother told me not to stand from the microwave and I know on the show I'm listening to now. It is Show 49 about text messaging and microwaves and penis skin that you were talking about microwave, but it's more related to it leeching nutrients out of food.

I was wondering if you also know, if there was any truth to whether or not you should stand in front of microwave or avoid that and whether it's due to the microwave effect or the heating effect.

On a separate but related note, as this is another topic in the show, I wanted to kind of respond to the lady that called about the extra penis skin. When my son was born, he had a penis that went to one side after about two-thirds. So the last third of the penis is crooked and it looks like – I don't know if you ever seen Liar, Liar with Jim Carrey – but how the new husband tried to do the claw with his one finger instead of his whole hand. That's what it looks like.


So we had already decided before we have him, because I know I was having a boy, to get a circumcision and it did correct it. So his penis is no longer crooked. But this was a great episode for me to hear because I noticed that there is some extra skin on his left… No, his right, on the right side of his penis. And the other reason she gave me was that it was partially because the skin was too tight and that was what was making it crooked. And so she gave us a little extra slack that way after she circumcised him it wouldn't be crooked again. And also, after listening to your podcast, that it probably also has to do with to do with two snap pads.

But I love your show and I listen to it every day during work. I'm trying to catch up, obviously since I'm only at 49. Keep up the good work. I will try to do an iTunes review but I usually remember when I'm at work and they don't let you on iTunes. I really appreciate you taking the time out of your day to do the podcast. Thank you and I will continue listening and tell my friends. Bye. This is Lavonna in Seattle.

Dr. Mike Patrick: All right, so Lavonna in Seattle is the culprit here. Microwaves and penis skin. All right, Lavonna. Let's take microwaves first. Are they a problem during pregnancy? What about the radiation? What about the heat?


Well, heat is easy, OK? Heat from the microwave is not a problem. The heat is contained in the box and you can verify this because you have receptors and your skin that can detect heat and you don't feel any heat when you're standing by the microwave. That's because it take lots of concentrated microwave to excite water molecules which creates the heat. And you have lots of water in your skin, you have heat receptors in your skin, you don't feel any heat because there's no heat outside the box, because there aren't a lot of concentrated microwaves escaping.

But what about the few microwaves that might leak out? They're not enough to create heat, but are these stray rays dangerous to the fetus? Well, that question was actually asked in a recent study published in the journal, Teratology. And teratology is the study of abnormal development and this study came out in 1999. And as always, I have a link to the abstract in the Show Notes so you can read about the study for yourself.

I'm not going to go into the details of the study and if you really want, you can check it out yourself. But the bottom line is this, the researchers concluded that RF exposure or radio frequency, which is what microwaves are, presents no teratogenic risk as long as the exposure is below the "maximal permissible guidelines". Got to love that.

The maximal permissible guidelines are far greater than you would expect from microwave oven leakage of stray rays. Now, I suppose if you have one of those really old gigantic radar ranges from the '70s, maybe more microwaves get out. It's possible. Or if you picked up a $2 unit at the garage sale, OK, that might be an issue. Maybe you get more exposure on that case. But if you have an up-to-date microwave, chances are there isn't a stray ray problem. At least not enough stray rays to push you over the "maximal permissible guidelines".


The study goes on to say that the only reports of teratogenic effect are with studies that involved exposure that is far, far, far greater than – let's all say it together – the "maximum permissible guideline".

So if you put the fetus in the box, there's going to be trouble. But that's not really a surprise, right? I mean, there are a lot of places around your house that will be dangerous to your fetus, including the microwave. The safest place, of course, is inside mom's. So that's where you want to keep the baby as long as possible, well, until 40 weeks or so. You know what I mean.

OK, let's move on because Lavonna was not done. She also had a question about extra penis skin where her baby's penis was crooked like Jim Carrey's claw in Liar, Liar but it was fixed after the circumcision. I know, Lavonna.

OK, the extra penis skin that you're talking about is foreskin. OK, let's use the medical term for it, Lavonna. That's the term I'm going to use. If the foreskin is more adherent to the tip of the penis on one side compared to the other, it can cause a crooked appearance. So you basically have adhesions of the foreskin on the tip of the penis and so you get this crooked appearance like Jim Carrey's claw on Liar Liar.  

But during the circumcision procedure, those adhesions are broken and the crookedness goes away and that does happen from time to time. It's not really a problem and if you hadn't elected to have your baby circumcised, the adhesions will likely have fixed themselves with some time. So the circumcision procedure was not required to fix the problem. It likely would have fixed itself.


Now, there is another common penis shape issue we commonly see and that's torsion and that's where the shaft has a twist. So, the part of the penis attached to the body has a normal orientation but the tip is rotated to one side or the other and these two often corrects itself as the baby grows, so the tip just twists back to its normal position. But having said this, if any of these kind of conditions are present and they're not fixing themselves or there're other structural abnormalities present with the penis like hypospadias, for example, for the urethra opening is along the shaft rather than at the tip, then a referral to a pediatric urologist is certainly in order.

OK, Lavonna had even more to say. So let's take a listen.

Lavonna: Hi, Dr.Mike. This is Lavonna from Seattle again. I was just listening to Episode 65 and you were talking about Gardasil and the shot. And there was a comment from a& 15-year-old that was having problems getting her second shot and as a result, ended up switching& doctors.

I have noticed that a couple of people calling in with comments or emailing in with comment have been younger like around the age of 15. I myself am 20 and I was wondering if we could possibly do like our little version of a research round-up and have a poll and see how old these are and where they're from and whether they're parents or those who for themselves& have possibly siblings. Just because I was wondering. Obviously, I don't have anything against young parents, because I'm one myself. My mom had me when she was 17. But I was just wondering if you ever thought of doing your own research.

I guess it'd be a risk, this round-up. And like a listener's comment… What's it called, it's not session. But I can't speak the work and I don't want to waste your time. So anyway, I was just wondering if you'd thought about that.

All right. Have a great day and keep up the positive podcasting.


Dr. Mike Patrick: OK, so is there a difference and opinions about HPV vaccine broken down by age of the mother or age of the child? It's a good question, and my hypothesis would be that overall there is a difference with the younger moms being more in favor than older moms. And I would also guess that moms who have had issues with abnormal pap smear themselves or cervical dysplasia or actual cervical cancer would be far more supportive of the vaccine. But that's just my hypothesis. I would have to design a study to test out my theory.

A poll would be a good place to start. I love the idea of PediaCast conducting our own research and polls and we've talked before about forum boards. The problem, unfortunately, is time and resources. So Lavonna, find me a sponsor that not pays my bandwidth and studio fees, but also my mortgage and my kids' braces and my health insurance, and hey, I'm there. But until then, those things are just going to need to wait awhile.

All right, that still was not enough for Lavonna. There is more.

Lavonna: Hey, Dr. Mike, I'm listening to back episodes and I'm on 97. You said that you're specifically talking about children and I believe pyloric stenosis. But you said that the blockage could lead to projectile vomiting which could lead to an electrolytes imbalance which could lead to seizures.

I was wondering if this is true in epileptic seizures and non-epileptic seizures and if this is just for babies or what. Because the first thing I've thought of, was I should tell my ex to drink some Pedialyte because he has seizures. But the reason he has seizures is he had a benign tumor and he had it removed and the scar tissue in his brain is causing him to have seizures. So I was wondering what the correlation is like, really, between electrolytes and seizures. And if they have electrolyte maybe in seizure pills, if you could do that, or are electrolytes just in electrolytes just in liquid?


OK, this is Lavonna in Seattle again. Oh, I noticed something you say Pediacast is a podcast for parrots – parents. Oh, my goodness, I'm horrible today. I haven't had any coffee. But in your old introduction with the British or Australian girl, she said for parents, and grandparents and aunts and uncles or anyone else that has to do with kids or something similar to that. And I was just wondering why you would change that instead of possibly saying parents, guardians, and relatives or children or something like that. I don't know.

Thank you and have a nice day.

Dr. Mike Patrick: Can someone send Lavonna a latte or prafuccino, please? I think she does need some caffeine. I guess I wasn't as clear as I should have been in the discussion that Lavonna is referring to.

There is a difference between seizures caused by electrolyte imbalances and ones that are caused by structural problems in the brain and ones that are the result of true inherited-type epilepsy. And seizure is nothing more than out of control and persistent firing of a group of neurons.

If the neurons that are firing go to muscles, the muscles are going to contract and you have a motor or tonic-clonic type seizure. If the involved neurons go to a specific muscle or set of muscles, you have a focal seizure. If they go to most muscle groups, you have a generalized seizure. If the neurons firing come from sensory receptors, you get paresthesias or burning sensations, tingling, that sort of thing. If the firing neurons are involved with the emotional centers of the brain, you can get something called the complex partial seizure.


OK. I'm simplifying all these to a degree but hopefully not so much as the cause even more confusion like apparently I did last time.

So the way to deal with the seizure is to figure out what is causing the abnormal firing of neurons, OK? Neurons use electrolytes, sodium for example, to fire so severe abnormalities and electrolyte levels can cause a seizure and the best way to stop this kind of seizures is to fix that electrolyte abnormality.

Now pyloric stenosis can potentially cause this cascade of events, but that's rare. Most babies get diagnosed with pyloric stenosis long before it gets to that point. But there are conditions were electrolyte abnormalities can lead to seizures and you have to fix the electrolyte problem to effectively stop the seizure.

In the case of the structural abnormality, like a tumor, the neurons are being excited for& different reasons, same with inherited epilepsy. In these cases, abnormal electrolytes aren't the problem. So fixing electrolytes won't help because they don't need fix to begin with. They're normal.

So if you have a kid with a seizure because of a brain tumor or a brain tumor that used to be there, Pedialyte would never, never, never be the answer. Actually, it wouldn't be the answer even if there was an electrolyte problem. It might help prevent an electrolyte problem and the kid with vomiting and diarrhea, but it wouldn't be the answer to a seizure.

So hopefully that's a little more clear for you, Lavonna, and I guess that's why we go to medical school to learn these kind of things. So, the bottom line is if your child has a seizure, they need to see a doctor right away, OK? And then, let us figure it out.


All right, I am definitely running along here. So, we need to finish up the Skype line question part of the show and I will be back to wrap things up right after this.


As always, thanks goes out to Nationwide Children's Hospital, audiblekids.com, Vlad over at Vladstudio.com for helping us out with the art work on the website and in the Feed. Also, Medical News Today and, of course, my family and listeners like you.

Speaking of my family, my lovely wife Karen does a blog called PediaScribe. And my teenage daughter does a blog called BaggaChips like all that in a bag of chips. And we have some blog entries to highlight for you this week and you'll find links to the actual post in the Show Notes at pediacast.org.

For PediaScribe, Karen says "If They End Up In therapy, It's My Fault". So that's a good one. You got to check that one out. And for BaggaChips, I'm picking the music track. You've got to check this one out. All right, if you want some insight into Dr. Mike's mind and a little peek in the family life here in the Dr. Mike household, you got to check out the music track at Baggachips.com.

Also reminders, the PediaCast shop is open. We have t-shirts and bags. Someone wrote in and said, "Hey, don't always just talk about the t-shirt; you got great bags on this site, too." So we do have tote bags with the PediaCast logo on them. And remember, I don't make any money off the PediaCast shop. It's all helping us spread the world.


iTunes reviews are the most helpful thing that you can possibly do. Our position in iTunes is very much related to our many, many, many positive reviews and a lot of you took the chance to listen to the PediaCast because of all those positive reviews. So if you've not a chance to leave a review yourself, please go to iTunes and leave us a review there.

Someone said, "Hey, you don't have a link on your site." That's because iTunes is not on the internet. iTunes is a program. Go to apple.com/itunes I'll bet. Or do a Google search for iTunes, and you can download the program and do the review that way.

So, really I'm talking to the people who are using iTunes and iPods and that kind of thing. Although, if you don't, doesn't hurt to download iTunes, it's free and give us a review and then still listen however you usually do.

The Poster Page is available at the website. They're PDF files you can download, print out, hang up on bulletin board. That's always appreciated. And, of course, there is a Listener Survey at the website and the sidebar which helps us to determine demographic information.

All right, I hope everybody has a great week, what's left of it, and a great weekend. I think since this show is so late in the week, we're going to count it for next week as well. So I will be back early July.

And, until then, this is Dr. Mike saying, "Stay safe, stay healthy, enjoy your Fourth of July and of course, as always, stay involved with your kids and be safe with only using legal fire things on the Fourth of July….

All right. So long, everybody!


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