Hypopigmentation, Toddler Sweat, Single Kidney – PediaCast 130


  • Childhood Eczema / Asthma
  • Lipid Screening And Heart Health
  • Violence Prevention
  • Hypopigmentation
  • Toddler Sweat
  • Single Kidney



Dr. Mike Patrick: A warm thanks goes out to the good folks at Audiblekids.com for sponsoring today's episode of PediaCast. Be sure to visit Audiblekids.com/pediacast to download a free audio book today.

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 parents. It's Episode 130 for Monday, July 21st, 2008, "Hypopigmentation -it's a big word – Toddler sweat, and Single Kidney".

First, it's been a while, I realized this. I've been doing PediaCast now for two years. It's hard to believe, two years. I think that this is probably the longest period of time that I've gone without doing a show. And, of course, you guys hadn't let me forget that back. In fact, just a couple of listener emails that I received while I was gone.

This one is from Dory, a US military spouse living in England. She said, "Dear Dr. Mike, every time I refresh my podcast on my iMac, I hope to see a new PediaCast. I guess it's only been a couple of weeks but I miss the show already. Just wanted to thank you for all of the hard work you put into the podcast. You helped me gain confidence as a mom. My son is 21 months old now and I love that you use big words," – like hypopigmentation – "to your audience like we're intelligent adults."


We're going to talk about toddler's sweat today, folks. But, OK, I guess intelligent adults have to talk about toddler's sweating, too.

"Thanks, thanks, thanks. Hope the summer is better than the summer here in England. We need our jackets. Take care – Dory."

And then, I got one from John in Rancho Cucamonga, California. John says, "I've been listening to the podcast for some time now. I really enjoy it. It's very informative and I recommend it to all my friends that have children. It's just been awhile since the last show, so I'm just making sure that everything is OK. Hope it's just a summer vacation. Thank you again for the show. Keep up the great work – John."

Well, actually, I wish it were just a vacation. But as it turns out, we've been really, really busy and the reason for that – and actually, if you've been reading Karen's blog over at pediascribe.com, then you have the skinny on this – we are moving.

So, we're moving about a thousand miles away. Now, this is going to come as big news to those of you out there who are my patients in my office practice and you haven't heard this. But we are moving come middle to late September. As it is right now, September 19th is going to be my last day in my office, and then we will be moving to Florida.

So I'm going to be – actually, not joining a private practice down there – I'm going to be working at a network of pediatric urgent care centers, which has a little bit of a different schedule. I'll be working evenings and much fewer hours at the office than what I'm putting in right now. And the advantage that that's going to have for PediaCast, and I did hint about this a few months ago, that there would be some big changes coming and they would affect you. Well, they affect you, in that by working less hours in the office which this job will let me do, I would be able to spend more time on PediaCast. So, see? What did I tell you? Great news for you.


Now, the disadvantage is that in the process of doing the move, it's taking up a lot more time. So, I tell you, I thought getting a medical license in Ohio, there was a lot of red tape. Let me tell you, Florida, wooh, boy! Oh boy, oh boy, talk about paperwork. Well, I guess it's good. I mean, you don't want anyone just saying they're a doctor and getting licensed to practice medicine. But I tell you, it is a lot of paperwork and so we're going through that process right now so that I can get my medical license.
If you are listening right now and you have some sway with the Florida Board of Medicine, it's not a problem getting my medical license. It's just the red tape. It's the form after form. The paperwork is just incredible. So, like I said I thought Ohio was bad, but Florida wins.

Kind of like in college football and college basketball a couple years ago, remember Florida was number one, Ohio State was number two and both of those sports, well, when it comes to red tape bureaucracy and paperwork, Florida beats Ohio once again.


Dr. Mike Patrick: OK, what are we going to talk about today? We've got some interesting topics, actually. I did mention in the opener that we were going to talk about hypopigmentation, toddler's sweat, and single kidney use. But we have some other things, too, in terms of news items.

We're going to talk about asthma and eczema and how they're related, lipid screening and heart health. What are the latest recommendations for a lipid or fat screening cholesterol, triglycerides, that sort of thing? What are the recommendations for screening kids? And then, what do you do if you found out that they're high?

Also, violence prevention, its important role for pediatricians and nurse practitioners and family practice doctors in terms of having an impact on children and preventing violence. So, we're going to talk about that as well.


Don't forget if there's a topic that you would like us to talk about, just go to pediacast.org and click on the Contact link. You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS.
And I'm a little behind on Skype messages, too. The last I checked I had 15 of those in the last three weeks and I've got about well over a 100 unanswered emails that we've not addressed on the show.

So, I don't say that to make you not want to write in or call in. Please do. But understand if we don't get to your questions, there's a lot of them out there and we're trying very hard to include all age group and a variety of topics. So, don't take it personally and keep those questions coming because the more we have to choose from, really, the better the material.

All right, I will talk more in the future shows about what this new job entails and more about our moves. So, we'll hint about that. I want to go ahead and get to the meat of the program today because I know it's been awhile since we've done this and you, guys, are just itching for information. And of course, if you really want to check the scoop on the move, there'll be tons more in the blog that Karen does and over at pediascribe.com.

Don't forget the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, call your doctor and arrange a face to face interview, and hands-on physical examination.

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

With that in mind, we will 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 the news partner, Medical News Today, the largest independent health and medical news website. You can visit them online at medicalnewstoday.com.

A study, published online in the Journal of Allergy and Clinical Immunology, calls for trials of aggressive therapies against childhood eczema in an attempt to reduce the incidence of asthma in later life. The study, conducted by the University of Melbourne, Monash University and Menzies Research Institute in Tasmania, has followed more than 8,500 people who are part of the Tasmanian Longitudinal Health Study from the ages of seven to 44. Lead author, John Burgess from the University of Melbourne School of Public Health, says the study is the first to demonstrate an association between childhood eczema and asthma into middle age.

The study found people who had childhood eczema were more likely to develop childhood asthma, new-onset asthma later in life or have asthma which persisted from childhood into middle age. Dr. Burgess said childhood eczema increased the risk of someone developing asthma well into adulthood. The incidence of asthma in people from the ages of 8 to 44 who had childhood eczema, was nearly double that of people who had never had eczema.

Dr Burgess said the study's findings also supported the concept of the "atopic march", in which eczema is often the first step in an allergic process that leads on to asthma or hay fever in later life. "The results of the study showed childhood eczema clearly preceded asthma in each later stage of life… later childhood, adolescence, and adulthood. This makes a strong argument for trialling aggressive therapies against childhood eczema to help reduce the burden of asthma later in life."


OK,& I've got actually several things to say about this news story. It's not a good one. And I think anyone who understands the immune systems' role in eczema and asthma would tell you that this the way they present this is just full of problems.

What you have to realize, folks, is that the immune system mediates eczema and asthma. So in other words, you have an allergen or there's something that you're allergic to or there some other trigger that makes the immune system start creating inflammation and if that occurs in the skin, then the end result is eczema. If the end result is in the lower airway, then you have asthma because you have wheezing because you have swollen bronchial tubes. The inside lining becomes swollen. And if it's happening in the upper airway, then you have allergic rhinitis.

So, by aggressively treating eczema… Let me say too, did the study looked at the group of kids with eczema and take one group and treat their eczema aggressively and take another group and not treat their eczema aggressively? And then, down the road showed that the group that was treated aggressively for eczema had less asthma than the group that was not treated as aggressively, then I'm a believer that treating eczema very strongly, vigorously, is going to make a difference in terms of the incidence of asthma later in life. But that's not what this study did it all. It simply looked at the incidence of eczema, the incidence of asthma later on and said, "Hey, if you have eczema early, then later, you're more likely to have asthma."


So, it is not a cause-and-effect kind of thing, because if the immune system is causing the reaction in the skin first, and then in the breathing tubes, you're going to have eczema followed by asthma. But treating the eczema, you're just treating the end results of the inflammation on the skin. That's not going to prevent the same thing from happening in the lungs.

So, it's really kind of like saying that if you have a burn and you treat it really, really aggressively, then it decreases your chances of getting burns down the road. That's not true at all because you're not addressing the underlying cause of the burn. And when you treat eczema, you're not really treating what's going to happen inside the lungs and you're really just treating what's happening at the surface of the skin.

So, the immune system problem, unless you put someone on systemic or oral steroids over a long period of time, well sure, then it's going to help their eczema and it might prevent their asthma later on. But that's not what we do. When we talk about aggressively treating eczema, we're still talking about topical treatments that aren't going to have any effect on the immune system in general as a whole or on the immune system in the lungs.

So, if I were going to make a hypothesis here, the hypothesis would really say, what they were really looking at is – children with eczema, are they more likely to suffer from subsequent asthma?& And I do believe that because the underlying process is the same,& just once happening in the skin, and then it happens in the lung.

But again, this doesn't mean that eczema causes asthma which is the way that they make this sound, because the title of their article is "Aggressive Treatment of Childhood Eczema Could Help Prevent Asthma". And that's really; it's just a bad title because it's not what their study was showing. Treating eczema will not prevent asthma.


Now, that's my hypothesis. OK, my hypothesis would be treating eczema is not going to prevent asthma. And then, I could design a study to do that. Again, I mention how to do it. You just take a group of kids with eczema, treat them aggressively; another group, and just kind of let their eczema flare and not do a whole lot. Maybe use some topical 1% hydrocortisone cream that's over-the-counter strength, whereas the group that you're treating aggressively, you might have intermittent burst of oral steroids, you might do a prescription-strength steroid cream. You might be even give them topical medicine that helps prevent inflammation in ways that are not steroids and there's like for atopic and the others.

So there are things that you can do to make it an aggressive treatment and then compare that to the group that you don't treat it as aggressively, and then see what their rates of asthma are down the road. Again, this study did not do that.

My hypothesis would be that decreasing inflammation in the skin is not going to decrease lung inflammation down the road because you're not addressing the underlying problem.

So anyway, again, I had to bring this one up because it's not a very good news article. But you know the news media, that's the kind of thing that they really get excited about, "Hey, if we treat eczema in kids, it's going to prevent asthma down the road." But it doesn't make any sense from a science standpoint. I just wanted to point that out.


OK, The American Academy of Pediatrics has issued new cholesterol screening and treatment recommendations for children. The policy statement, "Lipid Screening and Cardiovascular Health in Childhood", recommends cholesterol screening of children and adolescents with the family history of high cholesterol or heart disease.

It also recommends screening patients whose family history is unknown or those who have other factors for heart disease including obesity, high blood pressure or diabetes. Screening should take place after age two but no later than age 10. The best method for testing is a fasting lipid profile. If the child has values within the normal range, testing should be repeated in three to five years.

For children who are more than eight-years old and who have high LDL concentrations, cholesterol-reducing medication should be considered. Younger patients with elevated cholesterol reading should focus on weight reduction and increase activity while receiving nutritional counselling.

The statement also recommends the use of reduced fat dairy products such as 2% milk for children as young as one year of age for whom obesity is a concern.

Pediatricians can help prevent future violent behavior in their patients with a brief one time office intervention during a routine exam, according to a new study published in the July issue of Pediatrics. The study involved 5,000 families with children ages two to 11 and more than 200 providers at a 137 practices across the American Academy of Pediatrics, Pediatric Research and Office Settings Network.

It is the largest study to date showing that pediatricians can reduce violent behaviors according to Shari Barkin, director of the Division of General Pediatrics at the Monroe Carell Junior Children's Hospital at Vanderbilt. This concept of anticipatory guidance that pediatricians can have a public health impact through a brief, one-time office intervention is key," said Barkin, who designed and implemented the study with co-authors while working at Wake Forest University School of Medicine.

The research was based on changing factors previously shown to impact the risk of future violent behavior, such as excessive media time (computer games and television often depict violence), access to unsafely stored firearms and corporal punishment.  


"This study provides important new evidence demonstrating the value of strategies that can be used in pediatricians' offices to reduce the risk of violence for children," says Steering Committee chair Stephen Pearson of the American Academy of Pediatrics PROS Network.

One group of parents received specific violence-prevention intervention, including timers for monitoring media use and time-outs, cable locks for safe storage of guns, and office referrals for childhood aggression. The other group received only printed literature on literacy promotion and no information related to violence prevention.

After six months, there was a significant increase in the number of caregivers limiting their children's media time to fewer than two hours per day, with intervention group families watching, on average, 45 minutes less of media per day. Additionally, firearm owners exposed to the intervention in the study were twice as likely to store their firearms more safely. Use of time-outs was not significantly affected, but there was a decrease in families who reported corporal punishment, more in the intervention group than the control group.

"We showed that this type of dialogue between the pediatrician and the family, which only lasts three or four minutes, can motivate change," Dr. Barkin said. "We hope this will become an intervention that all pediatricians adopt as part of their regular practice for families. Reducing violence is a pediatric and public health imperative."  

All right, that concludes our New Parents Can Use today and we will be back to answer your questions right after this.



Dr. Mike Patrick: I want to take a few seconds to tell you about today's sponsors, audiblekids.com. Audible Kids is a one of a kind community of parents, educators and their children, with a shared interest in igniting a young person's love of reading through digital audio books. Audiblekids.com offers 3,500 titles from over 75 publishers and many of them are unabridged.

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All right, we're going to go ahead and just dive into our Listener Segment today. This first one comes from Euvan in Plantation, Florida, and no I didn't pick her question because I'm going to be a resident of the State soon. It just happened to be good one.

Euvan says, "Hello. First, I'd like to thank you for this podcast. I'm a 23-year-old single mother to a 14-week-old baby. This is my first child and information you provide is priceless. My question is about white spots. My daughter has this white spots on her face mainly on the cheeks. They can be noticed more when her skin is dry. My pediatrician says it's nothing and I just put lotion on her face. He says it's because of my daughter's pigment."


"I am White-Hispanic and her father is African-American. My question is the spots while not very nice looking; do not seem to bother my daughter. Everyone who sees her keeps telling me to get a second opinion and to go see a dermatologist. It's getting to the point where I am starting to doubt my pediatrician. Please let me know your opinion. Should I get a second opinion or leave it alone? I didn't even know dermatologists see babies. Thank you, Euvan."

Well, thanks for the question, Euvan. Yes indeed, dermatologists do see babies and in fact there are specialists who are dermatologists that only see kids called pediatric dermatologists. And there are not enough of them out there, actually, and it can take awhile to get in to see one. But that's another story.

I would trust your pediatrician. This sounds to me, and again, I'm a little bit of a disadvantaged because I can't ask you questions and I can't see your baby's skin which is important in practicing medicine. So, I will say, though, that the way you describe as it sounds to me like patchy hypopigmentation.

Now, let's break down that word – hypo means less, and pigment is the coloration of the skin. So you have less coloration to the skin in a patchy form and it happens to be on the face.

Now, inflammation of any kind of the skin – whether it be from eczema, what we call seborrhea, or contact dermatitis, even sunburns, impetigo – anything that causes inflammation in the skin can affect the underlying pigment cells. And the cells, these underlying pigment cells, can respond to the overlying inflammation of the skin by either increasing or decreasing their pigment production compared to nearby pigment cells.


So, the result is, you have this area where there was inflammation, again from bug bites, sunburns, eczema, seborrhea, contact dermatitis, any of these things. And once that has resolved you're going to notice that the skin there is either lighter or darker. Now, it is more noticeable in Latinos and Blacks than in Asians and Caucasians because of the fact that there is more surrounding pigment and the pigment cells usually respond in those ethnic groups to a larger degree, because they're more active. And so you get areas that are either lighter or darker.

Now, in your case, it seems like it is an issue with the pigment cells making less pigment in these patches. And you talk about the skin being dry, so I suspect that your daughter has had some problems with the eczema, dry skin in the past. And so, you're seeing patches of lighter skin where the eczema used to be.

Now, the good news is that the pigment production usually returns to normal. So the patches blend back in with the surrounding complexion color. But the bad news is, it takes a while. It can take months and sometimes, it can take years. So, we're not talking about days or weeks here. It usually takes a long time.

Now, there is another type of pigment cell problem called vitiligo. You probably heard it before. It is when the immune system attacks pigment cells and so they stop making as much pigment. But in this case, it's not because of overlying inflammation. It's because the immune system is specifically attacking the pigment cells. And so, you're get lighter patches all over the body and those can become wide-spread, last much longer than the hypopigmentation that we're talking about and it involved a lot more of the body.

And this is a disease that's frequently treated by dermatologist with immune system suppressing drugs but we don't generally see it or treat it with those kinds of medications during the infant years.

So, in your case, Euvan, it sounds to me like a classic case of post-inflammatory hypopigmentation which is likely a consequence of dry eczematous patches on your baby's face. Conservative observation is the best medicine for that particular condition, so I think your pediatrician is right on the money.


OK. Next stop is Scott in Toronto, Ontario in Canada. And Scott says, "Thanks for the great podcast, Dr. Mike. My wife and I were discussing that neither of us has noticed our two-and-a-half-year-olds sweat. This past weekend, it was especially warm and sunny. After what seemed to be a moderate time in the sun, she felt unusually hot, but not the least bit sweaty. Obviously, we moved her to a cooler location but it's concerning. Yes, we took the usual precaution, sunscreen, wide-brimmed hat, hydration. The next evening, she had a fever but I don't know if that's connected."

"This is a child who needs to be encouraged to drink enough fluid and tends to be a light eater. Naturally, I'm going to ask her pediatrician next time we visit. I'm wondering if you could cover why a child might have trouble regulating their body temperature in warm, sunny weather despite reasonable precautions."

OK, Scott, temperature regulation actually occurs in the brain stem, so it would be odd for a normally developing child with no brain problems to have temperature regulation issues. On the other hand, a kid with the history of hypoxic or traumatic brain injury certainly could have temperature regulation problems.

First, I assume, Scott, that your child is growing and developing well, no history of brain injuries and otherwise, generally healthy with the normal birth history. And so, that's kind of the line I'm going to take with my explanation here.


First, I wonder what her core body temperature was when she felt hot.& In other words, it would have been interesting if you had taken her temperature when she felt that way. If she had a fever the following night, perhaps she was beginning to have a fever that day. Maybe that was the very onset of her illness. So, that's possible that the heat you were feeling was actually her trying to get a fever because that's when the illness was starting, and then the next night, it went up even higher and she had the fever and the illness.

Sweating usually doesn't happen with fever until body temperature is heading back down. Remember, sweating is a way that the body uses to cool the core body temperature. So if your body is trying to make a fever, you aren't going to sweat because your body isn't trying to cool. Your body is trying to raise the temperature. So you're not going to sweat until you break the fever, then you start to sweat and that's how the body gets the temperature to come back down.

So perhaps, you caught her before her body was ready to break the fever, so to speak. And then, you move her to a cooler environment and her core temperature dropped, so she didn't have a need to sweat. Because she was ready to break the fever and you helped out and so she didn't sweat. So, that's possible.

Now, if her core body temperature was elevated when you checked her, so let's say when she was in the sun, her skin felt warm, you use the thermometer, got a core body temperature and it was elevated but she wasn't sick. So, in other words, she didn't have a subsequent fever the next day which I know in your case she did and she didn't developed any other illness type symptoms, then early heat exhaustion is possible. And, you are right, in that situation, she should have been sweating.

So, I think that's unlikely to be the explanation. So, I don't think that she was having temperature regulation problems. Otherwise, well, you wouldn't' expect that in the normally developing kid without any brain problems. So in fact, she did have a fever the next night though too, so that kind of speaks against it being heat exhaustion.


Now, on the other hand, if her core body temperature was normal when you checked – which I believe it probably would have been, unless again, it was the very beginning of a fever – then she just didn't have any reason to sweat because it's the core body temperature that you're regulating, not the skin temperature. So a person's skin can feel warm and that's not a problem. Well, other than worrying about sunburn, then that is a problem with sunburn. But just because her skin felt warm does not mean that her core body temperature was elevated.

So the moral of the story is, how the skin feels is not always good predictor of core body temperature. There had even been plenty of times when my own kids, you feel their foreheads or you feel their cheeks and you think, "Man, they're burning up!" And you think, "I wonder if they're getting sick," and you take their temperature and it's 99. And you would have sworn by the way that their skin felt that it was a 102.

That's why doctors take the quote, "She was burning up," with a grain of salt. We want core body temperature because that's the definition of fever. Core body temperature is what the brain stem is regulating, not skin temperature and the best way to measure core body temperature is rectally. That's sort of the gold standard on how you do it.

There's also this fancy temporal artery scan now. We probably have seen some doctors do it. You can buy them at the stores, too, where you just scan across the forehead over to one side and it measures the temperature of the temporal artery that's underneath the skin there. And that's a good estimate of core body temperature.

The next best are oral and axillary or armpit thermometers. Skin thermometers – and we're not talking about the temporal artery one – but like the little strips that you put across the forehead, they're the worst. And the ear thermometers are pretty bad, too. They don't work very well.


Never add a degree on your own. Just tell your doctor the temperature you measured. Let them know how you measured it, then let the doctor decide what it means.

My advice is next time you're out and about in the sun, carry a thermometer with you. And next time the situation – no, I'm not saying that everyone needs to do this – I'm just saying, again, in your situation, you might want to carry a thermometer with you. Next time that the situation repeats itself, see what your child's core body temperature is. And if her skin feels warm and she's not sweating but her core body temperature is normal which is less than a 100.5 degrees Fahrenheit or 38 degrees Celsius, then you know that it's not a problem. It's just her skin feels warm because of the sun but she doesn't have a reason to sweat because she doesn't have a true fever.

Now, on the other hand, if her core body temperature is elevated and she's not sweating, and there's no subsequent fever or symptoms to suggest illness in the next day or two, then I would be concerned. Not sure what I would do in that situation, maybe get an MRI, maybe consult with a pediatric neurologist because it would be really unusual.

I bet your child was either sick and you just weren't noticing her initial fever or that her core body temperature was normal despite her warm skin, so she did not have any need to sweat. You did the right thing, obviously, moving her out of the sun, do a cooler location and offering her fluids. So, good job there.

And please after you talked to your doctor and let things play out, let us know what the final outcome is because I think they'll be interesting. So, my final impression, I don't think you have a long-term issue here but let us know.

All right, and finally, we have Sarah in Harrisburg, Pennsylvania. Sarah says, "Hi, Dr. Mike. Long time listener, big fan of your show. Thank you so much for all of the time you put in to it. I also enjoy the fact that you are a big Disney fan. My husband and I are avid Walt Disney World tourists as well."


Did I mention that we're going to be living like five minutes from the Magic Kingdom?


Dr. Mike Patrick: See, I am excited about this move.

"On to my question, I am currently 26 weeks pregnant with my second child, a girl. I was recently told after a prenatal ultrasound that she would likely be born with only one kidney. They were about 95% sure of this diagnosis even though she would only show her right side and it was difficult to see the left kidney area. But the doctors didn't see any blood flowing to that side. He explained many people are born with only one kidney and live perfectly healthy lives. And his only recommendation was she avoids contact sports such as gymnastics, football, et cetera. After leaving the office with his diagnosis, I got a several additional questions that may arise after the baby is born."

"Since girls are more prone to urinary tract infections, should she get one, will she have more complications than the child born with two kidneys would have? Also, diabetes runs in our family. My mother has Type 2 diabetes and my husband's father also has Type 2 diabetes. Should she develop diabetes down the road, how could this affect her one kidney? Any additional information or recommendations you might have regarding babies born with only kidney would be greatly appreciated. Thank you so much for your time."

Well, thanks for writing in, Sarah. Make sure you let your baby's doctor, once you have a pediatrician or family practice doctor, let them know about the findings of this prenatal ultrasound. And if I were the baby's doctor, the first thing I would do is order a post-natal ultrasound.

The prenatal ultrasounds are notorious for not being quite right. And you have to understand, prenatal ultrasounds are tough. I mean, you can't control the baby's position; you're sending sound waves through skin, and then water and then another layer of skin before you hit this wiggling target. And then, you have the same layers and the same wiggling as the sound waves are coming back. So, the picture is just not as clear.


So the first thing I would do is repeat the test after the baby is born because you can hold the baby still and only have one layer of skin to get through to see the kidneys.

OK, so let's say that we corroborate the prenatal ultrasound and there is only one kidney. Now, personally, I think it's more likely that when you repeat this, the kidneys are going to be fine.& It seems to me that nine times out of ten, when they find the problem with the kidneys on a prenatal ultrasound, when you recheck it after the baby is born, everything is OK.

And, usually, it's not them not seeing a kidney. Usually, it has to do of what we call reflux where there some urine around one of the kidneys and a lot of times that corrects itself before the baby is born. So when you do the ultrasound again after they're born, the fluid is gone. So that's a little bit different.

But in this case, let's just say, for the sake of this discussion, that there is only one kidney. Personally, at that point, I think I would send the baby to see a pediatric nephrologist or pediatric renal or kidney doctor. Because there is a higher likelihood of a problem in that remaining kidney and a higher likelihood of the problem developing down the road with that kidney.

Lots of other questions to ask if I were the doctor looking at this and seeing the study, is it truly one kidney or is there a fusion of both kidneys into one kidney which is called the horseshoe kidney? I'd want to know how well is that solitary kidney functioning. Is there reflux, where there is a flow of urine back toward the kidney from the bladder? Are there any associated tumors or cysts on the remaining kidney? Are there any stones present in the urinary systems?

So, there's a lot of things to consider here, so you definitely want to let your doctor know so that you can look in to them right away and get a better picture of exactly what's going on.


I certainly wouldn't wait for a first urinary tract infection to delve into this problem. I'd be very proactive and then get settled in with the pediatric and nephrologist or kidney doctor. And you want to pick one that's associated with the children's hospital and who sees kids all the time. So, and you're going to probably need to see that doctor on a fairly regular basis for awhile.

In terms of the no-contact sports recommendation, it's a good one. And certainly, there are a lots of people born with one kidney who lead healthy lives. But on the other hand, you do want to avoid any kind of impact sports that would put that the one kidney in jeopardy.

On the other hand, even though lots of people are born with one kidney and lead healthy lives and do fine, there is real potential for problems here. I mean, there may be associated conditions, the remaining kidney may not be functioning well. It may develop problems in the future. And the issues that you bring up, Sarah, recurrent urinary tract infections and diabetes, certainly, those may be issues down the road in which makes it even more important to get established with the pediatric kidney doctor right from the get-go.

Unless, of course, the post natal ultrasound is completely normal which again wouldn't really surprise me either. And then in that case, there is no problem and no need to see specialist.

So that's my two cents, anyway, Sarah. Hope that helps.

All right, we're going to wrap things up and I'll be back to close of the show right after this.



Dr. Mike Patrick: As always, a big thanks goes out to Nationwide Children's Hospital for helping us out with the bandwidth for today's show; also, audiblekids.com for sponsoring this particular episode. Vlad over at Vladstudio.com, he's the artist that takes care of us in terms of the artwork on the website at pediacast.org and in the Feed. Also, thanks to Medical News Today for helping us out with the news department. And, of course many, many thanks to my family and listeners like you.

Speaking of my family, both my wife and my daughter have blogs I want to tell you about. My wife's blog is pediascribe.com and the featured post this time, this week, is called "One Man's Junk". It basically it's our free garage sale that we had for family because we're kind of getting rid of some things so that we have less to haul a thousand miles away. And we had some family over to see if they want to do sort through it. And it's really not fair to call this post "One Man's Junk" by the way because Karen and the kids contributed plenty of junk as well. Alright, not junk. It's treasures, right? Treasures that we want to recycle. That's it.

All right, and then my daughter Katie, she has a blog called Baggachips which you can find at Baggachips.com and the post highlighted this week is "Niagara Falls". She had a great Canada trip with grandma and grandpa and she and her brother saw Niagara Falls up close and personal and she's got some pictures of her trip on the website at baggachips.com.

Also, I'd like to remind you PediaCast, The Shop, is open. We have t-shirts, bags; lots of things with the PediaCast logo on it which helps spread the word. You can find link to that in the side bar at the website.


Also, iTunes reviews are very helpful. We actually cross the 300 mark, 300 reviews. And I remember when we were getting close to 200 and I was really trying to get people to do reviews to get us over hat 200 mark and now just a few months later, we're over 300. So thanks. If you haven't left a review on iTunes yet, please consider doing so. And I would just remind you, if you're one of these people who was looking an iTunes for a podcast and you read our positive reviews and that made you take a listen, please pass on the goodness and recruit more listeners for posting a nice review yourself.

Also, the Poster Page is available if you'd like to print out a PDF and make copies, hang it up on bulletin board to help spread the word. This is a grassroots effort, folks. I don't have the big advertising budget. I don't have much of a big budget at all to be honest with you. Our sponsors don't pay that much. So, this is fun and I enjoy doing it and I'm glad that you guys enjoy listening.

There's also a Listener Survey in the sidebar at the website, you can find it. It helps us to collect some demographic information the helps when we are obtaining sponsors.

So once again, thanks for your patience, everyone. It's been a crazy three weeks. I was interviewing for jobs. I had to take trips for site visits. And we're looking for property, we're trying to get our house staged so that it's ready to sell, all these kind of things. So, it really just took up an enormous amount of time and my family has to come first, so I did not have time to get out the show.

But, hopefully, we'll have more time now and things will be a little bit better and more regular. And then, once we get settled, which again we're hoping for around October, then I'm going to have a lot more free time to devote to PediaCast. So good times are ahead but it may get a little worse before it gets better. You understand though, I know you do.

All right, and until next time whenever that may be, hopefully it won't be too long, this is Dr. Mike saying, "Stay safe, stay healthy and stay involved with your kids….

So long, everybody!


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