Meagan Church, She-Devil, Anxiety – PediaCast 131


  • Breast Milk Flavoring
  • Are Cell Phones Dangerous To Your Health?
  • Meagan Church Discusses Her New Book: Unique As Pete
  • 16 month-old "She Devil"
  • 7 year-old with anxiety
  • Acne in an 11 year-old



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

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


Announcer: Welcome to PediaCast, a pediatric podcast for parents. And now direct from BirdHouse Studios, here is your host, Dr. Mike.


Dr. Mike Patrick: Hello, everyone and welcome to PediaCast, a pediatric podcast for moms and dads. It is Episode 131 for Monday, July 28, 2008, Meagan Church, She-Devil and Anxiety.

No, Meagan Church is not a She-Devil. I realize that it doesn't sound so good, close together, as I was reading it. You don't think about these things when you type it, but when you read it, then OK. My apologies, Meagan.

Meagan Church is a children's book author and she's going to be along in a little while to talk about her latest picture book for kids. It's called "Unique as Pete: How Autism Does Not Mean Different."

It's a great book. It's aimed at kids, although moms and dads will get a lot out of it, too. There happens to be Glossary in the back that defines a lot of terms that are related to autism.


So if you have some questions about that and she has a good introduction when your kids are exposed to children who have autism. That's really who it's sort of geared toward. But anyway, I don't want to steal her thunder. She'll be along in a little while and we'll talk about it.

It's going to be a big, big, big show today. It's going to be a long one. I can tell you that now because there's a lot of information. But, there's unlikely going to be a show in the next week or two so savor this one.

You may want to listen a little bit when you get to the interlude music. Save it for a few days later because I have a feeling the way that events have been unfolding here at the homestead in Ohio, I'm going to be busy, I believe, in the next couple of weeks.

So those of you who listened last week know what's going on. If you missed last week's episode, we are packing up and moving to Florida.


As you can imagine, you're moving a thousand miles away and packing up the house and all the things that go along with that, plus wrapping up an office practice that I've been in for the last 10 years. There's a lot to do.

And unfortunately, for you guys, that job has to come first because that's the one that pays the bills. But, anyway, the good news and I mentioned this before, too, is that with the new job, there's actually fewer hours, a little bit of a different schedule so I'll be able to spend more time on PediaCast. So bad times then good times.

This fall is going to be excellent. You just wait and see because I think I'm going to be in a position to really devote lots of time to this program. So I'm excited about that.

Those of you who don't read Karen's blog, PediaScribe, but first you should [Laughter] and second, of course, I may be a little bias.


Second, you're not going to know as much if you don't read her blog about what's going on in our lives, which you may not want to know. But this new job, it's an exciting one. I'm not going to be working in an office, so to speak, a pediatric office, seeing kids for well child checks and behavioral visits and those kinds of things.

Instead I'm going to be working for a network of urgent care centers called After Hours Pediatrics and they're in Orlando. And they have five centers right now that are open basically in the evenings and on the weekends. So they see kids who are sick and injured when the pediatricians' offices are closed, and then they also take care of tourist kids.

So if you find yourself in Orlando and you have a sick kid, of course, call your doctor back home. And then if they want to see someone, the best place to go is going to be After Hours Pediatrics. So look them up. There's one actually at Hunters Creek, which is pretty close to Walt Disney property.


And hey, maybe you'll see me because that's where I'll be.

OK. Let's go ahead and get moving. Because like I said, we have a lot to talk about today. We're going to do a news segment and the interview and to answer some questions. So like I said, it's going to be a little bit of a long one.

In the News Segment today "Breast Milk Flavoring: Does What Mommy Eat Make A Difference On How The Breast Milk Tastes?"

Also, we're going to talk about cell phones. Are they dangerous to your health? And then like I said, Meagan Church will be along to discuss her new book, "Unique as Pete". And then we're going to talk about She-Devils. That is a mother's term for her own child, not mine. [Laughter] I didn't label her child a "She-Devil". The mom did.

Also, we're going to talk about a seven-year-old with anxiety and acne in an 11-year-old. So that's all coming up.

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

And with that in mind, we will be back with News Parents Can Use, right after the short break.


I failed to mention in the Intro and this is an important thing to talk about. If you have a question that you would like to ask on PediaCast, or you have an idea for a topic or the lead for an interview, you have an access to someone that would be really special to get on PediaCast, just drop me a line.

You can go to and click on the Contact link. You can also email, or call the voice line at 347-404-KIDS. That's 347-404-K-I-D-S.


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

Researchers from the University of Copenhagen in Denmark have found what a mother eats has a fairly instant effect on the taste of her breast milk, as well as influencing what her child prefers to eat.

An infant's first flavor experience may be through the transfer of dietary flavor compounds into the breast milk, say the researchers. Helene Hausner and team asked 18 lactating mothers to consume capsules with various flavorings, such as caraway seed, licorice, menthol, and banana.


The mothers provided samples of breast milk before taking the capsules and several times after. The milk was collected 2, 4, 6, and 8 hours after each capsule was consumed and analyzed by a dynamic headspace method and gas chromatography-mass spectroscopy.

I guess they couldn't really do it through taste test.

They found that flavored chemicals do get into breast milk and stay there at different rates and speeds. The caraway and licorice compounds reached their peaks in the breast milk two hours after consumption, while the banana compound became undetectable after one hour. All flavors were gone from the breast milk within eight hours.

The findings in this study might help mothers understand why their child does not want to feed. Hausner says, "It is possible that breast-fed babied may be more receptive to flavors than bottle-fed babies." Because the bottles are going to taste the same every time.

Of course, that's only if it's formula. They really probably should have said formula-fed babies there because you can express breast milk put in a bottle.


And I would assume if the flavored chemicals are there, it's still going to be flavored. But, OK, so I'm getting a little technical.

I do have a link, by the way, to that article's abstract in the Show Notes. So if you go to, you can find it there.

A prominent U.S. Cancer Institute has posted a notice on its website urging cell phone users to take precautions when using cell phones because advice from an international panel of experts says cell phones have not been around long enough for scientists to be sure about their safety.

The announcement comes from the Center for Environmental Oncology, part of the University of Pittsburgh Cancer Institute based in Pittsburgh, Pennsylvania. The group considered the advice of an international panel of experts, including cancer specialists from Europe and the United States, before making the following proclamation.

Their quote "Electromagnetic fields generated by cell phone should be considered a potential human health risk."


"Not enough time has elapsed for us to be sure of the biological consequences of cell phones and cordless phone technology," said the Center, "and until then, people should be careful."

Recent studies which include subjects with a history of cell phone usage for a duration of at least 10 years show a possible association between certain benign tumors, such as acoustic neuromas and some brain cancers on the side the device is used.

Researchers that estimate the penetration of electromagnetic radiation from cell phones based on age, show that children are considerably more vulnerable than adults and frequency bands used by cell phones from 800 to 2200 MHz, even below the power threshold required by most safety standards, causes an "increase in the permeability of the blood-brain barrier and an increased synthesis of stress proteins."

Neither the expert panel nor the Center for Environmental Oncology suggests people should stop using cell phones, which they refer to as "a remarkable invention and a breakthrough of great social importance."


One of the experts, a brain cancer survivor, Dr. David Servan-Schreiber, continues to use his cell phone.

The message, therefore, is that users should take precautionary measures and especially those who have cancer already.

The Center suggests this 10-point list of precautions:

Children should only use cell phones for emergencies and organs that are still growing are likely to be most sensitive to electromagnetic fields. So that's the reason.

When using your cell phone, keep it away from the body as much as you can. Compared to holding it next to your head, the amplitude of the electromagnetic field drops to 25% at 2 inches away and to a mere 2% at 3 feet away.

Use speaker phone or a wireless Bluetooth headset, as much as possible. These have less than 1% of the emission of a normal cell phone. A hands-free ear piece may also reduce exposure.

Using your cell phone in public, crowded places, like a bus, means others are passively exposed to your phone's electromagnetic fields, so avoid using it in these places.


Keep your phones away from your body as much as possible. Don't carry it in your pocket. Oops! Don't keep it near your body at night, such as under a pillow or on a bedside table. Oops, again. Furthermore, put it in "flight" mode," which stops electromagnetic emissions but allows other functions to work such as the alarm.

If you have to carry it on your body, keep the keypad toward you and the back of the phone pointing away from you so more of the transmitted electromagnetic field moves away from you rather than towards you.

OK. For long conversations, use a landline with a corded phone , of course unless there's lightning in the area , and not a cell phone or cordless phones since both use similar electromagnetic emitting technology.

Alternate right and left ear when using your cell phone, to spread the exposure. Wait until the person you are calling answers before placing the phone right next to your ear. In other words, do everything you can to cut your exposure time with the phone close to your body.


Avoid using your phone when travelling at speed, such as on a train, or when the signal is weak. The phone will be trying to connect to a new relay antenna and uses higher power to do this.

Text message rather than call, as much as you can, because this limits exposure in two ways: less time on the phone and the phone is further away from your body.

Also choose a phone with the lowest possible Specific Absorption Rate or SAR, which is a measure of the strength of the magnetic field absorbed by the body. And you can use the keyword phrase "SAR ratings cell phones" to search on the Internet.

Which I did by the way and I discovered that the iPhone is middle of the road so that's good, I guess. And now you know what kind of phone I use.

There has been a somewhat skeptical reaction to the Center's announcement with many sources, saying there is a considerable body of research that has found no health risk from cell phone usage.


The National Cancer Institute website says that studies have so far failed to show a link between brain tumors and cell phone use. The U.S. Food and Drug Administration says on its website, that the available scientific does not show any health problems associated with using wireless phones. But the FDA goes on to say, there's also no proof that wireless phones are absolutely safe.

In research, there is a saying "absence of evidence is not evidence of absence" , to give you something to think about , and that perhaps urges us all to, what I mean the meaning of that, [Laughter] perhaps urges us all to consider this news carefully and then make up our own minds.

I do have some links in the Show Notes for you. The full announcement from the Center for Environmental Oncology in Pittsburgh and then also a nice breakdown on cell phone facts, as it relates to health from the FDA.

All right. That concludes our News Parents Can Use and we will be back with our interview with Meagan Church, right after this.



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All right. We are joined today by children's author Meagan Church to talk about her new book "Unique as Pete: How Autism Does Not Mean Different," so welcome to the program, Meagan.

Meagan Church: Thank you. Thanks a lot for having me.

Dr. Mike Patrick: Oh, you are more than welcome. I love this book, by the way. And then so, I guess, a great place to start will just be to let everybody know, the low down on what this book is all about.

Meagan Church: OK. Sure. Let me start at the very beginning. The book concept began about two years ago when I and others who , there were sort of a development team that went into this. And we're a bunch of freelance artists who are called the Creative Underground, just a bunch of writers, photographers, designers, musicians and more.

And we've come together as a group because we have a strong desire and passion for helping non-profits and socially conscious companies and groups. And one of our members had a connection with one of the founding members of our local chapter, "The Autism Society".


We're located in the South Bend, Indiana. He found out about our desire to open an applied behavioral analysis in our area and that's an ABA Therapy Center that would help autistic children to grow and learn and develop.

Dr. Mike Patrick: Great.

Meagan Church: So we were trying to find ways to help them raise funds for this "dream" that they had. And so the Creative Underground got together and decided to come up with this book concept, where a portion of the proceeds would go to help them realize that dream.

So basically we've been working on this for a few years and as you well know, autism, the diagnosis just continues to rise and it's not fully understood at this point.

Dr. Mike Patrick: Right.

Meagan Church: So there's just so many questions surrounding it with, well how can we maybe help answer some of those questions. It's not like we have all the answers by any means.


But we just wanted this book to educate its readers from children to adults on how to interact with them. You know treat other children who have autism.

Dr. Mike Patrick: Right. So this is a picture book, isn't?

Meagan Church: Yes.

Dr. Mike Patrick: It's kind of hard in a podcast format. [Laughter]

Meagan Church: Right.

Dr. Mike Patrick: To get that across. But it's a picture book. And as you read it, I guess on the surface you would think, oh, this is really geared toward kids to help them understand autism and why some kids are unique and don't seem to fit in, but then it goes to talk about how being unique really is fitting in.

Meagan Church: Right.

Dr. Mike Patrick: But there is something in there, even though it's a picture book, and aimed at kids, there really is something in there for adults to get out of it, too.

Meagan Church: Sure. Some of the pages within a bright, colorful illustrations and rhymes, for the kids specifically, but then in the back, is a resource center to help adults because adults have so many questions, whether it is a parent, a grandparent of an autistic child, or a teacher working with an autistic child, or even a doctor or someone to help their profession.


So it's a resource center that has vocabulary and basic definitions for common terms associated with autism, along with biographies of the groups and individuals involved and testimonials from experts such as yourself.

Dr. Mike Patrick: [Laughter] I was happy to do it.

Meagan Church: [Laughter] We really appreciate it. But as those series of books evolved, we hope to grow that resource center more and more, just to offer more information, whatever information is available out there, just to give people some sort of foundation, sort of educational center to be able to turn to.

Dr. Mike Patrick: Yes, that's great. I'm just looking at the Vocabulary right now and it has definitions for things, such as Asperger Syndrome, Autism Spectrum Disorder, Pervasive Developmental Disorder.


And I think especially for parents who want to know more about autism but don't necessarily have an autistic child themselves, or they just want to help teach their children more about autism, it's a great for them because these are terms that you hear, peripherally, unless you have a child with autism.

I mean you hear these terms sort of thrown around but it's not always really evident what they mean.

Meagan Church: Right, exactly.

Dr. Mike Patrick: Now the illustration, you said they're bright and colorful, and that's an understatement. [Laughter] They are just really remarkable. How did you get together with the artists? Were they a part of the Creative Underground group to begin with, or did you have to go out and recruit them?

Meagan Church: No, actually they're part of the team. And Dana Hooton is the founding member of the Creative Underground. And she was the one who was the project manager of putting this book together. And she works with another illustrator named Tom Sours, and they just brought life to Pete and other characters in the book.


Dana was the one who had the idea to make Pete into a puzzle piece, which autism often uses puzzle pieces as graphic elements to help reference the disorder. So we turned Pete into a puzzle piece, and they really did a great a job of using just bright colors and everything to try to engage those young readers.

Dr. Mike Patrick: Yes. It's really remarkable and really just pushy in, I mean, more so than any picture book that I've seen in a long, long time.

Meagan Church: Thank you.

Dr. Mike Patrick: Now do you have a sequel on the way? [Laughter]

Meagan Church: We are right now working very hard on this first one but yes. We have already been considering future books so we hope to be able to follow this one out relatively soon, with the next one on the series and then we continue from there.


Dr. Mike Patrick: Now in terms of getting something like this published especially when you're looking at it as a fundraiser, how did you go about doing that? I only mentioned it because there may be other groups out there who are interested in doing the same sort of thing. How do you take the concept and actually bring it to the printed page?

Meagan Church: Sure. It takes a lot of research and educating. Dana really handled so much and that part of it. The rest of us just sat back and waited for updates from her. But we went through a company called AuthorHouse, which is a self-publishing print-on-demand type of place.

It wasn't one of the big New York houses or anything. It was a place that they took what we did and just put into this professional looking book format, and whenever we need copies, we'll run whatever we need. So that's pretty much how it works.


And they have connections with major distribution places like Amazon and Target and Barnes and Noble. They just helped us to get that book out there so it's available to more and more people.

Dr. Mike Patrick: That's great. What is the easiest way for parents to find "Unique as Pete"?

Meagan Church: They can visit our website that's devoted to the series that we're developing. It's called or to directly find the book to purchase. They can go, which is our publisher, or Amazon, Target, or Barnes and Noble.

They can also ask their local bookstore. They might not be available in the bookstore but most bookstores have the ability to order them, if they're not on the shelves.

Dr. Mike Patrick: Great. And we'll make sure we include all those links in the Show Notes, too, so people can find them pretty easily.

Meagan Church: OK.

Dr. Mike Patrick: Let me ask you very quickly about the Applied Behavioral Analysis Center, where some of the portion of the proceeds are going to support. What exactly is that all about?


Meagan Church: [Laughter] For specific details, that's not my expertise area.

Dr. Mike Patrick: Sorry.

Meagan Church: But in talking when we first developed this book, we sat down with some of the parents in our local chapter, The Autism Society. This is who's going to benefit. And we just listened to their stories which were unbelievable. I mean the stories of commitment and patience and understanding.

And I was happened to be pregnant with my first child at that time. And I was a month away from delivering and I was just listening to these stories and was overwhelmed by what it took to care for these kids with autism. You talked about full-time job.

Dr. Mike Patrick: Right, oh sure. Definitely.

Meagan Church: Yeah. These parents had had experienced with ABA Therapy in South Bend's Course Notre Dame. It's a couple of miles up to the road here so, which is not the only thing we're known for here in South Bend.

Dr. Mike Patrick: [Laughter]

Meagan Church: So there is a professor there who has actually lined up students to work with some of these families with the ABA Therapy.


And as far as, I don't have a deep understanding of how that works but all I know is that the results that these families have seen from that one-on-one teaching and learning interaction has just been incredible.

And they've been so excited from the results that they've had within their own families that they want to be able to open a center that can reach even more families and hopefully help their children to grow and develop, just like what they've seen in their own personal lives.

Dr. Mike Patrick: Right. It's tough because they are scattered around, specialty clinics, multi-disciplinary approaches that treat kids with autism and provide support to families.

Meagan Church: Right.

Dr. Mike Patrick: But a lot of them are just so overwhelmed with people trying to get in and there's waiting time. So it's nice to see that there's a community effort in South Bend to help support the families in that area. So it's good.

Meagan Church: Yeah, absolutely. And there's so many different therapies out there.

They even meet families who worked with ABA, have tried so many other, whether it be diet or medication, the list just goes on.


It's just people are still scrambling to figure out what works and what does not work. A lot of times, we're caught reacting to it instead of being proactive. It's just great to see this group of families that are so overwhelmed in their day-to-day lives with taking care of their own children that they're really committed to taking the time out to be able to bring that resource to other parents so that they can hopefully see the same results.

Dr. Mike Patrick: Yeah, that's great. So you have a son or daughter now?

Meagan Church: I have a son.

Dr. Mike Patrick: A son. And how old is he now?

Meagan Church: He is 21 months.

Dr. Mike Patrick: Great. So it's a great life change, isn't it?

Meagan Church: Yeah, you can say that for sure.


Dr. Mike Patrick: As I understand that you have a parenting blog, too?

Meagan Church: Yes. Yes. Actually I just started a blog.


It's called "Defining Motherhood". I am a writer and I have written all sorts of different types of things from fiction book, children's books, advertising and everything else. And so, I was always very good at journaling before my son came along.

And then after he came along, that sort of what the wave … So this is a way to get back into that and just with the focusing on motherhood because I found that there are a lot of definitions. There are stereotypes out there as to what a mother is, but so many are constricting or a cliche.

Dr. Mike Patrick: Right, right.

Meagan Church: And so this is just an attempt to define it in my own terms, according to what my experiences have been. So it's basically just a collection of stories and observances, having to do with, or somehow relating to motherhood, at least.


Dr. Mike Patrick: And it's

Meagan Church: Yes.

Dr. Mike Patrick: Right. We'll put a link to that in the Show Notes as well. That's really how PediaCast got started. I actually started writing Pediascribe which is now Karen does. And it was basically my observations as a pediatrician and then it morphed into the podcast. And I enjoyed this a little more but¡K


Meagan Church: We enjoy having you, that's for sure.

Dr. Mike Patrick: Oh, it's great.

Meagan Church: The information you offers they're quite valuable.

Dr. Mike Patrick: Oh, please, please stop.


Thanks for stopping by. We appreciate it.

Meagan Church: Thank you.

Dr. Mike Patrick: When the sequel comes out, we'll have to have you back.

Meagan Church: Oh, absolutely.

Dr. Mike Patrick: All right. Take care.

Meagan Church: Thank you.



Dr. Mike Patrick: All right, welcome back to the show.

Tammy in Columbus, Indiana, is up first in our Listener Segment. Tammy says, question for Dr. Mike. My used to be very calm and pleasant, never crying and always cooing baby girl [Laughter] has developed into , most of the time, pleasant and very good inquisitive toddler.

I have to say most of the time because the rest of the time she is completely off for rockers. She screams, rolls on the ground, picks things up and throws them, swats things out of your hand, pushes you away and every other non-pleasant behavior that you can think of.

Basically she knows exactly what she wants and demands that she has it when she wants it. Currently I asked her to use words if it's in response to her breaking rules such as "Now markers stay in the table."


I explained it to her and I tried to redirect her attention. If she is inconsolable, I tell her I'm going to play in her room and she can come and join me when she calms down and I simply walk away, although this is a bit harder to do in public.

My question, what the heck am I supposed to do when my 16-month old turns into She-Devil?


All right, Tammy. First let me say, you're not alone. OK. I mean, I think, what you have described could be described for most six-month olds whether they'd be boys or girls. I mean, most of the time, they're going to be pleasant and very inquisitive.

But sometimes they just completely go off the rocker and they scream and roll on the ground and pick things up, basically, throw a temper tantrum.

And really Tammy I think that the way you are handling it is exactly the right thing to do. Most 16-month olds don't really quite understand right versus wrong yet.


They're getting there. And some of them are going to understand. But you're right on the brink, in terms of brain development when kids really understand right versus wrong and so, timeouts often don't work quite as well at this young age.

So I think distraction and redirection is really the best tactic in most cases. Now when their frustration leads to complete and utter meltdown [Laughter] and distraction and re-direction isn't going to work, then what I would do is make sure that they're in a safe place and walk away. And then when they're calm, then resume your distracting and redirecting.

The worst thing you can do or the worst thing you can do is to leave them in an unsafe environment. You obviously don't want to do that, near the stairs, or with outlets that aren't plugged or things they can pull down on themselves. You want them to be in a safe place.


But the next worst thing you can do is "give in" to their demand when they are throwing a tantrum. And even if you want to give in, even if it's perfectly acceptable, whatever their demand is, and you're OK with it.

Let's say they wanted something and you were going to get it for him but you didn't have a chance to do it yet, and then they start throwing their tantrum and it's something you really want to give into.

But once they go into meltdown mode, you can't give in, even if you want to, until they're calm. Otherwise you reinforce that meltdown tantrum behavior, and it's going to become much more difficult to extinguish down the road.

So keep up the good work, Tammy. I think you're right on the money with your game plan. It's exactly what I would do. And the fact that your 16-month daughter is sometimes a "She-Devil" [Laughter] is not that unusual for 16-month olds.

OK, next up, we have Karen in South Carolina.


Karen says first let me thank you for your service to mankind. OK [Laughter] that's a little thick, Karen. As soon as the kids jump out of the car to school line, my iPod switches to "PediaCast: You Are My Hero". Ahh, OK.

After that shameless buttering up, here's my question/plea. My seven-year-old daughter is being referred to a psychiatrist to screen her for an anxiety disorder due to months of escalating behavioral issues at school.

It took one session, just one session, for the counselor to determine that she should be screened by a psychiatrist. Both the counselor and her pediatrician suspected an anxiety disorder due to her specific behaviors and the presence of anxiety disorders on both sides of the family, specifically OCD, obsessive-compulsive disorder.

Since there is a long waiting list to get an appointment with a child psychiatrist, I'm trying to get information to be prepared for this meeting. What are the causes of anxiety disorders?


What treatments are available and effective for a child this age? What concerns should we have about any medications that are likely to be suggested, if that is the suggested course of action?

Since many but not all of the things that trigger the anxiety attacks are academically related, how can we assist her in achieving academic success? Currently the typical methods of de-stressing have not worked, and our counselor has admitted that she's a little stumped, after one session.

Would anxiety disorder be considered a disability? If so, would an IEP or Individual Educational Plan be a recommended course of action? Thanks so much for any and all help.

All right, Karen. So you have listed several questions and I'm going to try to hit them all in just a couple of minutes.

But first I want to say, I don't really have a clear idea of exactly what your daughter is doing. I mean, I hear you say anxiety and its academic related. But I'm not really clear on her specific behaviors and symptoms.


You do not mention anything specifically about an attention issue along with this, but it's definitely something you need to consider. I would say, in my practice and in my observations, one of the biggest sources of school-related anxiety, particularly as it relates to academics in this age group, is going to be untreated ADD or ADHD.

So why would an attention problem that is unrecognized and undiagnosed lead to anxiety? Well, you have a kid who wants to do well in school and they are trying their absolute hardest. I mean, they want to succeed. They want their teacher and their parents to be proud of them.

And despite their best effort, things aren't going well. The teacher and the parents are frustrated so it's easy to see how anxiety results. You're really trying to do your best and you're trying to please everyone but your best isn't working. And everyone's frustrated and that creates lots and lots of anxiety.


So for these kids, the way to treat their anxiety is, first to treat their attention problem. And whether that'd be with a stimulant medication or whether it'd be with changing their school environment and teaching them a little bit of a different type of plan, and that's where IEP comes in handy.

But I will admit that most kids do not end up doing well with just alterations in the classroom environment or the way that they're being taught. Many of them need a stimulant medication in order to correct their brain chemistry that helps them to pay attention, and then this improves their school performance, which makes everyone — the child, the parent and the teacher — happy again. And it extinguishes their anxiety.

Now obviously, Karen I can't diagnose your child with ADHD over the Internet. But I wouldn't discount that possibility.


And if your child has not been screened specifically for attention, impulse control, hyperactivity — those sorts of things — you're really doing a disservice not to think about that. Because so many kids that I see with anxiety at that age, they get their ADHD, their attention, their impulsivity, their hyperactivity-type stuff under control and the anxiety goes away.

So in my mind, you have to deal with any underlying thing first that might be causing the anxiety. And it's not always ADD. I just used that because it's very, very common example. But other sources of school anxiety to consider.

Are there any bullies in the classroom? Are there girl cliques? Even in this young age, kids can be so mean to one another. Or is there a group of girls that used to include her and aren't including her anymore? Is there inappropriate behavior on the part of the teacher? Sometimes teachers start to "nitpick" everything about a certain child and that can create anxiety in the kid.


Are they having any physical problems, frequent stomach aches, headaches, which can go along with depression? Or they might actually have a physical disorder? Constipation often times causes chronic belly aches, and if you have a chronic belly aches at school and it's interfering with your ability to concentrate, that can lead to anxiety and you got to treat the underlying thing first.

And are there any social problems at home — mom and dad? Again, I'm not talking Karen necessarily just to you. But, in general, kids who have anxiety at school, are there social issues that we have to consider?

And so, I do question if this counselor only saw you one time and then immediately said, "Oh, we got to get her to a child psychiatrist." You might want to see a different counselor. I mean, really! I mean just one time, did they thought that?

So you got to explore all of these things and it takes some time to do that. So you have to eliminate any underlying things that could be leading to the anxiety.


OK. That's the first thing.

Now, let's say there are no other issues. Let's say, there's no ADHD. There's no bullies in the classroom. There's no social issues at school or at home. There's no physical disorders. I mean there's really nothing at all after we've really, really looked into this.

We just have isolated anxiety in a seven-year old. So we have a primary anxiety disorder because there's nothing that we can tell that's causing it.

First, let me say that will be pretty rare in a seven-year old. Not unheard of but pretty rare. If there are obsessive-compulsive symptoms along with that, such as frequent hand washing, checking for things over and over again. Don't forget my lunch money. You're checking your pocket every five minutes. Did I forget to do my homework?

Again, as we're getting a little bit older now, or extreme sensitivity to clothing not being exactly right, to the point where it's interfering with your life, you can see obsessive-compulsive tendencies in kids as young as seven, although, again, it's really rare thing.


However, if it is a primary anxiety disorder or obsessive-compulsive disorder, that is a problem with brain chemistry. And in particular the chemical in the brain that seems to be involved is one called serotonin, as opposed to dopamine which is the chemical that typically is involved with attention and hyperactivity disorders.

Now this, of course, is oversimplifying it to some degree. There's likely other chemicals that are also involved. There's likely a continuum between attention issues and anxiety issues. But just as the ADHD medications work on the dopamine system so like Ritalin, Metadate, Concerta, Adderall, Focalin, Daytrana, and the list goes on, there are also medicines that worked on the serotonin system, so that helps with the anxiety and obsessive-compulsive tendencies.


And the one drug that probably has the most "user experience" in pediatrics, especially when there's a strong obsessive-compulsive tendency related to it, is Zoloft. So Zoloft is a medicine that you can.

It is approved that has a pediatric indication for obsessive-compulsive tendencies then anxiety as well, in the pediatric population. As young as age seven, it's going to depend on the exact situation, the comfort level of the parent, the comfort level of the child psychiatrist, and there are other serotonin-type drugs that work as well. But Zoloft will be definitely one to consider.

OK, but again, that would be the last thing I would do. The first thing I would do is to try to find if there's any underlying things and correct those first. And you have to remember that ADHD, attention-impulse type problems have to be considered.


Even if you don't have a kid that's hyperactive, you still have to think about attention and impulse control.

OK. Let's get to your specific questions, Karen. What are the causes of anxiety disorders? You asked. I think we covered this pretty well. You're going to have environmental things. So if there's social situations at home and at school, those can lead to anxiety. So you have to make sure there's nothing there. And if there is, either correct it or teach the child how to deal with it.

What we would call co-morbid conditions, so other psychiatric disorders that lead to anxiety, and again, ADD would be an example of that.

A kid who's really trying to do their best and it's not working and everyone's upset, and they're upset of themselves and that leads to anxiety. And then, the third cause would be a primary disorder and brain chemistry where you have to fix the serotonin system in the brain.

So again, I'm oversimplifying a little bit but those are probably the three most common causes of anxiety disorders in the pediatric population.


OK. So what treatments are available and effective for a child this age? Again, identification and elimination of the source or alter the brain chemistry with a drug.

What concerns should you have about any medications that are likely to be suggested? This question alone, Karen could be an hour long discussion easily because there's so many agents out there, so many types of side effects to deal with.

In general, though, I would say that the life disruption that goes along with ADHD and anxiety and obsessive-compulsive disorders, the life disruption that goes along with those, so the effects that those disorders have on your child, are more detrimental to the health of your child than concerns that arise from the small possibility of side effects from the medications that we typically use, in my opinion.

And I don't want to short change you on this, Karen.


But then again, I also don't want to waste time on irrelevant information. So I tell you what. After you see your child psychiatrist, if they recommend a specific medicine, although in my opinion it's probably an attention issue, you get your seven-year old on like a little Concerta and they're able to focus better at school and do better, the anxiety is going to go away.

But again, I can't say that over the Internet since I really don't know your specific information and details. But I'll bet that's it just from lots of prior experience.

But, anyway, if your child psychiatrist recommends a specific medicine, write back and let us know, and then we'll have a little discussion on that particular medication — how it works, its safety, its side effects — the works. I'll do that for you.

So just write me back once you find out if there is a medicine, what the medicine is, and we'll go from there.

Finally, you asked, "Would an IEP or individual educational plan be a recommended course of action?" I would say absolutely.


Coming up with an individualized plan to help your child succeed in the classroom is always important even when medication is used. Unfortunately, many schools lack the funding and resources needed to conduct IEPs on all the kids who need them.

And sometimes as a parent, you have to be the "squeaky wheel". You have to be the toddler throwing the tantrum to get the school's attention. And hopefully, the school officials don't listen to PediaCast and don't know that the best way to deal with a tantrum is to walk away from it and then will perform the service, basically, to shut you up.

It's not ideal but all too often it is how the real world works. And it shows you how smart toddlers are, to use tantrums to get their way. So as PediaCast listeners, you now know when to throw tantrums and how to make others stop throwing them. Good thing is to know. [Laughter]

OK. Let's move on to our final question. This is one is Mel in Arizona. And Mel says, "Hi, Dr. Mike. I have boy turning 11 and it seems like he might be starting to get acne on his nose."


"I was wondering at what age acne starts and what can I do to help this not become a serious issue, when he becomes older. Thanks, Mel in Arizona."

Great question, Mel. First, let me say that, in terms of what you can do to make it not become a serious issue when he becomes older, there's really not a lot. If it's going to become a serious issue, it's going to become a serious issue and then you're going to have to deal with it at that point.

So if you have an 11-year old who is starting to get some acne, you just basically have to treat it. If treating is not necessarily going to prevent it from becoming more of a problem down the road, it's just that when it becomes more of a problem, you've got to ramp up your treatment a little bit.

OK, basically, there's a wide range of ages when acne can start, just as there is a wide range of ages when puberty starts. And as it turns out, the two are related.


So as the body gears up for puberty, certain hormones under the picture, which lead to lots of body changes including acne. And it's not uncommon for the acne to appear before noticeable body changes but rest assured those changes are occurring.

Especially in boys it's a little bit harder to tell those changes are going unless you see him naked. So you may notice the acne first. And girls as they get a little breast development, it's a little bit easier to say, "Oh, yeah, she's going to puberty and that's why she's starting to get acne." But in boys, it's a little bit different.

So when exactly does this process begin? In the United States the onset of puberty ranges from 9 to 14 for girls and ages 10 to 17 for boys. So Mel, your son is right in that group. I mean he's definitely , sort of I'd guess you'd say an earlier bloomer because he's 10 going on 11 and the age of onset for puberty of boys ranges from 10 to 17.

So you may not want to admit to it but, Mel, your son is going through puberty.


OK? T9hat's why he's got the acne. Now in terms of the acne itself and what you can do for it, I'm going to take the easy way out here, because we're running a little bit short on time and because it doesn't make sense to re-invent the wheel, and because it maybe a couple of weeks before I'm able to get another show out. So this will give you something to do in the mean time.

So I'm going to direct you to PediaCast number 44 because I interviewed a dermatologist about acne in teenagers. The show is about a year old but it's still relevant and chock-full of information. And plus, to make it really for you, I'll even put a link up to Episode 44 in the Show Notes so that you can find it easily.

So, as I mentioned, there's probably not going to be a show next week and maybe there'll be one in two weeks; it might be three weeks, depending on how events pan out over the next week or so.


So this will give you a little something to do. Go back and listen to Episode 44. We've got a whole acne conversation with a dermatologist, so that will point you in that direction.

All right, that's going to put a wrap on our Listener segment this week. I will be back and we'll put a wrap on the rest of the show, right after this.


As always thanks goes out to Nationwide Children's Hospital for providing the bandwidth for the program. We really appreciate that.

Also AudibleKids at for providing support for this particular episode.


And again to get your free audio book and find out more about them, just go to

Of course, thanks to Vlad over at for helping us out with the artwork. He's got great posters at the site, if you like the pictures that we have for our logo and also in the side bar at and

Those pictures come from Vlad and you can order to decorate your home, nurseries, children's bedrooms. Really, he's a great artist. He's from Russia. But the service that provides the print work is actually in the United States, so you're not going to pay for overseas shipping. I think it's in California, maybe San Francisco. But don't quote me on that.

Also thanks to Medical News Today for helping us out with the news portion of the show.

And, of course, thanks to all of you for taking time out of your busy schedules to include PediaCast in your day. My wife Karen does the PediaScribe blog, which is basically a general parenting-type blog.


My featured post this week is "Friends Are Friends Forever" because Karen gets a little serious and sentimental before the big move. But you can't blame her.

So she talks a little bit about friends and leaving friends and starting new, in a new place a thousand miles away. But fortunately for her, a lot of her friends are through the Internet so , and there'll be new friends down in Florida.

Also, that's my daughter Katie's teenage blog. She just turned 14 actually. And so, she does BaggaChips, if you haven't checked that out. That's safe for you and your kids to visit — not all teen blogs are — but hers is.

And the post that I'm highlighting this week is "My Birthday Cake". You got to know our family, folks. We're a little different. [Laughter] OK, Katie's Birthday Cake says: Her 14th birthday cake says, "Happy 12th Birthday, James!"


Now, OK. [Laughter] no, we didn't get it on sale. This was my son's idea, OK. This is typical 11-year-old boy.

Actually the story goes , I'll give you the short of it. Katie and Nick were visiting grandma and grandpa. They actually went on a camping trip up in Canada, saw Niagara Falls, went biking — really had a great time.

And while they were with grandma and grandpa, it happened to be when Katie had her birthday. And so the boys, grandpa and Nick, were assigned the task of getting a birthday cake for Katie.

And they came back with a cake that said "Happy 12th Birthday, James!" for Katie who is turning 14 and it's a girl. OK, you get it. Anyway, that's my family. Got to love it. So you can find out more about that at


OK, reminders. We do have a PediaCast shop. It's open. We have t-shirts and bags, tote bags, duffle bags — those kinds of things with the PediaCast logo on it, great way to help spread the word about the program.

iTunes reviews are extremely important. By the way, if you listen on the website but you have iTunes on your computer, make sure you add us. Make sure you subscribe to the podcast because that helps with the numbers, which helps with our rankings, which helps with exposure, and helps to recruit new listeners.

And also iTunes reviews, particularly if you're a person who found out about the show because you read the reviews, if you can please just take the time to leave a quick review on iTunes that would certainly be helpful.

We also have a poster page where you can download PDF files, print them out and hang them on bulletin boards, telephone poles, the swim place on the doors that go into the facility, like the YMCA or wherever. Those posters are great way to help spread the word as well.


All right. Unfortunately, as I mentioned, lots and lots of stuff is probably going to be happening in the coming week or two, so I don't think I'm going to get around to doing a show. I do have a lot of Skype messages go through, so we'll have a show answering messages from the Skype line here coming up soon.

And even though we won't have the show for a week or two, keep the questions coming. And again, I do understand that we don't have to get to all the questions in the shows. So there's a good chance that the questions that you sent in won't make it on the show. But please don't be offended by that.

We're really just trying to pick a good variety, different age groups, different topics, things we haven't done in a while in order to make it a good program. And the more questions that we have to pick from really the better the quality of the information.

So keep those questions coming. I really appreciate it. And you can get a hold of me at by clicking on the Contact link or you can email or call the voice line at 347-404-KIDS.


All right, again, even though I won't be here for a couple of weeks, good days lie ahead. Just remember that. Because once we get settled in Florida this fall, there's going to a lot more time to devote to this.

And I'm really excited about the possibilities and have some ideas in my head about that. So until next time, this is Dr. Mike saying, stay safe, stay healthy and stay involved with your kids.

So long, everybody!

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