Dog Bites, Throwing Food, Head Banging – PediaCast 143

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Topics

• Video Games And Cell Phones
• Seizure Surgery
• Alcohol And Television
• Hospice Care
• Dog Bites
• Socialized Medicine Comments
• Water In Newborn Ears
• Tylenol Before Shots
• Crawling And Walking
• Throwing Food
• Head Banging
• Homeschooling

Links

• Wear Sunscreen! (YouTube)
• Video Games, Cell Phones, And Academic Performance
• Seizure Surgery For Babies And Toddlers With Epilepsy
• TV Shows Convey Mixed Messages About Alcohol
• Nationwide Expansion Provides Hospice Care For Kids
• Kids, Dogs, And Warm Weather: A Recipe For Trouble
• K12 Homeschool Curriculum
• K12 International Academy

Transcription

Pediacast_143

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

[Music]

Welcome to PediaCast, a pediatric podcast for parents. And now, direct from Birdhouse Studios, here's your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone, and welcome to PediaCast, a pediatric podcast for moms and dads. It is Episode 143, 143 for Monday, March 30th, 2009 and I'd like to welcome everyone to the show. We've got a big line-up for you here. I don't think the show will last as long as last week's, but I was like on a roll last week with the tangents.

0:01:10

And so I'm going to try to keep things a little bit in line, in check, not let my thoughts get away with to me, get away from me too much this week so yeah, maybe it won't be quite as fun then. No, I don't think so.

We've got some cool topics. Video games and cellphones, are those good for kids or bad for kids? The answer might surprise you. We're going talk about surgery for seizures. Is that an option instead of medication. Also, alcohol and television, hospice care, I know we don't like to think about end of life sort of things, in general.

And when it comes to kids, you don't want to think about it even more, but the hard truth is that there are children who have life-threatening terminal diseases and the hospice care is important for them and some of them aren't getting what they should. At least in some states. So we're going to discuss that.

0:02:07

Also, dog bites as the weather gets warmer and the dogs are outside more and the kids are outside more, there's a little chance for interactions between the two with negative outcomes, I should add. So we're going to talk about dog bites.

Also, last week, I went off one of my tangents, one of my big tangents. We talked a little bit about socialized medicine in the United States and what that could mean for the future. Lots and lots and lots of comments on the whole socialized medicine thing.

I'm not going to go through all of them because then it would be a long show. And I would go off on more tangents. So we're just very briefly, I'm going to share with the audience what some of you had to say in response to the prospect of Obama's administration bringing in socialized medicine, which it seems like after the economic system is "fixed" next on line, maybe a fixed for our medical system. So we'll see.

0:03:09

Also then your questions this week, water in newborn ears, a good thing, bad thing, what do you, how do you keep it out, do you have to keep it out. We'll talk about it.

Also, Tylenol. Should you give Tylenol before kids get their immunization? Will it help immunizations in terms of comfort? Are kids better off if you pre-dose them with some Tylenol before they get their shots.

Crawling and walking. Do all kids crawl before they walk? No, but we'll talk about some of the nuances of that. When do you get concerned if your child is not crawling.

Also throwing food and head banging. I told you it was going to be an interesting show. And then we're going to discuss very briefly homeschooling. We had a couple of questions on that. Actually, I get a lot of questions on that and I usually just sort of ignore them because I don't know, I'm not really an expert on education even though we homeschool here.

0:04:05

We actually don't do a lot of the work ourselves. We use some great curriculum and as the teacher, a homeschooling teacher, which really, that's my wife, I don't do much of that. But it's — what we use makes it really easy so you don't have to be smart and know about all these — all of these subjects. So we'll talk about that a little bit at the end and those of you who have no interest whatsover in homeschooling, you can just shut us off a little early. So we'll save that one for last.

Before we get started with the meat of the program, I do want to take some time to talk about something that, I guess, has been coming and I've just had not the chance to address it yet and the time has come to do so.

I kind of feel like the preacher on Sunday morning who has to talk about finances and a few are the new person who has never attended that congregation before, all this talk about, ah, you got to give 10% and this and that and you go on and on about it and it kind of lose a bad taste in your mouth if that's first experience with said church.

0:05:09

So we're going to — I do need to talk about finances here a little bit. The truth of the matter is that PediaCast has become and I mean, I'm happy about it, but it has become large enough of a thing that it actually cost quite a bit of money to put these shows out. And the real cost comes in bandwidth. We do, of course, have a bandwidth sponsor, but they became our sponsor well before the show sort of ballooned into what it is today and there's so many more expenses that go along with putting the show out in terms of the total bandwidth.

And, I guess, sort of what has spark is, and then we talked about this a little bit last week, that I had to switch hosting providers. And in doing so, I found out pretty quickly that with — even with some mega plans, the bandwidth, there's been a couple of times in the past month when the site was shut down. and the reason is because the bandwidth is just too great.

0:06:12
And so it becomes very costly to do this in such a way that you're not waiting forever for files to download. Just for instance, we had well over 100,000 hits to our feed just in the first three weeks of March.

And so that kind of traffic really costs money. And unfortunately, I don't have a lot of personal money to put into this. I enjoyed doing it, I certainly have put money into the studio and into quality equipment so that we sound good and into production software so everything sounds great.

So what am I talking about bottomline here? If you enjoy PediaCast, if you get something out of this program and as you know, it is completely free for moms and dads. And I've been very leary of going to paid type of format because putting this information out there is really what is the most important thing to me. But one obstacle is the cost of doing so.

0:07:12

So what — I'm a terrible person of trying to — they don't want to put me on is the guy on public TV trying to get you to part with some money and support the endeavor. So if you like PediaCast, if you enjoy it, if you think you get something out of it, I would just ask that you donate a little bit of money to help with production costs.

And it's very easy to do this. This is new, it's brand new on the site. If you haven't been to pediacast.org in a while, please do so and on the left hand side, you'll see a little button that says donate. This is sort of modeled after the Twit Network. This week intact with real report. they do this sort of thing and have done it for a number of years and it's been successful for them.

0:08:00

And again, I've just — I've not wanted to do this because the money part of PediaCast is not why I do this. But as I said, it has come time for something to give. And hopefully, that will be you. What I'm asking is not much.

You'll notice that once you go to the Donate page, there's some choices. It's all done through PayPal. You do not have to have a PayPal account to participate. You can just use secure — their secure interface for donating with a Visa or MasterCard, that kind of thing. Or if you have a PayPal account, you can do it.

And what this will do is there are several options. One is a $2 a month recurring charge to your PayPal account. For that one, you do have to have a PayPal account if you the recurring ones. But basically, it's like a subscription. You can cancel at anytime. It just takes $2 a month out. And I think $2 a month, if everybody did $2 a month, we would be rolling in money and this show will be a fabulous. And I would probably be able to cut way down on my daytime job and life would be beautiful.

0:09:05

But of course, not everyone's going to do the $2 a month, so hopefully some of you would consider doing a little bit more. There's also an option for $5 a month, another option for $10 a month. And there's also an option for one-time donations there as well. So I would just ask if you get something out of this show, if PediaCast mean something to you, if you would just give a little bit back, you can help this show to continue and to be all that it can be into the future.

You know my hopes had been with sponsors, but with the economy the way that it is now, podcasts are just being dumbed right and left in terms of sponsorship. And you can understand that. I mean when you look at bang for your buck, you get a lot more advertising bang when you go with someone who has millions of people in the audience and we don't have that. I mean we have a great audience. We have a loyal audience, a supportive audience and I thank you guys for that, but unfortunately, it is an expensive show to do and so I'm not going to spend anymore time on this.

0:10:09

Just go to pediacast.org, click on the Donate page and there won't be anymore long tirades about it. I'll remind you from time to time, but again, the goal here is just to get enough cash to pay for things like studio equipment, the software that's needed, the hosting, the bandwidth, all of that is really what we're after and what we need. And it doesn't take that much, a couple of bucks a month from all the listeners out there would more than take care of that. So again, just go to pediacast.org and click on the Donate button. Appreciate it.

Alright, if there's a topic you would like us to discuss on PediaCast, it's really easy to get a hold of me. Just go to pediacast.org, click on the Contact Link. You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS. That's 347-404-K-I-D-S or 5437, if you don't have letters on your phone dial.

0:11:04

I also want to mention — here lately, sort of there's been a trend for people to message with questions through Facebook. I don't mind it and ones that I've gotten so far, I have copy and pasted into the appropriate place where I keep your questions.

But it is — when I have too many places that are people are asking me questions, it gets a bit confusing. So I would ask to please limit your question asking to pediacast.org the Contact link or through email or through the voice line. Please don't ask a question through Facebook only because that venue is the one that's the most likely to sort of get left behind and your question not get through.

So far, I have done a pretty good job of keeping up with those, but if you could please, in the future, just use the Contact page or email.

Don't forget the information presented in PediaCast, of course, is for general educational purposes only. We have to satisfy the lawyers here. See, I had to hire a lawyer to come up with all of our Terms of Use agreement that's at the website. I mean it's this big, long document and lawyer-ist.

0:12:14

That's the kind of thing I'm talking about where expenses come in that just don't get reimbursed. And then my wife gets, you know, not real happy about that because then there's less money for things like groceries.

Okay, so 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. And with with all that in mind, we will be back with some actual information for you in our News Parents Can Use department right after this break.

[Music]

0:13:28

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.

Using cellphones and playing video games may not be as harmful to children's academic performance as previously believed, that's according to new research from Michigan State University. Investigators found that cellphone use had no effect on academic performance and while they did uncover a strong relationship between video games and lower grade point averages, playing video games did not appear to affect math skills and had a positive relationship with visual spatial development.

0:14:05

These skills in which a child learns visually by thinking and pictures an images are considered the training wheels for performance in science technology, engineering and math. And these are the areas where we want to see improvements in our children's academic performance, said lead investigator Linda Jackson, Michigan State University Professor of Psychology.

The study is a part of a larger MSU project funded by the National Science Foundation in which Jackson and colleagues are exploring the effects of technology on children's academic performance and their social skills, psychological well-being and moral reasoning.

The researchers surveyed students from 20 middle schools and an after-school center in Michigan. They asked how often the children use cellphones and played video games both online and offline and they measured the children's grades, visual spatial skills and performance on standardized tests in math and reading. As expected females use cellphones more frequently than the boys while males played video games far more frequently than the girls.

0:15:02

Some 81% of adolescents play video games online according to the Pew Internet and American Life Project. Jackson said it's unrealistic to think kids will stop playing video games so video game developers should focus more on the elements that develop visual spatial skills and less on themes such as violence.

Also more games should be develop that appeal to girls to better develop their visual spatial skills which are essential in profession such as surgery. She said, "Girls are at a disadvantage by not having that three-dimensional experience," Jackson said. So when they get to medical school and they're doing surgery in the virtual world, they're not used to it.

When it comes to cell phones, Jackson said she's on no detrimental effects to the students academic performance. However, further research is needed on older students who are more apt to engage in devious behaviors such as text messaging text answers to each other.

The global cell phone market had 1.8 billion subscribers in 2007, a number that is expected to reach 3 billion by 2010, according to Baskerville Communications in London.

0:16:04

Okay, so I've always maintained that video games have some use. I mean certainly, they're not going to be good to spend hours and hours and hours for days on end and just increasing your screen time and you have less physical activity and less reading and that sort of thing. But in moderation, they have a place.

And I think, one interesting thing from this story, girls are on the phone more and play video games less so there's less chance for them to develop these visual spatial skills which I think is interesting about that is because 20 to 30 years ago, I bet it was really the girls who were developing their visual spatial skills more often. And I don't mean to be a sexist here, I'm just — this is just a life observation.

When girls had more home economic classes and in schools, learning to cook and sew and sort of the more domestic kind of thing, so again, don't read into this. Is it right, is it wrong. I'm just saying 20 to 30 years ago, girls did more micromanipulation type things with their fingers than they do now. You know what I'm saying?

0:17:08

So it's just interesting to me that now with the advent of video games and sort of less of the domestic stigma on girls to learn cooking and sewing and those kind of things that now boys are learning sort of micro — the micromanipulation skills whereas before, when they were out tossing the football, it was more gross motor skills that they were good at. So times are definitely changing and now it's the boys apparently developing the micromanipulation skills.

Okay. One other thing about that, that I wanted to mention, first, in terms of the research and we had another story that I'm going to do kind of ties in with this, it's interesting these researchers think that through their research, they're going to get the game developers to change what they're doing.

Like the game developers don't care about what sort of things that you're learning and whether it's good or whether it's bad, whether there's violence or whether there's not violence, I mean these researchers got to start living in the real world. Game developers develop game to sell them.

0:18:13

And as long as parents are going to let their kids buy violent games, okay, the games are being sold, they're going to keep doing it. Showing video game developers research that, oh, come on, we got to have more games that show have good influence and not the bad influence, that's not going to do anything.

Now, I guess, if you say, hey, is there a certain game that would interest girls more, that might work because then they're going to sell more of their products to girls. So these researchers, they have good intent, but in the real world, I don't think video game developers are looking at the research at all.

And if they do and their games are going to be the boring one that don't sell, they're going to be out of the job.

Okay, let's move on. I told you no tangents and I'm — this is going to be a longer show than I thought.

0:19:01

A new study published in the journal, Epilepsia, reveals surgery for babies and toddlers suffering from epilepsy is relatively safe and is effective in controlling seizures.

The findings also show the early surgery may have a positive impact on baby's brain development. The study reviews epilepsy surgeries in children under three years of age across all pediatric neuro surgical centers in Canada between 1987 and 2005. 116 children had epilepsy surgeries in eight centers across Canada.

Okay, I've had to pause here. We've talked about the Canadian Health Care System from 1987 to 2005. Okay, I mean that's a long time. 116 kids had epilepsy surgeries. I wonder how many of those — how many went to the United States to have their epilepsy surgeries. Okay, I mean they don't mention that, but I know it's a tangent. But only 116 kids had these surgeries from 1987 to 2005. And 82% of those children who had the surgery were children who started to suffer seizures in their first year of life.

0:20:07

The children generally underwent major brain operations including removal of or disconnection of half the brain. Despite such large operations, there were few complications and only one death. At the time of surgery, children were having an average of 21 seizures per day with one child having as many as 600 seizures per day.

One year after surgery, 67% were seizure free, 14% had a greater than 90% improvement in their seizures and only 7.5% did not benefit at all from the surgery. Also development improved in 55% of the kids after the procedure was done. The result of the study lead us to conclude the epilepsy surgery in children under 3 years is relatively safe and is effective in controlling seizures, says Dr. Paul Steinbok of British Columbia's Children's Hospital in the University of British Columbia, lead author of the study. Thus, very young age is not a contraindication to surgery in children with epilepsy that is difficult to control with medications.

0:21:04

A large percentage of infants in young children who might benefit from epilepsy surgery are not undergoing the procedure, currently such children are often treated ineffectively with the various anti-seizure medications on the assumption that surgery should be considered a treatment of last resort.

There's also this study argue that surgery maybe a better option than continuing drug management and should be considered earlier in the treatment process than is typically done.

Okay. So I do, of course, present this one with a bit of caution. First we're talking about removing or disconnecting up to half of the brain. Now why would that work? The reason is because seizure starts somewhere in the brain at one or more spots.

And so where the seizure begins, it then spreads from there. So basically, if you cut out or disconnect the spot where the seizure starts, it's going to stop. Of course, you also lose whatever other function that bring tissue with supplying, but the good news there is we know young brains can adapt and different areas of the brain can take over for different functions which is pretty crazy when you think about it.

0:22:05

But if you're disconnecting half the brain, there's only so much taking over, I suppose, that can occur. But then again, the quality of life for these kids is in question. And the family's quality of life are pretty much stinks. These are kids again who were having an average of 21 seizures per day.

So this is not your typical where a kid is having a seizure once or twice a week or even once or twice a month. I mean these are the kids who basically are seizing all day long.

And if you — here's the thing, as a parent, you just don't realize what other parents go through from a child health standpoint because there are kids who have seizure disorders like that and parents who are dealing with this on a daily basis. So when you're going on about your life, just remember those, folks. Because you know it's really it's really stressful on families and a hardship on families.

0:23:00

And now there seems to be more hope though for these kids when medicines aren't helping. But again, keep in mind, these are the bad cases, not the kids are having a seizure once a week.

Prime time television shows and mixed — I should have put this news story, should have been after the first one, I'm sorry. Prime time television shows and mixed messages to teenage viewers regarding the outcomes of alcohol consumption and these exposures may influence the way teens feel about drinking.

That's according to a new study published in the spring 2009 edition of the Journal of Consumer Affairs. The research led by Dale and Crystal Russell, both scientists at the Prevention Research Center in Berkeley, California is based on a content analysis of prime time television shows during the 2004 to 2005 season.

The primary more central alcohol message was often associated with negative elements such as crime, addiction or lower job performance while the secondary such as having fun or partying, those kind of outcomes were the positive ones. So the positive messages might undermine any negative messages is how these researchers feel.

0:24:06

And they conclude by saying policy makers and parents need to remain vigilant in monitoring alcohol depictions especially product placements given the current environment of self-regulation of the alcohol industry's marketing and advertising endeavors.

Because of television's effect on the audiences attitudes and behaviors, the prevalence of alcohol message in the content of television programs raises concerns over their likely impact on audiences especially young ones.

The research team is continuing its efforts to study how young viewers process these messages and the consequences the messages have on viewer beliefs and drinking behavior.

Okay, again, and the reason I say this I really should have done this news story after the first one is again, these are researchers who are saying to the people who write television programs, you need to have more negative outcomes with alcohol so that our children can learn it's bad to drink.

0:25:00

And you need to not show the people in the characters in the show should not be having partying and fun times that relate to alcohol because then, you are showing alcohol in a good nature and is it likely then that kids are going to say hey, alcohol's fun, let's do it.

I mean that's basically the bottomline of what this research is getting at and they're saying that we need to do more of that kind of thing. Again, television researcher or television writers are not listening to pediatric research. And it kind of bothers me a little bit because there's the whole committee for instance within the American Academy of Pediatrics whose goal it is to make the media safer for kids, to depict the good things more often and depict the bad things less often. And that's fine. I mean I can understand that. Let's not show people having fun partying, but the problem is with that is that people watch this television shows as entertainment. And they do it because their lives suck. Right?

0:26:10

I mean they just have — people's lives generally have bad things going on. And so when you watch TV and you watch these shows and you see characters who are in a worse position than your end, it makes you feel good about yourself.

Now again, I'm not trying to say it's right or it's wrong. That's just the psychology of it. I mean people tune in to Grey's Anatomy because you are living vicariously through those characters and the predicaments that they get themselves into make you feel better about your own life.

Now so will television writes stop depicting alcohol in the sense where it seems to be a good thing more often than the negative consequences of it. I don't think they're listening to this research at all. Not at all. So I think really where our focus should be is with the parents.

0:27:04

And actually, this article did mention that, which I like, because a lot of times, they don't get parents involved in these kind of things. They say in this article that this is a policymakers and parents need to remain vigilant in monitoring what your kids are seeing.

So again, I don't know that policymakers should be the ones monitoring this. I mean really — okay, I don't know. Tangent, tangent, tangent. It bugs me to think that someone out there wants there to be policy like government policy on what's in our television shows. I mean this is just getting crazy, folks.

But the better thing is have the shows have — depict what they wanted to pick, let the writers write what they want to write and then audiences are going to watch what they like. And that is how it's always going to be in a free market.

Parents, on the other hand, do need to monitor what your kids are watching and talk to them about it. Talk to them about — if you get rid of all the negative consequences of alcohol — or I'm sorry. If you just show negative consequences of alcohol and you don't show any positive outcomes from the alcohol, you do lose some teachable moments for parents and kids.

0:28:16

For parents and kids to sit down and say, hey look, in the real world, that person who looks like they're having fun could get in the car wreck on the way home and kill someone. And that you sort of miss the opportunity, I think, as a parent for these teachable opportunities when you just show wholesome goodness on TV and only show the bad outcomes because you have to depict these things as real world and truth or people aren't going to be entertained by them and then they're not going to watch them.

Now the Lifetime Channel, on the other hand, the people who write for shows on the Lifetime Channel, they are following the prudent measures placed by the policymakers and the American Academy of Pediatrics and doing what they wanted them to do. But look, who's watching those shows? Nobody.

0:29:01

So anyway, my point here is just that you have to look at this from a — and a logical standpoint, I think. And the goal here should be to get parents to start interacting with their children more. Monitoring what their children are watching and when what they're watching does not equal real life, debriefing your children about that. Okay, that's my own little perspective on the matter.

Let's move on. Less than 11% of children with life-threatening illnesses receive hospice care in the last year of life in part because insurance requirements make it difficult for families to obtain care. That's according to a new study at the University of Florida.

But a pilot program in the Sunshine State has redefined when children can receive pilot of care and that could change this. Dr. Caprice Knapp, an assistant research professor at Epidemiology and Health Policy Research in the College of Medicine and the lead author of three studies recently republished on Pediatric Palliative Care in Florida says one barrier has been the way the reimbursement system works.

0:30:01

You can access hospice care, but a physician must certify the child is within the last six months of life. And even though hospice, services are beneficial and families who end up using them are happy with the care, parents might perceive this as giving up hope due to the six-month rule.

Florida was one of the four states selected to receive 3.2 million to develop a new model for Pediatric Palliative Care and was the first to implement its program in 2005.

Called Partners in Care Together for Kids, this program allows children on Medicaid or the state children's health insurance program to receive palliative care from the time they are diagnosed with the life-threatening condition regardless of prognosis.

Care for children at the end of life costs a lot of money, Knapp said, but if we move them into this new model of care, we might be able to save money and improve their quality of life. Prior to the program, between 7% and 11% of children who died in Florida received hospice services at the end of life, according to a study the researchers published in March in the Journal of Palliative Medicine.

0:31:00

By contrastingly 30% of adults with cancer received hospice care at the end of their life. So 30% of adults with terminal illnesses received hospice care and only 7% — between 7% and 11% of children. Not so good.

Between 2005 and 2008, enrollment in the programs which is available in seven cities across Florida increased from 80 patients to 468 patients. And of those families, 85% reported that they were pleased with the program.

Although the word hospice tends to trigger thoughts of older patients in their last days of life, palliative care actually ranges from managing a patient's symptoms to offering psychological services to patients and their families. Children who have palliative care often live better, said Dr. Sarah Friebert, Director of a Palette of Care program in the Haslinger Division of Pediatric Palliative Care at Akron Children's Hospital in Ohio.

She says their families are well-adjusted, their symptoms are more controlled, they are able to enjoy the good times they have left. Palliative Care can really help make that better. Dr. Knapp added because Florida's new program allows children and families to obtain pediatric palliative care anytime after their diagnoses, more families can now receive that care. And depending on the outcome of the program, private insurance companies might eventually choose to adapt similar practices.

0:32:14

Florida's the only state where the rule has been changed across the board, but Knapp says it's about the big picture. We're making small strides toward a comprehensive pediatric palliative care coverage and this is the first time this has ever been done by a state.

And I want to mention here too, they talked about saving money if you enroll more kids into hospice-type program, it's going to save you money. Obviously, it's going to cost more money in the beginning because you have to pay for the hospice service that you weren't before. But the truth is that more kids who are receiving hospice and palliative care are less likely to show up in emergency rooms and need more expensive care in the hospital when some things can be done at home through a hospice program.

So I just wanted to mention that because when you're first hearing that, it's like okay, how does that really save you money? But it does, it does.

0:33:06

Okay. Let's go and move on. Kids, dogs and warm weather. This is a recipe for trouble. If you and your child are ramping in the park or enjoying a stroll on a warm spring day and a dog approaches, be ultra vigilant. Children and warm weather and dogs, even family dogs don't mixed well, according to a study conducted by pediatric otolaryngologists, those are the ear, nose and throat specialists from the University of Buffalo School of Medicine and Biomedical Sciences.

A result showed children are especially vulnerable to severe dog bites in the head and neck areas and that there's a correlation between cases of dog bites and rising outdoor temperatures. A dog is a man's bestfriend, but could be a child's worst companion, notes Dr. Philemona Behar, Professor of Otolaryngology and one of the study's authors.

Children are particularly vulnerable to severe dog bites and especially when the injuries are in the head and neck and the injuries can be extensive and even life-threatening especially in young children.

She said kids don't understand the need to distance themselves from danger, but these same kids may look like prey especially as they run around and children cannot outrun dogs or defend themselves against them.

0:34:11

The study appears in the March 2009 issue of Otolaryngology Head and Neck Surgery. The authors reviewed charts of 84 children up to 19 years of age who were treated for dog bites at women and children's hospital in Buffalo from 1999 through 2007.

Results showed the average age of injured children was six years, one-third of the bites occurred on the cheeks, 21% on the lips and 8% each on the nose and ears. 64% of the patients suffered more than one facial wound and 40% of the total injuries had to be repaired in the operating room under general anesthesia.

Dog bites increased as the weather warms and the family pet was the culprit in 27% of the injuries. Doctors, nurses and others involved in treating the dog injuries need to be educated to collect precise information, she emphasizes. For instance, it's very useful to know the specifics.

What is the breed and sex of the dog, has it been spade or neutered, who is the owner, what is the dog's vaccination history and is the dog available for close-up observation over the next couple of weeks. Was the dog restrained? How long ago did the attack take place and where? Does the child have a history of dog bites? Does the dog have a history of aggression? Was the dog provoked and was the child adequately supervised?

0:35:20

These questions not only aid in treatment decisions such as the possible needs for rabies shots, but also identifies trends so health care providers and families can team up to develop and promote prevention strategies.

Alright, that wraps up our News Parents Can Use this week and we will be back to answer your questions right after this break.

[Music]

0:36:08

First up in our Listener segment, last week's commentary on the State of Medicine in the United States and the prospect of a reckless socialized medical system, courtesy of the Obama regime drew lots of heated comments on both side of the issue.

Here are a few of my favorites. Liza on Facebook said, "I wasn't here last podcast. Thank you for speaking out against socialized medicine and for your critical analysis of medical studies."

Sarantos in Brooklyn, New York said, "Medicine in the U.S. is only as good as you can afford. God forbid you get cancer or sickness that requires long-term care. Also, anyone out of a job which is a benefit of eight years of a GOP president and six years of GOP control in Congress cannot afford any insurance which typically costs a thousand dollars per month. Please stay with topics you know and stop creating propaganda for the right. While you build a new home, millions of people are losing their jobs and their insurance benefits." Sorry, Sarantos, but I'm not shying away from this one.

0:37:01

The fabric of the American Health Care System is a topic I care about and I know very well. And I'm just as qualified to talk about that as I am pediatric health issues and I'm more qualified to talk about than politicians in Washington. I have never seen a sick child turned away from care in this country in our current system because of inability to pay. Whether it's a surgery for congenital heart disease or leukemia or diabetes or the need for tonsillectomies or ear tubes, kids who need medical care in this country today get it and that's not based on research or report. It's from living and working in this system for the past two decades and knowing how it works.

The biggest mistake doctors have made is staying out of this debate and we can't do that any longer. Otherwise, bureaucrats, not doctors or patients, will be dictating the hows and whys of the doctor-patient relationship which means big brother's interest win out over the patient's interest every time. And I do not want to see that happen. And for the record, Sarantos, I don't have a right wing agenda. I'm not proby to the propaganda machines on either of the political spectrum and I don't get talking points in my inbox. What you get from me is opinion based on experience and research. I am not and will never be a megaphone for any organization whether it be medical or political.

0:38:13

And with regard to my ability to build a new home, come on Sarantos, my ability to build a home has nothing to do with the state of the American Health Care System. On the other hand, it has everything to do with good decision making. Decisions to work hard toward an education when no one in my family had ever gone to college, decisions to spend within my means, to limit and quickly pay down debt and decisions to choose a home in a comfortable price range while resisting the temptations and in some cases railroading by realtors and brokers to do otherwise.

And by the way, is any of these pertinent to PediaCast? Of course it is because it's high time for parents to teach kids to make good decisions and to accept the consequences of those decisions and to stop playing victim and blaming others when things go wrong.

Kristen in O'Fallon, Illinois says, "Congrats on getting back in the game. I would be a liar if I said I hadn't missed you and the podcast. Glad to know things are settling some in the new abode.

0:39:05

Thanks for coming back in an era where some great podcasts are not able to keep up their good works, you did. And you continue to bring information perspective and brilliant insight to all of your listeners whether they agree with you politically or not.

That being said, thank you so much for your thoughts on the current state of health care. While I voted for the current administration as the spouse of a military retiree and a wife having had the privilege to live overseas including England, I couldn't agree with you more. There are some aspects of our system that are broken, but socializing them won't fixed it. Can't wait for more shows. Sometimes it makes me wish you are my kid's doctor. Warmly, Kristen.

P.S. I think you tackled molluscum contagiosum in a relatively recent show. Do you remember which one? I may need to relisten."

Kristen, that would be episodes 63 and 137. Both of those covered molluscum. And we have an easier way for you to figure this out now. If you go to pediacast.org and click on Search, there's a Search page and you can easily find that kind of information.

0:40:01

Our search engine, by the way, is another example of an added expense to the program that I have to shell out because the Google search engine just was not cutting it. It was not working well. So we have a customized search engine there. If you type in molluscum contagiosum, you get the episodes where we talked about it. And I did that for you. It was Episode 63 and 137.

Kate in Seattle says, "I have listened to PediaCast since the very beginning and I was delighted to see that a new episode was available this week. I've missed the podcast since you've been away and I'm glad to hear that your family is now more or less settled in to your new home.

Your health care policy discussion, however, was a major disappointment for me. Not only do I disagree with you, but I found myself irritated by hearing a lengthy political editorial rather than the enormously valuable and practical health information you typically dispensed. I don't have my head in the sand. I consume a significant amount of political news everyday representing a diverse set of viewpoints and I believe that robust policy debates are critical, but that's not what I want from PediaCast.

0:41:03

I was in the PediaCast because I'm interested in learning more about how to care for my child's health. You have said many times that it's your show and that you can say what you want and of course, that's true. I just wanted you to know that this direction, if it is, in fact, the start of the trend will likely alienate some of your listeners like me who are seeking medical information from you and not political opinion.

One final quibble, I really resented the patronizing way in which you warned you will not like the changes that are coming to our health care system as if you are all knowing and the rest of us have no clue. Having lived overseas for many years, I have first-hand experience with different systems and I can tell you that I was far more comfortable delivering my first baby in Hong Kong where I got excellent care in a public hospital than I am delivering my second baby here in the U.S. where the costs have already exceeded those of my first pregnancy and the care has not been nearly as good.

Again, I'm glad you're back and I'm looking forward to learning as much from you in the coming years as I have in the past, just had to share my two cents."

Thanks for your two cents, Kate. Hey, last week's episode was still packed with pediatric information. It wasn't all political commentary and we have a full play of more great info coming your way here in just a couple of minutes.

0:42:08

But the political debate, I'm afraid, is here to stay. And to be fair, there has always been a political edge to this show. And I think you might be remembering the past more rosily than it actually was.

Who out there remembers the term breast [nazi_0:42:20] and the trouble that caused me? Remember my tirades about home breathing and the arguments that ensued with that? What about our immunization mercury and autism debates? Sure, it may be more intense now, but we are talking about our health care system and the future of that system for our children. If we can't talk about access to pediatric health care and a pediatric podcast, Kate, where can you do it?

Phil in Omaha, Nebraska says, "Thanks for your great podcast on March 20th. I really appreciated your views on Obama's socialized medicine plan and I'm so glad to hear there are doctors willing to give their perspective on the dangers of this new system.

And finally, Melissa from Facebook says, "I really like the new podcast, so informative even if I may not agree with all the political stuff. The beauty of this country is that we can disagree and say our opinions out loud. Thanks again."

0:43:06

You got it, Melissa. You know, if I lived in China, I probably be in jail right now. Let's move on to your questions this week because we do have some good ones.

First up, Leslie in Peetz, Colorado. Leslie says, "I love your podcast and found it from your appearance on the pregtastic podcast." Thank you. "My daughter is 10 weeks old and loves to take baths with me and float in a big tub. I hold her head and she is able to kick her legs and wave her arms in the water. She absolutely loves it. My question. Is it okay to have her ears in the water? My husband does not think it's good for her."

Okay, you win, Leslie. You win over your husband with this. Water and baby's ears is fine, not a problem at all. I think what happens is that parents get this feeling that water in the ears are going to cause ear infections. And ear infections are not caused — a typical ear infection so ones that we talk about kids getting lots of middle ear infection, also called otitis media.

0:44:05

These are infections that arise from mouth bacteria going up to Eustachian tube which is the little tube that connects the back of the throat to the middle ear space and setting up shop reproducing in that middle ear space, they get trapped there because the Eustachian tube may be sort of floppy or mucus from a virus or from allergies or from smoking — exposure to second-hand cigarette smoke.

This mucus can block the Eustachian tube and now, any bacteria that had gone up into the middle ear space can't get back down to the mouth and to get trap there, they reproduce, fill the space body sense and white blood cells will take care of them. You get inflammation in pus [span_0:44:43], you had a middle ear infection.

So that's the genesis of the ear infection on babies. It's not from wind or water or anything coming from the outside through the ear canal toward the ear drum. It's not how it happens so water in the ear is fine.

0:45:00

Now having said that, there's another kind of ear infection called otitis externa or an external ear infection which is actually an infection of the skin of the ear canal which is a different beast than what most of us think about when we're talking about ear infections in babies.

But it is possible, so if you had water in the ear all the time and some skin breakdown in the ear canal and some bacteria on the skin was able to get through the safety barrier of your skin and create a cellulitis or skin infection in the ear canal. That sort of thing is happening, then yes, I would avoid getting water in your baby's ears because that was probably the culprit. But for most babies, that's not the case.

The other sort of nuance with this is if your child has had recurrent ear infections and has ear tubes in, that's the little round plastic tubes with a hole in the middle that goes to the eardrum. Why do we do that? When you know that the genesis of the ear infection, how it happens which we just discussed, what you realize is that if you have a small hole to the eardrum, now any bacteria that have become trapped in the middle ear space that can't get back down to the mouth because the Eustachian tube is now blocked because it's floppy or because there's mucus, it presents an exit route.

0:46:14

So this trapped bacteria can go through that plastic tube to the outside part of the ear, the ear canal, the skin and basically go from becoming mouth bacteria to becoming skin bacteria.

So it's basically, that's what we call ventilation tubes. They just help to ventilate that area to create an exit route for trapped bacteria. So if you have one of those tubes in place, then it may not be as good of an idea to get your head — to put the baby's head under water because now water can go from the outside into that middle ear space because you have a hole in this plastic tube through the middle of the ear drum. So now, that water can get to the middle ear space and you really don't want that to happen.

Now having said that, if you get a room full of ear, nose and throat doctors, pediatric ear, nose and throat doctors. Let's say, you take a hundred of them and you ask all of them, is it safe for babies with ear tubes to get their heads underwater?

0:47:08

Half of them are going to tell you, it's fine. Half of them are going to tell you, don't do it. And half that say it's fine, what they'll say is that the water needs to be under some significant pressure to get through the hole in that tube in any significant amount.

So that if it's just a little water emerging, yeah, it's not such a big deal. I mean you wouldn't want jet off water like in a shower. You wouldn't want them to be diving in a pool, but look, babies aren't doing those things anyway.

So what's the right thing to do? I would follow the advice of whoever put the tubes in. I mean if your pediatric ear, nose and throat doctor is saying use the ear plugs, use them. If they say it didn't matter, then don't use them. That's personally what I would do because then, if you do end up with a problem, you can say hey, I listened to the expert to put the tubes in. I didn't just go off on my own and do what the crazy guy in PediaCast said to do. So I would go with what the doctor who put them in, what they said.

0:48:00

Okay, we went off on a little tangent there, but I think it was helpful to explain the pathophysiology of ear infections.

Okay, Joy in Troy, New York says, "My son recently received his first batch of immunization and needless to say, he was miserable afterwards. A few people have told me to have him take infant Tylenol before the shots next time to help with the pain. Is this a good idea? I find out your podcast to be quite helpful. I appreciate all that you do for your listeners. Thanks again."

Okay, Joy, first let's talk about why you get fever following immunization. We've talked about this before, the quick rundown is that when you inject the child with an immunization, you are faking the immune system out.

Okay, you're trying to get the kid's immune system to think they have this disease. But it's not the type of disease — it's not the form of that organism that could actually infect them and reproduce and go crazy and cause the illness. It's an attenuated form when it's sort of been bred or a killed virus which can't infect you so that you don't get sick from it.

0:49:09

But you're still trying to get your body to think it's real. So that it will make antibodies against it. Well, part of making those antibodies, inflammatory mediators or chemicals get released in the body that cause fever, achiness, that chills that go along with the fever, it just — when I get sick with the virus, I say, ooh, I feel viral. I mean I've got a headache, my joints hurt. I feel achy, I just want to lay on the couch and be left alone. And that's because — it's not the virus making me feel that way. It's actually my bodies immune system, it's the side effects of the chemicals the body is using to fight off this infection.

And so when kids feel miserable after they had shots and we give them Tylenol, it's to help that. It's basically to block the effects of these chemical mediators that give you the fever and make you feel bad.

0:50:00

What Tylenol doesn't do is block a signal from a pain receptor in the skin to the brain. Okay, it does not do that. That's not how it works. So giving a child Tylenol and then thinking the injection itself is not going to hurt as much makes no sense from a scientific viewpoint when you look at how these things work.

Okay, the pain from the immunization comes because you are penetrating the skin with the needle and you are stimulating pain receptors in the skin to send the signal to the brain that says hey, that hurts. And Tylenol does not block that. So in terms of is it good to pre-medicate with Tylenol so that the shot doesn't hurt as much, no. Not a good idea, it's not going to work. Because that's not how Tylenol works.

Tylenol is going to be better at blocking the effects of the body's immune systems response to getting that immunization and that comes much later so you're fine doing the Tylenol when you get home.

0:51:02

Now do you need to do Tylenol? Here's the thing. If the shots — some kids tolerate the immunizations better than others. Some have more of these reaction where they get a fever and feel crummy. And others, don't really get a fever and feel crummy. And it's hard to predict who's going to do what. And it also is not always the same in the same kid from episode one to episode two.

I mean how they react to the shots at two months maybe different than how they react to their shots at six months and maybe at how they react at 12 months. Plus, between like the two-month and the 12-month when we're talking about a whole different shots here.

So there really can be a variety of experiences that your child has. So I wouldn't do the Tylenol until they actually start to have those problems. And the reason for that is because the Tylenol is not [innocuous_0:51:48]. I mean you can have problems form the Tylenol. You can have allergic reactions. You could accidentally overdose. We've talked about Steven Johnson's reaction here recently which is a terrible, horrible allergic-type reaction that you can get more often with ibuprofen products than with Tylenol, but it's possible with any drug.

0:52:07

So my point here is that if your child wasn't going to have any bad symptoms, why put a chemical in their body that they don't really need? So that's why I would say go get the shots, see how they're doing, if they start to get fever and feel crabby, go ahead and give them the Tylenol. That's how I would do it.

Okay, let's move on. This one is from John in Rancho Cucamonga, California. "Hi, Dr. Mike. Long-time listener, third-time emailer, glad to see you back. I went for the website a while ago and it was gone." Yeah, I know because I couldn't pay for the fee. I couldn't pay for the bandwidth because you guys are going crazy with the show.

"At least you're back now and hey, you've got a new website out of it. I've emailed…" Actually it's not completely true because it's been owls since we've had the new website too because, you know, the bandwidth issue. "I've emailed before asking questions regarding our little princess, Scarlet, and she is turning one on April 11.

0:53:02

Around Christmas time, she would stand with help but not pull herself up, now she's not having anything to do with it at all. If you try, she just goes spaghetti legs and wants nothing to do with it at all. And we have always tried tummy times and she wanted nothing to do with that either except cry, cry, cry.

We figured she just was going to skip crawling and being on her belly and go straight from lying on her back and then walking. Now we don't know what she's going to do. We're not sure if we're doing something wrong or if she is just being a lady in taking her time. Your input will be greatly appreciated. Thanks again for the podcast, keep up the great work. Hope everyone is enjoying the new house. John and Nicole in Rancho Cucamonga, California."

I love saying that, Rancho Cucamonga, California. Although can you imagine having to write that address out or spell it for people over the phone, maybe not so much fun there.

Ugh, John, this is kind of a tough one. I mean there's certainly kids out there who take their time walking and there are kids who never really crawl much. My meter stick at around 11 months which is what you're talking about with your daughter here, sort of my meter stick at 11 months is can they get from point A to point B in some fashion if they really want to?

0:54:14

If they can, they really want to get from one place to another, if they can get there some way, I'm less concerned. If there's something they really want, there's a toy, some motivating thing to get them to move, I don't care if they roll, if the crawl, if they scooch, it doesn't really matter because the kid doesn't care.

In the kid's mind, they want what's over there. And so they're going to get there whatever way they feel more comfortable with and so really, they have a means to get from A to B is what's important at 11 months of age.

Now the other thing that would be included in my meter stick for being concerned or not is do they have a normal neuromuscular examination. So if you have a kid at 11 months who's not really crawling, not really taking an interest in standing or taking some steps, but they have a completely normal neuromuscular examination.

0:55:07

Their neurological system is normal. They have nice muscle tone. They have good strength. These sort of things and they're growing and developing well and they can get from point A to point B if they want, then I'm not worried and you just give them a little bit more time.

And I've certainly seen normal kids who don't really start to walk until they're between 15 and 18 months of age. You get to 18 months of age and they're still not walking, you start getting a little bit more concerned that either there really is something going on or they're really neglected kids who are not having an opportunity to learn how to walk.

So those are — if the answer to both of those things are yes, then you just give them more time. If they can get from point A to point B and they have a normal neuromuscular examination. So this does take seeing your doctor. So if your doctor says they're not really to worried about it, in their mind, they've already made sure they can get from point A to point B and they've already done the neuromuscular examination. So if your doctor says they feel comfortable with it, I would feel reassured as well.

0:56:09

On the other hand, if the answer to those are no, then I think at 11 months, more is needed to look into this problem. Because there are lots of different neuromuscular concerns, diseases, disorders and we won't go through all of those because it will just scare you. Because there's so many different things that can go wrong in kids. It can make them not walk at this age. Okay, I'll name a few of them.

There are lots. Okay, spinal muscle atrophy is one of that usually — usually, you see that in younger kids. That's one thing — they could have early onset of Duchenne muscular dystrophy, you could see that. They could have spinal cord lesions, they can have something going on in their brain that's causing this. There are lots of different things. Toxins can do it. Botulism, for instance, botulism toxin could do it.

0:57:03

There's lots of things and so, if you have a kid with an abnormal neuromuscular exam who can't get from point A to point B in some way if they really want to, then I am concerned and I think of for the workup is needed. So definitely get in touch with your doctor about that.

Okay, Nicole in Utah says, "Glad you're back, I've missed the show. Personally, I love to hear your views and tangents." Not everyone does, Nicole. See, it's tough for me. Because you get people, you know like Kaye, who says if you keep doing this, I'm not going to listen anymore. And then you get Nicole who says, I love it. And I don't know who there's more of. And I could walk the line and just be boring, but then that's no fun for me.

Okay, so anyway, Nicole says — oh, she does say maybe it's because I agree with most of them. Okay, so there you go. Kate, you don't agree. That's your problem, Kate. You need to start agreeing with me and then my tangents wouldn't be so offensive.

Okay, Nicole also says, "Like Karen know I was a subscriber to her blog through GoogleReader. She should definitely bring it back."

0:58:06

Yeah, you know I need to sit down with Karen for a couple of hours. We were talking about this earlier today. And get the PediaScribe blog back up and running because our readers miss it. I know they do. And again, the great crash of 2009 because my host provider went poof destroyed the blogs of my wife and daughter too. So we do need to get those back online here some point.

Okay, Nicole, do you actually have a question here? She says, "My question is less of a medical question and more of an experience question. My 17-month old throws his food the whole time he's in his high chair. I don't know what to do about it. I don't want to overreact so that he continues for my reaction. I was told I should take him out of his chair as soon as he starts throwing food so he will learn dinner is over if he throws his food. The problem is that he hardly eats anything before he starts to throw the food. Any ideas or suggestions on how to deal with this will be great.

0:59:01

Maybe you could even talk Karen into joining you on a rant and rave to answer some questions. I always love her perspective too plus you two are fun to listen to together. Thanks for all the time and effort you put into PediaCast."

Alright, well thanks, Nicole, for the question. It's a good question. It really is and my son did this. It's like he was experimenting in gravity combined with some need for an animal house food fight kind of thing. And more often it's the boys that are doing this than the girls.

It's tough because — I mean you want to distract them. You want them to stop doing what they're doing and yet, experimentation with their environment is important. I mean you want them to learn about gravity. You want them to learn the cause and effect of when they drop something, it splatters on the floor. But again, you got to maintain your sanity as a parent and you got to maintain a clean kitchen. You don't want to create unnecessary work for yourself. So there becomes a time when you really — when you really have to stop this sort of behavior. So what do you do?

1:00:01

I think the most important thing here, really, is the reason that your child is doing this is because they're not hungry. I mean I found at least with my son when he would do this, that usually was the problem. He just wasn't hungry. And so the food was there. You're not — you don't really want to put it in your mouth so you're just going to scoop it up and throw it, throw it on the floor, watch your reaction, those kind of things. And so — and the — I think the most important thing here is to not give them food if they're not hungry.

So then the next thing the parents get upset about is why my toddler not hungry all the time? Well, toddlers don't have the need for calories that they had when they were babies. I mean when you're a baby and you're growing at a phenomenal rate, I mean when you look from, check up the check-up. How much weight they gained? It's amazing and they need all these calories to grow and so they're going to be hungry and they're going to eat a lot.

1:01:00

Then they get to be a toddler and they're not growing as much and they're not eating as much. And parents and grandparents, because grandparents are the biggest problem here because they always make these snide comments.

They say he's not growing now because he's not eating. Well, no. That's not it. He's not eating now because he's not growing now. That's the way you got to look at it. So if your body's — if your natural order of things is now to grow slowly, you don't have as much of a calorie need. You're not going to feel as hungry. You're not going to eat as much.

So toddlers when you look at how much do they really need, you'd be surprised, it's not much. And kids do a really good job of eating when they're hungry and stop eating when they're full. And you've got to stop putting on a toddler your expectations for how adults eat. Because we don't eat right either. We should be eating like the toddlers eat. Okay, we should be eating when we're hungry and stop eating when we're full and cutting out tons and tons of calories from our diet because we're just feeding ourselves to death.

1:02:04

So I think the first thing here, Nicole, is that you have to realize your child probably is not hungry when they're sitting there. And so the food is a toy. And that's why they haven't started to eat much because they're not there to eat.

So I think it's fine to take the food away from them. And I would be really persistent with that. As soon as the food — okay, you want them to experiment like I said, but this is not the time and place if I'm going to maintain my sanity as a parent. There are other opportunities for throwing things on the floor and learning about gravity. This is my opinion. Food's not one of them.

So I would say, if they're not hungry, don't worry about it. Just let them in a supervised area or maybe it's important that everyone sits down together for dinner as a family. Give them something to do with their hands that's more productive and it's not going to be as much of a problem as food and then sort of adjust when your toddler eats from more of their rhythm of when they're hungry. And then I think you'll have less of a problem with this.

1:03:05

So it may not be at dinner time when your toddler's hungry and maybe a couple of hours after everyone's eating, that is when their blood sugar's dropping, that's when they feel the need for hunger and they want to eat. You go with that. Go — the family dinnertime, everyone eating at the same time with a toddler in the house is less important than allowing your toddler to eat when they're hungry and not eat when they don't feel hungry. But again if you want everyone to be together at the table, that's fine. Just don't feel like you have to give them the food.

Now you may — what you may find is that you take the food away and now they're upset so so you — but if you replace the food with something that they can do with their fingers, I think that will help you out. Your toddler may still see you that you're eating something and then they want what's on your plat e on their plate. But then when they get it, they still just throw it.

In those kind of situations, you might have to remove the child from the table and put them in a pack and play with some toys, someplace safe that you turn your back and they get themselves into trouble because they're not supervised. You may have to really individualize this for your child depending on their temperament and whether they're going to tolerate being there, sitting there or not.

1:04:14

But again being persistent, doing the same thing over and over so that they learn, if I throw the food on the floor, it gets taken away from me every single time that it's going to stop. If you take it away from them and then they wanted back and they're crying and 10 minutes later you give it to them, then it's on the floor again. You take it away, 10 minutes later you're giving in again. It's not going to stop. It's not going to stop because it has become a game and your child knows if they cry and whine long enough,you're going to give them the food back so they can throw it on the floor again. So you do have to be persistent, consistent and not given. You can't let your toddler win when it comes to battles like this in my opinion.

Okay, let's move on. We have another — oh, I love this one. This is from Cecilla in Fort Smith, Arkansas. And Cecilla says, "Dear Dr. Mike, my daughter who is 13 months old has begun to bang her head on things when she is not getting her way. I'm afraid she's going to hurt herself. We have talked to her regular doctor about it and he says that it's just a phase and that she's not going to really hurt herself. I'm still uneasy about it. Can she hurt herself? Also, how can I get her to stop?

1:05:21

I also want to take some time to thank you for your advice on the difficult decision we had to make concerning our daughter. You may remember me writing, asking about her extra thumb. It was a complete duplicate thumb and your unbiased opinion really helped pushed my husband into having the surgery done. Apparently, it was big deal on our small town. My husband was afraid the doctors just wanted to ues here as a learning experience since the hospital was a teaching hospital. We had a bad experience after she was first born. I think every intern in the hospital had came in to see her and her extra thumb when she was only several days old even after we asked them to stop.

So you didn't put much — so he didn't put much stock into what the doctors there were saying. After much discussion with several other doctors and hearing from you who had nothing to do with that hospital, it really helped him to go ahead with the surgery, so thank you.

1:06:08

Keep up the good work. The new website looks great. I know you've put a lot of hard work into it. Best wishes to you and your family, Cecilla."

Thanks for the compliment on the website. It took quite a bit of time to get that up and running and designed. I had to buy a new software and okay, I'm not going to go there again to the donation page. Thanks for the nice words, Cecilla, really.

It's a good question, headbanging. Headbanging, this is another tough one. And you guys are asking the tough questions today. I sort of look at headbanging into three possible reasons why a kid would do it. One would be pathologic. And this is what I would refer to as sort of the traditional autism picture. So you have a kid who's very withdrawn. They're withdrawn verbally, they're withdrawn socially and do lots and lots of self stimulation. So these are the kids who really are sort of the classic severe autism-type picture and sort of that gray area of mental retardation and severe developmental delay.

1:07:12

So the pathologic headbangers are the ones that sat in the corner and just repeatedly bang, bang, bang, bang. Okay, obviously that's a problem. They need evaluation and help. And I know this is not the kind of headbanging that you're talking about, Cecilla.

Okay, the next one I would say is the attention. So if a kid is not getting what they want or you are not paying attention to them in a manner in which they want you to pay attention, they start banging their head. And it helps them to get what they want because you don't want to see them banging their head, so you go ahead and give them whatever they were after or you give –you give them attention which is what they were after to begin with. So the attention getter headbangers, that's the second group.

1:08:00

The third group is sort of a milder form of the pathologic group but they don't have all the other baggage that goes along with it. These are the self-stimulators. There are a lot of kids who do different self-stimulation-type things and it's really boredom as a component, sort of exploring with their bodies. But they're not withdrawn, they're not delayed. They don't have the other things that go along with it. So these are the kids who, they get up in the morning and they're banging their head at the end of their crib. And they're just banging away and you walk in, they look up, they smile at you. They might bang it a couple more times. But they're just — they're just happy headbangers.

And those kids, it's not so much of a concern and you don't really need to stop it. And this actually, this sort of discussion is not just for headbanging. There's some kids who stick their fingers down their throat and gagged themselves. That's their self-stimulation behavior. There are little boys who are playing with their penises all the time, self-stimulation behavior. Little girls doing the same thing with their parts.

I think I talked about my daughter when she was little. Oh, she'll kill me if I mention it now. She had a Tickle Me, Elmo, you know the Tickle Me, Elmo's from like the mid-'90s, do you remember those? You don't want to know where she put that when she was a toddler.

1:09:12

So the self-stimulation behavior, whether it be in the genital region, whether it be gagging yourself or banging your head' but development otherwise is fine, that's sort of the third group that we're talking about.

So as I mentioned, let's talk about these a little bit more detail in terms of what you need to do about it or not do about it. Again, the pathologic kids, the ones that are very withdrawn, developmentally delayed, those kids need more help than we can talk about here in terms of evaluation on what the bottom problem is and what sort of health treatment plan you could do because those are the kids that are likely to hurt themselves. Because they're not doing it for attention and they're not doing it for the fun of self-stimulation.

They're just doing it because their brain is telling them to do it. And so there is the possibility that they could hurt themselves and you really need to look into this.

1:10:04

The kids who are doing it for attention or because they want something, these are the kids that's the easiest one to deal with actually. Because what you have to do is totally ignore it. And you have to make sure that when they start doing that behavior that you absolutely, positively never given to them when they're doing the behavior.

I mean you don't want to, you don't want to give positive reinforcement to their behavior at all. And if you wait 10 minutes after they stopped doing it and then you give in to them — because here's the thing, sometimes a kid wants something and your first instinct is no, no, you can't do it. And then they whine, they complain, they bang their head, whatever.

And you start to think to yourself, was it really such a bad thing that they were whining? Maybe I was being a little bit too quick to say no, a little bit too — I don't know just kind of mean about it. What's the big deal? Sure, you can have this. You don't want to do that even when you're wrong because then again, they have associated with what they're doing is they don't understand that you've thought about this in your own mind and you've changed your mind because of your own thoughts, not because of what they're doing. They're going to see it as hey, it worked. I banged my head and I got it or did whatever and I got it.

1:11:18

So even when you want to give in, even when it's fine to give in, you still can't do it. You have to wait until they stop the behavior, that enough time has past so they're not going to associate getting it with you — with what they had just done. So you wait till they haven't banged their head for 10 or 15 minutes and then you say okay, now's a good time to do this or that you can have this. So just a little nugget there for you on that.

So you really don't want to reinforce this in any way. And eventually, it will extinguish itself because the reason the kid was doing it was to get what they wanted. If it doesn't work, they're going to try something else. So that behaviors is going to go away if the sole reason is for attention or to get what they want and it's not working. Then they're going to move on to another strategy. So in that case, just ignoring the problem is the best way to go.

1:12:08

Now in terms of the self stimulation, just sort of the fun — the kids doing it for fun. These kids aren't likely to hurt themselves because it's pleasure they're after. And you know okay, you bang your head onto the wall lightly, even mediumly. You're not cracking your skull. You're probably not getting much of a bruise. It's kind of cool. And even if it does hurt a little bit, some people like pain.

So I mean these kids are doing this because they want to do it, they're having fun doing it. And again, you're best off just ignoring it. But in this case, it's not going to go away because you ignoring him is not going to make – is not what they're after. They just want to do it. And your best bet really is just to let them do it. As long as they're not hurting themselves and they're not likely to hurt themselves in this case, at least not severely because they're doing it for pleasure. And again, if you like pain, it's a little bit of pain, not a lot of pain. Okay, let's not go there.

1:13:07

So the things to watch out for though, just in case. So you say, okay fine, I'm going to let them do it but how do I know if he really does hurt himself? First, let me say, it takes a lot of force to crack a skull. There've been several studies that look at — I don't have the references right off the top of my head but you just got to trust me on this.

There have been several studies that looked at accidental falls from cribs in hospitals. Where a kid was in a crib, maybe the side was left down, God forbid, by the staff or by a parent. And the kid rolled out and crack their head on the floor in the hospital setting. So they immediately get x-rayed or CAT scanned and are shown, do they have a skull fracture, do they not have a skull fracture. And the results of those kind of studies are surprising. A fall from the crib onto a floor hardly ever causes a skull fracture.

1:14:00

So my point is you need a lot of force to get a skull fracture. It takes a lot of force. So headbanging, it's probably not going to generate — if you don't typically get a skull fracture from falling out of a crib onto a tiled floor, you're probably not going to get a skull fracture from banging your head into the — with the force of that the baby's able to do it on the bed board or on the wall or whatever.

So it's not likely you're going to have a head injury. But just in case, things that make you worry about head injuries, loss of consciousness, vomiting over the next few days if they have start to have vomiting, you worry about that. If they're very — in a baby — in a bigger kid, you say, hey, do you like to have the worst headache of your life. That's obviously a warning sign of a head injury. But in babies, they can't tell you if their head hurts, so extreme irritability, difficult to console. These are all things that go along with the significant head injury. But again, this is probably not going to happen.

1:15:01

But if you come into an emergency room or a pediatric urgent care center and you have a kid who's got a bruise on their head, the doctor is going to ask you questions about how this happened. And if it really is from headbanging, they're going to question it because headbanging usually doesn't cause a bad bruise.

So again, my point is that you're probably fine just letting them do it. It's really unlikely to cause them injury. Maybe a little bruise, but not a bad bruise. And again, if you're in an emergency room or urgent care and the doctor sees a bad bruise on the head, they're going to ask you questions because it probably didn't come from headbanging. So point is, headbanging, it's probably fine.

Also, if you want to see something funny with regard to headbanging, I love this, the old movie with Steve Martin. I think I mentioned this in the podcast before but it's been a while. There's a movie called Parenthood with Steve Martin. And there's a toddler who puts a metal bucket over his head and just bangs into walls.

1:16:07

And it's funny, it's funny because it's true. It's true life. And you see this little kid and the parents are arguing, whatever, and this kid's just banging his head into a wall with this bucket over his head. And you think yeah, yeah, that could happen.

All right, let's move on. We have one more question. This one comes from Geraldine who emailed the question and tsk, tsk, tsk, Geraldine. You forgot to say where you're from. I love knowing where people are from when they write in. So on the Contact page, there's a place there that you have to write where you're from. But if you just emailed the show, make sure that you put where you're from because we all want to know. So we're nosy.

Okay, Geraldine says, "Hi, Dr. Mike. A big fan of your show. Also love when your wife is on the show. There's like a trend here. Okay, so we got to get Karen back onto the program and do a rant and rave show here soon. Geraldine says, "I'd like to start homeschooling my kids and I would like to know if you could help with the material, which books should I use, that sort of thing. I'd really appreciate your help. Keep up the good work, Geraldine."

1:17:04

Geraldine, I'm not going to spend a lot of time with this. There's tons of choices. And we did not evaluate all the choices out there. And in fact, we didn't really even try many of them at all. So keep that in mind as I talk about this because I'm really not a good one to say, oh yeah, we tried the [XX_1:17:19], we tried this, we tried that. And this is the one that worked. We just went with K12 and have been nothing but happy that we did. K12, K-1-2, is a homeschool and they also have charter schools and private schools. We'll talk about the difference here in a minute.

Curriculum, it is not religious-based, which I actually prefer. I'm not sending out a religious prison and that's not the point here. But I think I'd like to keep religion out of education in terms of the influences that it can cause. I'd rather — and to the same extent, I'm not saying that I want to treat or want to teach evolution or don't want to treat – teach evolution.

1:18:07

I don't want to influence what my kids are exposed to based on a belief system. That's all I'm saying that I think it's best, me personally, for my children, that they get exposed to everything. And then let's talk about it. Let's talk about this evolution make sense, does it not make sense. This does, this that, whatever. But I don't like it being ignored as if it doesn't exist. Because I don't think — yeah, I mean your kids got to learn to be critical thinkers on their own. And if you go with a curriculum that's very influenced by any particular religion, I think you're less likely to get that. Again, my opinion.

So K12 is not a religion, it's not a religious-affiliated curriculum. It is a classical education curriculum. It sort of it's what — they teach the things that used to be taught from a classical point of view. You read the classics, the books. You learn to appreciate art and music. So it's really kind of a cool — it's really cool curriculum.

1:19:10

It was started by – again, I'm like — like this is going to be a big ad for K12. I don't mean it to be. It's just that I feel strongly about liking it. It was started by Bill Bennett, William Bennett. He's one of my heroes. Bill Bennett was the drug czar of the United States under Reagan and Secretary of Education under Bush one. So he — he's a conservative. He's the author of the Book of Virtues, if you've ever seen that around. He's a conservative pundit so you might have seen him around the new show circuits as well.

He's actually not with the company anymore, but the company without him still continues to shine. He was the sort of the person who put this whole thing together because he felt that there should be alternatives for people who wanted to homeschool that was not influenced by religion that still had a good strong classical education type content when he came up with this. So check them out there at www.K12.com, K-1-2.com.

1:20:17

Now a lot of states actually offer their curriculum through what's called a charter school. So this is a public school that uses that curriculum and and then you have teachers that sort of check in with you. So it's not a true homeschool experience. It's what we call a charter school. And there's a lot of argument in the homeschool community about whether that's a good thing or a bad thing.

I think it's a good thing. I mean I think it's a good thing to have someone looking over your shoulder and make sure that you're doing a good job and that you're keeping up with deadlines and your kids are learning what they're supposed to be learning. So it sort of keeps you in check.

Now we didn't do it even though I say it's a good thing. We didn't do it because we wanted a little bit more flexibility. One of my kids were younger in terms of our schedule and vacations and for them to be able to do more school in the summer and so we could travel some in the winter, that kind of thing. So we didn't actually do the charter school. We did the true homeschool thing.

1:21:12

But now that we live in Florida and I don't feel the need to travel as much because my life has more like a vacation everyday living down here. Because of that, there's a third option that's what's called an online private school. And K12 also offers this. This is basically very structured with teachers that are online and you have assignments. You have — like the charter school, they look over your shoulder and they make sure you're doing a good job.

They say, hey, you've got to be done by this date, but go at your own pace. Whereas the online private school, it is you have an assignment due this day. You must get it done. You get grades, you have to do placement tests. You have to — you end up with a diploma. I mean basically it's a private school but it's done online. And there's classes. You have to pick your classes. You're doing the class with other kids, you meet in chat rooms with the teachers. So it's kind of a cool experience but it is very structured.

1:22:10

And my daughter just started high school this year and so we did want something more structured for her. And so she's been doing the online private schools. And that's called the K12 International Academy. And you ca, get to their website, www.K12, K12.com/int for International. So K12.com/int. And that will get to the International Academy's website. I'll put all these in the Show Notes. We'll have a link to K12 and a link to the International Academy as well.

This is not the only way to do it, obviously. And you're going to get — you get a group of homeschoolers together, they're all going to argue about who's got the best curriculum. So don't just go with what I'm telling you, Geraldine, because I didn't do a lot of research. I'll be honest with you. We did not do a lot of research on this. I just knew I didn't want a religious-influenced educational curriculum for my kids. And if that's what you want, I'm not saying — I'm not going to think badly about you. I just really wanted my kids to get an education that wasn't influenced by a religious establishment.

1:23:16

Okay, let's — we really are — here I am, it's an hour and 23 minutes. I don't know. This is the new studio. See, I'm sitting here in this beautiful new Birdhouse Studio. I mean my studio is — I just love it. I love this. And I don't want to leave when I sit down behind the microphone. So I think we may have to just do more shorter shows but get them out more frequently or something because I'm like way over again.

Okay, let's take a quick break and I'll be back for a final wrap-up right after this.

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1:24:18

Alright, as always thanks go out to Nationwide Children's Hospital for helping with the bandwidth. They don't cover the whole thing. Also, thanks to Vlad at Vladstudio. He helps with the artwork and we really appreciate that. Medical News Today, of course. Thanks to my family for letting me spend a couple of hours here with you and the hours it takes to put one of these shows together because they don't put themselves together, folks. Also, thanks of course, most of all, thanks to you, the audience. Because you coming back week after week, listening to the show, participating in the show, writing into the show, even the negative comments, even the negative comments.

Kate, keep writing in and keep listening, please. Because it does make the show better. I do listen to what you're saying. I'm not going to do it completely. I'm still going to be a political edge to this show and it may not be the political edge that you seek. It's still going to be there. But I do listen and so the criticisms are helpful as well and obviously we don't shy away from them here at PediaCast. We put them along.

1:25:19

But if you write something critical in, you're probably more likely to get on the sho w than if you don't. I don't know if any of you out there listen to Mark Levine. If you're a Democrat and you have something bad to say, man, you're getting on the show. In fact, sometimes conservative Republicans lie and say they're Democrats to get on the show and then he's going to kick them off. So anyway, it's just probably the same thing. And again though, I want to say here folks, I'm not a Republican. I'm not, I am conservative. But I wouldn't call myself a Republican. I just — I am me. And that's what you get. We've been here and talk about that.

If you like PediaCast, please consider a donation to the show. It takes a lot of time, a lot of effort and a lot of money out of my pocket to put the show together. And so any help that you can give would be very much appreciated. If you go to the homepage of PediaCast.org, click on the Donate button. That'll take you to the Donation page.

1:26:17

There are several options there for you. You can do a $2 a month recurring subscription, a $5 a month, a $10 a month. I would just ask whatever you feel that we're worth to please help us out. Think of it as as a co-pay. You're just paying your co-pay for PediaCast. You're helping out with the costs.

So if you get a lot out of the show and you listen week after week after week and you put some of the material that we use or that we give you to practice and it helps you to be a better parent and understand your child's health better, please help us out and consider donation. One-time donations are also accepted at the website. If you do a subscription, you can cancel it at any time without any problem at all.

Also in the future, we're going to have some premium content coming your way. We're going to do individual half-hour shows on things like otitis media, gastro esophagial reflux disease, recurrent urinary tract infections, ADHD, autism, Kawasaki's disease, Asperger's.

1:27:16

I mean lots of different things that we will discuss and talk about in terms of a half-hour premium shows. And then we'll have more information for you. I hope to get those, the first set of those launch. I'm hoping to have about 20 of them in the library when we actually go live with it. And that will be, hopefully, I'm thinking late summer, mid-to-late summer. Something like that. And we'll have a subscription services through there too so you can purchase the ones that you really want to listen to and it will be full of information, not full of opinion and tangents. I mean it will be solid information for you on a particular topic. And so those are coming up.

I also want to remind you iTunes reviews. I didn't talk about this last week. If you found PediaCast through iTunes and you gave us a chance because of the positive reviews that you have read there, if you could please leave a review of your own. I would really appreciate it because the number of reviews that we get, the number of five star reviews that we have does determine your placement — it's one of the things that determines your placement in terms of rankings and how well you are seen on iTunes.

1:28:22

And the reason that's important is because it helps to build a bigger audience which costs more bandwidth, but hopefully we'll get some donations here and that won't be as much of an issue. So we really, really want to try to increase the exposure for the show and you taking the two minutes that it takes to write a nice review on iTunes would be very helpful.

We also have a listener survey on the homepage again. If you go to pediacast.org, click on the Survey button. That just helps to determine the demographics of our audience which helps with the solicitating advertising sales. Although I will say this, I will say this. If there is a really great outpouring of listener support through donations, I would very much consider eliminating the whole sponsorship thing altogether and just getting rid of it.

1:29:08

Because my listeners, my loyal listeners and my audience are much more likely to support and help and provide for the show than an outside company who doesn't know what we're about and what we do and what our goals and mission are. So if we get lots of donations and this really works out well, then the listener survey may not be necessary. In the future, I guess, is what I'm trying to say.

Alright, we really need to stop now because I'm at the hour. I've actually exceeded last week. In the beginning I said, oh yeah, it's going to be a shorter show. Yeah, right. So anyway, I better stop — I'll say I just love being with you guys. Until next time, which will hopefully be next week. This is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long, everybody.

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