Sleep, Sleep, Sleep — Awake! – PediaCast 149

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Topics

• Fluoride in Drinking Water
• Teenage Marijuana Use
• Sleep Duration and Obesity
• Back to School and Eating Disorders
• Young Athletes and Concussions

Listener Segment

• Benzoyl Peroxide and Breastfeeding
• Crossed Eyes (Strabismus)
• Continuity of Pediatric Care
• Tummy Sleep
• Babies Rocking While Sleeping

Research Round-Up

• Low Back Pain in Adolescents
• Outcome of Adenotonsillectomy on Obstructive Sleep Apnea
• Insufficient Sleep Among High School Students

Transcription

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

[Music]

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

Dr. Mike Patrick: Hello everyone and welcome back to PediaCast& It is episode 149 for Thursday, September 9th, 2010.& "Sleep, Sleep, Sleep, Awake".& That's what we're calling this one.& PediaCast is awake after a much needed sabbatical. &

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You just get to the point folks really when you have a full time job that's sometimes more than 40 hours a week and you have family life and you're in Florida and it's tough because this show takes lots and lots of research time.& And it was getting to the point that every free moment of my life was consumed with PediaCast.& But we got some things in place to fix that to make it a little bit easier.& So we are back in business.& I can't guarantee shows every week, although we'll get there.& But right now if we get a shot every couple of weeks, I'll be happy and you'll be happy hopefully.& As we move forward, we may involve some other hosts from time to time and will be doing more interviews and round table discussion. But as we move forward here I do promise the best, most complete and easiest to understand source of child health information available on the internet.

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So just check us out if you have not go back to the old programs.& We have lots of great information for you and as the future is ahead of us hopefully we will have more shows and continue to address the things that you want us to talk about. &

OK.& So what are we going to talk about during this particular PediaCast?& Well, in our News Parents Can Use, we are gonna to talk about fluoride in drinking water.& Could it be linked to pre–term birth and anemia.& Also teenage marijuana, does it lead to harder drug use.& Sleep duration may be linked to obesity.& Back to school time leads to an increase in eating disorders and younger athletes, actually as young as age eight are seeing a rise in sport related concussions, we'll talk about that.& Also your questions, benzoyl peroxide, should you use it while breast feeding.& So if you have acne and want to treat that while you are breast feeding, should you use Clearasil and other products that contains benzoyl peroxide, we'll touch on that.

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& Also, crossed-eyes, otherwise known as strabismus, continuity of pediatric care.& Tummy sleep and babies rocking themselves while sleeping.

In our Research Round Up, we're going to talk about a little back pain in adolescents.& The outcome of getting your tonsils and adenoids out on obstructive sleep apnea.& And insufficient sleep among high school students.& See, that's another reason that we're calling this episode "Sleep, Sleep, Sleep, Awake…, not only because that's what PediaCast is doing, but also because we have a lot of stories and information for you and question to answer regarding sleep.& So that's all coming up on this episode of PediaCast.& See what I'm talking about here guys and gals, seriously, you look at all the information that we are going to present during this episode, it really takes a long time to put all of these together because I want the best for you.& We really do want the most current information available.

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So even though I'm a pediatrician and you think, " Hey, he should be able to answer all these questions right off the top of his head….& I still research them because I want to make sure that we have the most current up to date and medically sound advice that is evidenced based, not just what we think it might be but what really is the right answers what we're after on this show and so that kind of quality takes time and effort to put together.& But we are back and I'm excited about that.& If you have a question or a comment for the show, just give us a holler.& You can go to pediacast.org and click on the Contact Link and send it in that way or just to email us at pediacast@gmail.com.& You can also call the voice line at 347-404-KIDS which is 5437.& Don't forget the information presented in PediaCast is for general educational purposes only.& We do not diagnose medical conditions or formulate treatment plans for specific individuals.& If you have a concern about your child's health, call your doctor and arrange a face to face interview and hands on physical examination.& Also your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at pediacast.org.& And with that in mind, we will be back with News Parents Can Use, right after this short break.

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All right, we are& back and our News Parents Can Use is brought to you in part by Medical News Today bringing you hourly news updates from sources you trust and you can visit them online at medicalnewstoday.com.

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Fluoride avoidance reduce anemia in pregnant women it also decrease pre-term births and enhance baby's birth weight, that's the conclusion of fluoride expert AK Shusheila and colleagues in the study published in Current Science, May, 2010.& Susheila's team explained that anemia in pregnancy which can lead to maternal and infant mortality continues to plague many countries despite nutritional counseling and maternal iron and folic acid supplementation.& This is the first examination of fluoride as an additional risk factor for anemia and low birth weight babies.& Pregnant women living in India whose urine contained 1 mg/l of fluoride or more were separated into two groups, the experimental group who voided fluoride in the water, food and other sources and ate a nutritious diet per instruction.& The controlled group received no instructions.& Both group supplemented with iron and folic acid.& Results revealed that anemia was reduced and pre-term and low birth weight babies were considerably fewer in the fluoride avoidance group as compared to the control. &

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Two still births occurred in the controlled group and none in the experimental group. The author say maternal and child malnutrition and anemia are not necessarily due to insufficient food intake but because of the derangement of nutrient absorption due to damage caused to the GI or gastro intestinal mucosa by ingestion of undesired chemical& substances.& They're going to say fluoride which is present in certain foods and water is an example of a chemical which can cause such damage.& They report that fluoride avoidance regenerates the intestinal lining which enhance the absorption of nutrients as evidenced by the reduction in urinary fluoride followed by a rise in hemoglobin levels.& Could the same thing be happening in the United States.& State university of New York reseacher& found more premature births and fluorinated than non-fluorinated upstate New York communities according to a presentation made at the 2009 American Public Health Associations annual meeting.& Current science reports that adverse reaction of fluoride consumption are known to occur including reducing red blood cells, reducing blood folic acid activity, inhibiting vitamin B12 production and the non-absorption of nutrients for hemoglobin biosynthesis. &

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Citizens must demand water fluorination be stopped says Atty. Paul Beaver, President of the New York State Coalition opposed to fluoridation.& It's disturbing that public health officials and organized dentistry continue to ignore the overwhelming evidence revealing fluoride to be non-nutritive, unnecessary and unsafe… says Beaver.

OK.& So let's talk about this, is this the magic study that once and for all gives the anti-fluoridation folks grounds to stand on?& I say no and here is why. First no one is debating that too much fluoride is bad for you, OK.& Too much fluoride, number one, it can damage the inside lining of the intestine as this article pointed out.& That can cause a decrease in the absorption of nutrients and that including iron, folic acid, and other nutrients that are needed to make red blood cells. &

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So if you have malabsorption of these nutrients because of the damage the fluoride did to the intestine, then you can become anemic.& No one is questioning that at all.& Also, the fluoride gets taken up and replaces calcium in bones and teeth and causes problems there.& So, no one question too much fluoride is a bad thing.& So the question is, is this a good study that we can translate to the United States of Americans, "hey, we shouldn't be putting fluoride in the water here….& One of the things that this article brings up is that there are more pre-term births in communities that fluoridate versus ones that don't fluoridate.& Let's take a step back from that for just a minute and think about this.& Where do pre-term babies get born in greater numbers.& At big tertiary care hospitals.& So are there more premature babies being born in a big city hospital or in a small world hospital. &

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Where are the pre-term babies being born.& Irregardless of where you live, where are they being born.& They're being born at the bigger tertiary hospitals that are set up to handle pre-term babies unless it's an absolute right now emergency.& So, I think to say that there are more premature babies born in fluorinated communities, well yeah, and that's where the big tertiary hospitals are.& That's where more people live.& So that I think we can sort throw out right away.& But a couple of issues I have with this study.& Number one, the author start with people whose urine contain 1mg/l or greater of fluoride and then they divided them into two groups.& So these are people who are already getting too much fluoride.& Now they put in an upper level on this so there's room for these two groups to really have different starting urine fluoride concentrations.& So sure they're all over one but what if one group skewed so that their average is 3mg/l and the other group has only one. &

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And maybe they did that they just didn't explain that in the study and in the article.& So, you really want your two groups to be pretty identical except for the control. The control group in this case is the people who are ingesting their normal diet which is high in fluoride and so they have fluoride problems that is making them women anemic and have more pre-term babies.& So know you are going to take your experimental group and you're going to have them avoid fluoride rich foods and water.& And you're going to have them nutritional counseling so they pick better things which is all part of that fluoride avoidance and see if it makes a difference.& & Now, and it did made a difference. And I don't question that at all.& But here is the thing, does water fluoridation in the United States cause urine fluoride concentrations to be at or above 1mg/l.& That's the big question. &

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Because we're looking at people who are in India& who are exposed to lots of fluoride enough and yeah, it's a problem.& It's really too much of a good thing.& It's too much.& So does that translate into water fluoridation in the United States?& Well, several well designed studies showed that fluoride supplementations at levels recommended in the United States result in urine fluoride concentrations of about 0.1 micro gram / liter.& Seriously folks, 0.1 micrograms/liter.& So they're taking a study, they're looking at people with 1 mg/l. So these people have mega high doses of fluoride that they're being exposed to and they're trying to say, "Hey, this is dangerous, we shouldn't be doing it in America and yet in the United States, when we fluoridate the water, we're putting just enough fluoride in to cause the urine fluoride concentration to be 0.1 micrograms/liter not 1mg/l. &

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So this is really comparing apples to oranges here folks.& And for this lawyer to say, "Citizens must demand that water fluoridation be stopped.& It's disturbing that public health officials and organized dentistry continue to ignore the overwhelming evidence revealing fluoride to be non-nutritive, unnecessary and unsafe….& I mean, this is just craziness, okay.& We're talking about a tiny amount of fluoride here.& So anyway you really can't compare, incidentally why are the levels of fluoride so high in India.& Do they over add fluoride, no.& There is large reservoir of water with extremely high levels of natural fluoride. &

0:13:59.9

They're drinking the water, they're irrigating their fields and cleaning their foods with this water which leads to way too much fluoride in the local population.& But there is no studies that show that fluoridation at levels done in the United States causes ill effects but there are many well designed trials which will clear benefits on dental health when water fluoridation is done at the proper levels.& I should also mention that there are some areas in the US with dangerously high levels of natural fluorides.& So if you have well water you should have it tested to determine its fluoride concentration.& If it's too high, just consume bottled water, preferably water that's fluoridated to the correct level and if it's too low, ask your doctor about the best way to supplement fluoride in your diet.
OK, let's move on.& New research from the University of New Hampshire shows that the gateway effect of marijuana, in other words teenager who use marijuana are more likely to move on to harder illicit drugs as young adults is over blown. &

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Whether teen agers who smoke pot or use other illicit drugs as young adults has more to do with life factors such as employment status and stress according to the new research.& In fact the strongest predictor of whether someone will use other illicit drugs is their race and ethnicity not whether they ever use marijuana.& Conducted by UNH Associate Professor of Sociology, Karen Van Gundy and Cesar Rebelan.& The research appears in September 2010 issue of the Journal of Health and Social Behavior in the article A Life Course Perspective on the Gateway Hypothesis.& The author say in light of these findings, we urge US drug control policy makers to consider stress and life course approaches in their pursuit of solutions to the drug problem.& The researchers used survey data from 1,286 young adults who attended Miami Date public schools in the 1990's with the final sample, 26% of the respondents were African-American, 44% were Hispanic, and 30% non-Hispanic white. &

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The researchers found that young adults who did not graduate from high school or attend college were more likely to have used marijuana as teenagers and other illicit substances in young adulthood. In addition, those who used marijuana as teenagers and were unemployed following high school are more likely to use other illicit drugs. However, the association between teenage marijuana use and other illicit drug abuse by young adults fades when stresses such as unemployment diminish.& Employment in young adulthood can protect people by closing the marijuana& gateway so over criminalizing youth marijuana use might create more serious problems if it interferes with later employment opportunities, Van Gandy says.& In addition, once young adults reach age 21, the gateway affects subsides entirely while marijuana use may service a gateway to other illicit drug use in adolescents our results indicate that the effect may be short lived subsiding by age 21.& Interestingly, age emerges as a protective status above and beyond the other life conditions and we find that respondents age out of marijuana gateway, in fact regardless of early teen stress exposure or education work or family factors the researchers say. &

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They also found those strongest predictor of other illicit drug use appears to be race ethnicity not prior use of marijuana, non-Hispanic white show the greatest odds of other illicit substance abuse followed by Hispanics and then by African-Americans.& OK. So marijuana may not be the gateway the we once thought, leading towards the use of harder drugs.& But still parents you want to know what your kids are doing and hanging out with their friends, smoking dope, probably shouldn't be one of those things so may want to ask them about that.& And know where they are and know what they are doing.& I do think it's interesting that the researchers say that we may not want to over criminalize marijuana use because then the kid gets a criminal record and then have a harder time finding a job and we know that unemployment is a risk factor for harder illicit drug use.& Am I saying that we should legalize marijuana, no.& I'm not saying that, but it's an interesting point that the authors make.

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All right, let's move on. Teens who sleep less eat more fatty foods and snacks.& A study in the September 1st issue of the journal Sleep, shows that teens who slept less than 8 hours per week night ate higher proportions of fatty foods and snacks than adolescence who slept 8 hours or more.& The research suggest& that short sleep duration may increase obesity risk by causing small changes in eating patterns that cumulatively alter energy balance especially in girls.& Research shows that a shorter mean week day sleep duration was significantly associated with an increase in the percentage of calories consumed from fats and a decrease in the percentage of calories from carbohydrate.& After adjusting for potential confounding things such as age, sex, and race, teens who slept less than 8 hours on week nights consumed 2.2% more calories from fats than 3.0% pure calories from carbs than teens who slept 8 hours or more. &

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Further adjustments for body mass index have little effect on this association and secondary analysis stratified by sex the results were significant among girls but not for boys.& The relative increase in fat& consumption among shorter sleepers by 2.2% per day chronically may contribute to cumulative increases and energy consumption that will be expected to increase risk for obesity and cardio vascular disease said senior sleep author and the principal investigator Dr. Susan Redline, a Professor of Medicine in the Division of Sleep Medicine at Brigidon Women's Hospital and Beth Israel Dickens Medical Center which are both teaching affiliates at Harvard Medical School in Boston, Massachusetts.& The demonstrations of chronically altered dietary patterns in adolescence with shorter sleep provides insight into why shorter sleep has been associated with obesity and in& prior experimental in observational studies. &

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The study also found the relationship between sleep duration and snacking for each one hour increase in sleep duration, the odds in consuming high amount of calories from snacks decrease by an average of 21%.& Analysis of sleep duration and timing of nutrients intake revealed that a significantly greater proportion of teens who slept less than 8 hours per week night consumed food in the early morning between 5am and 7am.& Altered timing of eating in shorter sleepers& may also be metabolic stress that contributes to metabolic dysfunction said Redline.& The study involved 240 teenagers between 16 and 19 years of age who were participating in the ongoing Cleveland Children Sleep study at Kays Western Reserve University School of Medicine& and Rainbow Babies and Children's Hospital in Cleveland Ohio.& 18% of participants were obese.& The find is at or above the 95th percentile of BMI of 30 or higher. &

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Sleep was evaluated at home by Risk Actigraphy, an average sleep duration was calculated using at least three week nights of data.& The mean week night sleep duration was 7.55 hours and only 34% of the participants slept for an average of 8 hours or more.& The American Academy of Sleep Medicine recommends that teen agers get at least 9 hours of sleep each night to feel alert and well rested the next day.& Macronutrients intake was measured using two 24 hour multi pass recall interviews conducted by trained staff.& Details were collected about food items and portions sizes as well as the timing, location, type and preparation of each meal or snack. Nutrition data was analyzed using the nutritional data system for research, a comprehensive nutrient database.& The authors noted that it is unclear why the association between shorter sleep durations and unhealthy dietary habits may be stronger in girls than boys, however one explanation may be the increase propensity for female teens to engage in emotional eating. &

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Further& researchers needed to understand how gender may modify the relationship between sleep, stress, metabolism and eating behaviors , Redline said.& The cross sectional analysis did not allow for an examination of cause however redline states that physiologic studies have identified numerous pathways by which sleep loss may promote weight gain.& Reductions in sleep duration may alter metabolic rate and effective production of hormones that regulate appetite.& Sleep restriction may also provide increased opportunities to eat, initiate stress responses that promote word seeking such as eating and reduce the physical and motivational drive to exercise.& A CDC study published last January in the journal of American Medical Association, reports that the rate of obesity and US adolescence between the ages of 12 and 19 years was 18.1% in 2007 and 2008. &

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The authors conclude that the prevalence of high BMI in childhood is remained study for 10 years and has not declined despite coordinated prevention efforts.& Redline believes that sleep maybe the missing link in obesity intervention that focuses only on diet and exercise.& She suggest that improving sleep duration should be an essential component of obesity prevention and weight management programs.& So moms and dads, your teenager should be getting at least 9 hours of sleep each night.& And if they aren't, and they're overweight despite good diet and exercise regimen, then maybe they just need to sleep away those pounds, so to speak.& And incidentally what percentage of US high schools aren't getting enough sleep, well stay tuned to our Research Round Up for more information on that. &
In the meantime millions of students at all grade levels from elementary to high school to college will head back to school or are heading back to school and many times this is met with mixed emotions.& Not because the summer fun is ended, but because has some new pressures into the mix with many kids focusing on trying to be popular and some just trying to fit in. &

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Many times this pressures can manifest themselves& physically with young men and women trying to be in ideal body size and weight just like they see in the people they idolize in magazines and movies.& As many as 10 million females and& one million males are fighting a life and death battle with anorexia nervosa or bulimia, another 25 million are fighting a binge eating disorder that's according to the National Eating Disorder Association and because of this body image and eating disorders are growing concerns in schools and around the country.& This is an especially critical time to be aware of potential problems and watch for warning signs says Dr. Kimberly Dennis, Medical Director of the Timberline Knowles Center, a leader in treatment of eating disorders.& During this time,& when schedules change drastically with the start of school and new pressures are added in the mix, children and young adults can be more susceptible to& body image issues and concerns. &

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Warning signs could be a potential problem in a loved one include refusal to eat, difficulty concentrating, denial of hunger, obsession with body size and shape coupled with low self esteem, skipping meals and making excuses for not eating.& It can also eating only a few certain foods which they consider safe and usually those are low in fat and calories.& Recognizing these signs and symptoms of a loved one could be a critical first step in working to improve body image distortions through early intervention and therapy a positive body image can be restored and a life free from the obsession& of reaching an ideal body size and shape can be achieved.
And finally, the number of sport related concussion is highest at high school age athletes but the number in younger athletes is significant and on the rise.& In the study Emergency Department of Visits for Concussion in young child athletes, in the September 2010 issue of Pediatrics, concussion related emergency department visits were analyzed for patients between the ages of 8 and then 19 from 1997 to 2007. &

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From 2001 to 2005, US children age 8 to 19 years had an estimated 502,000 emergency department visits for concussion.& Approximately half of all ED visits were sports related concussions and the 8 to 13 year old age group accounted for 40% of these.& Emergency department visits for concussion and organized teams sports were highest in ice hockey and football and the most ED visits for concussion in individual and recreational sports were in snow skiing, bicycling and playground activities.& Although organized team sports participation decline from 1997 to 2007, ED visits for concussions in 8 to 13 year olds doubled and they more than doubled in the 14 to 19 year old group.& Study author suggest that additional research and injury prevention strategies are needed in order to protect young athletes.
And that concludes our News Parents Can Use segment.& We're going to b back and answer some of your questions right after this.

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All right, welcome back to the program.& In our listener's segment , first up we have Rebecca from Grand Rapids, Michigan.& She says, "Hi, Dr. Mike.& I've been listening for a while and I noticed you aren't producing podcast anymore. Are you taking a summer break or are you done for good.& I hope that you are coming back, I really enjoy your wisdom….
And Page in Point Beach, Florida says, "Dr. Mike, where are you?& We all hope you are having a great summer.& We also hope you are OK.& I think this is the longest you've gone without doing a podcast.& And yes my iTunes has been lonely but I'm really beginning to worry and I hope all is well….

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Kay in Seattle says, "You are missed, maybe I miss an announcement about a hiatus but just wonder when will you be back.& You and your show are missed, I hope all is well with you and your family….
And Sydney in Ashprin, Virginia says, "Hi, Dr. Mike.& Getting concerned now is such unexpected in long MIA period, hope everything is OK with you and your family.
Well thanks everyone and there were lots more than that. I just picked a few, just want to really thank you, it makes me feel so good that you cared that we were away.& We are back with a renewed passion and renewed interest in getting information into your hands.& So keep sending those questions in.& You can do that by emailing pediacast@gmail.com or go to pediacast.org and clicking on the Contact Link. &
OK.& So let's actually answer some of your questions.& Leslie in Pitts, Colorado says, "I've listened to most of your podcast and love them, thank you so much for all the information you provide, you're a wealth of it. &

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I've asked a question previously about water in the ears causing ear infections and was surprised when I found the podcast next& you had answered it, thank you.& My current question involves breastfeeding and acne medications such as Clearasil that contains benzolperoxide.& Is it safe to use during breastfeeding. I have not used it during pregnancy but I'm curious to know if it's safe to use now….
All right, well benzoperoxide is category C drug.& As in A, B, C, D.& That's a category C drug.& What that means is either studies in animals have revealed adverse effects on the fetus or baby of that animal.& But no control study has been done in humans or no studies have at all in either animals or humans.& And this should only be used if the potential benefit clearly outweighs the potential risk.& So you want to make sure that the benefit you are getting is better than the potential risk. &

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Which is really something you should talk to your doctor about. Because each person's reason for using benzoperoxide is going to be a little bit different.& For example if you have early mild acne, it's probably not worth the risk.& Now, what risks?& We don't know for sure because there aren't any studies but with any chemical, you don't exactly know if there are risk or not because no good studies have been done. It's probably best to avoid that medicine.& So there is really nothing we can think of on top of our head that benzoperoxide will do to harm your baby when your breastfeeding.& But we don't know that for sure because it's not been tested.& On the other hand, severe acne leading to skin infections and other problems or cosmetic issues that are causing depression then maybe because the risk is small and we don't know of anything that benzoperoxide will do to the baby. &

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It's still possible but sort of unlikely, then that small risk maybe overshadowed by a bigger benefit that you get because of your complexion is really causing depression problems or skin infections and that sort of thing.& So again it's really a decision between you and your personal physician.& There is nothing about benzoperoxide that yells out "Don't use it for& sure, absolutely not, it's really, really dangerous….& On the other hand we just don't know for sure, so you want to make sure that the potential benefit clearly outweighs the potential risk. &
OK, Diana in Monoray, California, she says, "Dr. Mike, I recently had a son who in two months is preparing to visit the eye doctor to begin treatment for cross eyes.& I have& strong family history of cross eyes and was not terribly surprised about this.& What is the correct treatment for this condition.& Are there successful options other than surgery.& Also, my husband and I are both active duty Navy officers…, thank you very much, "and generally move every couple of years.& With the prolong treatment condition like this, do you have any tips for how I can ensure the best continued care for my son. &

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Across multiple doctors, thanks so much for your wonderful show it's helped new moms stress a little bit less.& Lt. Diana….
All right, Lt. Diana.& I believe when you are talking about cross eyes, you are speaking about strabismus.& This is when one or both eyes in a relaxed state tend to turn in or turn out.& So when the eyes are relaxed and supposed to be looking forward, one or both of them looks a little bit in or looks a little bit out.& And the problem here is that, if that happens your two eyes aren't focused on the exact same spot, exact same object.& So your brain is not getting a clear picture.& You are going to see some double vision, you're going to have some blurriness because both eyes aren't focused on the same spot.& And the brain will compensate for this by ignoring the errant eye or both eyes are affected it will choose one of the eyes to ignore. &

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Now this allows for normal vision.& It's not stereo vision.& You lose some depth perception, but it's& not blurred and it's not double vision if your brain can ignore one of the eyes.& So the problem this can result& in irreversible blindness in the eye that the brain is ignoring.& The main non -surgical treatment is patching the so called good eye or the case when both eyes are affected, patching one of them.& In that way the brain doesn't have to ignore it.& It just doesn't get any stimulus from that eyes.& So if you patch it, you can't see from that eye, but vision is maintained, because the brain is not having to ignore that eye.& So this sort of clears up their vision and preserves vision but often times the strabismus does not resolve on it's own.& And you really can't go along a period of time with the eye patching business.& So most of the time it does result in the need for surgery. &

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And the surgery that's done for this, basically they shorten the eye muscle on the opposite side from which the eye points.& So if the eye is drifting inwards, they'll shorten the outer muscle, if the eye is drifting outward, they'll shorten the inner muscles.& And that just pulls the eye that's not in the right spot.& It pulls it back into alignment.& It's a pretty simple surgery that is done many, many, many times over.& But it should be done in my opinion by a pediatric ophthalmologist at a dedicated children's hospital who has experienced doing that kind of surgery, doing lots, and lots, and lots of them.& Now, in terms of continuity of care, that's a good question.& It has a pretty simple answer, when you get to your new town, you want to get in touch with the pediatrician or family doctor right away, I prefer pediatrician, I'm biased, but will be an equal opportunity podcast today and mention family practice doctors as well. &

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And so once you get into your new city, it's been a couple of years, you go to the new town, you find your pediatrician or family practice doc and you ask for a referral to a pediatric ophthalmologist.& And you may have to travel to the nearest big city to see one that just sees kids that is really good at doing this surgeries at a children's hospital.& But it's worth it.& You just want to do that as soon as possible when you move to your new neighborhood. &
OK, Laurie in Stratford, Connecticut says, "Hi, Dr. Mike.& I have a question about sleep positions for infants.& My four month old daughter has been rolling over onto her tummy every night in her crib for about two weeks now.& I put her to sleep on her back and within 15 seconds she turns on to her tummy.& When she's in a deeper sleep, I go back to the room and turn her on her back again after a while she ends up on her tummy again and seems to be much happier in that position.& Do most children at this age turn over in their sleep and should I be concerned with SIDS because of this or is that risk reduced because she's able to turn by herself. &

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Our pediatrician feels it isn't much of a concern because she's able to turn on her own, I'd love to know what you think.& I love you podcast and your honesty….
Well, thanks for your question Laurie, I agree with your pediatrician.& The concern is your child getting stuck on their belly.& And since it's easier to push& over from front to back than to go from& back to front.& The theory is that if a baby is coordinated and has the muscle strength to& get themselves from their back on to their belly, then it follows they can also get themselves back over under their back.& Since that's the easier thing to do.& And you certainly can't drive yourself crazy flipping them back over on their back every time they flip to their tummy.& So here's what I suggest that parents do. Always put them to bed on their back.& And if by 46 months of age, they start rolling on their own, fine.& Just let them be, let them sleep on their tummies.& If they get themselves into that position.& But don't put them down on their tummy.& So put them down on their back, if they flip, fine. &

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But you do want to make sure that there's nothing that can become entrapped or entangled or suffocated with, so, no pillows, no blankets, no stuffed animals, just warm clothes and the crib mattress with a fitted sheet and that's it. &
OK, let's move on.& Elizabeth in Salt Lake City, Utah has a question about rocking behaviors.& She says, "Dr. Mike, thank you for your very informative and entertaining podcast.& It's great to hear more in depth answers to common questions about our children and new and interesting studies.& I have a 10 month old son who in the last couple of months started rocking back and forth on his hands and knees in his crib while he still sleeping.& We hear his crib banging against the wall and going to check on him and place him back on his back and all the while he still sleeping.& Is this something to worry about.& Is it a sign he may sleep walk when he is older and is there anything I can do to prevent this.& Thanks again for your podcast….
All right, well it's not a problem per se.& And my guess is that your child is not really sleeping deeply and& is really just comforting or stimulating himself. &

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Sort of a keen to many of us rubbing our feet or ankles together as we drift off to sleep.& Personally, I would just leave him alone, no need to flip him over and if the crib is banging the wall, just move it away a little bit away from the wall so it stops banging the wall when he does it.& And in terms of sleep walking, is he more likely to do it, well true sleep walking is rare.& But comforting, stimulating movements as you describe are very common.& So I don't think there's really that much of a greater risk.& Now, I'm not basing this on any studies, just my own experience.& But I don't think there's much of a greater risk.& But in the end, time will tell.& So when is this rocking behavior a problem, well, it may be a sign of a neurological disorder if your child is rocking like that when they are awake, and you are unable to distract them into stopping.& If that is occurring, you want to make sure you let your doctor now right away.
All right, that concludes our answers to listener's questions.& And admittedly these are some old ones.& Since we haven't been doing shows here for a little while. &

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But please send in questions and we will take the newer ones, that would be the preference.& So if you got a question right now, it's very likely that it will get answered in the next episode.& So just send those questions to pediacast@gmail.com or go to pediacast.org, click on the contact link and you can send it in that way. &
All right we are going to take another break, obviously, I'm getting a little frog in my throat so I need to get a drink of water and we'll be back to do our Research Round Up right after this. &

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OK.& We are back and ready for our Research Round Up.& We got three studies here for you.& They're three good ones. &
The first one, low back pain in adolescence.& This was done in Japan and was published in the American Journal of Sports Medicine in April& 2010.& The question before the researchers was among freshman in college, is there an association between the history of low back pain and the type and duration of participation in sports activities.& They did a cross sectional survey, basically what they did between 2004 and 2006, they took freshman university students and they have them do surveys regarding their experience with low back pain and their experience in sports.& The survey address this experiences during the student's lifetime, in particular during the previous four weeks.& They asked about school absences due to low back pain.& They asked about associated pain and numbness in the lower extremities and they asked about back pain that was so bad it resulted in the students quitting competitive sports activity.& Respondents were divided into three groups based on their duration of sports participation. &

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The low group never was involved in competitive sports .& The high group was involved in competitive sports during elementary, middle and high school years and the mid group, was involved in competitive sports during one or two of these periods. Either elementary, middle or high, one or two of those periods. &
The total sample size was 4,667 students and the median age was 18.4 years, so what they find.& Well,& the percentage of male students who experienced low back pain at some point in their lifetime was 60.5% and the percentage of female students experiencing lower back pain at some point in their lifetime was 63%.& So 60.5% for the boys, 63% for the girls.& The percentage of low group experiencing low back pain at some point in their lifetime, so those who were never was involved in sports was 50%,

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the percentage in the mid group, so they were involved in sports either one or two, either in elementary, middle or high school, one or two of those, was 62%.& And the high group where they were involved in sports in elementary, middle and high was 72%.& So, 50% of the no group, 62% of the middle group, and 72% of the high group reported low back pain at some point in their lifetime.& OK, now in terms of school absences, the no group, 4.4%, the mid group, 5.7%, the high group, 9.6%.& So, the more active they were involved in sports, the more likely it was that they had school absences because of their lower back pain.& And in terms of dropping out sports, the mid group which was involved in one or two, either elementary, middle or high, 3.6% and if they were involved during all three of those set of years, then 7.9%.& And incidentally, the sport with the highest risk of low back pain, volleyball.

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All right, so their conclusion, low back pain is a frequent symptom in adolescents with a higher percentage of athletes suffering from it compared to non-athletes.& So over all this was a good study.& Limitations, forces one to rely on sometimes distant memory.& So this was a retrospective study.& It will take a long time.& But if you can design a prospective study where you follow the students through elementary, middle and high school.& And as you follow them along, made note of when they had low back pain problems and whether or not they participated in sports, that will be a much better study, but that's not something you can do very quickly as with a retrospective study, you can.& But in the meantime, the one of the limitation is your force to rely on sometimes distant memory. &

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Also they didn't take a note count pre-exercise conditioning, they did not take into account the weight of the child and they did not take into account none sport related accidents and activities. So these are all things that also could affect and cause or prevent low back pain.& So were the kids in one group or another more likely to do pre exercise conditioning, stretching, what are the weight of the kids and as an athletic kid more likely to engage in hazardous activities.& So if you have a kid who is active in sports in elementary, middle and high school, and they have back pain more often, is the low back pain really from those sports or is that the kind of& kid who is more likely to engage in a hazardous activity such as sledding, skate boarding, snowboarding, off road biking, water skiing, usually this are the more active kids and so he is going to be more likely to hurt his lower back more because of his personality than because of the actual organized sports.& So that's another question. &

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Regardless, we need to be more aware of lower back pain in adolescents particularly how to prevent it and how to treat it so we can keep kids from missing school and dropping out of sports.
OK. Let's move on to our second research topic and that is the outcome of adeno-tonsillectomy& on obstructive sleep apnea.& So if you have a kids with obstructive sleep apnea, you get their tonsils and adenoids out, is it going to help?& That's the question before the researchers.& This was conducted at eight pediatric institutions in the United States and Europe.& And it was reported or will be reported in the American Journal of Respiratory Critical Care Medicine, October, 2010, coming up.& The question before the researchers, among children under going adeno-tonsillectomy for obstructive sleep apnea, what factors promote incomplete resolution of the obstructive sleep apnea?& Let's briefly talk about obstructive sleep apnea really quick.& It's not the same thing as snoring, OK.& Lots of people with obstructive sleep apnea snore, but not all snorers have obstructive sleep apnea. &

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Obstructive sleep apnea is diagnosed by sleep studies.& So you go to the hospital, you sleep on a lab.& They hook you up to monitors, they measure your sleep-awake time, they keep track of your oxygen saturation and other vital signs, they synthesize the data and they come up with a number.& And that number which takes a note count, are you loosing oxygen in your blood, and then waking up and then falling back asleep.& Sometimes you don't even know you're waking up.& But it does disrupt the normal sleep cycle which can then cause behavioral problems, paying attention problems, those sort of things.& So, they synthesize all these data, they come up with a number and it's called the apnea hypopnea index or AHI, OK. And if that is less than one, it's considered normal, greater than one is abnormal and the higher& that number the worse your obstructive sleep apnea is. &

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So true obstructive sleep apnea, not snoring, because lot of snorers do not drop their oxygen saturation and wake up frequently.& But true obstructive sleep apnea leads to sleep deprivation and can affect health behavior and school performance. &
OK.& So what did they do for the study. Well, they did a retrospective review of pre and post-surgical sleep studies.& So the post-surgical& sleep studies, they look to see what the number was that, we talked about the apnea hypopnea index, that number they wanted to find out what that number was before surgery and then what that number was after surgery and see if it dropped.& So, they did a retrospective review of pre and post sleep studies.& The post-surgical sleep study had to be at least 40 days after surgery but not longer than 720 days after surgery. &

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So, nearly two years after surgery who was included.& Really?& I mean does this really let you know if the surgery helped or not?& So that's kind of a long, I think they did that because then they were able to include more numbers in their data. Cause there's probably a lot of people who have their tonsils and adenoids out. They're not snoring anymore.& They seem to be getting a good night sleep.& They don't have any behavioral or academic problems.& So the parent's don't go to get that post-op sleep study done until a year and a half later they're having problems again and then they get it done.& And the researchers wanted to include those people in here as well, I'm guessing that's what happened and why they allowed the post-op when it's to be so long after the fact.& They did eliminate patients with possibly confounding conditions such as down syndrome and Prader-Willi syndrome.& Basically things that have an effect on the airway, they did not include those in the study.& So they studied 578 children.& Their age is range from 8 months to 18 years, the mean age was 7 years.

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60% of them were males, 38% were females.& 60% Caucasians,23% Blacks, 12.4 Hispanics and incidentally, BMI data was also available for 471 of the children.& And of those, 50.6% were obese with a BMI greater than 95%.& So data collection, the results of the pre surgical and post surgical studies were compared and in particular, again researchers look at the apnea hypopnea index, which is that number that reflects just how bad your sleep apnea is.& And the results, well for all the kids, the pre surgical apnea hypopnea index, that number, was 18.2.& For the post-surgical group, the mean was 4.1.& So if you look at all the kids, the average number of how bad your sleep apnea was 18.2, and then post surgical, it went down to 4.1. &

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So definitely getting your tonsils and adenoids out help with the severity of sleep apnea.& But remember, a normal is less than 1, OK.& So there's a statistically significant decline in those scores and kids with obstructive sleep apnea following adeno tonsillectomy.& However, only 27% of the kids had a normal number defined as less than 1 following surgery.& The following variables was associated with persistence of obstructive sleep apnea and was statistically significant if you were older than 7 years of age, if you were obese, had asthma or a really high number of you obstructive sleep apnea prior to surgery. So, if you are older than seven, obese, have asthma or have really bad obstructive sleep apnea, those are the ones that were more likely, it got better but it didn't go away completely. &

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Variables not associate with persistence of obstructive sleep apnea were gender, allergic rhinitis, race, nationality, prematurity, and a family history of obstructive sleep apnea.& So in conclusion, the author say that although, adenotonsillectomy, getting your tonsils and adenoids out, leads to a significant improvement in obstructive sleep apnea as determined by the apnea hypopnea index, surgery may not completely eradicate the problem especially if the child i sover& seven years of age, obese, has asthma or a severe case of obstructive sleep apnea prior to the surgery.& So parents keep that in mind, if your child has obstructive sleep apnea, getting their tonsils and adenoids out, still a good idea and will likely improve their condition but it does not guarantee that all of their symptoms are going to resolve.& So keep that in mind. &
OK.& And finally, insufficient sleep among high school students, this was a research study that was conducted in the United States and reported in the Journal of Adolescent Health on April 2010. &

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The question before the researchers among US high schools students what is the prevalence of insufficient sleep hours on an average school night.& All right, so what did they do?& They used the Youth Risk Behavior Survey, and this is conducted nationally every two years. Includes a representative sampling of US students in grades 9 through 12.& Participation is voluntary and anonymous and it's designed to identify and measure the prevalence of a variety of health risk behaviors.& And in 2006, questions about sleep were added to the survey.& Now, specifically, the question on the survey was this, "On an average school night, how many hours of sleep do you get?…, and the choices were 4 or less, 5, 6, 7, 8,9 or 10 or more hours.& They collected 14,041 surveys.& Well actually, there were lots and lots of surveys, but they took this survey and they looked at 14,041 of them. &

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And the responses were collapsed into three categories.& Either you have insufficient sleep which was defined as 7 or fewer hours.& You had border line sleep, which was 8 hours or you had optimal sleep which was 9 or more hours.& So what were the results?& Well, insufficient sleep, 68.9%.& Border line sleep, 23.5%. Optimal sleep, 7.6%.& so, nearly 70% of all of our high school students get insufficient sleep every night.& No wonder there's obesity problem, right?& According to our News Segment.& In terms of prevalence insufficient sleep, it was highest among 12th graders at 78.2% and lowest among 9th graders at 57.7%.& Females, 71%, of all females had insufficient sleep while 67% of all males.& And 71% of all Blacks versus 66% of all Hispanics had insufficient sleep.

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So the conclusion, US high school students aren't getting enough sleep and the authors recommend that nationally endorsed evidenced based sleep duration guidelines be developed to inform and promote through public health measures optimal sleep duration.& And remember again, moms and dads, getting less than 9 hours of sleep each night is associated with the consumption of more fatty foods, snacking and obesity as you and I recall from our News Parents Can Use segment.& And given that teenage obesity is such a problem these days and seeing how nearly 70% of our teen agers aren't getting optimum sleep, maybe it's time for parents to step up to the plate.& Find out how much sleep your teen ager gets each night and if it's not enough, do something about it while there still time and you still can.
All right, that concludes our Research Round Up for this week and we are going to be back and wrap up the show right after this.
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All right, thanks go out to Nationwide Children's Hospital for supporting our program.& Also Vlad Studio, Medical News Today, Wizard Media, as always my family.& And of course listeners like you.& Don't forget to tell your friends, PediaCast is back with new shows, great information and a commitment to get content into your hands on a regular basis.& So when will we have another show?& I don't know, I don't have the exact date, but hopefully it will be soon.& We definitely have plans for weekly production around the corner.& iTunes reviews would be most helpful since we haven't had a show in a while, if we get a little more, we get some activity on the review board on iTunes, that will be super. &

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I kind of look into this new iTunes thing.& Somehow now you can do social networking through iTunes I understand.& And I have to admit that I have not downloaded the new version 10 yet.& But I need to do that and look into it.& I'm not sure if that includes podcasting or if it's just through your music that& you can say, "Hey, I like this…, and share it with your friends and maybe it integrates with your Facebook and Twitter and that sort of things.& But, we certainly need it to look into that and maybe there is a way for you to share with your friends through social networking that PediaCast is back.& So stick around the corner, we have exciting news regarding the future of PediaCast. We're here, we're here to stay.& Again, I don't know how long till the next show but I can guarantee and promise you it won't be as long as since the last show. &
And until that time, this is Dr. Mike, saying stay safe, stay healthy, and stay involved with your kids.& So long everybody.

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