PediaCast 156 * Tanning Salons, Folliculitis, Vapor Rub
Join Dr. Mike as he breaks down several topics, including: fever phobia, new research on tanning salons, MRSA, measles, and over-the-counter drug-related poisonings. Dr. Mike also answers listener's questions about food allergies, razor bumps (folliculitis), and Vick's vapor rub.
- AAP Issues Advice On Managing Fevers In Children
- Fever and Antipyretic Use in Children — AAP Clinical Report
- AAP Recommends Prohibition of Salon Tanning By Minors
- Ultraviolet Light: A Hazard to Children — AAP Policy Statement
- Careful Cleaning of Skin Wounds Key To Healing, Regardless Of Antibiotic Choice
- Measles Scare At Three US Airports
- New Study Identifies the Medical and Financial Impact of Drug-related Poisonings
- Article on Food Allergies — The New Yorker
- Vapor Rub for Treatment of Nocturnal Cough — PubMed VapoRub and Ferrets — PubMed
Announcer: Bandwidth of PediaCast is provided by Nationwide Children's Hospital. For every child. For every reason.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from Birdhouse Studios, here is your host, Dr. Mike!
Dr. Mike Patrick: Hello, everyone, and welcome to PediaCast a pediatric podcast for moms and dads. It is episode 156 for March 2nd, 2011. Tanning salons, folliculitis, and vapor rub. Of course we got lots more topics coming your way, and we'll tell you exactly what those are in just a couple of minutes.
We are finally getting settled in here on the campus of Nationwide Children's Hospital. We flew Birdhouse Studio in and we've landed right in downtown Columbus, Ohio. We're getting used to the weather, you know, we have been in Florida in particular Orlando, Florida for the last two and a half years.
And I know -I can't believe how quickly you sort of lose your tolerance to cold weather once you've been in Florida for a couple of years. But we're getting used to it in typical Ohio fashion. Well, first you know you're in Ohio, when you talk about the weather all the time.
And the other thing about Ohio weather is it changes. We seriously -a couple of nights ago it was 65 degrees and there was a confirmed tornado. And then this morning it's 22 degrees with heavy frost on the windows.
So that's Ohio in February. I also want to give a here, I have not talked about this so far on the show, we are still trying to sell our house in Florida and the real estate market stinks. And like everyone else our house has lost lots of value. And so you know, there was a big cost to coming up here to Ohio and doing the podcast on the campus of Nationwide Children's Hospital.
No regrets, we're happy to be here, we're ecstatic to be here, but it's been a little bit of a hardship. And I just want to give a shoutout to our relatives in particular my father and his wife Valerie because they have taken us in. And you know, we're still trying to sort out you know, do we want two mortgages, do we wait until the house in Florida sells to buy our house.
Exactly what are we going to do? And we're still kind of in limbo with that. And I mentioned this because I know lots of you out there are having hardships with the economy that way that it is, and folks losing job, and two mortgages and loss of house value, and loss of 401K value.
I just want to let you know, you're not alone. I'm right in there with you too, but we've got a great family and I just wanted to give a shoutout to those who are helping us out in our time of need. Also want to let you know pediacast.org, if you haven't been to the website in while we have a new look.
So go check it out, pediacast.org. Basically the same stuff that was there before as someone here at Nationwide Children's said, it's the same girl with the new dress. So we dressed her up in a nicer dress, but most of the same stuff is there at the website.
Now, I also want to mention that the look may not be the greatest if you're using an old browser. So we use some HTML5 mark up kind of stuff and everything is functional, everything will work if you're using an older browser, but it may not look the nicest.
The way I figured is this, if you are so cutting edge technology that you're listening to podcast and you're subscribing to feeds, you know, you owe it to yourself to download the way this version of your web browser. OK. So the latest version of Internet Explorer, Firefox, Safari, all of those things, the website is going to look great.
So if it doesn't look quite right to you, you might want to think about updating your browser. Now someone say, "Well you know, just dumb down your site, so that the older browsers can -so it looks good on all browsers. But you know, we don't dumb down anything here at PediaCast.
We might explain it in ways that parents can understand, but we're into dumbing it down. So I would just encourage you if the new site is not looking that so great, just update your browser.
OK. One new thing that we do have at the site, I have sort of breathed a new life into the Pediascribe blog. Now for those of you who go way back like to 2006 when we very first started PediaCast, you'll remember that we actually started as a blog. And the blog morphed into the podcast, and somewhere along the way, the blog really fell into disrepair and finally just disappeared off the face of the earth.
And there was a time actually when my wife wrote for the blog, and it actually had a bigger following when she wrote regularly that when I wrote for it. So the blog is back and we don't have any of the new posts, I don't know, I can't find them, they're somewhere.
But we're starting out with a new post, so there will be some just in general thoughts, some helpful hints, some parenting thing, some medical things just you know, thoughts about life in general and I'm sure we'll recruit Karen to write some posts for us from time to time as well.
So if you want to check that out just go to pediacast.org and look for the Pediascribe blog. There's an RSS feed so you can subscribe to that in addition to subscribing to the podcast itself. So that's happening at the website, so check it out.
Also I want to give one more mention, if you have not helped us out with Miracles at Play, please consider doing so. It's to benefit Nationwide Children's Hospital, you know, one of the largest children's hospitals in the country, lots of research going on here, and we don't just treat people from Central Ohio, we have people coming in from all over the world who receive treatment at Nationwide Children's.
And it's really easy, all you have to do is sign up with your email address, or that's not the only way. You can also follow the Facebook page of Nationwide Children's, or follow their Twitter handle, either one of those three things. If you do that, the Wolfe Associates will donate $1 to the hospital up to a total of $100,000 and we're still quite away from reaching our goal.
So it literally will take you three or four minutes to go to miraclesatplay.org, signed up with your email address or just follow. Click the buttons to follow Facebook or Twitter of Nationwide Children's. If you do one of those three things, $1.00 goes to Nationwide Children's.
So it's an easy way to raise some money and it doesn't cost you anything, just five minutes of your time and you can help a kid. It's one of those things that nobody -if everyone thinks, "Hey, everyone else is going to do it", then it doesn't get done. And that's kind of what's happened to us to some degree because we have not had the turnout yet that we would like to see.
So please if you have not done that, please do so. OK. What are we going to talk about today; first up fever phobia. The American Academy of Pediatric has come up with some recommendations on fever and whether parents should be worried and when do you treat and how do you treat. Also we're going to talk about tanning salons. Are they safe? You know what the answer to that's going to be, but we have some data for you.
Also, MRSA skin infections, do they need an oral antibiotic or is just draining them and putting on topical antibiotic enough? Also there was a case of measles exposure to three different United States airports in the last week or so, so we're going to discuss that. Drug-related poisoning is on the rise, prescription and over the counter.
So we're going to talk about how to keep your kids safe. We had listener question about food allergies. Another one about folliculitis or razor bumps. And then we're going to talk about a research study that concerns vapor rub -Vick's vapor rub, is it safe? When do you use it? Should you use it? What do the studies show?
All right. If there's a question or a comment that you have for us, it's really easy to get a hold of us. Just go to pediacast.org and click on the contact link, you can also email firstname.lastname@example.org, and we're also on Facebook and Twitter. You can find us -easiest way to connect to us through Facebook and Twitter is at pediacast.org, just click on the Facebook and Twitter icons.
Also we do have a voice line, and the Skype line is up and running. OK. I tested it, it works, we are ready to rock and roll with that which is going to help us to be able to do some offsite interviews in the future. In fact I have a date with Manic Mommies coming up here soon.
So the Skype line is ready, and if you'd like to jump on board with that just call 347-404-KIDS, that's 347-404-5437 and you can connect with us that way on Skype line. All right. I want to remind you that 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. That's the best way to find out what's wrong with your child.
Dr. Mike Patrick: OK. Before we start our news, I have to say one more thing here, I need to give a shoutout to Kelly. Kelly is our social media guru here at Nationwide Children's. And she taught me how to use Twitter this morning.
Again, in our last show, I think I surprised everyone by saying, "Hey, we're on Twitter." You know you think that doing a podcast that we would have been all over Twitter, but we weren't.
And I don't know there's just a lot more that Twitter can do in terms of reaching out the folks that I had no idea. So we're going to be growing our presence on Twitter, and if you haven't followed us yet, please do. The handle on Twitter is PediaCast, pretty easy. So just find us there and we're going to be expanding our Twitter presence in the coming days and weeks.
All right. Our News Parents can Use is brought to you in conjunction with the news partner Medical News Today, the largest independent health and medical news website. You can visit them online at medicalnewstoday.com.
A fever in a child can be worrying to parents and it's one of the most common reasons that moms and dads seek a pediatrician's care. To help doctors educate parents and families about fever and fever phobia, the American Academy of Pediatrics has issued a clinical report called 'Fever and Anti-Pyretic use in children', it's published in the March 2011 issue of the Journal of Pediatrics.
Fever is a physiological mechanism that has beneficial effects in fighting infection. Although many parents administer anti-pyretics to children to reduce fever s, the report emphasizes the primary goal should be to help the child feel more comfortable rather than to try to maintain a normal body temperature.
By the way, anti-pyretic is simply a fancy word for fever fighting medicines like acetaminophen, or tylenol, and ibuprofen such as Motrin and Advil. Parents should focus on the general well-being of the child. His or her activity observing the child for signs of serious illness and maintaining appropriate fluid intake.
According to the American Academy of Pediatrics, 'Parents should not wake a sleeping child to administer a fever reducer.' They also advised that anti-pyretics must be stored safely to avoid accidental ingestions.
I'm going to talk about those coming up a little later in the news segment. Parents should be aware that the correct dosage is based on a child's weight and that an accurate measuring device should always be use.
Also I want to point out right there, there's a difference as you know between like infant Tylenol and children's Tylenol, and again between infant Advil or Motrin and children's Advil and Motrin. And the concentration is different so you definitely want to pay attention to the dosing recommendations based on your child's weight because if you mixed up one with the other, you could easily overdose your child.
And even though you think, 'Hey, Tylenol, and Motrin, or Advil, hey, how bad can it be, it's just fever reducers and they're available over the counter they must be safe'. But in overdose situation they can be deadly. So you definitely want to make sure that you're using the right dose for which type of medicine that you're using.
There's also some evidence that combination therapy such as alternating doses of acetaminophen and ibuprofen maybe more effective at lowering body temperature. Questions are mainly about whether it's safe to do this and whether it helps the children feel more comfortable.
Combination therapy also increases the risk of inaccurate dosing. I'm going to put a link to the American Academy of Pediatrics clinical report which again they call, 'Fever and Anti-Pyretic use in children.' So if you look in the Show notes at pediacast.org for episode number 156, we'll have the link for you.
Basically this report just emphasizes what pediatricians already tell parents everyday. And here's the talking points: number one; fevers themselves are not dangerous. They make kids uncomfortable, and that's why we treat them, but the fever itself is not dangerous and it's a bi-product of the body at work fighting infection and to some degree it's probably helpful in fighting infection. What is it that parents fear most about fever? That seizure.
I mean, you hear about kids who have a fever and they have a seizure or a febrile seizure. And as we talk about it in a recent PediaCast, in fact it was episode 154. Febrile seizures are not the result of brain damage caused by a high fever. They usually occur in kids who have a genetic pre-disposition to getting febrile seizures and they're usually the result of a sudden change in body temperature and not the product necessarily of a high fever.
Now having said that, your child's fever could be caused by something benign like an upper respiratory virus or a cold, or could be caused by something life threatening like meningitis. So a fever itself is not dangerous, the underlying cause of the fever could be. So if your child has a fever talk to your doctor, ensure that your child is comfortable, but by all means don't panic.
And again if you want to hear more about febrile seizures and a lot more depth, episode 154 is where we talked about that, and you can find that in the feed, and at pediacast.org in the Show notes.
All right. Moving on. Numerous public health campaigns encourage people to protect themselves from the risk of developing skin cancer. The people of all ages continue to overexpose themselves to harmful ultraviolet radiation from the sun. Teenagers and young adults are also exposed to UV light in tanning salons.
Rates of skin cancer including melanoma, the most serious form of skin cancer continue to rise even in young people. A new American Academy of Pediatrics policy statement called 'ultraviolet radiation' hazard to children and adolescents was published in the March 2011 issue of The Journal of Pediatrics and it offers guidelines to parents and pediatrician on skin cancer prevention and safe sun exposure practices.
Lifelong sun protection is recommended starting at an early age, education about UV light exposure is important for all children especially those at high risk for developing skin cancer. High risk kids include those with light skin and eyes, those who freckle or sunburn easily, and those with a family history of melanoma.
Pediatrician should advice children, parents, and teens about the dangers of UV light exposure. Recommendation include wearing proper clothing and hats, timing outdoor activities to minimize peak midday sun which is 10:00AM to 4:00PM, applying sunscreen and wearing sunglasses. Infants younger than six months should be kept out of direct sunlight and protected with clothing and hats.
The use of tanning salons is a common practice among teenagers especially females and a national survey, 24% of non-hispanic white teenagers, 13 to 19 years of age, those are the high risk ones used a tanning facility at least ones. The intensity of UV radiation produced by some tanning units can be 10 to 15 times than the higher midday sun.
Along with the World Health Organization, the American Medical Association, and the American Academy of Dermatology, the American Academy of Pediatrics supports the legislation prohibiting access to tanning salons or use of artificial tanning devices by children under the age of 18.
Now I know spring isn't quite here yet, but prom season is around the corner. And it's the time of year many teens starts working on their tans in your local skin cancer tube. So moms and dads, look, don't let them do it. Don't wait for the government to outwatch, just put your foot down, tell your kids you love them, but tanning is dangerous.
Teenagers do get skin cancer. I personally know teenagers who have had to have surgery, radiation therapy, and chemotherapy because of skin cancer. And some teenagers die from skin cancer. There's plenty of parents out there who wish they had put their foot down. So just say, No.
And how about parenting by example. Are you working on your tan as a mom or dad? If so, Stop. You want to live to see your grandkids, right? Right. All right. We'll have a link to the American Academy of Pediatrics policy statement about tanning salons and UV light exposure in our Show notes over at pediacast.org.
When it comes to curing skin infected with antibiotic resistant bacteriums such as 'MRSA' or Methicillin-resistant Staphylococcus aureus. Timely and proper wound cleaning and draining may be more important than the choice of oral antibiotic. That's according to a new Johns Hopkins Children Center study and that work is published in the March issue of The Journal of Pediatrics.
Researchers originally set out to compare the efficacy of two oral antibiotics commonly used to treat Staph skin infections randomly giving a 191 children either Cefalexin, a classic anti-staph antibiotic known to work against the most common non-resistant strains of Staph, but not so good against MRSA or clindamycin which is known to work better against the resistant strains.
Much to the researcher's surprise, they said, 'drug choice didn't matter', 95% of the the children in the study recovered completely within a week regardless which antibiotic they received. The finding lead the research team to conclude that proper wound care and not oral antibiotics may have been the key to healing.
The good news is that no matter which antibiotic we gave, nearly all skin infections cleared up fully within a week says study lead author Dr. Aaron Chen, an emergency physician at Hopkins Children, the better news might be that good low-tech wound care cleaning, draining, and keeping the infected area clean is what truly makes the difference between rapid healing and persistent infection. Chen says, "Proper wound care has always been the cornerstone of skin infection treatment. But the researcher say in recent years, "More and more physicians have started prescribing antibiotics preemptively."
Although the Johns Hopkins investigators stop short of advocating against prescribing antibiotics for uncomplicated MRSA skin infections, they call for studies that directly measure the benefit if any, of drug therapy versus proper wound care. The best study they say would compare patients receiving placebo with those on antibiotics along with proper wound cleaning, draining, and dressing for both groups. Antibiotics can have serious side effects, they fueled drug resistance and they raise the cost of care significantly, the researcher say.
Many physician understandably assumed that antibiotics are always necessary for bacterial infections, but there is evidence to suggest this may not be the case says another investigator Dr. George Siberry, "We need studies that precisely measure the benefit of antibiotics to help us determine which cases warrant them and which ones would fare well without them." The 191 in the study ages six months to 18 years were treated for skin infections at Hopkins Children's from 2006 to 2009.
Of these, 133 were infected with community-acquired MRSA, and the remainder had simple Staph infections with non-resistant strains of the organism. Community acquired MRSA is a virulent subset of the bacterium that's not susceptible to most commonly used antibiotic. It typically causes skin and soft tissue infections, but in those who were sick or have weaken immune systems that can lead to invasive and sometimes fatal infections.
At 48 hour to 72 hour follow ups, children treated with both antibiotics showed similar rates of improvement, 94% in the cefalexin group improved, and 97% in the clindamycin group improved. By one week the infections were gone in 97% of patients receiving cefalexin and in 94% of those on clindamycin.
Those younger than one year of age, and those whose infections were accompanied by fever were more prone to complications and more likely to be hospitalized.
So if your child has a MRSA skin infection and I know more and more parents out there know what I'm talking about when I say this, then you know what these things look like. So the question is, should you skip seeing your doctor, skip the oral antibiotic, and just drain and clean the wound yourself at home? No. That's not what we're saying. You should still see your doctor, let your doctor do the draining and decide if antibiotic therapy is warranted.
So I'm saying basically with these researchers are saying. Maybe we don't need oral antibiotics, but you as a parent probably don't want to be the one to make that judgment call you know, if your kid has a skin infection, you want to see your doctors, they can decide what to do. But you know, just so you know, it could be that oral antibiotics aren't necessary all the time and we're still trying to figure out when you need to do it and when you don't.
All right. Let's move on to measles. A passenger who traveled from the United Kingdom with measles walked through three U.S. airports triggering a massive hunt for anyone who might have been passing by and could be at risk of becoming infected.
The infected woman went through Dulles International Airport in Washington DC, Denver International Airport, and Albuquerque International Airport last week according to the Centers for Disease Control and Prevention. Authority say the CDC supplied health officials with data regarding passengers on the same flights as the woman with measles and they're desperately trying to track them all down and find out whether they are up to date with their shots.
The infected passenger who had flown in from the UK is from New Mexico. Colorado health officials informed their staff that she had been at Denver International Airport for several hours last Tuesday. CDC officials cannot confirm, but believed the woman became ill while overseas. The CDC says it's in close contact with stat officials to establish who might have been at risk of infection starting with those sitting closes to the woman on the planes.
It's not a good day when you get a phone call from the CDC, you know, "Hey, Mrs. Smith we have a little bit of a concern about someone you may have been exposed to." Yeah, that would not be a good phone call.
Measles is a highly infectious illness, it is a viral infection caused by the rubella virus. Expert say this is an endemic disease, this means it is forever present in the community, many people people develop resistance. If the virus enters an area where nobody has ever been exposed or vaccinated, the results can be devastating. An outbreak in Cuba in 1592 killed nearly 2/3 of the native population of the island. Two years later another outbreak in Honduras killed half of all the people in that country.
In the 1850's about 20% of the people in Hawaii died from an outbreak of the measles. The rubella virus stays in the mucus of the throat and nose of an infected person who is contagious for four days after the rash appears and continues to be so for approximately four to five days afterwards. The illness can pass on or through physical contact with an infected person -well that didn't make any sense, did it? Not even going to go back and correct that one.
The illness can pass on through physical contact with an infected person. Being in close proximity when the infected individual coughs or sneezes and by touching a tainted surface. The virus can remain infectious for up to two hours on the surface of objects. About 180 people in Boston have been vaccinated at two clinics near one of the woman's places of employment.
In the U.S.A., and many other countries, children need to be vaccinated against measles to attend school. In 2008, 130 cases of measles were reported in 15 states and that's the largest recent outbreak. Is another devastating outbreak like those seen in the 16th century possible? Officials don't think so, thanks to current vaccination efforts here and abroad.
And finally in our News Parents Can Use, the medicine cabinet, a new study identifies the medical and financial impact of drug-related poisonings. Over the past decade drug-related poisonings have been on the rise in the United States, in fact in many states, drug related poisoning deaths have now surpassed motor vehicle crash fatality to become the leading cause of injury death.
While the fatalities from this epidemic have been well reported, they really are just the tip of the iceberg. A new study by researchers at the Center for Injury Research and Policy of the Research Institute at Nationwide Children's Hospital examined emergency department visits for drug-related poisonings and found that in just one year in 2007, in the U.S, there were approximately 700,000 ED visits costing nearly 1.4 billion in ED charges alone.
This equates to an average of 1,900 drug related emergency room visits and 3.8 million in emergency department charges each and everyday in the United States. You know, I'm just going to say that again, 1,900 emergency department visits everyday in the United States is from drug-related poisonings. The magnitude of these findings is staggering said Dr. Gary Smith, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children's Hospital.
The number and cause of drug-related poisonings identified in the study indicate a public health emergency that requires a decisive and coordinated response at National state and local levels. According to the study which appeared in the March 2011 issue of The American Journal of Emergency Medicine, poisoning by antidepressants and tranquilizers and poisoning by pain and fever control medicines were responsible for almost half of emergency department visits for drug-related poisoning.
Among cases involving anti-depressants and tranquilizers, 52% were suicidal poisonings and 30% were unintentional ingestions. In comparison, 41% of poisonings by pain and fever control medicine were suicidal and 40% were unintentional. The current epidemic of drug-related poisonings has a new phase said Dr. Smith also professor of pediatrics at the Ohio State University College of Medicine.
Unlike epidemics in the past involving illegal drugs such as heroine and crack cocaine, these use of prescription drugs especially opioid pain medications is now the cause of an unprecedented number of emergency department visits and deaths. Our study also demonstrated that the rate of ED visits for drug-related poisoning is three times higher in rural areas than in non-rural areas.
Also of concern was the study's finding that children five years and younger had the highest rate of ED visits per unintentional drug-related poisonings that compared to all other age groups. Despite the fact that successful prevention strategies targeted at young children have helped or decrease the occurrence of drug-related poisonings in these population.
The number of unintentional poisonings among this age group is still too high said Dr. Smith. Our findings reinforced the importance of increasing efforts to prevent unintentional drug exposure among young children in the United States. So moms and dads, make sure your medications are out of sight and locked up, OK. Don't leave them on the counter or an easy to reach cabinet.
If you're afraid you'll forget to take your medicine, if it's not setting out, so if your medicine's setting out, so you remember to take it, leave a note on the counter, not the medicine bottle. Purses are also a dangerous place to keep your medicine because kids have easy access.
And spread the word to baby sitters and grandparents. All medicine should be out of site and locked up whether it's prescription or over the counter period. All of it -1,900 drug poisonings a day in the United States is way too much. And whose to blame for the accidental ones? We are as parents. So take a look around your house tonight when you get home, make it safe.
All right. We're going to take a quick break and we will be back with our listener's segment, right after this.
Dr. Mike Patrick: All right. First up in our listener's segment is Alicia in Washington, DC. And Alicia says, "Hi, Dr. Mike. I was reading an article in the February 7th, New Yorker and thought it would make a great show topic that just seems to be the old guidance which my pediatrician is still telling me of waiting to introduce peanuts and other potential allergens until kids are two or three, doesn't really prevent kids from developing food allergies.
It was an interesting article, but as a parent I'm not sure what guidance it leads to or what the study is talking about really say. Hope the move is going smoothly and I'm looking forward to the next show, Alicia. Well, thanks for the question, Alicia. I'm going to put a link to the New Yorker article that you're referring to in the Show notes.
So if those of you out there who are interested in reading the entire article from the New Yorker, there will be a link to it in the Show notes over at pediacast.org. It's an interesting read and here's the deal, Dr. Hugh Sampson and Dr. Scott Sicherer, I think I'm saying his name right. Dr. Scott Sicherer and Dr. Hugh Sampson, these two are from the Ja e Food Allergy Institute at Mount Sinai Medical Center.
And they have conducted several population studies in the United States that show the rate for the incidence of food allergies is rising sharply. And they say now that 3 to 5% of the population is allergic to milk, eggs, peanuts, tree nuts, and seafood. So why is the rate rising sharply? Well, they don't know for sure, but they have a hypothesis. Now let me repeat, this is a hypothesis. They don't know for sure, and they'd like to design a study to see if it's true.
But here is what they think might be happening. By waiting to introduce high risk food, we might actually be causing more kids to become allergic to them. So let's break this down, first of all let's look at why that might be the case, and second; let's look at why the current recommendations to wait are in place. Let's do the latter first actually.
So why did we tell parents or why do we tell parents to wait to introduce high risk foods like peanuts, seafood, strawberries, those sort of things. Why do we tell parents to wait in the first place? Where did this idea actually come from that early exposure to high risk foods might be a bad thing. Well, in 1980 doctors noticed that the incidents of food allergies were rising in the west. But they remained rare in Africa and Asia.
So researchers postulated that breastfeeding longer might protect kids from food allergies because in Africa and Asia, more people breastfed and they breastfed for a longer period of time compared to the West. So they thought well, maybe breastfeeding longer protects you from food allergies.
And then in 1989, one of the only population prospective studies on the subject so where they actually took kids from birth and broke them into groups of breastfed versus bottle fed when they were introduced food should this to be true that breastfeeding longer lead to fewer food allergies in childhood.
So in the 1990s many agencies began recommending breastfeeding longer and waiting to introduce high risk foods as long as possible. Now, you'll notice though that their initial hypothesis was that it was breastfeeding longer that protected you,, not waiting on a high risk foods.
And in the studies that they did, what they were really looking at was breastfeeding longer, not necessarily at waiting. So this sort of became over time this idea that it's not just breastfeeding longer that could protect you from food allergies later , but waiting to introduce high risk foods and breastfeeding instead was really what was going on even though that was never really what the studies looked at. well despite that, in 1988, the Department of Health in the United Kingdom released official recommendations that kids should wait until they're two or three years old to have high risk foods.
Things again like peanuts, milk, eggs, that kind of thing. And in 2000, the American Academy of Pediatrics jumped onboard, but despite these recommendations since 1998, 2000, despite these recommendations the incidence of food allergies has continued to rise and it's rising sharply. So why? Why is that?
Well, Dr. Sampson and Sicherer think that the increase might be caused by the current recommendations to wait. Again 'my' is the keyword here because this is a hypothesis. But let's talk about why they think this. So why would waiting make allergies more likely. Well let's just do a little immunology 101 to understand this.
You know, going back to sort of high school biology, an allergen is something that causes the immune system to respond. And so what an allergen in? Let's just take peanuts for example, a peanut protein is the allergen, that's something that causes -if you're allergic to peanuts, that causes your immune system to respond so you have the allergic reaction.
Now the sudden introduction of a large anogen load when it's not been introduced before causes something we call sensitization. And what this means is you have a peanut protein and you don't have a reaction to it, but your body's immune system recognizes it as foreign and starts to make antibodies against it.
So the next time that that thing comes along, which depending on what it is and your own bodies immune system, you know, it might be the next time, might be the next day or it might be a month from now, but you are now sensitized to that thing. So that the next time the anogen is introduced, those antibodies are there, they're ready to go and you have the actual reaction. But we also know that constant low level anogen exposure, reduces that reaction.
And that's the basis for allergy shots. So you create frequent low level exposure and the immune system finally subtles down. And we think this does happen with food allergies too because 80% of infants who are allergic to milk and eggs, outgrow their allergy by their teenage years. Why do they outgrow it? Well either because the immune system just settles down on its own or there are still some low level exposure even in the diets of kids who try to avoid those specific items.
You know, they're still in some foods, it's very difficult, if you're a parent with a child with a food allergy you know how difficult it can be to make sure their food does not have XY or Z in it. But it's not always possible you know, especially at restaurants, and packaged foods, things gets sort of knocked in. And so we think that there's still sort of a low level interment and exposure that then helps you not to be allergic anymore by the time you're a teenager.
So there's another doctor that I'm going to sort of talk about here. His name is Dr. Gideon Lack and he's a researcher ho even back in the late 90's and 2000 questioned the guidelines set fort by the UK Department of Health and the American Academy of Pediatrics and he believes that based on how the immune's system works and knowing about sensitization and knowing about reactions and the fact that food allergies tend to go away over time.
He right from the get go believed that children become more tolerant of foods through exposure to food allergens even in the first six months of life and that by delaying exposure, that might be creating more food allergies and making these food allergies last longer. Everyone sort of laugh at him in the beginning and said you know, "No. That's not what we're seeing. That's not what the current study show.
The current studies are showing if you breastfeed longer and wait, they can add to that then we're going to have less reactions. So now it's coming around full circle and suddenly Dr. Lack seems to be, 'Hey maybe he's on to something here'. But again he believes this to be true, it's still a hypothesis. We need more research on this.
So in the meantime what's a parent to do? Well the safe answer of course is to follow the advice of your doctor especially since some food allergies can be life threatening. But what should your doctor's advice be? Well, here's where the art of medicine really comes into play because we just don't have good science to guide us on this one, at least not yet.
The American Academy of Pediatrics here in the United States their guidelines of waiting are still in effect and I'd stick with those for now at least then you have someone to blame if your child has a life threatening reaction. Hey, you know, I did what the experts told me to do, just becomes difficult when you have different experts telling you different things, right?
And that's why you want to go with the opinion of your families, friendly personal pediatrician someone you know and trust. Of course if your pediatrician hasn't heard about the controversy on this topic, direct them to PediaCast episode number 156 and we'll introduce them to the dilemma.
I mean, it's tough because you know, one way or the other a child out there is going to have a life threatening reaction, you know what I'm saying? It's going to happen. And it's going to happen in the kid who waited, and it's going to happen in the kid who didn't wait. And so, the parents -when something bad happens to your kids, you want to blame someone, really you do and I totally get that.
So it becomes tough being the people who were advising parents because you're going to have kids with adverse effects either way that you go. The research is still out on this and we need to explore more, we need to really look at it, there needs to be more research. This is an area where I think it would be pretty easy to get grants to study this.
So there's more to come on food allergies. In fact sort of in the back of my mind, we're going to devote here in the future a whole podcast to food allergies and we're going to talk to a pediatric allergist who's on the cutting edge of current research on food allergies and also talk to a pediatric emergency medicine physician who's on the front lines of treating the effects of acute food allergy when kids have antiphylaxis and have a life threatening event with their food allergies.
So look forward to that in the coming episode. All right. Also I should mention speaking of telling your pediatrician about PediaCast, that is a great way to spread information about this program. So moms and dads out there please, you know, we talked about doing reviews on iTunes, and Facebook, and then your blogs, and Twitter.
But please when you go in to see your pediatrician or family doctor, let them know about PediaCast, tell them, "Hey, you know, it's from Nationwide Children's Hospital. Dr. Mike has been doing this." We do the research, we really do evidence based medicine here. And just point them to our pediacast.org, I'd be so appreciative. All right. Let's move on; Ann in Lafia, Indiana. Says, "Hi. Dr. Mike. Congratulations on making it back to Ohio. I have a question regarding my teenage daughter. She gets for lack of a better word pimples along her bikini line.
She describes them to me as pea size lumps under her skin that sometimes pop like pimples. Sometimes they follow the underwear line and sometimes they're two to four inches further down her leg. She is embarrassed by this especially when summer swimsuit season approaching. I bought different cleansers some gentle, and some with salicylic acid.
She says, there's no improvement with anything she tries. I am unsure if she needs to see her doctor or if she needs to go to a dermatologist. With her embarrassment over this skin issues, I would like advice on what might be causing her problem and/or a way to correct it. Thanks for all your hard work and welcome back to the chilly north, Ann.
Well, thanks for your question, Ann. By your description it sounds like your daughter has folliculitis. Now notice I said sounds like, we talked about this often, and I want to mention it again. The only way to get an accurate diagnosis is to see your doctor. And the only way to know how to treat or prevent the condition is to get accurate diagnosis. So definitely see your doctor about this.
I don't think you need to see a dermatologist, you know, just start with your regular doctor, and if he or she thinks you need a dermatologist, she'll let you know and refer you to one who sees kids. Now having said that folliculitis is common in places where teenage girls shave. So what is folliculitis? Folliculitis is a skin infection that involves a hair follicle, so where the hair comes up through the skin where it grows from, bacteria get down there and causes infection.
So how does this happen? Well, remember the surface of the skin is covered with bacteria and some areas have more than others, the bikini area is warm and moist and bacteria flourished there. So what happens when you shave? Well, hairs are pulled up and cut off. So now you have an opening where there used to be a hair poke in through, right?
When the hair is poking through, it's a little harder for bacteria to get in there, but when you pull the hair up, cut it off, now suddenly that opening is open and it's easy for skin bacteria to get in there.
Now also when you shave, you typically are using warm water, and the heat on the surface of the skin causes the hair follicle to become bigger. So that dilates and so the hair follicle itself is a little bit bigger, again it makes it easier for bacteria to get in there. And there may also be micro abrasions, not cuts that you can see, but you know, you just move eraser across the skin so you can get some micro abrasions in the protective layer of the skin.
So the bottomline here is there's several factors that allows surface bacteria to enter the hair follicle around the time that you're shaving. Now as the hair grows back out through that opening or is dead skin settle slough off with shaving, the opening can become occluded again and now the bacteria are trapped. So you cut of the hair, the bacteria got in there, the hair grows back out, now the opening is blocked again.
And the other thing that can block the opening is dead skin cells which is why salicylic acid sometimes helps3 to prevent this because it helps to get all those dead sloughs skin cells off and we've talked about that before with acne.
So you have a situation now where the bacteria are trapped, they overwhelm the follicle, they reproduce, they fill up the space, the body sends in white blood cells to fight the infection and the result is an inflamed and sometimes pus-filled bump. The infection may spread to the surrounding skin if it does that we call that furuncle and several nearby infected follicles may join together into one larger infection and when that happens we call it a carbuncle.
So how do you prevent this from happening and how do you treat it when it does happen? Well, since we're doing latter things first here, seems to be the way we're doing it this show. Let's talk treatment first; if it's a small infection it's what will cause self limiting, the immune system does the job and may even go unnoticed. You know, maybe just little red bump, your child might not even know it's there.
For your daughter when she says that they pop like pimples, in that case it sounds like it's a small infection, the body is taking care of it, she drained it, nothing worse happened. But when there's larger infections and they turned into furuncle or carbuncles, you may need a topical antibiotic, something over the counter prescription.
Sometimes the infection is bad enough you'll need an oral antibiotic and sometimes if it's a really bad invasive skin infection that started out this way, your child might even need an IV antibiotic. So basically ones the infection is there, if it's a significant one, you'll need to see your doctor for it. So really I think what you're interested in is how do you prevent this from happening in the first place?
And the best way to do that is to wash with soap and water before shaving, so you want to try to decrease the bacterial load on the skin, so wash with soap and water before shaving.
Use a shaving gel rather than soap or shaving cream, so you get a slippier surface and you can help to avoid microabrasions by using a gel and then again clean with soap and water immediately after shaving. So soap and water before shaving, then use a really slippery gel and then soap and water again immediately after shaving.
Now let's talk about the razor itself. You want to wash the razor well because the razor itself can harbor bacteria on it and if it continues to be problem, because think this, if the blades of your razor have bacteria on them and you're using this frequently, not only could you be causing microabrasions, you may be injecting bacteria into those abrasions.
So you really want to clean razor and using old dirty razor is probably one of the biggest culprits to shaving folliculitis in teenagers. So what you may want to do is get disposable razors and only use them one time and that may help you out.
All right. Finally in our listener's segment this week, a couple of your comments, Christie in Austin, Texas says, "If I hadn't listen to episode 154 a couple of weeks ago I would have been freaking out this morning when my nine month old had a febrile seizure. I went to the doctor and got it all clear, but in the meantime I was able to keep a clear head.
Wow! What a gift. Thanks." Well, you're welcome, Christie. And really that's why we're here, I mean, hearing comments and feedback like that just seriously warms my heart, that's why we do this program. And Christie hopefully you mentioned to your physician PediaCast and let them know that, 'Hey! I felt a lot better about febrile seizures after listening to episode 154.
Again, I don't want to downplay this, you did the right thing seeing your doctor because remember as we talked about when we discuss febrile seizures, you know, the actual febrile itself could be caused by something dangerous so you definitely want to see your doctor, things like meningitis can also cause fever and seizures at the same time.
So you don't want to just assume that it's a benign process and kids can be sick and have a head injury and have a seizure if they have a fever and they have an unwitnessed fall, and they have a head injury, and they're seizing from their fall and it just happens to be at the same time they have a fever.
So you got to still use your common sense and your judgment, so you know, on PediaCast when we're trying to make you feel better about febrile seizures, you'll realize that there are situations where it may not really be a febrile seizure, it may be more complicated and that so. You definitely did the right thing still, Christie, seeing your doctor. All right. Crystal in Dubuque, Iowa says, "I just wanted to write a note saying thank you for all your hard work and producing this podcast.
As a nurse and a mother of two, I find you a great help when things occur with my own children. Also I'm going to school to get my BSN and your research round-up is wonderful, how you present the studies and how you validate them has made some of my classes easier to understand and makes me realize how I will use these skills in my practice. Thanks again, Crystal."
Well, thank you, Crystal. And speaking of our research round-up, we have a new one coming at you and we will get to it right after this.
Dr. Mike Patrick: All right. We are back and before we start the research round up, I just want to mention that seems to be another thing this show isn't it? Not actually getting on with what we're supposed to be doing. We had a research round-up last week, the week before we had an in depth segment on febrile seizures. The week before that we had an in depth segment on ear infections.
And I've been promising you interviews with pediatric specialist here at Nationwide Children's, and we haven't done it yet. And the reason we haven't is because I've got a couple studios here on the campus. Right now I'm in my office, and my office is fantastic, it's quiet, I've got the studio microphone set-up, I can work on the script, do my work, you know, have meetings, and actually record right here in one place.
The problem is the marketing department and public relations department where my office is located is not in the main hospital. And it has been my desire to not have -we're about a mile from the actual main hospital building here where we are in the marketing department. So my goal has been for the specialist not to make them come here.
So we want a studio that's actually in the main hospital. So physicians if it's between clinics or after they're in the OR, or before they do a shift in the emergency room whatever, they can stop by the studio right there where they work and do the interview.
So we're really close to having the actual hospital studios done, and once that's done which should be in the next week, maybe week and a half, we can start doing the actual interviews on the campus -we're on the campus, but in the main hospital building. So we're really excited about that.
We do have that plan, we're not just teasing you and saying, "Hey! We're going to have a special zone and then you know, we never have them. We are and that is planned, but we're not quite there yet. So let's do another in depth segment on with the research round-up.
This one is an interesting one, vapo rub, Vick's vapor rub or off brand vapor rubs for the treatment of a nocturnal cough, does it work? Is it safe? This was a research study that came out of the Pennsylvania State College of Medicine and published in the Journal of Pediatrics in December of last year.
And the question before the researchers was among children aged two to 11 years of age, is a single application of vapor rub or petroleum not vapor rub petroleum jelly superior to no treatment for nocturnal cough congestion and sleep difficulty caused by viral upper respiratory infections. They did a randomized prospective control study, so that means they didn't look back at medical charts or ask people to recall past things.
A prospective study means that we're going to take kids from the beginning and then follow them forward rather than looking back. They were randomized, that means that of the kids who enrolled, it was a random process to decide which group whether it was one of the experimental groups or the control group that they were enrolled in. So what did they do here?
Well, all together they had a 144 children enroll, 138 of them completed the study, so there were few who kind of flaked out, didn't want to do it. So 138 kids is what they looked at. Each child was between the ages of two and 11 years of age, and each was diagnosed with a viral upper respiratory infection -so cold.
Each child was randomly assigned to one of three groups, the first experimental group, the parents were told to put vapo -well they were given an ointment which happened to be vapor rub because the parents were blinded to which group they were in and we'll get to that in a minute. So one group the parents had vapor rub and they just put the vapor rub on their child's chest 30 minutes before bedtime.
The other group that you could have been randomly picked or randomly put into was another experimental group and this one was just plain petroleum jelly. So there was no vapo in it, it was just basically Vaseline petroleum jelly on the chest again 30 minutes before bedtime, and then the third group was the control group and they put nothing -nothing on the chest.
So the control group could not have been blinded, right? You know which group you're in if you didn't put anything on your child's chest. Now they wanted parents though to be blinded whether it's vapor rub or plain petroleum jelly. So what they did is they had parents in both of the experimental groups whether it was vapor rub group or just regular petroleum jelly group.
They had those parents apply vapor rub to their own upper lips before applying the unknown ointment to their child's chest. So they smelled vapor rub while they're putting the stuff on their child's chest. So the idea here was so the parent wouldn't know what they were putting on was actually vapor rub or not. And then the children and any family members were told not to comment on any odor arising from the child. All right.
It's kind of tough because then, part of this is they're going to ask the parents how well their kids slept and you know, I'm not sure if they had the parents continuing to reapply the vapor rub to their own upper lip, but at some point I think the parents could smell it on their child's chest in the middle of the night, but anyway. So I'm not sure how well that blinding procedure really would work, but we'll talk about that again as we get into the results.
OK. So data collection; prior to treatment and again the next morning, parents from each group rated the following, the frequency and severity of cough, rhinorrhea or runny nose, nasal congestion, the impact of symptoms on the child's sleep, the impact of symptoms on the parent's sleep, and then the vapor rub and petroleum jelly group were also asked about side effects the next morning secondary to the treatment. So what did they find out? Well the mean age of all participant was 5.8 years.
So the average age of the kid were looking at here was almost six years old. They had upper respiratory infection symptoms for an average of four days prior to enrolling. So most of these kids are about four days into their cold virus. All together 44 kids were in the vapor rub group, 47 were in the petroleum jelly group, and 47 were in the control group.
Now both treatment groups before and after ratings, so whether they're in the vapor rub group or in the petroleum jelly group, their before and after ratings showed improvements for all measured outcomes and these improvements were significantly different. So by statistical analysis, not likely to occur by chance.
So whether they were vapor rub or petroleum jelly, both groups the parents said, all of those things we mentioned cough frequency, cough severity, runny nose, all of those things, they improved from before treatment versus after treatment.
Now let's compare just the vapor rub versus the control group who had nothing put on. Vapor rub had significant improvement compared to the control group in terms of cough severity, cough frequency, nasal congestion, child sleep, and rhinorrhea or runny nose was the only outcome not significantly improved when you compare the vapor rub group to the control group.
When you look at the petroleum jelly group versus the control group, there was no significant difference in any outcome measurement. So even though the petroleum jelly group said that they improved compared to before they used the petroleum jelly. When you compare them to the control group, the amount of improvement was not significantly different for the petroleum jelly group.
Now let's compare the vapor rub group to the petroleum jelly group and that when you compare those two, there was significant improvement with regard to child's sleep and the parent's sleep in the vapor rub groups. So the vapor rub group did better and it was significantly better with regard to child's sleep and parent's sleep.
OK. Finally what about side effects? Well, 46% of kids in the vapor rub group experience at least one mild irritant side effect, 38% reported a burning sensation on the skin, hello? It's vapor rub. Is that really a side effect or is it just, you know, expected. 16% reported a burning sensation in the eyes, OK, that's not good, 14% reported a burning sensation in the nose. How well were the groups blinded?
Well, the control group wasn't blinded at all because the parents knew that they didn't put anything on the child's chest, so they knew which group they were in. Now, to find out how well the blinding work for the vapor rub group and the petroleum jelly group, the parents were asked the next morning to guess which group their child was in. And 86% of the parents in the vapor rub group guessed correctly, and 89% in the petroleum jelly group guessed correctly.
So my guess is they went into the middle of the night to check on their kid and they could smell whether it was vapor rub or not, that's my guess. So what was the conclusion here? Well, the authors conclude that despite mild irritant adverse effects, vapor rub provided symptomatic relief for children with viral respiratory infections and allowed them and their parents to have a more restful night sleep.
OK. So let's talk about this. There's no question that there was improvement in the vapor rub group in terms of cough severity, cough frequency, nasal congestion, and how well you sleep. OK. They improved with vapor rub, and they improved more when you compare them to petroleum jelly and they improve more when you compare them to not doing anything. Now the question becomes why?
Was that really an effect of the vapor rub or was it because they were another day further into their viral upper respiratory infections, so they were just having natural resolution of their disease, or was it placebo effect because the vast majority of parents knew they were in the vapor rub group. So there is some question about whether did they really better or is there some bias because the parents knew they were in this experimental group that sort of thing.
Now another issue is this study was funded by the makers of Vick's vapor rub. Now as long as the study is done well, that shouldn't matter. But I want you to keep that in the back of your heads because we're going to circle back around to that and find out where that significant in a couple of minutes.
Another precautionary note before you jump on the vapor rub bandwagon. The active ingredient in vapor rub is camphor. And camphor can cause neuro-toxicity and in particular can result inn seizures and because of this the FDA limits camphor concentrations to 11% in over the counter products
Now Vick's vapor rub contains 4.8% camphor. So it's definitely in the safe zone when it's used correctly. However if your child opened a jar and started eating it, that could be a problem. So we're back to drug-related poisonings here, right? Over the counter medicines like vapor rub seems safe, but if ingested it's not safe. So keep vapor rub out of site and locked up just like all of your other medications.
And then one more point regarding vapor rub, there was a study published in the Journal Chest in August of 2009, which showed exposure to Vick's vapor rub cause respiratory distress due to inflammation, increase mucus production, and decreased ability to clear mucus from the airways and ferret.
I know what you're saying, you're talking about ferrets not five and six year old kids which was the average age of kids in the study we're talking about today. But the reason for that study in the first place was because some doctors were noticing babies coming into emergency departments with respiratory distress came in after their parents had used vapor rub on them.
And so they hypothesized that vapor rub was to blame and as it turns out the respiratory tract to ferrets is remarkably similar to the respiratory tract of young humans. So when this vapor rub ferret study came out about a year and a half ago or so, it received a lot of press in the medical community and I suspect that vapor rubs sales dropped a little bit because of it.
Now jump back to our current study which again was funded by the makers of Vick's vapor rub and you wonder if they aren't just trying to get a little bit of their credit back. So what's a parent to do? Well, I say use common sense. You know, if you're child is older and healthy, try vapor rub, if it's irritating, stop using it, and if it's well tolerated and seems to help, great!
On the other hand if your child has underlying respiratory issues like asthma or cystic fibrosis, or history of prematurity with lung complications, then vapor rub might not be the best idea.
And it's just another example of the lack of black and white in the practice of medicine. I'll put links in the Show notes to the current vapor rub study that we just talked about, as well as the vapor rub ferret study, and from Pub Med, and you can find those at the new and improved pediacast.org in the Show notes section.
All right. So that is going to wrap up our show today. Well, it actually warps up our Research round-up show, part of the show segment. I'm getting all tongue tied, it's because we've ran over the hour mark here. So we warp up our Research round-up. We're going to take a quick break and then we'll be back and wrap up the show, right after this.
Dr. Mike Patrick: All right. As always things go out to Nationwide Children's Hospital, Medical News Today, Vlad at Vlad Studio, Wizard Media and listeners like you. So we really appreciate our partners and really, really we appreciate you moms and dads for listening. I just want to remind you if you have not done a review on iTunes, if you could take a minute to do that we'd really appreciate it.
A lot of our iTunes review are old and we'd like to get some new ones on there. Also be sure to talk us up in your blogs, and on Facebook, and in your tweets. And remember we do have a Facebook page, if you go to pediacast.org, you can find a link to it.
We're also on Twitter and I'm learning, OK. I'm learning how to this stuff. I'm going to spend after we get this show produced, and packaged, and uploaded, and on the feed and all, sometime this afternoon really working on Twitter and following some good sources and just learning how to use it better. So look forward to some Twitter and I'll look for you on Twitter.
Also and this sort of came up during the show, be sure to tell your doctor about PediaCast, you know, let them know it's a product of Nationwide Children's Hospital, we do evidence based stuff here, and really research everything that we talk about. And so it's a good source of information and we just want pediatricians and family doctors, primary folks out there, nurse practitioners, to know about the show and to use it as a resource in their own practices, and you can help us do that by just letting your doctor know about it.
I think at some point here we're going to need to have -and I did this back in the early days of the show, and it just sort of got pushed aside and I never put it back up there, but we used to have some flyers and posters that people download and print, you know, to put in examination rooms, you know, what the information about PediaCast.
So I probably need to do that again and get those up on the website so that doctors and nurse practitioners out there have an easy way to let their patients and parents know about the show. Also I want to mention again Miracles at Play if you have not done so, please just go to miraclesatplay.org and then Facebook about it, tweet about it.
You know, you can say why do I want to support a Children's Hospital in Central Ohio. And the bottom line is Nationwide Children's Hospital is one of the five largest children's hospitals in this country and probably one of the top 10 children's hospitals in the world.
And there's a lot of research that happens here, crazy amount of research. I mean it just staggers the mind how much research comes out of this place. And we also treat kids from all over. And so by supporting Nationwide Children's, you're really helping kids all over the globe.
And it doesn't cost you a thing. All you have to do is go to miraclesatplay.org, give us your email address. They're not going to spam you, they're not going to sell it, it's just to keep you in the loop of what's going on here at the hospital, and what kind of research projects they're doing, you know, how they're helping kids. If you don't want to give your email address, no biggie.
We just want you to follow them on Facebook, or on Twitter and there are links to do that, or you can look for them on Facebook and Twitter and just follow them and for every follow on facebook and Twitter, and for every email address we get, one of those three things -you don't have to do all of them just one, what the associates is going give the hospital $1 up to a maximum of $100,000, and we just want to meet that goal.
I mean, it would be sad to walk away from this and not having got as large of a gift as Wolfe Associates said they would give because not enough people took the time to like us on Facebook and Twitter. So it won't take you long, just over your lunch break today or tomorrow. You can go to pediacast.org and we have a link to miraclesatplay.org, and then from there you can give your email or follow on Twitter or Facebook.
So please do that at miraclesatplay.org. And then if you have a comment or a question for us it's easy to get a hold of us, pediacast.org, there's a contact link, you can also email email@example.com, if you go that route just let us know where you're from, we'll appreciate that. and also now the voice line is alive and kicking, and working, just go to 347-404-KIDS, 347-404-5437.
And you can leave a message that way on the Skype line and we'll get that on the air as well. And until next time. This is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody!