PediaCast 164 * Acne, Asperger Syndrome, Nail Biting

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  • Acne
  • Asperger Syndrome
  • Nail Biting
  • Ohio Family Vacation Spots

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Dr Mike Endorsed Ohio Family Vacation Spots

Transcript

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike!

Dr. Mike Patrick: Hello, everyone! And welcome to PediaCast it is episode 164 for June 16th, 2011. And we're calling this one Acne, Asperger Syndrome, and nail biting. It is a listener's edition of PediaCast, so these topics come from you, going to get to some of your questions here in just a minute.

01:08

We're back and quickly, so I promised you during the last show that we're going to be doing more frequent shows, but more often. And I wasn't kidding. So two days later and here we are back with a listener's edition of PediaCast. I've already had some feedback and I appreciate that, really I do.

In fact I'm going to share one of those emails with you, and if you have some feedback for us on this shorter, more frequent shows, let us know. It's sort of our plan for the summer and in the fall we'll regroup and decide if we're going to go back to the longer format or stick with the short ones.

Also in keeping with our new plan, I wanted to chat with you a little bit about family vacations and some cool places in Ohio to do it. Now that we've moved to the campus of Nationwide Children's, we're getting a lot of listeners from Ohio. And I just had some ideas for vacation spots, things you can do on a one tank trips kind of thing, that's fun for the family.

02:06

And there maybe some of you out there who aren't in Ohio, but will be visiting Ohio for one reason or another, and you may want to know about some of these things as well. But we'll save that for the end. I want to remind you also that's easy to get a hold of us here at PediaCast, if you go to pediacast.org you can click the contact link, you can also email pediacast@gmail.com or call the voice line 347-404-KIDS, that's 347-404-5437.

We have a lot of people use that mechanism. Most people use the contact link on the webpage which is great, but we'd love to hear you as well. So if you call 347-404-KIDS, you can get a hold of us that way and leave a comment or a question for us here at PediaCast.

Also want to remind you the information presented in each and every episode is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. And if you have a concern about your child's health, make sure you call your doctor and arrange a face to face interview and hands on physical examination.

03:11

Also your use of this audio program is subject to the PediaCast terms of use agreement which you can find at pediacast.org. All right. Teresa in Vancouver, Washington says, "Hey, Dr. Mike! Great show today on multicystic dysplastic kidney. My oldest son, now 13, was diagnosed with this while I was pregnant. I wanted to let the mom who wrote in know that everything the show covered was exactly my experience.

We visited a kidney doctor for two years just to watch the kidney and by his second birthday that kidney had completely disappeared and his other kidney was twice as big, but it was healthy as ever. In fact he is so healthy that I almost forgot about him having one kidney.

I was also happy to hear that all the advice I got 13 years ago is still the standard. There are lots of things to worry about when it comes to kids, but luckily this was not one of them.

04:01

So I want to remind you it wasn't long ago PediaCast 162 we did an interview with Dr. David Hains on multicystic dysplastic kidney, so if you're interested in that, it's back in episode162.

All right. And then Crystal in Spanish Fork, Utah says, "Dear Dr. Mike, I'm a long time listener. I first listened to your show when I was pregnant with my four year old and I have always enjoyed and appreciated it. Being a busy mom of four children, I actually really enjoy the shorter show. I didn't think I would, but when I listened to a regular link show, it can sometimes take a few days to get through all of it depending on what is going on. I was able to listen to the shorter one with only a few breaks while preparing dinner.

I would like to address the news article you brought up concerning the death of cereal characters. Frankly I'm fed up with big brothers stepping in every time the government thinks we parents aren't doing our jobs. It's not their job to parent our children, I believe the obesity epidemic begin in our homes and should end in our homes.

Parents need to lead by example, eat more fresh fruits and vegetables, be active on our own and with our children, and making wiser choices in regard to sweets and snacks.

05:09

Turn off the TV and the video games, and do something. And if our children are getting a little hefty, it's time to say no to purchasing sugar loaded cereal, softdrinks and snacks that contain little in the way of nutrition. Parents wake up! It's not the government's job to tell us what we can and cannot feed our children, but we have to be accountable for our own choices.

No one is making us buy sugar loaded cereals, and those lovable cartoon characters on the cereal boxes are not to blame for our overweight children. If we continue to expect and allow the government to rule our choices,one day we will wake up and realize we no longer have any choices to make.

All right. Well, thanks Teresa and Crystal for your feedback and let's get right into your questions now. This first one comes from Geraldine in Ra'anana, Israel. And Geraldine says, "Hi, Doc Mike! Absolutely love your show. My 11 year old daughter is starting with some kind of acne.

06:03

She's using Benzac AC 10%, is there anything she might use? I did some research about home remedy treatments, but there are so many that I don't know what to do. Thanks for your show and I'm very happy about your new project with university. Regards, Geraldine from Israel.

Well, thanks for you question, Geraldine. We've talked about acne in the past, but it has been awhile. Let me just start with the description of what causes acne in the first place and then we'll do a quick overview of the treatments and those treatments that will make more sense once we understand exactly what it is that causes acne.

Almost all teenagers get acne at one time or another. And it's caused by the hormones of adolescents gearing up. And those hormones of puberty caused glands in the skin of the face, the back, chest to wake up and start producing oil. And then the cells that lined those oil ducts gets larger and the body starts to replace them more often.

07:03

And as they slough off, so as you get rid of the old cells and make new ones, the duct can be blocked with all these old skin cells and then the oil that the gland is making becomes trapped and that leads to whiteheads and blackheads.

The whiteheads so sort of start out first and if they aren't taking care of and that the dead skin oxidizes it, it will turn into a blackhead, and then what will happen is skin bacteria can invade these clogged glands and then that causes redness, and swelling, and infection.

Things that aggravate acne and make it worse you know, pinching or popping forces oil in the gland to penetrate surrounding skin and this can cause more redness and swelling. And if you scrub too harshly with soaps, that can also irritate the skin which again can cause even more redness and swelling in the area of the acne.

08:00

Anything that has prolonged close skin contact may irritate the skin, so example hats, hair, hair accessories, chin straps, brows, eyeglasses. These are all things that can irritate the skin and if you already have acne in that area, that also increase the redness and the swelling. Also in addition to the slough or dead skin cells blocking the duct there, other things that can block the duct as well and also cause or exacerbate acne including makeup, creams, hair products that sort of things.

And then there are some medications in particular steroid medications that can also increase gland oil production and increase cell turnover which promotes those glands to become blocked again with the dead skin cells. Also changes in hormone level during monthly cycles can also do it, and emotional stress and nervous tension can also cause there to be more hormone release which could exacerbate acne.

09:01

So these are all things -get a picture here of what it is that's causing acne and the things that can make it worse. Now what about some of the myths? So here's some things then that will not make acne get worse.

Now to sort of make sense when you think about the pathogenesis or exactly what it is that's happening at the cellular level to give you acne then it sort of makes sense that food is not going to make acne worse. Softdrinks, greasy good, chocolate -non of these things are going to cause acne to get worse and it's easy to understand that once you realize the process in the skin that's actually happening with acne.

Also acne is not contagious, it is not spread from one person to another, and sexual thoughts, sexual activity, masturbation, these kind of things will not cause acne or make acne worse. Again we're just dispelling myths with that.

OK. So what do you do? Well, to treat acne we're basically going to focus on looking at what causes it and then reversing that process. Now you can't really reverse the process of those glands waking up because that's part of puberty and you have to have that going on. Those glands are going to wake up, they're going to make oil.

10:09

So our treatments are really going to focus on unplugging those glands and killing any bacteria that might be getting down into the gland and causing there to be infection. So what kind of treatments do we use? Well the staple is been sort of peroxide.

And that is what with that you've been using for Geraldine in Israel when she talks about using Benzac AC 10%, that is a 10% benzoyl peroxide. And basically what this does is benzoyl peroxide helps get rid of the slough skin that's plugging the ducts.

So there's dead skin plugging the oil gland, the benzoyl peroxide helps to loosen tat up, helps to dissolve it, helps to get rid of this that's plugging the gland, and then also kills skin bacteria as well.

11:02

We start usually with a 2.5% and you can use that once daily and if that's not working you can advance that up to using it twice a day or you can increase the concentration. There's also an addition to the 2.5% there's also 5% and 10%. And again Geraldine, it sounds like you're using the higher dose benzoyl peroxide 10% which you can then use once or twice daily.

Now, too much of a good thing is too much of a good thing. And so there can be problems with using too much benzoyl peroxide, it can dry out the skin, it can actually irritate the skin which again leads to more redness and swelling. So you can actually -even though you're getting rid of the acne, you can still have some other skin problems including dryness, redness, some swelling if you use too much or too often of the benzoyl peroxide.

Also something to keep in mind, benzoyl peroxide is a bleach, acts as a bleach so it can bleach color from clothing, bed cloths, pillows, and that sort of things, so you got to be careful with that.

12:03

Now another substance that's available in lots of over-the-counter medications is salicylic acid. And salicylic acid works in a way that's similar to benzoyl peroxide, although it's not that strong. But the advantage to that is it doesn't have the sort side effects that you can get with benzoyl peroxide, so you don't get as much of the drying, red, swelling, irritating effects that benzoyl peroxide causes on the skin.

So if you have someone who with mild acne who doesn't tolerate benzoyl peroxide very well because their skin is so sensitive, salicylic acid oftentimes works well for these kids. So it also works by getting rid of that slough dead skin that's plugging those oil glands , but again it's not as strong, it also doesn't kill bacteria as well as benzoyl peroxide does.

But works well enough the dry and irritated side effects for some kids. If benzoyl peroxide is not working in the high percentage that you're using frequently, you know, twice a day, salicylic acid is unless your symptoms are caused from side effects from benzoly peroxide. But if the benzoyl peroxide is not helping the true acne, it's unlikely that salicylic acid is going to help because it's again doesn't work quite as strongly.

13:18

Another agent that's available in lots of over-the-counter medications for acne is retinols. And this is another unplugging agent that's a relative of vitamin A. The over-the-counter versions of retinols tend to be expensive and are low concentration, so they don't work really all that well. For the retinols to work you really need prescription strength something like Retin-A.

The cost of these over-the-counter retinols probably doesn't really justify its low potency. So if you're to the point where you need retinol because benzoyl peroxide or salicylic acid is not working, you probably want to visit your doctor and get a prescription strength retinol because the over-the-counter one is just aren't that strong.

And then another product that used to be available in over-the-counter products and actually the last time that we've talked about acne on PediaCast it's been a while, it's kind of in the early days of the show.

14:06

Triclosan was antibiotic that was often found in antibacterial soaps, and it was also in over-the-counter products, but there have been some questions about its safety. The FDA hasn't actually done a full scale ban on it, but a lot of manufacturers have voluntarily removed triclosan as an ingredient from their products. So if you listen back to an old episode where we talk about acne, we do mentioned the antibiotic Triclosan, but you're probably not going to find in over-the-counter products these says.

OK. So let's say you're trying the over-the-counter stuff and it just isn't working. So you're on a higher potency benzoly peroxide, you're doing 10% and things just aren't working well. First you want to make sure you've given it enough time because these whole process of dissolving and loosening, and getting rid of these dead skin cell plugs take some time.

15:04

So you really want to give whatever treatment that you're working with, give it a week or two. Probably closer to two weeks to se if it's going to help, and if it's not helping and things are getting worse, it's definitely time to go see your doctor. So what kind of prescription medicines can doctors treat for acne?

Well they can use a benzoyl peroxide antibiotic combination so when you add an antibiotic to kill the bacteria that we've talked about that can cause redness and swelling associated with acne because the skin infection. So then you get products like benziclin and Duac, and these are just products that have benzoyl peroxide with an antibiotic added, but again to get these you need to visit your doctor to get a prescription.

And as we alluded to before you can get higher concentrations of Retin-A products or retinols, and these are things like Retin-A, the micro Retin-As, Avita, Renova, Tazorac and these are all Retin-A again vitamin A derivative products that helped with unplugging these blocked ducts to get rid of the acne.

16:05

With the Retin-A products, you do have to avoid sun exposure so that's something to think about. And then also doctors can prescribe oral antibiotics, so sometimes a low, once daily dose of something like tetrocyclin or a relative of the tetrocyclins can be use, and that oftentimes can help kids with problem acne.

And it's not just a cosmetic issue because the source and the infections can actually cause scarring which can be a permanent problem. So you definitely want to take acne seriously and if it's not resolving with what you're trying at home to see your doctor. And then again an oral antibiotic is another possibility with this tetrocyclin antibiotics you still do need to avoid sun exposure with those. And then the big guns with acne is going to be Accutane which is oral vitamin A derivative.

However Accutane can be associated with severe birth defects and fetal death. So girls, teenage girls definitely need to a pregnancy test and someone argue they should be on birth control if they're going to be on oral Accutane.

17:07

Most family practice doctors and pediatricians are not going to prescribe Accutane, you probably -if you're to the point where your acne is bad enough that you're considering something like this, you probably want to be seeing a dermatologist. But that's the big gun answer to acne issues. reminders you want to be patient again, it can take several weeks to see improvement, you have to use the medicine consistently even if it seems not to be working just keep at it, avoid scrubbing the skin as this can cause more redness and swelling.

You don't want to overdo it more that once or twice a day, and using too high of a concentration can make the skin redness and swelling worse, and don't use medicine that's been prescribed to your friends especially things like Accutane, you want to use something over-the-counter or see your doctor and follow all directions on the label.

And let your doctor know if the treatment is not working after you've given a couple of weeks. So again back to Geraldine's question, Benzac-AC 10% is a 10% benzoyl peroxide. So it's a high potency benzoyl peroxide.

18:05

Basically it's the strongest benzoyl peroxide you can use. If that's not helping either the problem is that you're having skin irritation from the Benzac and so you need to go down to a lower concentration or use it less often, or combination of those two things.

Or it's because the acne just isn't getting under good control and if the Benzac is not helping then you need to see your regular doctor to talk about doing something like again the combination products with antibiotic or oral antibiotic, or one of the prescription strength retinoids like Retin-A. All right. So hopefully that helps you understand acne a little bit better, Geraldine.

Let's move on to Tiffany. And Tiffany is in Grants Pass, Oregon. Tiffany says, "Hi Dr. Mike! I love your podcast. I'm so very glad that you are back. I have missed you so much. And I was wondering if you could talk a little bit about Asperger Syndrome on your show. I have a 14 year old son who's been diagnosed with this and I would love to hear your knowledge and insight on the problem.

19:03

He has been on some pretty heavy duty medication and still seems to have behavioral issues especially mood swings and angry outburst, and acute crying spells both at home and school. Thanks again for this podcast, it's so very informative." Well thanks for your question, Tiffany.

And I think that more and more people have heard about Aspergers. And what exactly is it? Well let's define it first. Asperger is a developmental disorder and it's one of the autism spectrum disorders. It's sort of at the milder end of autism and it affects socializing and communication skills.

And this kids will sort of exhibit a social awkwardness and they often have an all absorbing interest in specific topics, these are two of the more common things/characteristics that you see with Aspergers. And individual symptoms are going to vary from child to child, but in general these kids will engage in one sided, long winded conversations without noticing if the listeners listening or trying to change.

20:08

So they're really self absorbed in their long winded, one sided conversations. They usually display unusual non-verbal communications such as lack of eye contact, few facial expressions or awkward body postures and gestures. They also show an intense obsession with the one or two specific narrow subject such as baseball statistics, train schedules, the weather, snakes, dinosaurs, you know these sort of things, they really seemed to have an obsession with them.

They appear not to understand empathize with or be sensitive to other people's feelings, and they have a hard time reading other people or understanding humor. They often speak in a voice that is monotonous, rigid or unusually fast and often move clumsily and with poor coordination. Now not all kids with Asperger will have all of these characteristics, and the severity of these traits will very greatly from child to child.

21:04

And another important point to some degree, many of these are normal behaviors for young kids, and it's normal for preschool kids to be shy and ego centered, just think about themselves and not always have empathy for what other people are feeling. It's also normal for them to have extreme interest in a particular topics like dinosaurs or race cars, or fictional character and just sort of seemed to be all that they want to talk about, or watch the same movie over and over, and over again.

But with Aspergers these traits are extreme and do not extinguish as the child gets older. So what causes Aspergers? Well it's unknown. It's a common disorder, it's more common in boys than in girls and there's likely a genetic component which leads to an alteration in brain structure and chemicals, but the precise cause at this point is unknown. What we do know is that it's not link to childhood immunization and this has been established by several large sample well done studies in the past.

22:03

So we don't think it's really due to childhood immunizations. Aspergers doesn't show up in infancy or early toddler development, these kids don't really have a delay in early physical or language development, but the difficulty begins to emerge during the preschool years when they have trouble with friendships and difficulty holding normal conversations.

They also have trouble with coordinated physical activities, trouble using play equipment, catching a ball, participating in sports activities. And there really isn't an opportunity for these sort of things to show up until the preschool years. So early development is usually normal, and things don't really become an issue or a problem until kids are more like three years old or so.

Now lots of other conditions both physical and psychological can cause similar symptoms. So this is not a diagnosis that you make on your own at home. If you have concerns it's definitely time to see your doctor and to get professional opinion and help on this because Asperger Symptoms can overlap with many other problems.

23:05

Now how will your doctor tease out your child's specific problem? Is it Aspergers or is it something else? Well it is difficult for primary care doctors to do this because it takes a lot of time and evaluation especially with the history taking part of it and most pediatricians and family doctors if there's a suspicion for this will refer you to a behavioral medicine clinic at a large regional children's hospital.

And there a multi-disciplinary team can evaluate your child. And this is going to include a behavioralist, a child psychiatrist, psychologist, geneticist, social workers, physical therapist, occupational therapist, and audiologist, and eye doctors because vision and hearing problems can sometimes show up with similar types of symptoms until you address the real problem. So these group of professionals especially when working together will be best suited to come up with the specific diagnosis if one is to be had.

24:00

And again in my opinion behavioral medicine clinic at a regional large children's hospital really is your best entry point. Now one of the tools that the professionals will use to diagnose Aspergers is to use the criteria that's available in what's called the Diagnostic and Statistic Manual of Mental Disorders also called the DSM. It's published by the American Psychiatric Association and some of the DSM criteria for Aspergers include they don't have significant language delays.

They do have a lack of eye to eye contact, they have unusual body postures or social expressions, they have difficulty making friends, they have a preoccupation with one subject, they have no interest in interactive play, and they have an inflexible attitude toward change.

So these are some of the official criteria in the diagnostic and statistics manual from the American Psychiatric Association. Again there's an overlap between Aspergers and other problem such as attention deficit hyperactivity disorder, obsessive-compulsive disorder, again vision and hearing problems and other mental health issues. So proper evaluation is a must.

25:07

OK. So your child has been evaluated by a multidisciplinary team and they've been diagnosed with Aspergers, now what? Well there's no definitive treatment, so no cure so to speak. Really treatment is individualized to a child's particular challenges and issues. And this will likely require a combination of psychological counseling and what we call cognitive therapy.

And cognitive behavioral therapy basically it helps kids identify problems before they escalate out of control and teaches them mechanisms for coping with the situations. So it's basically teaching your child to realize, "Hey I have a problem with interactive relationships, but I can identify when a problem is going to occur and I can deal with it in a successful way."

So it's behavior therapy based on anticipation and what is your response to a situation going to be. And obviously kids have to be a little bit older and more mature to learn in this kind of fashion.

26:03

So this is really helpful mostly for the older kids with Aspergers. Now there are some medications that can help. There's no medication for Aspergers per se, but there are some medicines that will improve specific symptoms. So if kids have a lot of agitation and irritability associated with their Aspergers, a group of medicines called the Atypical Antipsychotics kind of a bad name really sort of has a bad feel to it, but that's what they're called. Atypical Antipsychotics these are drugs like Abilify and Risperdal, and they really do help a lot of kids.

There are a lot of children out there with Aspergers whose agitation and irritability symptoms get better with these, but they're not a magic bullet and there are some problems associated with these medicines, they can lead to what's called a metabolic syndrome where you have increased weight gain and increase cholesterol lipid levels and insulin resistance and blood sugar increasing which can then lead to Type 2 diabetes.

27:04

So if your child's on Abilify or Risperdal they definitely want regular blood work being done to make sure they're not starting to get a metabolic syndrome. Also for some of these kids especially if they have some depression or some anxiety or repetitive behaviors, the SSRIs or Selective Seratonin Reuptake Inhibitors things like Prozac, Zoloft, Luvox these kind of all be helpful to help these kids with some of those kinds of symptoms that relates to depression, anxiety, and repetitive behavior.

Also with motor skills, physical therapy, and occupational therapy may be helpful. The big difference between those two physical therapy looks at big muscles, occupational therapy looks at the little muscles like the fingers. So as you can see treatment with Aspergers really will differ from kid to kid depending on what their particular issues are, and that's another reason why the team approach at a large pediatric center with experience dealing with Aspergers is really the best way to go.

28:02

The other thing that I want to mention that's important and that support for parents with kids who have Aspergers, you want to find local support so you can be involve in a community of other parents who are dealing with similar situations and you known having that and to have a parent that says, "Hey, been there, done that. This is what we did.

This is what was successful. This is what was not successful." Doesn't mean that it will apply point for point to your child, but I do think it's helpful when you can talk to someone who has been there, been in your shoes. If you're having trouble finding local support, there's a really good online resource called The Online Aspergers Syndrome Information Support Center or OASIS. And it's been on the web since 1993, I mean, 18 years on the internet.

So this a player in Aspergers for sure. Their site is great, it has news and research, blogs, forums, articles, newsletter, a bookstore, and a really cool local support finder where you basically put in your location and it will let you know what kind of groups are available in your area for local support.

29:08

We'll put a link to it in the Show notes, it's www.aspergerssyndrome.org. And since they've been there for 18 years back then 1993, there's probably not much of competition to get Aspergers Syndrome as your domain name. So there you have it Aspergers Syndrome in a nutshell. So I hope that was helpful for you Tiffany in Grants Pass, Oregon. And thanks for writing in, we really appreciate it.

All right. And finally we have Terry in London, Ohio. And Erica in San Jose, California with similar questions. Terry says and is again in London, Ohio. "I love your show. I recently discovered your podcast while searching for a moms podcast on iTunes.

I have a question about nail biting. My two year old son just started biting his nails pretty consistently in the last month. Either my husband or I bite our nails, we have not notice any other kids at the daycare biting their nails although we suspect that that is where he learned it.

30:02

My question; how bad is this really should we fight with him to take his fingers out of his mouth between the nail biting and thumb sucking another issue. It seems like his fingers are always in his mouth. He comes up to us and shows us his boo boo that is from him biting his nails down so low that he's now chewing the skin and sometimes even drawing blood.

Isn't this bad for his teeth? Could this cause him to get sick more frequently? Thanks again for the wonderful podcast, you're doing the fabulous show." And then Erica in San Jose, California says, "Hi, Dr. Mike. I have two boys, a three year old and a one year old. And I had recently noticed that my three year old is biting his fingernails. He does it in the car, watching TV and when he's playing. I don't know why he does this. Is there anything I can do to make him stop this ugly habit.

His doctor said to redirect him instead of saying no, but then he just does it again. Please help. Thank you in advance and thank you for all your knowledge, great advice, rants and tangents I look forward to them every week." So thanks for your questions Terry and Erica.

31:00

So let's talk about nail biting and I'm going to take a quick break, give me just a second. See this is the disadvantage to the shorter shows with no interlude music. Sometimes I just got to get a drink of water. And when we don't have anything to distract me you know, like interlude music, it's harder to do. So definitely disadvantage to the shorter shows.

OK. So let's talk nail biting, you know this is not one of those topics they teach you on medical school or in pediatric residency for that matter. There's not a chapter on nail biting on any pediatric textbook that I've come across. So I'm going to approach this as we do with so many topics on PediaCast from a benefit versus risk ratio kind of thing.

What's the benefit of nail biting? In other words, why do kids do it? And what are the risks of nail biting? Well problems can it cause? And then use this discussion to figure out if anything should be done about it and if so what?

32:01

OK. So what's the benefits of nail biting or why do kids do it? Well, a lot of kids and adults have an oral fixation and they'd like something in their mouth. You know whether that's cigarettes or chewing gum, or they're biting their teeth -not biting their teeth, but biting their fingernails. They just have an oral fixation and they want that stimulation that comes along with a satisfying to oral fixation.

And so for this kids if they're not putting their fingers on their mouth, they'll be putting something else in their mouth or wanting to. The other thing that causes kids to do is boredom. It's something they can bite on, it's something that comes off, it's interesting, 'hey, I can make this nail come off'.

Other kids don't like long fingernails, they just don't like that feeling, they're scratching themselves, and they don't like it they want shorter fingernails, so they bite them off. So there are benefits, not saying they're good benefits, but there are benefits to nail biting which is why kids do it in the first place.

33:02

OK. So what are the risks? Well, trauma -you can bite them too low, too down too far. You can bite the skin, you can get skin infection which is pretty common in nail biters. You can get blood infections from skin infections, and then kids you know, could become septic and have to be in the hospital and possibly can die from it.

That's rare with nail biting, let's face it, that's rare. But you know that's one of those well potentially could happen, but probably have a better chance getting hit by a car while playing in your yard than to get septic because you're biting your fingernails, but still it's there. The risk is there. You can introduce microbes that are on your fingers into your mouth which can make you sick and this is especially in a daycare setting when there's vomiting and diarrhea illnesses going around during flu season.

So having your fingers in your mouth can make you sick that is possible. And then you are reinforcing the oral fixation and you know, there's not been a lot of research on this, but can that then lead to eating disorders, smoking, chewing gum down the road.

34:07

So by allowing them to do it sort of another one of the risk is that you are reinforcing their oral fixation. Another risk is swallowing the fingernails. Not really much of a risk here, in 15 years of this, I've never come across a kid with a problem because of swallowing fingernails. It's just not a large quantity that kids are swallowing, and the digestive tract seems to be able to tolerate that if they are swallowing it.

It would probably best to teach them not to swallow their nails of they're going to bite their nails, but just sort of collect them and throw them in the trash. But that's another issue I've never really seen it being a problem, but something to consider. And could hurt your teeth, it could especially if you had some cavities or enamel problems. If you have strong healthy teeth, probably it's not going to be much of an issue, but you know, it again that possibility exist.

35:03

And then the other thing to consider is remember, this is something in a lot of kids that may just pass on, so and you don't need to do anything with it anyway, just sort of self extinguish and suddenly they're not biting their fingernails anymore. Or they could start having some of these risk factors actually come to life and happening or they may not.

So you really kind of look at is the benefit worth the risk and should you intervene. And that's something you have to decide. You know, what would I do? If risks are starting to manifest themselves, in other words my kids are getting skin infections frequently or seems like they're sick more often than other kids. If I'm seeing manifestations of these risks and especially if they're recurrent, and I think that there's a pattern, I for my own kids I would say, yeah. It's probably best to intervene and make them stop doing this.

On the other hand if it's a transient, short lived thing, they've been chewing on their fingernails for a week or two, and there's not really been a problem with it, maybe if I just leave it alone, they'll stop doing it. That's a possibility too.

36:04

I don't think there's a right or wrong answer here. But let's say, OK. You decide I'm going to intervene, I want my kids to stop doing this, and I want to intervene. What do you do? I think your doctor talking about redirection is good advice. The thing to keep in mind is redirection. So in other words you notice them doing it, you pull their hand out of their mouth and something else to do.

You know, you're trying to redirect them to get their mind busy 'I'm thinking about something else', but it's more of a positive way that saying, "Hey, get your fingers out of your mouth', and 'No, no, no'. The positive redirection can work, but it does not work quickly. And you have to be consistent and persistent really keep out it, and they will likely take several weeks for that torque. It's nit a quick fix, but it is sort of take advantage of this concept of extinguishing a habit

. So as you redirect and redirect, and redirect, the thought is eventually their brain will stop wanting to do it. And I have seen it work, quicker. You can get quick results with this if you also combine it with a positive reinforcement program like a sticker chart.

37:04

In other words you start out, "Hey, every time that I put your hand away and redirect you, if you don't immediately go right back to it or give me a hustle with it, then you get to put a sticker of the sticker chart when you get so many stickers you get an award or a price or something. So you can kind of custom tailor a positive reinforcement sticker program that works for your child.

And then you start out easy and then it becomes more difficult like you don't -as you work your way down this it goes from "Hey, if I redirect you and you're happy and you do a good job with that redirection you're going to get a sticker. You can then work it to the point where now to get your sticker you have to go the whole day without me seeing your fingers in your mouth. And at the end of the day if we prove you back, "Hey you didn't do it all day today, then you get your sticker". I wouldn't start with that because no one is going to succeed and they can't see that cause-effect relationship.

So you want to start with something that they can succeed at and then you know,you get five stickers, you're going to get a little toy or something that really get a new game for your game system once you get so many stickers. And we really come up with something that's going to motivate your child and that's going to be different from child to child.

38:12

The other thing too this seems obvious and that's just to keep their fingernails trimmed really short with clippers, so that there's not much to bite on. I should have mentioned that first. That's an easy thing that can help you out. So I hope that helps and thanks for the questions to Terry and Erica. And as I looked down worth 40 minutes.

See I try to do these shorter shows and I had a feeling this would happen you know, it's just three listener question and suddenly I'm 40 minutes into it. So you know, what can I say? I want to mention here real fast to please be patient with me with the interviews. It seems like we have this string of rescheduling and it's not anything personal, we've had three interviews scheduled come and go and in all three instances the physician had to reschedule because of patient care responsibilities.

39:04

You know something came up and they had to be in clinic and that time is not going to work out. And without a question, patient care is going to come first.. So I have no problem with that at all. I'm only mentioning it to let you know we've had interview scheduled and in fact starting next week we have an interview scheduled every single week all the way through the end of August.

So we have them lined up, it's just a matter of the last few have all had to reschedule. Dr. Koranyi, who I mentioned in my last show that she's going to be here next week to talk about hand, foot and mouth disease, she's actually going to be here in two weeks. Next week we're hopefully going to get our social media guru Kelly to stop by the studio and talk about social media offerings here at Nationwide Children's.

And then once we get Dr. Koranyi's interview in hand, foot, and mouth disease then again we have an interview scheduled every week. Some really cool ones too so I'm excited about it. So stick with me, I'm not going back on the interviews, they are going to happen, it's just a matter of patient care getting in the way which is a good thing. So we're fine with that.

40:12

My family recently went to Cedar Point and we had a great time on the big rollercoaster, something that Florida lacks. So when we lived there we got some great stuff in Florida, but large, big, you know, 300 and 400 foot rollercoasters is not among them. But we do have those in Ohio, and Cedar Point has a couple of great ones. And it got me thinking, you know, Ohio is sort of off the radar for most vacationers, but there really is a lot of cool things to do here.

And if you ever find yourself -you've done DC, you've been out West, you've done Florida, you've been on the cruises, you're really trying to find a family vacation that you haven't done before or if you don't have a lot of money for an expensive vacation, you know, that's exotic, Ohio maybe something to consider. There's some really cool things here that you probably didn't know about.

41:01

And so I've collected a list of them. And the other reason that this sort of got me thinking is because we're getting more and more listeners in Ohio because of our association with Nationwide Children's and through their Facebook and Twitter. And so, there may be some things that your family, their one tank trips that you've not thought about in Ohio or share with your kids, or maybe you've never done yourself.

So I just wanted to mention some of these as also sort of brain storming. And really the big thing is going to be to check out the Show notes at pediacast.org because I got a link to all those stuff. So obviously the amusement park Cedar Point and King's Island are the two biggies and lots of cool roller coasters, lots of other attractions as well. So that's maybe worth your while.

Also I've been to a lot of water parks when we lived in Florida, I mean, you get the Disney Collection of water parks, you've got Universal's Water Park in Orlando. So I've been to a lot of water parks, and there's a water park down by Cincinnati called The Beach Water Park. I mean for being in the Midwestern area and non tropical, it's quite surprising how nice of a water park this is and the cool stuff that they have there.

42:01

So I'll put a link to that. If you are in the Ohio region and you're into sports, you know, take the kids to see a Cleveland Indians game or Cincinnati Reds game, also minor league the Dayton Dragons and the Columbus Clippers are possibilities. If football is more of your thing, the Cleveland Browns and Cincinnati Bengals, and this fall it will probably be pretty easy to get a ticket to see the Ohio State Buckeyes play.

And I'm going to leave it at that. And if some of you moms out there who don't follow football, I don't want to stereotype here, but any moms that don't follow college football -I know a lot of moms do. But if you don't and your husband does, you can just say, "Why is Dr. Mike talking about being easy to get a ticket to Ohio State Football this fall?"

Maybe they could enlighten you on that. And then you can do an island tour in Lake Erie, Put-In-Bay, and Kelleys Island are two examples these are some cool off the beaten path vacation options that are kind of fun.

43:02

There's a place in Southeast Ohio called Hocking Hills. And when you go there it's like you're not in Ohio. I mean, this is like land of the lost kind of stuff, I mean your real Jurassic Park, I mean, you really feel like you're in a different world. And those of you who have been there know what I'm talking about.

So that's something -you can easily spend a few days checking out all the different natural wonders that are in these area called Hocking Hills. Also Mohican State Park more in the center part of the state, north of Columbus. Great for canoeing, they have Amish Country, is really close by. So you can go see handcrafted woodwork and homemade cheese, and lots of fun stuff there.

So Mohican And Amish Country. Also in that region, the Ohio State Reformatory is an old prison that is now used as a movie set for lots of movies in the past, most notably the Shawshank Redemption.

44:00

And you can actually get a tour. It's kind of like going to Alcatraz and you're get a tour of this old prison where Shawshank was filmed, and that also is in the center part of the state around Mohican and Amish Country up the Mansfield area, so that's something to consider. And then if you go underground, Ohio has some cool caverns, I mean, they're huge, and they're just these underground caverns with stalactites and stalagmites.

And I always remember that stalactites have to hold on tightly to the ceiling the other ones that go down stalagmites are mighty like an army, you know, marching on the floor, those ones on the ground that go up, that's how I always remembered it in Geology class. So Ohio Caverns and Seneca Caverns are two really cool places in Ohio that you don't find elsewhere, so you definitely want to check those out if you're in the Buckeye State.

Also Olentangy Indian Caverns is a smaller ones. Speaking of Indian, the Great Serpent Mound you may have studies that long time ago when the Indians who buried made mounds, and buried them, and one of them is and we don't know how old it is, but it's in the shape of a big serpent. And so that's kind of a cool thing.

45:10

The Piatt Castles they're over by Ohio Caverns near West Liberty. Basically these guys a long time ago they traveled far west and go to Ohio. So it's a long time ago. Ohio was the western frontier. And they build a couple of castles, and they're still standing today and are maintained.

So there's actually a couple of large, European style castles in Ohio that are preserved and have tours that you can go through. If you like zoos we have an incredible world class zoos here, and I've mentioned this before. I've been to the National Zoo, I've been to Brook Park Zoo in Chicago, I've been to the San Diego Zoo.

And there was not a better zoo out there than the Columbus Zoo. The home of Jack Hanna, and it was founded by him. It was an incredible zoo and we have a couple of other great zoos, the Cincinnati Zoo and the Cleveland Metroparks Zoo.

46:01

And then a couple other off the beaten path things. Over by Dayton, there's a Jersey Dairy Farm that is really cool, they have miniature golf, you can tour barns, get homemade food, called Young's Jersey Dairy and that's a cool place. And then of course the National Museum of The United States Air Force is also in Dayton. It's associated with Wright Patterson Air Force Base.

And it really a truly rivals the Air and Space Museum in Washington DC. It is an incredible place that you've probably not heard about or been to. So if you find yourself in Ohio near Dayton, the National Museum of The United States Air Force is a pretty cool, cool place. So none of these has anything to do with pediatrics, but it has everything to do with having a great time with your family.

So Ohio does have a lot to offer. Of course I don't get any endorsement or kickbacks, or any of these stuff. I'm just really trying to help you plan some fun time with your kids. And that's an important thing to make memories and to encourage them to grow up to be the kind of parents that want to make memories with their kids and so that's why it's important to me.

47:03

All right. So we are now at -yeah, we're going on a 50 minutes here folks. So I really need to wrap up and say thank you of course to Nationwide Children's and listeners like you for being a part of the show. Also iTunes reviews are important, blogs, Facebook, tweets. Tell y9our doctor, tell your friends and family, and most of all participate in the show.

Just give us a call at 347-404-KIDS, 347-404-K-I-D-S. And you can leave a message with a comment or a question. You can also email: pediacast@gmail.com or go to the website and use the contact link at pediacast.org. So let's wrap it up and with all of that in mind, I just want to say this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long everybody.

[Music]

48:06

Announcer: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

 

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