Hiding Veggies, Late Talkers, Banning Circumcision – PediaCast 173



  • Healthy Kid's Meals
  • Custody of Super-Obese Children
  • Hiding Vegetables in Food
  • Late Talkers
  • Dangers of Portable Pools
  • Social Networking and Kids
  • Proposed Circumcision Ban in San Francisco



Announcer 1: This is PediaCast.


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 once again to PediaCast. It is Episode 173 for August 10th, 2011. And we are calling this one, "Hiding Veggies, Late Talkers and Banning Circumcision". Of course, we have lots more coming your way. It is one of our news parents can use editions. And it has been a little while since we've had one of these shows, and so I am kind of excited about it. I think there is a little bit more of a personal connection between me and you during one of these shows. I don't know, when we have a guest in the studio, you know where it is like business. We are getting to the facts, we are answering questions and that's great.


But I think sometimes there is a little bit of a disconnect between you and me. Anyway, we are doing a news show this week. Lots coming up in the news program because we haven't done one in a little while. The other thing we haven't done in a few weeks is a listener's show but I have been collecting your questions.

Never fear that is coming up shortly, we will have a listener's show and getting some of the questions that you have. And we have more interviews planned as well. Don't forget if there is a topic that you would like us to talk about or you have a question for us here at PediaCast, it is easy to get hold of us, just go to PediaCast.org and click on the contact link. You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS. That's 347-404-K-I-D-S.

I also want to remind you 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, make sure you call your doctor and arrange a face to face interview and hands-on physical examination. Also your use of this program is subject to PediaCast Terms of Use Agreement, which you can find over at pediacast.org.

Alright, before we get to the news topic today, my family and I went to see American Idol Live last night. And it was actually the first time that we've gone to one of their live concert events. We, I don't- starting probably around Season Three, I believe, maybe it was Season Four, it was the Carrie Underwood season whichever that is that we started to watch American Idol that year as a family and we don't really watch a lot of television. We like Psych on the USA Network because it has a lot of sarcasm and we tend to like that in our home. We like that program and we watched Survivor for a while but American Idol has been sort of a staple, a staple in our house.


And so this year, we really thought that there was a good group of singers and my daughter for her birthday wanted to go see American Idol Live and so we bought tickets for her birthday and we went and saw that last night. And I was a little bit surprised. I don't know, I thought that there would be more of the teenage and I guess young twenty-something crowd there.

But I would say that I was even, being a middle-aged man I was probably still in the middle of the bell-shaped curve in terms of the age of the audience members. There were actually a lot of seniors at American Idol Live which surprised me a little bit. And the most interesting moment was when Stefano took off his shirt in the middle of the show and I don't know, the crowd went crazy.


It was a little disturbing considering the age and the demographics of the crowd. And I would have thought with Midwest sensibilities. I would have expected that when we were living in Florida. But no, I guess that thrilled the Central Ohio crowd as well. But anyway it was a great show but we are not an entertainment podcast and so I guess we better move on to the pediatric topics.

We are going to talk about healthy kid's meals. They are springing up at restaurants. Also super obese children. Should parents lose custody of these kids? And there are some out there in the pediatric world that think so. Also hiding vegetables and food, late talkers, dangers of portable pools, social networking and kids. And finally we will wrap things up with a proposed circumcision ban in San Francisco.

Alright but first stop, restaurants and healthy kids. This is kind of interesting. If you go to healthydiningfinder.com and we will put a link on the show notes over at PediaCast.org and click on the Kids Live Well link.


This is a partnership with the National Restaurant Association. And basically it is a website that lists 15,000 restaurants in the United States that represents 19 different chains including Burger King, Joe's Crab Shack, Outback Steakhouse, Cracker Barrel, Chili's, Denny's, IHOP and Sizzler. And basically these 19 chains are offering now healthy kid's meals and they are identified on the menu with a red apple icon.

Now these meals must include an entree, a side dish and a beverage, have no more than 600 calories total with caps on the amounts of fats, sugar and sodium. They also have to include fruits, vegetables, whole grains, lean protein and low-fat dairy.

I think this is a preemptive strike on the part of restaurants, you know they are getting a look at what's going on with the food manufacturers and the grocer's association with the outcry right now to really limit marketing of those products to kids unless they're healthy.


So you know as we have talked about before Toucan Sam may be at risk for losing his position on the Fruit Loops box. So I think the restaurants are looking at that and saying 'Hey, we're next' and so they're really doing something to try to have more healthy kid's meals. And it is important because kids eat out. One-third of their meals are eating out. And they really shouldn't have bad or junk food every time.

Now my idea here is they really need the same kind of menus for adults. And of course I understand the restaurants don't want to do that because they charge a lot more for an adult meal but in terms of the amount of calories that you get and the option of having whole grain foods, lean proteins or whole grains I should say lean protein and low-fat dairy as part of the entree I think is important and no more than 600 calories total. That's fantastic! So I still contend that it all should be ordered off of the kid's menu but that's just me.


Alright, recent commentary in the Journal of American Medical Association advocates that parents of extremely obese children should lose custody of their kids for not controlling their child's weight. Now the commentary was co-written by Dr. David Ludwig, an obesity specialist at Boston Children's . He says the point isn't to blame parents but rather to act in the child's best interests and get them help the parent isn't providing.

The other author, Lindsey Murtagh is a lawyer and researcher at Harvard School of Public Health. She said that despite the discomfort posed by state intervention, it may sometimes be necessary to protect the child.

Art Caplan, a bioethicist at University of Pennsylvania, disagrees with this approach and he worries that the authors are putting too much blame on the parents. He thinks obese children are victims of advertising, marketing, peer pressure and bullying. Roughly two million US children are extremely obese and at risk of Type-2 diabetes, liver problems, breathing problems, heart disease and hypertension.

But there was one case in particular that led Dr. Ludwig to think about state intervention. He had a ninety-pound three year old, let me say it again.


A ninety-pound three year old presented to his clinic several years ago, by age 12 she had weighed 400 pounds. And had developed diabetes, cholesterol problems, high blood pressure and sleep apnea. The State of Massachusetts did intervene and placed the child on foster care. And there she had three balanced meals a day, a modest snack or two and participated in moderate physical activity. A year later she had shed 130 pounds. Her diabetes had fixed itself and her sleep apnea was gone.

Now discussion of this isn't new, and it's not necessarily limited to America either. In 2009, an opinion piece in the Journal of Pediatrics said temporary removal from the home would be warranted "When all reasonable alternative options have been exhausted." In 2010, a commentary in the British Medical Journal identified extreme obesity as a factor in several child protection cases in Great Britain. They go on to urge British physicians to contact Children's Protective Services if parents are neglectful or actively reject efforts to control an extremely obese child's weight.


Dr. Ludwig's current commentary reminds American physicians that pulling extremely obese children out of their homes doesn't require new legislation. Healthcare providers are already required to report children who are at risk for a variety of reasons including neglect, abuse and failure to thrive, which is the term doctors use to describe a child who is extremely underweight. But whether children's services will actually step in and do something about the report depends on the policies and precedents in a(n) individual jurisdiction.

In a recent NPR report, parents whose children had been taken away because of extreme obesity were interviewed and they had some sobering things to say. For instance, a single mother in Greenville, South Carolina lost custody of her 550 pound, 14-year old son. She says she was working 2 jobs to keep her family out of the ghetto. She didn't have time to cook, so she relied on fastfood. She knew her son had a problem and asked doctors what she could do but instead of providing a workable plan, they reported her to authorities for neglect.

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Her son moved in with his aunt who implemented a special diet and exercise program, and the result was over 200 pounds of weight loss. She is happy with her son's weight loss but complains authorities have done other damage by pulling her and her son apart. So what do you, the PediaCast audience out there, think about this? In cases of extreme obesity, should healthcare providers report neglect?

When weight loss plans have failed, should children be pulled out of their homes and should it make a difference if extreme obesity is actually leading to health problems such as diabetes and hypertension or if those things haven't developed yet, there is just a mere risk of them happening. Is the risk enough to remove the child, or do they actually have to have those problems attributed to obesity?

Some physicians are advocating for weight loss surgery for extremely obese teens while others are against this tactic because the long-term outcomes aren't necessarily well-understood and very real risks and complications are involved with the surgeries. So, is removing a child from the home a better first alternative to surgery for these kids?


And the answer to these questions are not easy ones and sometimes, the best answer depends on the exact circumstances of a particular case. But, what are your, the listeners', feelings on this topic? Just drop us a line on the contact page at PediaCast.org. Write to us at pediacast@gmail.com or leave a voicemail at 347-404-KIDS and we'll share your responses with the rest of the PediaCast community.

Alright now, here's a classic example of parent trickery. Or to borrow a phrase from George W. Bush, strategery. Now, that wasn't actually Bush, was it? It was Will Ferrell in Saturday Night Live. Anyway, strategery. According to a July 25th article published in the American Journal of Clinical Nutrition, researchers at Penn State managed to get pre-school children to consume twice as many vegetables and 11% fewer calories. So, how did they do it?

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Well, by sneaking pureed vegetables into their favorite foods. That's right. They added pureed broccoli, cauliflower, zucchini, tomatoes and squash into things like spaghetti, breads, macaroni, chicken casserole, and the kids tolerated this approach well. 39 children were looked at between the ages of 3 and 6 and they were served vegetable-enhanced dishes on 3 separate days. Researchers gave another group of similarly aged children non-veggie enhanced versions of the same food. The kids in the control group ate the same weight of food but doubled their vegetable intake and trimmed over 10 percent of the calories.

Study co-author Barbara Rolls said the teens had gotten some flak for engaging in a deceptive practice but feels the end justifies the means. She says some people argue that hiding vegetables in foods is deceptive and that doing so suggests that whole vegetables are not acceptable. But I don't agree. Parents modify recipes all the time, she says. For example, it's well accepted that applesauce can be used to replace oil in cake batter.

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Penn State researchers aren't the first to sneak vegetables into food. Kraft made headlines a few years ago when they rolled out macaroni and cheese dinner veggie pasta. They pulverized and freeze-dried cauliflower before substituting the resulting powder for some of the flour used to make the noodles. Missy Chase Lapine also uses veggie strategery in her book "The Sneaky Chef: Simple Strategies for Hiding Healthy Foods in Kids' Favorite Meals". The book includes 75 deceptive recipes for moms and dads of veggie-hating kids.

And we'll put a link to Ms. Lapine's website, thesneakychef.com over in the show notes at PediaCast.org. We'll also put a link to her book at Amazon and Barnes and Nobles so you can find it quickly and easily. And I wanna remind you. PediaCast is a no kickback zone. So, we aren't getting paid to tell you about the book. We just thought it's one many parents would find helpful.

Parents are often worried when toddlers are slow to talk. But a study recently published in the journal Pediatrics should quell some of those fears.

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Researchers in western Australia followed more than 1,000 kids born between 1989 and 1991. They looked at their language development at ages 2, 5, 8, 10, 14 and 17. So, what did they find? Well, at age 2, children were identified as late talkers if they used fewer than 50 words and were not routinely stringing together 2 or 3 words into a sentence.

At age 2, these late talkers were more likely to have behavioral problems compared to non-late talkers but there were no behavioral differences between early talkers and late talkers at ages 5, 8, 10, 14 and 17. So, what does this mean? Well, it means exactly what I stated and no more. That late talkers who have behavioral problems at age 2 tend to lose the behavioral problems as they get older.

Some speech pathologists and child advocacy groups latched onto this study and complained that researchers were saying that late talking isn't a problem and that parents shouldn't worry if their child was a late talker. Of course, that was not what these researchers were saying at all.

15: 05

They were simply saying, if a child is a late talker, for whatever reason or non-reason, and if they have behavioral problems, as they get older, these behavioral problems tend to disappear. Keep in mind that there is a wide range of normal for language development and there are often differences between boys and girls, and between firstborns and subsequent borns. Some late talkers are late talkers because that's how they develop.

Some late talkers are late talkers because they have some other problem like hearing issues, social concerns and autism. But what about your late talker? Should you be concerned if your child is talking late? The best one to answer that question is you, the parent, along with your doctor. You know all the nuances of your child's speech and your doctor sees a wide range of normal and not normal and should be aware of resources in your region if there are concerns.

As the weather heats up, many parents turn to pools to keep their family cool. Due to their low cost and ease of use, portable pools which include wading pools, inflatable pools and soft-sided self-rising pools, have become an increasingly popular alternative to expensive inground pools or waterpark visits.

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While portable pools can be a great way for children to cool off during the summer days, a new study conducted by researchers here at Nationwide Children's Hospital has found these pools maybe more dangerous than many parents realize. The study which appears in the July 2011 print issue of Pediatrics found that every 5 days, a child drowns in a portable pool during the summer in the United States.

That's sobering. Every 5 days, a child drowns in a portable pool in the U.S. in the summer. The study looked at fatal and non-fatal submersion events and found that 94% of the events involve children under 5 years of age. 56% involved males. 73% took place in the child's own yard and 81% occurred during the summer months.

Dr. Gary Smith, senior author of the study says because portable pools are generally small, inexpensive and easy to use, parents often do not think about potential dangers these pools present.

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But it only takes a few minutes and a few inches of water for a child to drown and it's important for parents to realize that portable pools can be just as dangerous as inground pools. Parents must also realize that adult supervision around these pools is important but it is not always enough. More than 40% of the children in the study were being supervised by an adult at the time of the submersion event.

In 18% of cases, a brief lapse in supervision, such as socializing with neighbors, answering the telephone and doing chores, was enough to allow a submersion event to occur. The study's authors emphasize multiple layers of protection to prevent portable pool submersions, including measures to prevent children from accessing pools when adults are not present, keeping children safe during use, and being prepared to respond if a submersion injury does occur.

A hurdle that parents face is the relatively high cost or lack of availability of drowning prevention tools such as isolation fencing, safety covers, lockable removable ladders and pool alarms specifically designed for portable pools.

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Dr. Smith concludes by saying drowning prevention tools used for inground pools are often either too expensive or simply not available for portable pools. Manufacturers should develop more effective and affordable tools to help parents decrease the drowning hazards associated with these products.

Alright, from pool safety to internet safety, social network giants Facebook, MySpace and Twitter all require participants to be at least 13 years old. Why? Well, the Children's Online Privacy Act of 1998 makes it illegal for websites to collect personal information or cybertrack the online activities of those under 13. Since social media websites use this information to target advertising and since it would be costly to design and implement software that does not track the younger visitors, the sites simply ban the 12-and-under set from participating.

Now, despite these rules, consumer reports estimate 7.5 million kids younger than 13 have worked around the rules and joined Facebook.

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What's more, the parents don't seem to mind. In fact, a recent survey showed the number of parents who endorse social media use for their 10, 11, and 12-year old kids doubles in the past year. Of course, old concerns remain as sexual predators, identity theft, cyber bullying are very real risks but the benefit of the social media, even for these younger kids, is becoming more recognized.

Dr. Gwen O'Keefe, co-author of the American Academy of Pediatrics' April 2011 report called "The Impact of Social Media on Children, Adolescents and Family" says "for some teens and tweens, social media is the primary way they interact socially rather than at the mall or a friend's house. A large part of this generation's social and emotional development is occurring while on the internet and on cellphones. Parents need to understand this technology so they can relate to their children's online world and comfortably parent in that world."

The AAP's report warns parents to educate themselves on the pitfalls of social media and to actively monitor their participation but also acknowledges that engagement in social media and online communities can enhance communication, facilitate social interaction, and help develop technical skills.

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Youngsters can keep in touch with relatives, continue relationships with friends who move away, and discover opportunities for community service and volunteering. The report also encourages pediatricians to ask the question, "Are you on Facebook?" during physical examinations and to counsel parents and kids on the risks and benefits of social media involvement.

Of course, we are social media lovers here at PediaCast. After all, social media is the world we operate in, right? So, we are social media lovers to a degree. The real world, of course, is important too. In my opinion, it is still more important than the virtual one. So, playing outdoors, realtime face-to-face friendship, family activities, trips to see relatives, let's not let these things slip away for our tweens, our teens and ourselves.

And I would say that's a memo but I won't do that. Alright, I just did. Alright, finally, Jewish and Muslim groups are finally coming together not in the Middle East but in San Francisco where both oppose a proposed circumcision ban.

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The issue will be on the ballot this November and if enacted, would outlaw circumcision on males under the age of 18. And performing one would be a misdemeanor punishable by $1,000 fine or up to one year in jail. And it doesn't matter if the person holding the blade is a doctor or a mohel, it doesn't matter if one's religion calls for circumcision, they'll have none of that within the borders of San Fran. Supporters of the ban say male circumcision is unnecessary, it's painful and a form of mutilation.

A group of Jews and Muslims disagree and want the proposal removed from the ballot. They contend circumcision is a sacred right. And they're suing the city on the grounds that the ban is unconstitutional because it violates their religious freedoms. Standing between religion and state is the medical community. So, what do they have to say about it? Well, the American Academy of Pediatrics, in its official circumcision policy statement admits the procedure cuts both ways.

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It has the the potential to reduce the risk of urinary tract infections and it helps prevent transmission of sexually-transmitted diseases. But there are also anecdotal reports of chronic pain and reduction in sexual sensation. So, what do I think about this? Well, personally, I'm pro-choice on the circumcision issue. And if San Fran outlaws it, well, in that case, I see a lucrative prospect of circumcision clinics right across the border on the outskirts of town.

Alright, and that wraps up the news parents can use for this edition of PediaCast. It was good. It was good to get back to reading some news and really, connecting more with you guys rather than interviewing somebody here in the studio. Of course, for a while, we're sort of doing both during the show. But the show just got unruly in terms of their length. Well, I can sit here and talk and talk and talk for a long period of time. I know it's difficult to listen and bookmark.

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So, that wraps up the news. We are going to have a listener show coming up in the near future, where we take questions that you ask and answer it right here on the show. We don't give out medical advice but we can sort of point you to the right direction and explain how things work. So, I'd like to thank Nationwide Children's, to also listeners, like yourself. I want to remind you, if you have not put a review onto iTunes, we would appreciate that. It doesn't take much of your time. Just click on our site on iTunes. If you go to podcasts, click on Kids and Family, you can find us there in the Kids and Family section of the podcast area of the iTunes store.

And if you could leave us a review, we would appreciate it because… And I know a lot of you found this show because you read the reviews on iTunes. So, if you could just continue that tradition and help parents of the future decide to listen. Also, if you could mention us in your blogs, on Facebook and in your tweets, and of course, tell your doctor.

This is probably the most important one… really just to spread the word.

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Because we do want to grow the audience and just help more parents understand things and look at the world from an evidence-based standpoint so they can understand why their kids get sick, why certain treatments help and why others don't, why doctors do the things that we do to help you be more healthy. So just let your doctors know when you go in for your well check-up or your sick visit or whatever it is that you are going… your sports physicals, just let them know. Say "hey, PediaCast. PediaCast.org." And we're going to be able… we're going to help you out with that.

We have on the horizon, which will be soon, it will be before the end of the month, a new revamped website. And hopefully soon after that comes out. we're going to have some downloadable materials that you'll be able to put up on the bulletin boards, the nurseries, church nurseries, daycares, doctors' offices… I don't… neighborhood telephone poles, for all I care. Maybe you shouldn't do that. I don't want to get you in trouble. So, we do appreciate though every help cause we don't have a multi-million dollar advertising budget here.

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No billboards, no ads in magazines or newspapers. Just word of mouth. And so far, we've had over a million downloads of episodes since we started. So, the word of mouth has been great. And we would just ask that you continue to help us in that way. For new listeners, no, we don't go on and on and on about spreading the word in every episode. But, I just wanted to take the time and mention it since I don't have a studio guest waiting on me to finish.

See, that's the issue, isn't it? When we have a guest, I have to wrap things up. But when it's just you guys and me, we can go on and on and on. Alright, don't forget. If there is a topic that you would like to hear about on PediaCast, it's easy to get a hold of us. Just head on over to PediaCast.org and click on the contact link. You can also email at pediacast@gmail.com. If you do that, make sure you let us know your name and where you're from. Also the voice line at 347-404-KIDS. 347-404- K I D S.

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That's another way that you can get a hold of us and leave an audio message. And you know, every single email that comes through the contact page and on the voice line. And every single one of them, I personally listen to and sort of sort through to decide what topics we're going to cover and what questions we're going answer on the show. Alright. So that wraps things up. I appreciate your time and thanks for taking some time out of your busy schedule to join us here on PediaCast. Until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long everybody.


Announcer 3: This program is a production of Nationwide Children's.

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Thanks for listening. We'll see you next time on PediaCast.

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