Back Talk, Hair Loss, Growth Spurts – PediaCast 196


  • Food Presentation
  • Physical Activity Linked To Academic Performance
  • 12 Ways To Get Fit in 2012
  • Back-Talking Teens
  • Alopecia Areata
  • Epi Pens, Fluoride, Potty Training, Growth Spurts
  • Strep Throat and Dogs




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!

Mike Patrick: Hello, everyone, and welcome once again to PediaCast, a pediatric podcast for moms and dads. We're coming to you from the campus of Nationwide Children's Hospital in Columbus, Ohio.

This is Episode 196 for January 18th, 2012. We're calling this one "Back Talk, Hair Loss, and Growth Spurts". Of course, we've got lots more coming your way. It is a news and listener program, our episode of the show, so we know we're going to have a lot of your questions and some news stories for you. That's all coming up.


I want to remind you before we get to the lineup, though…actually not remind you. I want to tell you for the very first time, and we're pretty excited about this, Sports Medicine here in Nationwide Children's has started its own Facebook page. Now you may be thinking, 'OK, why is that exciting?' It is because they have great plans for this.

Dr. Tom Pommering, he is the Chief of Sports Medicine here at Nationwide Children's, he's been on the show a couple of times. This past summer, we talked about summer conditioning, and we had another show not too long after that, we talked about concussions in athletes. He's got a great staff with athletic trainers, physical therapists, sports medicine specialists, so they have a presence on Facebook, and I think it's going to become a pretty active presence with lots of great information for pediatric athletes, young athletes, kid athletes, teen athletes, and parents of those children.


So, anyway, why don't you check it out? If you head over to Facebook, just search for 'Sports Medicine at Nationwide Children's Hospital' and you'll find it. You can 'like' them and they'll keep you updated with lots of great information on topics related to sports medicine.

And to make it even easier for you, if you listen to the show at, you can click on the link there and it will take you right to the Facebook page for Sports Medicine. And if you're not listening on, if you're listening with your portable device, just head over to the website and we'll have a link in the 'Show Notes' for you.

OK, so what are we talking about today? Lots coming your way.

Food presentation. Everyone's trying to get their kids to eat healthier foods, so for young kids, can it make a difference in how you display their food in terms of if they eat it or not? We're going to talk about that.

Physical activity is linked to academic performance, positively or negatively? We're going to discuss that. Also, 12 ways to get fit in 2012.


Back-talking teens. Some of you may have heard about this. I'm going to throw in my two cents. It has to do with teenagers who talk back to their mothers, and whether that's good or bad. I mean, obviously we don't want our kids to back-talk us, but there actually may be some good in it. What could that be? We'll get to that in just a little while.

And then we have your questions. We have one on hair loss. Alopecia Areata is the particular disease we're going to discuss. So that's coming your way.

We also had a listener write in with quite a number of questions. She kind of unloaded her suitcase on us: EpiPens, fluoride, potty training, and growth spurts. But I included them all because they're all quick questions. We can get to each and every one of them. And of course we appreciate all of our listeners who write into the show and contribute.

And then we finally have one other listener who has a few interesting questions actually about strep throat, not your run-of-the-mill questions regarding it. In particular, one of her questions is dogs. Can a dog give you strep throat? Can a family dog be the carrier of strep throat in a family? So we're going to discuss that.


All coming up here in just a little while.

I want to remind you, if there is a question that you have, a news story you'd like to point us to, or if you have a topic you'd be interested in hearing us discuss, it's easy to get a hold of us. Just go to and click on the 'Contact' link. You can also email or call the voice line at 347-404-KIDS. That's 347, 404, K-I-D-S.

And before we get started, I do have 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. So 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 audio program is subject to the PediaCast Terms of Use agreement. And where can you find that? Well, of course over at


All right, we're going to take a quick break and we will be back with 'News Parents Can Use'. We'll do it right after this!


Mike Patrick: 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, and you can visit them online at

Parents of picky eaters can encourage their children to eat more nutritionally diverse diets by introducing more color to their meals. That's according to a new Cornell University study, which finds colorful food fare is more appealing to children than it is to adults. Specifically, food plates with seven different items and six different colors are particularly appealing to children, while adults prefer only three items and three colors.


"What kids find visually appealing is very different than what appeals to their parents," said Brian Wansink, Professor of Marketing in Cornell's Dyson School of Applied Economics and Management. "Our study shows how to make the changes so the broccoli and fish look tastier than they otherwise would to Little Casey or Little Audrey." The study is published in the January issue of "Acta Paediatrica".

The researchers presented 23 preteen children and 46 adults with full-size photos of 48 different combinations of food on plates that varied by number of items, placement of the entrees, and organization of the food. Compared with adults, children not only prefer plates with more elements and colors but also like their entrees located in the front of the plate and with figurative designs.


Investigators say, "Well, much of the research concerning food preferences among children and adults focuses on taste, smell and chemical aspects. Their finding show kids and adults are also significantly influenced by the shape, size and visual appearance of presented food."

All right, this is a little bit silly. Kids like pictures of plates with seven food items that are all different colors. Or close to that. I think I'm off just a bit. What do they say? Seven different items, six different colors; that was the preference. But these are pictures. I'm not sure that actually translates to which plate of food they would want to eat in front of them if the actual plate and the actual food were sitting there. I mean, a picture is one thing, but then actually seeing it there and being expected to start taking bites is something different.

And of course, once they do take a bite and taste the many different items of different colors on their plates, it doesn't mean that they'll actually eat more of the said items.


So I think the researchers, if they're serious about this notion, they really ought to try the study again with real plates and real food instead of pictures. I'd also like to know if the fancier presentations actually resulted in more nutritious food being consumed, if you know what I'm saying.

So a little ways to go yet on that study. In the meantime, though, it certainly doesn't hurt for parents to play around a bit with presentation, especially if you have some picky eaters at home.

A systematic review of earlier studies indicate that physical activity and academic performance of children may be positively linked. In the January issue of "Archives of Pediatrics & Adolescent Medicine", researchers from the Netherlands reexamined evidence regarding the relationship between physical activity and academic performance because of concerns that pressure to improve test scores often means more instructional time in the classroom with less time for physical activity.


The investigators looked at 10 observational studies and four interventional studies. Twelve of the studies took place in the United States, one in Canada, and one in South Africa. The studies' sizes ranged from 53 participants to approximately 12,000 participants aged between six and 18 years, with follow-ups ranging from eight weeks to longer than five years.

So what did they find? Well, the investigators say, according to the Best Evidence Synthesis, they found a strong evidence of significant positive relationship between physical activity and academic performance. In other words, physical activity helps. The findings of one high-quality observational study and one high-quality interventional study suggest being more physically active is positively related to improved academic performance in children.

According to background information in the article, exercise could benefit cognition through increased blood and oxygen flow to the brain, which increases norepinephrine levels and endorphins. These increased levels lower stress and improve mood while increasing growth factors that help create new nerves and support synaptic plasticity.


Got to love that. 'Synaptic plasticity'.

In other words, folks, exercise helps the brain grow and make the right connections.

The investigators state that at present, relatively few high-quality studies have explored the relationship between physical activity and academic performance, and they say more high-quality studies are needed on a dose-response relationship between physical activity and academic performance and on the explanatory mechanisms using reliable and valid instruments to assess this relationship accurately.

I think it does make sense physiologically that physical activity could enhance academic performance. And I agree with the authors; it would be nice to see a prospective study with a large sample size that attempts to find out exactly what kind and how much exercise is needed to produce a response of improved academic performance.


So that's interesting stuff. Of course, there are lots of other reasons to stay physically active, and of course it's great when kids and parents can be physically active together.

Fitness expert Michael Berry is Chair of the Health and Exercise Science Department at Wake Forest University and he says, "Fitness with your kids must include more than a predictable schedule. You have to engage your kids. Make it fun, make it even a little unusual, and get them excited about working out."

If you say, 'We're going to take the kids out for a walk this evening,' most kids are going to respond, 'Wait, we have to leave the video game?' or 'the television?' But Berry says, "Sure, kids like to play games, they like to be engaged, so exercise needs to be something that is sports-oriented or game-oriented."

Children need at least 60 minutes a day of physical activity, including muscle-strengthening exercises. That's according to the Centers for Disease Control and Prevention. And with that goal in mind, Berry offers 12 suggestions for getting fit with your kids in 2012.

Number one, get out and see the neighborhood. Look for different decorations and lights with each holiday and season. Check out the yards and gardens because there's plenty of interesting sights close to home. And while you're out, drop in on a neighbor, too, and say hello.


Number two, aim for two or three activities a week which will help you reach your daily adult fitness goal of 30 minutes of moderate activity five times a week.

Number three, encourage your kids to walk to school if it's safe and appropriate. Perhaps make it a challenge with a reward for a certain number of walking trips rather than a car or bus ride. Berry points out that bursts of activity in the morning can change your day.

Number four, replace pizza and movie night with a family fitness night at least once a month and get the kids excited about it with rewards, games, and healthy competition as part of the fun.

Number five, check out the fitness attractions your city offers. You can visit rock climbing gyms, trampoline arenas, roller rings, ice rings, tennis courts, biking trails, just to name a few. And be sure to follow all the rules and use the proper safety equipment.

Six, make a fitness wish list with your kids. Write down every physical activity they'd like to do and let them choose regularly.


Number seven, and here's one of my favorites, play like a kid. Thirty minutes of tag or kickball is good exercise for you and your children. Although I don't typically last the whole 30 minutes. You might have to work up to 30 minutes, especially if you're playing something like tag. I don't know why this reminds me, "Red Rover, Red Rover." You remember that one? I think that was kind of dangerous.

Number eight, use your gaming system to your advantage. Pick a high-energy physical activity that you like. "Just Dance" for Wii is an example. And make it a family competition. When the kids get bored, change the game.

Number nine, get outside and go beyond the neighborhood. Check out a local park or take a hike in a nearby nature preserve.

Number 10, if you want to add some extra fun, create a scavenger hunt with your hike complete with some prizes for the winners.


Number 11, make dining out or after-dining treats a physical activity by walking to the restaurant. If the nearest eateries are too far from home, park a few blocks away from the establishment and use your feet anyway. It will give you a chance to see some things that you'd missed from the car window.

And finally, number 12, join a parent-child league sport like soccer, basketball or even kickball. More opportunities for you and your kids to have fun getting fit together.

And finally in our 'News Parents Can Use', teens who openly express their own viewpoints in discussions with their moms, even if their viewpoints disagree, are more likely to resist peer pressure when it comes to using drugs and alcohol. That's one of the findings of a new longitudinal study by researchers at the University of Virginia, and that study appears in the journal "Child Development".

The researchers looked at more than 150 teens and their parents, a group that was racially, ethnically, and socioeconomically diverse. The teens were studied at ages 13, 15, and 16 to gather information on substance use, interactions with moms, social skills and close friendships.


Researchers used not just the youths' own reports but information from parents and peers. They also observed teens' social interactions with family members and friends.

They found that teens who hold their own in family discussions were better at standing up to peer influences to use drugs and alcohol. Among the best-protected were teens who had learned to argue well with their moms about such topics as grades, money, household rules, and friends. Arguing well was defined as "trying to persuade their mothers with reasoned arguments rather than with pressure, whining, or insults."

"The health autonomy they'd established at home seemed to carry over into their relationships with peers," suggests Dr. Joseph Allen, Professor of Psychology at the University of Virginia, who led the study. The study also found that teens who had formed good relationships with their parents and their peers were more likely to resist peer influences related to substance use.


Dr. Allen says, "It may be that teens who are secure in their ability to turn to their mothers under stress are likely to end up feeling overly dependent upon their close friends, and thus less likely to be influenced by their friends' behavior when it's negative." So if you can be independent from your mom, you can also be independent from your friends, and you're better off at being able to make the right choices.

So there you have it. Back talk, at least when it's in the form of a rational and reasonable debate, is not only a normal part of growing up but it appears it can also be an important part in your teen's road to healthy independence.

All right, that concludes our 'News Parents Can Use' this week. We will be back to answer some of your questions right after this.



Mike Patrick: All right, first up on our listeners' segment is Jean Anne in Greensboro, North Carolina. Jean Anne says, "Hi, Dr. Mike. I'm a pediatric nurse in a pediatric emergency department. I have taught pediatrics for five years now and I'm in the PNP, that's Pediatric Nurse Practitioner, program at UNC-Chapel Hill. I've listened to you and your podcast for several years while walking my dog and along car rides and just love it."

"I just wanted to let you know that at our website is a syllabus for our…" I'm sorry. "I just wanted to let you know that your website is on the syllabus of our Primary Care of Children class. I love your speakers, and I remember listening to a podcast and you mentioned a PediaCast Pro, I believe. Any more news on that?

Also, I started my clinical with a pediatrician, and I will be sending you a few questions or discussion topics as they arise from there. Thanks for a great podcast."


Well, thanks for the shout out, Jean Anne. Even though I kind of butchered it there.

I think it's really cool that PediaCast is on the syllabus of your class. And it kind of reminds me, if there are students out there who are in any field pertaining to pediatric medicine, be sure to tell your instructors about PediaCast so they can check it out for themselves and see if it is something that they'd like to share with their students.

In terms of PediaCast Pro, the idea behind this was PediaCast is aimed at parents, and if we kicked it up a notch and made it PediaCast Pro, that could be aimed toward clinicians, nurses, doctors, medical students and the like, that that would be kind of a cool thing to do. We're not quite there. It's really a matter of time and resources. A lot goes into this show.

I really right now have tried to ride that line here on PediaCast, as I'm sure many of you have noticed, between topics that appeal to parents and clinicians, both here on the same feed and with the same show.


We try to offer adequate depth of material but still trying to explain things, even though we go deep into it, in terms that everybody can understand, at least with a high school science background. And I think that's working pretty well for now, but someday, we'll see what happens.

In the meantime, Jean Anne, thanks for you comments, and I'll be on the lookout for your future questions and topic ideas.

All right, let's move on to a Tysen in Vancouver, British Columbia. Tysen says, "Hello, Dr. Mike. When my son was three years old, his hair started to thin. A few months later, it was thinning so much you could see his scalp in places, so we took him to the doctor."

"After an examination ruling out fungus and other scalp issues and some blood tests ruling out dietary or thyroid problems, he was finally diagnosed with Alopecia Areata. We waited a few more months to see if his hair would grow back, and when it didn't, we decided we would shave his head instead of having the bald patches."


"He is turning six this week, and other than his hair loss, he is perfectly a healthy, active young boy. He knows he has Alopecia and has a great attitude about it. He said he likes having a shaved head, but sometimes he does miss having hair."

"My understanding of Alopecia Areata is that it is a genetic autoimmune disorder and there isn't really a treatment for it. Sometimes it gets better and sometimes it doesn't. I was wondering if you could talk about it on the show. I am wondering about the actual mechanism at work here and what chances there are of it getting better or worse."

"Are there any treatment options that my doctor is unaware of that I could talk to him about? He did mention a cream like Rogaine, but it's not very successful. Are there any other health effects that could come up because of this?"

"Thanks, Dr. Mike. Love the show and really look forward to hearing about Alopecia Areata."

So we did have an entire episode on hair loss way back in PediaCast Episode Number 55. I looked back, it was actually in 2007, and we did cover several different causes of hair loss, one of which is Alopecia Areata. And we are going to cover that again here for you.


We're going to hit the highlights of it, anyway, but I wanted to mention this other show because there are lots of other causes of hair loss in kids. And just to give you some examples, Androgenetic Alopecia, Telogen Effluvium, Anagen Effluvium, Traumatic Alopecia, so great names, right?

And if you're interested in hearing about those disorders, which also can cause hair loss, then head over on to PediaCast 55. And to make it easy, because the information is still the same, hair loss info hasn't changed from 2007 to today, to make it easy we'll include a link in the show notes for this episode over at

So let's talk about Alopecia Areata. This is one of those diseases that doesn't have a common name so we just have to use the medical name, which is Alopecia Areata. It is a chronic inflammatory disorder affecting the hair follicles. It also sometimes affects the nails. So you were asking, can it cause other issues, and sometimes it can cause some problems with nail growth as well as hair growth.


Typically, when you look on the scalp, it results in circular areas of complete hair loss, which is exactly as you've described it. It affects about one in 1,000 people, so it's actually fairly common, one in 1,000. And the lifetime risk of developing it is about 2%.

Men and women are equally affected, and it can start at any age, including kids, although most cases of it start in young to middle adulthood, so kind of in the 20s and 30s. And it often follows a genetic or family pattern. So whatever the pattern of Alopecia Areata is in your family, that's likely how it's going to progress in any specific individual.

Now if there is sort of a new mutation or you don't have any history of this in your family, then you're going to have a harder time trying to figure out what the course of it is going to be and you just have to wait and see. But if there is a big history of this in your family, whatever other family members have experienced is likely to be what you experience as well, and that's because there is a genetic component to this.


So what happens? Well, the immune system, some part of the hair follicle, the body starts to make an antibody against it. Of course, there could be some other antigen that resembles the hair follicle that you're exposed to and your body makes antibodies, and those antibodies react with the hair follicle and destroy the hair follicle…not destroy it, but damage the hair follicle so that it's not as good at making hair. So it's your immune system that's the problem here.

What we typically see is that the immune system attacks circular areas, and in those areas on the scalp you do get the complete hair loss. The circles develop over a period of a few weeks, and then the immune attack seems to calm down. And then hair growth begins again and can actually last for several months, but then after a while the immune attack starts up again and the circles come back, maybe at different places. The circles can change shape, they can widen, they can coalesce into sort of bizarre-looking patterns of hair loss on the scalp.


Now sometimes it results spontaneously. Just for whatever reason, the immune system tends to just start quieting down on its own and it stops being a problem, and sometimes it comes and goes over your entire lifetime.

Again, these kind of patterns with it does follow a family pattern. So again, if there's other people in your family who have it, kind of look to them and what their pattern's been, and that will help you sort of predict what pattern your child's going to have. It's not absolute, but at least gives you a little bit of an idea.

So what can you do to treat this? Well, the first question you have to ask is, does it have to be treated? If your kiddo is fine with the shaved head and makes him unique in the class, it's his thing, certainly nothing wrong with that, and you may not want to do anything for it at all.

On the other hand, if it's causing your kid a lot of distress and you really want to do something about it, there are some things that you can do, that your doctor can do, and those include things that basically calm down the immune system first, so topical steroids, sometimes oral steroids. There's also a medicine called Methotrexate that's sometimes used for this. And the idea here is to quiet down the immune system so that you don't have as much of a reaction with the hair follicles.


Now, there's problems with that. There are other things that have to doing steroids over a long period of time can contribute to. Topical steroids over a long period of time can cause color changes of the skin. It can cause some thinning of the epidermal layers. I mean, it can cause some skin problems of its own. So again, you have to really look at the risk versus benefit portfolio here. Is it worth the risks for the benefit that you're going to get?

Same thing with prolonged use with oral steroids, especially higher doses of those. And Methotrexate suppresses the immune system. You could be opening yourself up for more viral infections and just your immune system having less of an ability to fight what it's supposed to be fighting. Sure, it doesn't fight the hair follicles as much, but it doesn't fight other things off as much as well, so that can be a danger at times.


Another treatment that's sometimes used that doesn't work very well for this particular disorder is Minoxidil, which is Rogaine. The way that we think that Rogaine works, this is kind of interesting. If you understand the hair cycle, the hair grows, that's called the anagen phase. That lasts about two to three years and 90% of hair follicles at any one time are in the anagen phase.

Then the follicle goes into a resting phase, and that's called the telogen phase. That lasts for three to four months and about 10% of the hair follicles at any one time are in this resting phase. At the end of the telogen or resting phase, the hair falls out. Each day on average about 75% or so hairs fall out, and those follicles begin a new anagen or growth phase that will last again over the next two to three years.


What Rogaine appears to do, although we're not quite sure about this, it appears to cause vasodilation, so it causes the blood vessels around the hair follicles to dilate, and it also opens potassium channels at the level of the hair follicle. And it's thought that those changes cause hair that's in the telogen phase to not wait the three-to-four months but to shed prematurely, kind of forcing that follicle into a new anagen phase.

So hairs that normally would just be resting and not growing, and they may be old hairs that are broken and small, those can fall out, and then a new hair can start being made.

But it seems like it really only helps especially men who are going bald early in life, in their 20s and 30s, and only in the first five years or so of when they start to experience hair loss. So it doesn't work for everyone, and in particular for Alopecia Areata, it tends not to work well.


But it's one of those things you can try. If it works, great; if it doesn't, it doesn't. There have been cases when it does seem to help for a while.

But Rogaine can have side effects, in particular, hypotension. Remember, it dilates blood vessels, and it can do that at other places of the body and that can result in lower blood pressure. So it's the kind of thing you definitely want to do under the care of your doctor, not something on your own.

And then the third type of treatment is actually to try to calm the immune system down through immunotherapy, like allergy shots. So if you can figure out what exactly antigen it is that your body's making antibodies to, the thought is that maybe someday there could be a shot that would cause your body to become sensitized to that antigen, and that could calm things down.

But that's still an experimental type of treatment that is not routinely available out there. But they're looking into that.


Phototherapy is another thing that can stimulate hair growth and has been used, although, again, you don't want to have too much UV light exposure because you can set yourself up for skin burns and cancer and that sort of thing.

So all of these things, again, you have to look at the benefit versus the risk, and it's definitely something that you want to talk with with your doctor because, again, it may be, you just don't want to do anything for it at all.

The best person, I think, if you aren't satisfied with your doctor's answers, is a pediatric dermatologist. This is their area of specialty. If you do have more concerns or you want to make sure that that's exactly what is going on, or to see what the latest treatment possibilities are, the expert in that field would be a pediatric dermatologist.

All right, so I hope that helps. Let's move on to Tiffany in Grants Pass, Oregon. Tiffany has lots of questions for us, but they're quick questions, so we'll get to all of them here.

First off, she says, "Love your podcast. I've been catching up on some past episodes, in particular 185 to 189, so I have a few comments and some questions that span those shows."


"A few shows back, you were talking about gas cans and how they are so hard to fill and/or pour." Yeah, the new ones are. The safety cans. "Well, my husband happened to be in the car during this episode and he wanted me to let you know that it's not a child-safe feature. It's actually an environmental gas-conserving feature. They make the new cans so fumes don't get out into the air and also to avoid your gas from evaporating. He agreed with you that they are a pain in the neck and he likes the old ones, too."

"When you did the show on anaphylaxis, my question while listening was, what happens if a child gets an EpiPen injection and didn't need it? You addressed everything else but I kept wondering about that."

The side effects of epinephrine are going to be a fast heart rate, so tachycardia, you can get a dry mouth, anxiety. Think about what your symptoms would be if you were really scared or anxious or nervous. So your heart's racing, dry mouth, anxiety. Epinephrine is a natural chemical in your body, and those are the effects that it has. So those are the side effects.


You definitely would, if you really seriously think a kid is having anaphylaxis, you're better off risking that you're wrong and it's not anaphylaxis and you cause some anxiety and fast heart rate than to be wrong the other way and not give it and they are anaphylaxis, and then they go into shock. So it's definitely worth those side effects.

OK, she continues, "We recently listened to the tooth care show. I have to be admit that I've been leery of fluoride and was glad our local water source is not fluoridated. That was mainly out of ignorance, though, I admit."

"When my son was the right age for fluoride drops, my pediatrician addressed this issue with me. I still wasn't sure if I was going to put my son on the drops, but I took the prescription anyway to think about it. Incidentally, I did fill them, but at my son's first dentist appointment I also inquired the dentist's opinion on the fluoride drops."

"Our dentist told me that fluoride is only effective when it's put on the tooth, as in applied directly on the tooth or in the mouth, and that consuming it doesn't do anything. The way I understood him was that the fluoride does not work systemically. So after that visit, I took my son off the drops and brushed his teeth with fluoridated toothpaste just as your podcast advised. "


"So now I'm royally confused. Am I doing my son a disservice by not giving him the drops? Is my dentist off his rocker? Is what your guest Dennis said about fluoride right and my dentist misinformed? Help! I'm in an oral quandary."

OK, so let's talk about this very briefly. Fluoride on the surface of the teeth, or in each individual tooth, is great for exposed teeth. But that doesn't help the adult teeth that are growing up above the baby teeth inside the gums. So the oral fluoride drops is primarily to make the adult teeth strong and cavity-resistant as they're forming, and that's why kids need ingested fluoride and topical fluoride.

All right, back to Tiffany. "One more thing. What is your position on potty training? Should I be regimented with my son, really cracking the whip with the whole 'Go sit on the potty' stance, or is it OK to take a 'He'll get the idea when he's ready' option?"


"He will go on the potty 90% of the time if we leave him naked, the other 10% of the time he pees on the floor, and if we put him in underwear he'll just pee in those. So I'd love to hear your feedback on that."

All right, so potty training, it's what your family needs with this. I mean, if you are in a situation where you need to put them in a day-care or some kind of a service where they have to be potty-trained, then you're going to be taking the 'cracking the whip', figuratively speaking, of course, 'Go sit on the potty' and you really want to make this happen because you have a reason to.

Now, you don't want to force that if your child is not physically and emotionally ready for that. But I would say that a kid who successfully does it 90% of the time probably is physically and emotionally ready.

On the other hand, if you don't have a pressing need for the potty training to happen, then I think it's OK to really take the 'He'll get the idea when he's ready' option, because aside from physical ailments that prevent kids from being potty-trained, kindergartners are all potty-trained, so it's going to happen.


And I think it is OK just to sit back and relax, especially if in your family it's not something that has to be done right now and you're good with where things are, it's going to get better, that kind of thing.

So let's say, how can you go, and a kid who's physically ready, what age is this? Most kids, it's three. Some kids are ready when they're two. Some kids are more an early for when it's happening. But for most kids, this is happening around the time that they're about three years old or so. And what can you do if they're physically ready and emotionally ready and they're doing it 90% of the time but they still have this 10% failure rate? How can you fix that?

Probably the easiest way I have found is games. Really, make it a reward system. I mean, not punishment, but, 'When you do go, you're going to get a sticker. And if you get so many stickers, we're going to have a toy, you're going to have a new toy,' or 'we're going to go out to your favorite restaurant.' Some kind of positive reinforcement that they have to earn.


And in the beginning of that, you want to make them successful so they can connect the dots. You want them to see that there is a cause-and-effect relationship here. So the first time you might want to say, 'Hey, you get two or three stickers, we're going to do something fun.' And then the next time after that, make it five stickers; the next time after that, make it 10 stickers.

But the more stickers, then you may want to make the prize a little bit bigger so it's not just, 'Oh, this is great. Now I've got to do it 10 times to get the same thing.' So you want to up the ante a little. But it doesn't have to be expensive. It may be something just fun that you're going to do, or something that…what's your kid's currency? What is it that they really like? Just try to come up with a positive reinforcement model that way and oftentimes that will push that 90% up to 100% for you.

But again, do you have to do that? If your family doesn't have to, then no, you don't have to, and yes, it will happen.


All right, back to Tiffany. She says, "And finally, I've heard for years that if your child's eating a lot, people will say, 'Oh, he's going through a growth spurt.' Then, if they're in a phase when they're not that interested in food, someone will say, 'Oh, they're just not growing right now.' Is any of this true or is it just our grandparents' overzealous rationale?"

"Thanks again for this wonderful podcast. I'm a faithful listener and appreciate and respect your advice and insight. Sincerely, Tiffany in Grants Pass, Oregon."

So I think we addressed all of your questions, Tiffany, except for that last one, and we'll get to it here. But I do want to thank you for writing in, and that wasn't too many questions. They were nice easy ones so it worked out great.

OK, so that last question, appetite and growth spurts. Yes, I am a firm believer that there is a correlation.

Now I'm going off the book here. I don't have scientific evidence to back me up. And I'm not sure that there is any scientific evidence out there in the form of a study as it relates to growth and appetite, but it really makes sense to me. I mean, growth takes energy. We get energy from eating. And if you aren't growing and you do eat, then the extra energy is stored as fat and we grow in a different way.


And I think that's one of the reasons that toddlers oftentimes have slim appetites. I mean, they're not doubling their length and weight like they did when they were babies. They're growing more slowly, and their appetite often reflects that. When we force them to eat anyway, we create bad eating habits and turn obese kids.

If your kids only want to eat when they're hungry and they want to stop eating when they're full, that's great. That's what you want to encourage. Now you want to of course check with your doctor, make sure that your son or daughter looks good on the growth chart.

You don't want to compare them to the neighbor kid. I mean, sure, your kid might look a little scrawny if the next-door neighbor's got an obesity problem, but that doesn't make that scrawny appearance abnormal. If you really look at the growth chart, what kids should weigh, it kind of looks thin to us now because of all the childhood obesity that we're seeing.


So it's an important thing to realize that if your kid looks good on their growth chart, whatever their appetite seems to be is good. You want to stick with that as long as they look good on the growth chart.

Now, if they are underweight to a degree that worries your doctor, then we've got to do something about their appetite and about their eating habits. And the other is true as well. If they are obese, we want to try to decrease their eating habits as much as we can and increase their exercise.

My point here is, kids eat for energy. They need energy to maintain their bodies. They also need energy for certain bodily functions and movement. And they need energy to grow. So, yes, they'll usually eat more when they are growing.

OK, finally we have Megan in Indiana.

Before we get to Megan's question, I just want to say, normally I don't mention last names when you write in, but for Megan I'm going to because this is Megan Church. She is our author friend. Back in Episode 131, she stopped by PediaCast and we talked about her book. It's called "Unique as Pete: How Autism Does Not Mean Different". It's a picture book for kids with autism. It's a great resource if you have a child with autism.


And if you want to hear the interview with her, it's on PediaCast 131. We'll put a link to that in the show notes, and also put a link to her book on Amazon, so if you're interested in getting that you can pick it up.

OK, what does Megan have to say? She says, "My three-year-old daughter was recently diagnosed with strep throat. When we told our family, my father-in-law, who is a dog trainer, said that strep is one of the very few illnesses that a dog can be a carrier for and spread to humans."

"We got a dog just a few weeks prior to my daughter contracting strep. I did a quick Google search and didn't find much information on the topic. I also asked our family doc, but he said he had never said of this happening, so I wanted to get your thoughts. Can dogs really be carriers for strep throat? And if so, what does that mean for the dog? Should she be treated as well?"

"On a somewhat related note, we took our daughter to the doctor thinking she had a urinary tract infection, since she had wet the bed four times in one night and she hadn't wet the bed in a year prior to that. She was complaining of stomach pain, too. She also had a rash of small red bumps that broke out on her chest and back a few days before. We thought it was heat rash and didn't think much of it since she wasn't complaining about it or itching."


"The doc said the rash could be a sign of strep. She showed no other signs of strep, no sore throat, so we were surprised by the positive throat culture but the negative UTI results. She just finished 10 days of an antibiotic and the rash still isn't totally gone, plus she is wetting once at night and sometimes complaining of abdominal pain still. Could these symptoms also be side effects of the antibiotic?"

"As always, keep up the great work. Been a fan of the show for years now, and I've really enjoyed the frequency with which you're posting shows and appreciate all the information." Well, we appreciate you contributing to the show, Megan And again, your book is great. I encourage parents to check it out.

So let's answer your questions about strep. First, can you get strep throat from a dog? The answer is no. The organism that causes strep throat is specific to humans.


Now, where did this idea come from that dogs could be carriers of strep? Well, several years ago, a study did show that in rare cases, Group A strep grew from cultures that were taken from dogs' mouths. But as it turns out, those tests weren't as precise as strep-testing is today.

And now what we think actually happened is that the test was falsely positive in dogs, and what it was picking up was actually canine-specific Group G strep but the test thought it was human Group A strep. So they were false positives. The old test thought that the dog strep was human strep, but it turns out that it wasn't.

And newer, more specific tests that are better at differentiating between Group A human strep and Group G dog strep, those tests have not shown any dog to be a carrier or infected with human-grade Group A strep. So don't blame the dog.


OK, next up. You gave me your kid's scenario of illness and said, 'We thought it was going to be UTI, and we went to the doctor and it was strep throat. What's the deal?' So I want to address this, because this really illustrates, I think nicely, where the art of medicine diverges from the science of medicine.

A lot of times, we don't know exactly what's going on with your kid, because things can show up when we do the testing in a certain way. And I'm going to get into this; I know I'm being a little obtuse here. What happens is we're not always right the first time, but we do the right thing, and retrospectively, we can figure out exactly what was going on.

Let me give you an example of what I'm talking about. Your kiddo had pain…I'm sorry, they didn't have pain when they peed. So that makes you think not about a urinary tract infection. But not always. You don't always have to have pain when you pee to have urinary tract infection.


The fact that she was bed-wetting when she hadn't before and she was having the abdominal pain absolutely was a great idea for your doctor to get a urine and check for urinary tract infection. Now the urine was normal. Now, that could still be a urinary tract infection if it's a really early urinary tract infection.

I have seen some kids where they have those symptoms, you check their urine, it's normal. The next day their symptoms are worse, you check their urine again, now bang, they've got a urinary tract infection.

Right there is just one example of where a doctor might say, 'No, it wasn't.' Things get worse, and now the next day it was. But you can't really blame your doctor for that. They got the right test, it looked negative. They said, 'If they get worse, come back. Things got worse, you came back, they diagnose the urinary tract infection.

So that's an example of where some people would say, 'Well, my doctor missed that diagnosis,' especially if they go somewhere else the next day when things got worse, then they kind of think disparagingly of their doctor.

And we've all been in that position before on both ends, being the first doctor to see them and being the second doctor to see them. Sometimes you're the villain, sometimes you're the hero. But at the end of the day, your kid got diagnosed with urinary tract infection and they got the right treatment, and that's the important thing.


In this situation, it looked like a UTI, but your doctor said, 'You know what, bellyache, and this rash looks like a strep rash, so I'm going to check their throat as well.' And he checked the throat and he found the throat swab was positive for strep.

Now this is interesting because your kid wasn't complaining of a sore throat. And it would be interesting to know what your kid's throat looked like when all this happened. I certainly have seen lots of kids who tell me their throat doesn't hurt and a lot of kids who tell me their throat doesn't hurt because they don't want the throat swab in their mouth.

So we look in there and it's red and swollen and looks like classic strep, although strep doesn't always have to have the classic look, and they do have strep even though they weren't complaining of a sore throat. So that's not too unusual.


Now if your kiddo had a normal-looking throat but had a bellyache and this rash, and your doctor swabbed them and found the strep, now the question becomes, do they really have strep throat or are they a carrier for strep, and their other symptoms are caused by something different and you just happened to find their carrier state?

And that happens to some degree as well. And I think that's important because we usually do use an antibiotic because just in case it is active strep, we don't want your child to go on to develop rheumatic fever, which can be very serious. So when we find strep, we treat it. But if the throat looked normal with these symptoms, then it could be that your child really had a viral illness that was causing their bellyache and the rash. There are viruses that can cause rashes that look like a strep rash. So, really, we're treating their carrier state and not active strep.

And the importance of that is that they may not get better right away because we're not really treating what's wrong with them, I mean, what's causing their symptoms is a virus and we just happened to find their strep carrier state and we're treating that with an antibiotic.


So, again, things aren't always black and white in the world of medicine. But again, we're using logic and going in a step-wise fashion, and at the end of the day, we're doing the right thing.

In terms of the rash, and this is interesting, too. A lot of kids may get diagnosed as strep, and strep can cause a rash, and the rash is because of a chemical that the organism is making, so there is a significant number of kids who get diagnosed with strep.

And this is one of the reasons that most pediatricians and people who are well-versed in the proper care of the child will do a throat swab to see if they have strep or not, because sometimes people look in there and say, 'Oh, their throat's red and swollen. It looks like strep,' and it's not strep, it's really a virus, but they'll call it strep without doing the test, put your kid on an antibiotic, and then they get a viral rash from the virus that they have, and now they get labeled allergic to the antibiotic, but really the rash wasn't from an allergic reaction to the antibiotic, it's really from the virus that they had. So this can also mess the picture up for you.


In any case, again, this is just why a vending machine can't be a doctor and why we can't say, 'Oh, you have X, Y and Z. You must have Disease A and you need Treatment C.' I mean, you really have to have a thinking head looking at the entire scenario, getting the history, doing the physical, doing some tests, and then making some sense of the whole thing, and taking the time to sit down with the parent and explain what they're doing and why and what to look for and 'If things don't get better, this is what you should do.' So it's all important, and it's why there really is an art to medicine and it's not just a science.

So thanks again, Megan, for writing in and providing some fodder for a fun discussion. I really appreciate it.

I want to remind you, if any of you want to contribute to the show, it's real easy to do. Just go to and click on the 'Contact' link. You can also email And the voice line's open, 347-404-KIDS, 347-404-5437. No, I don't answer that phone, but you can leave a message with your question and we can get you on the show that way.


All right, let's take another break, and we will be back to wrap up the show right after this.


Mike Patrick: All right. We are back, and we're going to say more than just a little good-bye.

I want to remind you, in case at the beginning of the show you thought, 'Well, that sounds interesting, but I want to listen to the show first.' I want to remind you about the Sports Medicine at Nationwide Children's Hospital Facebook page. Just another little plug for it.


When you get done with the show, if you haven't already checked that out and 'liked' their page, last I checked I think they had 66 'likes', so let's, as an audience, get them up over 100.

And I really think, if you have a kid who is involved in sports, this is going to be a helpful page for you to follow because they're going to have great tips and helpful hints and really be a community of student athletic support. And we have athletic trainers and physical therapists. I think it's really going to be a good place to go for those interested in sports-related topics.

So Sports Medicine Nationwide Children's Hospital on Facebook, and if you want to find it very easily, just go to in the show notes for this episode, 196, and we'll have the link for it for you.


I want to thank all the listeners out there, particularly those who've written in with questions. A reminder: it's easy to get a hold of me. Please do it. It's easy, 'Contact' link,, 347-404-KIDS. Easy to get a hold of me.

Also, if you have not done an iTunes review, I'm going to make another plead. Really, in terms of rankings in iTunes, one of the ways that we get noticed and are visible for other parents to see is by having great reviews. And the more of those we have, the better, so if you have not taken time to write an iTunes review and you get to us through iTunes, please do that. It doesn't take long. I mean, literally 30 seconds to voice your opinion about the show. We really would appreciate that in iTunes.

We also have a new resource that I haven't talked about in a while. If you go to the 'Resources' tab at, one of the things we have is a PediaCast flyer, and this is basically meant to be downloaded and printed out.


It's just a PDF file and you can print it, and it just gives folks some idea of what PediaCast is, tells them where they can tune in, and lets them know that we're supported by Nationwide Children's Hospital.

So if you would like to get the word out, you are free to download that and put it wherever you want that's allowed. If you want to put it in your daycares, on bulletin boards, church nurseries, gyms, any place where parents congregate and you're allowed to hang something, please do.

Also you may want to let your pediatrician know about this resource because they can hang it in exam rooms as well. And you can assure your doctor that we are evidence-based. Use that lingo and that will get you far. So we are an evidence-based podcast, except when I go off the book and I say that growth spurts and increased appetite are related without a study to back me up, but when I do that is because I feel very comfortable with it.

And hey, if someone finds an article or a research study that proves me otherwise, I will be the first to put it on this show and expose my wrongness.


All right. Again, thanks everyone for being a part of this show. I appreciate you stopping by and letting us be a part of your life.

Until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids.

So long, everybody!


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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