Screen Time, Bullying, Zip Lines – PediaCast 330

Show Notes


Join Dr Mike in the PediaCast Studio for another round of News Parents Can Use. This week’s topics include an update on screen time recommendations, gut bacteria & asthma, treating Tourette syndrome, anti-bullying laws, heart disease & ADHD stimulant medication, installing car seats and zip-line safety.


  • Screen-Time Update
  • Gut Bacteria & Asthma
  • Treating Tourette’s
  • Anti-Bullying Laws
  • Heart Disease & ADHD Meds
  • Installing Car Seats
  • Zip-Line Safety



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's a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital, on Columbus, Ohio. It is Episode 330 for October 21st, 2015. We're calling this one "Screen Time, Bullying, Ziplines".

I want to welcome everyone to the program. We have a News Parents Can Use edition of the show lined up for you this week. Lots of great topics, more than those mentioned in the title. As usual, I'll run down the entire list in a moment. 

First off, this is something I usually talk about at the end of the show, but I wanted to include it at the beginning this week, as a reminder of an additional resource that we have for you — the PediaCast audience — and that is, our social media presence. You probably heard me say PediaCast is on Facebook, Twitter, Google Plus and Pinterest. Google Plus and Pinterest to be honest, in those space, you're just going to find promos for the show, at least for now. 

However, we're really trying to build more of a community feel to our Facebook page and our Twitter feed, including show promos, yes, but also including news stories, support and interactions that you won't find on the podcast. I also think this is a unique opportunity for those who are interested — no arm twisting here, I just want you to know about the resource — but I think it's a unique opportunity for parents and providers to interact with one another in the digital space.

I've intentionally ;kept the PediaCast social media presence to one profile per social media channel. Even though we do have a consumer program, this one plain PediaCast and a professional face in Continuing Medical Education program, PediaCast CME. And I realized we have a large component of parents and providers in both shows' audiences, and what I love to do is to be able to facilitate all of you, parents and providers, interacting with one another on Facebook and Twitter. 


I really think each of you have great things to say, great perspectives and we can certainly learn from each other. Yes, doctors can learn from parents and patients just as easily as parents and patients can learn from doctors. We can all learn from each other. 

So bottom-line, if you aren't following PediaCast on Facebook and/or Twitter, please consider doing so. Easy to find, just search for PediaCast. And once you joined, feel free to speak up. We'd love to hear from you. 

Again, I really do think with this great opportunity for a unique community on Facebook and Twitter, as we build those spaces into something useful and supportive for both parents and providers alike. 

All right, let's bring the focus back to today's podcast. What are we talking about this week? We have some updated recommendations on screen time for infants, ;children and teenagers from the American Academy of Pediatrics. A couple of years ago, the AAP said no screen time at all for infants and toddlers less than two years of age, and a maximum of two hours a day of entertainment screen time for children over two in teenagers. 

The updated recommendations place less emphasis on numbers and more on common sense. Personally, I think the clarifications and update are great but there had been some detractors who prefer more rigid thinking and who believe parents need a simple formula which was most easily conveyed by the two-hour limit. 

The problem with that thinking in my mind is that the parents' grasp of concepts is more important and potentially life-changing than remembering and enforcing a number. We'll explore the details of the new guidelines together. That's coming up. 


Gut bacteria and asthma, you'd probably heard that overdone cleanliness and overuse of antibiotics during infancy might lead to an increased risk of allergies and asthma down the road. Well, we have some research available that might help explain why this is the case. It's not enough to act upon yet, but it certainly lay some groundwork for future studies, which may help us the reduce the prevalence of asthma. So that's an interesting one. 

And then, treating Tourette's. Tourette's ;is a tic disorder. You're probably familiar with this one as well. It involves motor tic and vocal tics. There's some research out now, a new research that sheds light on the possible cause of Tourette's at the chemical level in the brain, and an understanding of this may lead to new and successful treatment options. So, more of that is coming your way. 

That one gets a little science-y, so I tried to make it as understandable as possible. But when you're talking about neurotransmitters and pathways and areas of the brain, it does get a little bit complicated. But, hopefully, we'll keep things understandable during that news story. 

And then anti-bullying laws, a states with laws that includes specific anti-bullying components. Have your kids been bullied? So what are those components? Does your state have them and what policies and procedures does your local school district have in place when it comes to bullying? Should you care, and what should do about it? So, we'll answer those questions. 

Heart disease and ADHD medication, the FDA includes a warning with stimulants used to treat ADHD, that they might dangerous for those with congenital heart disease. But is the risk real or is it hypothetical? How should we evaluate benefits and risks as they pertain to stimulant use in kids with ADHD and congenital heart disease? We'll take a look at new research and explore that topic together. 


Installing car seats, have you ever bought or used a car seat that didn't fit your vehicle quite right ? Maybe you had to use a rolled-up towel to get it to fit. How big is that a problem, and is it really a safety issue? What should parents know before they buy a car seat? How can you tell if the one you plan to buy will be a good match for the dimension of your car's interior? We'll explore that task. 

Zip line safety — our family loves to go ziplining. Maybe your family does, too. But as more people zip, including children, it's probably no surprise that we'd see more injuries taking place. So what types of injuries are we seeing, how common are they? What are the mechanisms of injury and how can you ensure that your family will have a safe and fun experience? We'll explore those answers together at the end of the program. 

So that's the lineup. Lots coming your way this week. Before we get started, I would like to remind you, PediaCast is your program. So if there's a topic you'd like us to talk about, you have a question for me, or you want to point me in the direction of a news article or journal article, it's really easy to get in touch. Just head over to and click on the Contact link. You can also call the voice line, 347-404-KIDS. That's 347-404-5437 and leave a message or comment or question that way if you'd like. 

Also, I want to remind you, the information presented in every episode of 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 which you can find at 

All right, let's take a quick break, and I will be back with News Parents Can Use, right after this. 



Dr. Mike Patrick: You've heard it before in this program. The American Academy of Pediatrics recommends zero hours of screen time for infants and toddlers less than two years of age, and no more than two hours of screen time each day for children and teenagers over the age of two. These recommendations were first published before the dawn of the Internet, long before iPad and smart phones became universal used items. 

Well, a couple of years ago and in an effort to clarify, the AAP revised their stance to say older kids over the age of two should be limited to two hours of entertainment screen time, ;a nod to that fact that many current educational and social activities take place with the aid of the screen. Now, in an effort to be more helpful and clarify further, the American Academy of Pediatrics acknowledges there's more to the screen time equation than simple numbers, a whole lot more. And the screen's become ubiquitous in today's digital landscape. It's more important than ever for parents to embrace some common sense ideas, ones that will help all of us and our children explore the digital world of screens together. 

Here's a summary of their tips for parents: First, treat media as you would any other environment in your child's life. The same parenting guidelines apply in both real and virtual environments. Set limits; kids need and expect them. Know your children's friends, both online and off. Know what platforms, software, and apps your child is using, where they're going on the web, and what they're doing online.


Set limits and encourage playtime. Tech use, like all other activities, should have reasonable limits. ;Unstructured and offline play stimulates creativity. Make unplugged playtime a daily priority, especially for very young children, and don't forget to join your children in unplugged play whenever you're able.

Families who play together, learn together. Family participation is also great for media activities — it encourages social interactions, bonding, and learning. Play a video game with your kids. It's a good way to demonstrate good sportsmanship and gaming etiquette. And, you can introduce and share your own life experiences and perspectives and guidance as you play the game.

Be a good role model. Teach and model kindness and good manners online. And, because children are great mimics, limit your own media use. In fact, you'll be more available for and connected with your children if you're interacting, hugging and playing with them rather than simply staring at a screen. 

Know the value of face-to-face communication. Very young children learn best through two-way communication. Engaging in back-and-forth "talk time" is critical for language development. Conversations can be face-to-face or, if necessary, by video chat, with a traveling parent or far-away grandparent. Research has shown that it's that "back-and-forth conversation" that improves language skills, much more so than "passive" listening or one-way interaction with a screen.

Create tech-free zones. Keep family mealtimes and other family and social gatherings tech-free. Recharge devices overnight outside of your child's bedroom to help children avoid the temptation to use them when they should be sleeping. These changes encourage more family time, healthier eating habits, and better sleep, all critical for children's wellness.

Don't use technology as an emotional pacifier. Media can be very effective in keeping kids calm and quiet, but it should not be the only way they learn to calm down. Children need to be taught how to identify and handle strong emotions, come up with activities to manage boredom, or calm down through breathing, talking about ways to solve the problem, and finding other strategies for channelling emotions.


Apps for kids — be sure to do your homework. More than 80,000 apps are labelled as educational, but little research has demonstrated their actual quality. Products pitched as "interactive" should require more than "pushing and swiping." Look to organizations like Common Sense Media at for reviews about age-appropriate apps, games and programs to guide you in making the best choices for your children.

It's OK for your teen to be online. Online relationships are part of typical adolescent development. Social media can support teens as they explore and discover more about themselves and their place in the grown-up world. ;Just be sure your teen is behaving appropriately in both the real and online worlds. Many teens need to be reminded that a platform's privacy settings do not make things actually private and the images, thoughts, and behaviors teens share online will instantly become a part of their digital footprint indefinitely. Keep lines of communication open and let them know you're there if they have questions or concerns.

Finally, remember, kids will be kids. Expect them to make mistakes using digital media. Try to handle errors with empathy and turn a mistake into a teachable moment. But some indiscretions, such as sexting, bullying, or posting self-harm images, may be a red flag that hints at trouble ahead. ;Parents should take a closer look at their children's behaviors and, if needed, enlist supportive professional help, including from your pediatrician.

Media and digital devices are an integral part of our world today. The benefits of these devices, if used moderately and appropriately, can be great. ;But, research has shown that face-to-face time with family, friends, and teachers, plays a pivotal and even more important role in promoting children's learning and healthy development. ;Keep the face-to-face up front, and don't let it get lost behind the stream of media and tech.


So I love it that the AAP is not really stressing numbers so much anymore, although they still say that zero hours of screen time, less than age two, and two hours of entertainment screen time over the age of two is still a good idea. But rather than stressing those numbers, they really want to stress their common sense principles instead. 

And, if you'd like to read these tips for yourself, so you can digest them more fully and perhaps share them online with other parents and friends and family, I'll put a link to them along with some other great screen time resources from and the American Academy of Pediatrics. And I'll make it easy to find the links. Simply head over to and look for the Show Notes.

New research by scientists at the University of British Columbia and British Columbia Children's Hospital in Vancouver finds that infants can be protected from getting asthma if they acquire four types of gut bacteria by three months of age. More than 300 families from across Canada participated in this research through the Canadian Healthy Infant Longitudinal Development Study, with results recently published in the journal, Science Translational Medicine .

Dr. Brett Finlay, the study's co-lead investigator, says, "Our research supports the hygiene hypothesis, meaning we are making our environment too clean. It shows that gut bacteria play a role in asthma, but they play their role early in life when the baby's immune system is being established."

Asthma rates have increased dramatically since the 1950s and now affect up to 20% of children in western countries. The discovery opens the door to developing probiotic treatments for infants that may prevent asthma. The finding could also be used to develop a test for predicting which children are at risk of developing asthma.

The researchers analyze fecal samples from 319 children involved in the study. Analysis of the gut bacteria from the samples revealed lower levels of four specific gut bacteria in three-month-old infants who were at an increased risk for asthma. The four bacteria are nicknamed FLVR, which stands for Faecalibacterium, Lachnospira, Veillonella, Rothia. Most babies acquire these four bacteria from their environments, but some do not, either because of the circumstances of their birth or other factors.


The researchers also found fewer differences in FLVR levels among one-year-old children, meaning the first three months are a critical time period for a baby's developing immune system.

The researchers confirmed these findings in mice and also discovered that newborn mice inoculated with the FLVR bacteria developed less severe asthma.

Dr. Stuart Turvey, another co-lead investigator of the study, says, "This discovery gives us new potential ways to prevent this disease that is life-threatening for many children. It shows there's a short, maybe 100-day window for giving babies therapeutic interventions to protect against asthma."

Researchers say further study with a larger number of children is required to confirm these findings and reveal how these bacteria influence the development of asthma.

So this is very interesting, but it's also very preliminary. It does bring together the hygiene hypothesis of asthma development and may explain why early antibiotic use may be associated with asthma down the road. But, keep in mind, associations don't always equal causation, so we really need to study this in larger numbers of babies and get a better understanding of the underlying mechanism if we're to develop asthma prevention strategies based on these research that actually work. 

In the meantime, here's another potential reason to avoid unnecessary antibiotic use in young children. We already have many reasons but we can, at least for now, add this consideration to the list. On the other hand, if the advantages of antibiotic use in a baby outweigh possible disadvantages, including a small study like this, then we should still use them because ;they may very well be life-threatening in the face of a serious bacterial infection which can become deadly quickly for young infants. 


So lots to consider, still lots to learn, but we're making some interesting headway. 

By the way, we're talking about four specific bacteria here, none of which are typically components of commonly used probiotics available over the counter. So these researchers are not recommending probiotics for babies, yet, or changes on hygiene practices, yet. Still more research to be done. Of course, we'll fill you in here on PediaCast as more information is available. 

If you like to watch an interesting YouTube video produced by the research team, which details more specifics of their study, I'll include a link to it in the Show Notes for Episode 330 over at 


Dr. Mike Patrick: A chemical in the brain could potentially be harnessed to help young people with Tourette syndrome to overcome the physical and vocal tics associated with the neurological disorder, says the researchers from The University of Nottingham an in article recently published in the journal Trends in Cognitive Sciences.

Investigator say a neurochemical known as Gamma Aminobutyric acid or GABA is responsible for dampening down the hyperactivity that causes the repetitive and involuntary movements and noises.

Researchers found that increases in the production of GABA as a result of changes in the brain during adolescence may contribute to an improvement in symptoms for the majority of people with Tourette syndrome and could offer a new avenue for treatment that leads to targeted increases of the chemical in the areas of the brain that control motor function.


Dr. Stephen Jackson, professor in The University of Nottingham's School of Psychology, says, "This is potentially a very important finding. A widely held view has been that unwanted movements such as tics in Tourette syndrome are actively suppressed through the recruitment of frontal brain areas involved in volitional action and cognitive control.

"The finding that individuals with Tourette syndrome exhibit increased GABA in brain areas linked to the planning and selection of movements offers a more parsimonious account for how tics might be controlled in Tourette syndrome. Namely, that motor excitability is reduced locally within brain — motor areas of the brain — through the operation of GABA-mediated 'tonic inhibition'. This finding needs to be further replicated but if it proves to be a robust finding on subsequent studies, then it may have important implications for therapies for neurodevelopmental disorders."

Tourette syndrome is a neurological disorder affecting around 1% of all school-aged children, who are affected by an evolving series of chronic physical and vocal tics which develop over time and become increasingly worse. 

While children with Tourette syndrome can often suppress their tics, it takes great effort and can be both uncomfortable and stressful and eventually builds up until the urge to tic becomes uncontrollable.

Tics are at their worst for people with Tourette syndrome between 11 and 14 years of age. Fortunately, for the majority ;of those affected symptoms begin to improve throughout adolescence and into early adulthood. But, for a substantial minority, around 20 to 30% of those with Tourette syndrome, the tics continue and for some reason become increasingly severe and resistant to treatment.

Previously researchers thought the successful control of tics just comes over time through the purposeful and continued effort to suppress them. However, the Nottingham team, which also includes researchers from the United Kingdom's Institute of Mental Health, believe it is more likely that tics improve as a result of the changes in brain structure and function that occur during adolescence.

Specifically, they believe this could largely be attributed to the neurochemical GABA, the primary inhibitory transmitter found in the central nervous system, which plays the principal role in controlling the 'excitability' of neurons.


The brain's neural circuits are established early during development, with milestones including the creation and migration of neurons, the formation of synapses, which represent the pathways by which the neurons carry their electric signals, and the strengthening of those synaptic connections.

These early developments produce brain networks with a balance of influences that will excite and inhibit the brain, and a disruption to this natural order has been associated with a number of common neurodevelopmental disorders including Tourette syndrome.

GABA is the main inhibitory neurotransmitter in the brain and contributes to almost all functions.

Findings from previous research support the idea that Tourette syndrome is linked to changes in the levels and function of GABA in the brain. MRI studies have consistently shown a reduced level of GABA in the brains of those with Tourette syndrome and post-mortem studies have shown this decrease to be as much as 50%.

GABA is believed to have an inhibitory function in the area of the brain associated with higher motor function and that a decrease in this inhibiting factor leads to the tics experienced by people with Tourette syndrome.

A long-standing theory is that those affected gain control over their tics by developing self-regulating techniques to compensate, which in turn lead to a physical re-wiring within the neural pathways of the brain.

The Nottingham experts however believe that this new control may come as a result of a higher amount of GABA, which is being released in the brain during adolescents, and which inhibits the motor regions such as the Supplementary Motor Area.

The findings could offer a new avenue for treatments which mimic this inhibiting effect within the motor function areas of the brain and could potentially offer new hope for people with Tourette syndrome whose disorder does stays with them into adulthood and has a devastating impact on their quality of their life and their ability to make friends and maintain relationships.


So that's all very science-y, I understand. But it's really also a very interesting new research, which not only adds to our understanding of the natural history of ;Tourette syndrome, but also points us in a new direction as we search for successful treatment. Stay tune for more as more information becomes available. 

Students who live in the States with anti-bullying laws, which include at least one US Department of Education recommended component have lower odds of reporting bullying and cyberbullying compared with students living in states which lack these provisions. This, according to researchers at the Columbia University Mailman School of Public Health in New York, and recently published by JAMA Pediatrics. 

Currently, 49 states have anti-bullying laws in the books, but the effectiveness of these laws has not been well studied until now. Dr. Mark Hatzenbuehler and his team of investigators used data from 25 states to evaluate the effectiveness of anti-bullying legislation in reducing students' risk of being bullied and cyberbullied.

Data on anti-bullying legislation comes from the US Department of Education, which has recommended a framework for anti-bullying laws that was disseminated to schools across the country.

In a 2011 report, the department reviewed the extent to which state's anti-bullying laws adhered to those recommendations and found substantial differences among the states. The report identified 16 components of the laws divided into four broad categories. These include definitions of the policy, school district policy development and review, mandated procedures, and strategies for communication, training and legal support. 

These policy variables were collected from 25 states and linked to data from the Youth Risk Behavior Surveillance System on bullying and cyberbullying.


The final study sample included nearly 60,000 students in 9th through the 12th grades in public and private schools. The authors report students in states with at least one Department of Education legislative component in the anti-bullying law had a 24% reduction in self-reported instances of bullying and a 20% reduction in self-reported instances of cyberbullying.

Three individual components of anti-bullying legislation were consistently associated with decreased odds of being bullied and cyberbullied. These include a statement of scope, description of prohibited behaviors, and requirements for districts to develop and implement local policies.

The authors caution they can only infer associations between anti-bullying policies and rates of being bullied because the data were cross-sectional and they could not test causal associations.

The authors conclude by saying, "Bullying is a multifaceted phenomenon that requires a multi-pronged approach. Although anti-bullying policies by themselves cannot completely eradicate bullying, these data suggest that such policies represent an important part of a comprehensive strategy for preventing bullying among youth."

So what anti-bullying laws exist in your state, and do they meet the US Department of Education's recommendations? What about your local school district? What anti-bullying policies and procedures do they have in place? If you don't know, you should. You can find out and be an advocate for all of our kids, by contacting your state representatives and your local district officials. If you do, be sure to tell them Dr. Mike sent you. They'll love that, I'm sure.

In a study presented earlier this month at the annual meeting of the Society for the Developmental and Behavioral Pediatrics in Las Vegas, researchers at Cincinnati Children's Hospital Medical Center have found no increased risk of death or changes in cardiac vital signs, such as blood pressure or heart rate for children treated with stimulant medication who have ADHD and a history of congenital heart disease. This observation held true ;for kids with severe heart conditions. 


One the other hand, they found that heart patients with ADHD when treated with stimulant medications have significant improvements in their ADHD symptoms as measured by standardized rating scales. 

Dr. Julia Anixt, a developmental and behavioral pediatrician at Cincinnati Children's and senior author of the study, says, "Children with congenital heart disease are at high risk for ADHD, but fears about cardiovascular side effects, including sudden death, limit the use of stimulant medications. This study indicates that stimulants are both effective and safe when prescribed with appropriate monitoring and in collaboration with a patient's cardiologist."

Researchers studied 44 children between the ages of 6 and 18 seen in the Cincinnati Children's Heart Institute in Kindervelt Neurodevelopmental and Educational Clinic. They compared these patients to those with similar heart disease but who were not treated with stimulants. The researchers' next step is to study the effect of stimulant medications on electrocardiograms or ECGs, which measure electrical activity of the heart.

Since 2006, the US Food and Drug Administration has required labeling of stimulant medications to include a warning that they generally should not be used in children and adolescents with serious structural cardiac abnormalities, cardiomyopathy or arrhythmias. However, stimulants are the most effective medication to treat ADHD symptoms, and according to Dr. Anixt, patient families, cardiologists, and developmental pediatricians must together weigh the risks and benefits of medication treatment options for each individual patient.

So this is a small study, only 44 kids involved, all with congenital heart disease, some with severe heart disease, all with ADHD, treated with stimulant medication with no significant changes in vital signs, no serious side effects and no unexpected outcomes. 

So, let's say you have a child with congenital heart disease and ADHD, should your child take a stimulant medication despite the FDA warning? Well, that depends. What other treatment options have you tried? How are ADHD symptoms affecting your child's quality of life and what evidence exist to substantiate the FDAs concerns? In other words, you have to travel that road that explores risk versus benefits, and this study does provide some information along the way. 


Of course, it's not a course you want to travel alone. You want to carpool with your pediatrician and your child's cardiologist, and together, you can decide the best and safest plan for you little passenger. 


Dr. Mike Patrick: Many parents roll up towels and blankets– some even use pool noodles — in an effort to make their child's car seat fit better in the back seat of the family car. This common practice creates extra steps for parents and can make proper installation more difficult. This, according to researchers at ;The Ohio State University College of Medicine and recently published in the journal Traffic Injury Prevention.

Investigators found that child car seats and vehicle seats do not align properly more than 40% of the time. In an effort to improve the fit and position of child car seats in vehicles, the research team collected dimension samples from 61 vehicles and 59 child car seats currently on the market, and they identified the most common sources of incompatibility. 

Data from nearly 3,600 potential car seat-vehicle combinations and 34 physical installations were analyzed. The results showed less than 60% of rear-facing car seat-vehicle combinations fit properly between the vehicle's seat pan angle and the car seat manufacturer's required base angle.


Dr. Julie Bing, lead author of the study and research engineer at the Ohio State's Injury Biomechanics Research Center, says, "I want to emphasize that all car seats are safe and have passed federal regulations. But, to really optimize the safety of a child's car seat and provide the best protection for the child, one must make sure it fits properly in the vehicle."

Researchers found the width of the base of child car seats fit snugly between the vehicle's seat pan bolsters in more than 63% of rear-facing car seat-vehicle combinations and in more than 62% of forward-facing car seat-vehicle combinations. By the way, the width of the seat pan bolsters in the vehicle, if you're having trouble picturing this, is simply the width between the humps and buckles on each side of the bottom when you're sitting in the back seat of a car. 

Forward-facing car seats didn't bump up against vehicle headrests in more than 66% of the combinations; and compatibility rates of the length of the car seat base compared to the length of the vehicle seat and the ability of the top tether to reach the tether anchor exceeded 98%.

Dr. Bing says, "We want to encourage parents to take measurements of their car in order to make the most informed decision when choosing the safest car seat option for their child." 

Another goal of the study is to share the specific data points and assist with communication between child car seat and vehicle manufacturers, so they can more fully understand compatibility of their products and, ultimately, help improve individual designs. ;

The researchers urge parents to make sure angles of the vehicle seat and of the child car seat align, and there's no excessive interference with the vehicle's headrest and the child's car seat.


They conclude by saying, "We recommend parents go to the store and ask if they can take the model off the shelf and go out to the car and try it. It might look great on the shelf and have all the greatest safety ratings but, if it doesn't fit in your vehicle, it may not be the best option for you." 

If you're having trouble visualizing seat angles and pans and bolsters, the research team did produce a video showing parents how to get the right fit, and I'll include a link to the video in the Show Notes for Episode 330 over at 

The popularity of ziplining has skyrocketed in recent years with the number of commercial ziplines in the US rising from a mere 10 in 2001 to more than 200 in 2012. That's in addition to more than 13,000 amateur ziplines found in outdoor education programs, camps and backyards.

This increase in popularity has also increased the number of injuries related to ziplining. This, according to a study from the Center for Injury Research and Policy at Nationwide Children's Hospital, which was recently published in the American Journal of Emergency Medicine. 

Investigator say nearly 17,000 non-fatal zipline-related injuries were treated in US emergency departments from 1997 through 2012. Almost 70% of the injuries occurred during the last four years of the study period, indicating a growing problem. In 2012 alone, there were more than 3,600 people treated in US emergency departments for zipline-related injuries, nearly 10 per day. More than 90% of the injuries occurred April through October, with the number of injuries peaking in July, when people are ziplining.

Researchers found that falls accounted for 77% of zipline-related injuries followed by collisions, at 13%, with trees and other anchor structures. The most frequent types of injuries that occurred as a result of ziplining included broken bones (46%), bruises (15%), strains and sprains (another 15%), and head injuries and concussions at 7%. Eleven percent of the patients were admitted to the hospital for their zipline-related injury.


Tracy Mehan, manager of translational research for the Center for Injury Research and Policy at Nationwide Children's and one of study's authors, says, "Though the rate of injuries while ziplining is relatively low, when injuries do occur, they can be quite serious. The high rate of hospitalization is consistent with what we see for adventure sports and reflects the severity of the injuries associated with this activity."

Children younger than 10 years of age accounted for almost half of the zipline-related injuries while those between 10 and 19 years of age accounted for an additional 33%.

Many injuries reported in the study were associated with ziplines located at sport and recreation facilities, such as outdoor education centers, challenge courses, canopy tours, summer camps and parks. Although these ziplines are often used by the public, they are not regulated in many states and may not meet industry standards. Researchers say these self-regulated zipline operations represent an unaddressed potential hazard to the public.

Dr. Gary Smith, MD, director of the Center for Injury Research and Policy at Nationwide Children's and senior author of the study, says, "Currently, there are a number of national organizations with their own safety guidelines and standards for ziplines, which of these guidelines and standards are applied to zipline operations varies among states and even among jurisdictions within a state. Commercial ziplines and non-commercial public-accessible ziplines should be subject to uniform safety standards in all states and jurisdictions in the United States to help ensure safety."

Do-it-yourself zipline kits and specific zipline components such as wires and harnesses are available for purchase online. These backyard/homemade ziplines are built for private use and researchers warned against these products. 

Tracy Mehan says, "Due to the inherent risks associated with homemade ziplines, parents, caregivers, and children should not install and use ziplines at home. Improper installation, maintenance, or use of homemade ziplines can result in serious injuries and even death."


If you plan to go ziplining, researchers recommend the following tips to prevent injuries: 1) Seek out an organization that has well-trained staff and evidence that their ziplines meet industry safety standards; 2) Follow all posted rules and instructions from the staff; 3) Always wear proper safety equipment, such as a harness, helmet and gloves, and; 4) Do not use homemade or backyard ziplines.

So this is something that my family has done together and enjoyed immensely on many occasions, including a stunning scenic zipline tour in the Smokey's with black bears roaming beneath the lines. We've also done an underground cavern tour in Lobo. That's right, ziplining underground. That was pretty cool. Although deep crevices and very dark, that was actually a little more disconcerting when high up in the trees to be honest with you. 

Fortunately, we have not experienced any injuries in our family doing this, but if you aren't following zipline guidelines and I can definitely see the need for standardization of the guidelines across the country. But if you aren't following safety guidelines like we mentioned, I can easily see how injuries could occur. 

So stick with the professional course, not the backyard stuff, check out the ratings and safety information, wear the gear and follow the instructions and by all means, again, stay away from a do-it-yourself backyard ziplines. Unless, of course, you rig one between a bedroom window and a tree house and you're fleeing from invaders after you've been left home alone on Christmas eve. In that case, then the benefit of the homemade zipline might outweigh the risk. But, if you're one of the two home invaders who attempt to cross the zipline hand over hand and the boy in question has wire cutters waiting for him in the tree house, then in that case, I think the risk outweighs the benefit. Just saying. 


The researchers for this story also produced a video which highlights their findings. There is some zipline use going on in the video. I think they had fun putting it together, but they are following the safety precautions. If you would like to see it and share it among your social media friends, I'll put a link in the Show Notes for Episode 330 over at 


Dr. Mike Patrick: All right, we are back. We have just enough time to say thank you to all of you for making PediaCast a part of your day. Really do appreciate that. I want to remind you PediaCast is a production of Nationwide Children's Hospital. 

You can find PediaCast in all sorts of places. We're in iTunes and most podcasting apps for iPhone and Android, including the Apple Podcast App, Downcast, iCatcher, Podbay, Stitcher, and TuneIn.

We're also on iHeart Radio, where we not only have this program, but also PediaBytes, B-Y-T-E-S. Those are shorter clips from this show. They can be weaved together with other content providers to make your own custom talk radio station.

Then, there's the landing site, You'll find an archive featuring hundreds of past episodes, transcripts of each program, in case reading suits your taste, and a handy contact page to ask questions and suggest show topics.

We also have a voice line, if you'd rather phone in your question or comment. Our number there is 347-404-KIDS, 347-404-5437, if you need the digits. 

We're also on Facebook, Twitter, Google Plus and Pinterest with lots of great content you can share with your own online audience. 

Of course, we always appreciate you talking us up with your family, friends, neighbors and co-workers, anyone with kids or those who take care of children, including your child's healthcare provider. Next time you're in for a sick office visit or a well checkup or sports physical, or a medicine recheck, whatever the occasion, let them know you found an evidence-based pediatric podcast for moms and dads. We've been around for nearly a decade now with lots of great content deep enough to be useful but in language parents can understand.


And, while you have your providers' ear, let them know we have a podcast for them as well. Just launched this year, PediaCast CME, which stands for Continuing Medical Education. Similar to this program, we turned the science up a couple of notches and provide free Category 1 CME Credit for listening. Shows and details are available at 

Thanks again for stopping by, and until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody. 


Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast. 

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