Sibling Rivalry, Irregular Bedtime, Boosting Vocabulary – PediaCast 260

Join Dr Mike in the PediaCast Studio for another News Parents Can Use edition of our program. Topics this week include sibling rivalry, antibiotics & eczema, irregular bedtime, vaccines & robots, boosting vocabulary, and the correct use of EpiPens.


  • Sibling Rivalry

  • Antibiotics & Eczema

  • Irregular Bedtime

  • Vaccines & Robots

  • Boosting Vocabulary

  • Correct Use of EpiPens




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 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. We're in Columbus, Ohio. It is Episode 260 for July 24th, 2013. And we're calling this one "Sibling Rivalry, Irregular Bedtime and Boosting Vocabulary."

We welcome all of you to the show. We have another News Parents Can Use edition of the program for you lined up this week. I hinted at three of the topics in the show title, but as usual, we'll get to a complete rundown of this episode — all of the different things we're going to talk about. Because it's more than just those three and we'll get to all of those in a moment.

First, I have some good news and some bad news for you. Now, the bad news isn't terrible news. And I know — at least the way that I do it — if you have good news and bad news, if the bad news is really bad, you start with the bad news and then wrap it up with the good news to make everybody feel a little bit better about it. But I want to start with the good news since the bad news isn't really all that bad.

So, the good news first. Those of you who are regular listeners of the show will recall that back at the beginning of the year, so several months ago, I mentioned that I had some exciting news to share with you. And I hinted that some changes were around the corner — good changes, exciting changes. You may be wondering if you missed it, because it's been a few months. And, maybe you don't remember hearing anything, which is the case because you haven't.



Dr. Mike Patrick: Well, the good news is this, we are right on the verge of the big reveal. OK, so what is the bad news? Well, the bad news is, you have to wait three more weeks. And we're not having any new shows between now and then. Now, as it turns out, a couple weeks off was actually planned and it just so happened to be at the time that the big news became ready to tell you about. We have a two-week family vacation coming up. We're packing up the Patrick clan and heading to Florida to roast in the heat and humidity for a couple of weeks.

And you're probably thinking, especially if you're a new listener, "Is this guy crazy? Doesn't he know August is like the worst time to visit Florida?" Yeah, I know. In fact, we lived in Florida and I produced PediaCast from Florida for a couple of years. So, yes, I know, August is not the ideal time to visit the Sunshine State. But you know the drill, we have to take school and work schedules into account. And there's the family and friends looking forward to seeing us. And you know, there are beaches and air conditioning, so we'll be all right.

In the meantime, use our two-week absence to catch on some shows you may have missed. You can look through the Archives at And remember, when we return on August 14th, I have big exciting news waiting for you. So be sure to tune in then.

Now, speaking of those Archives, I did put together a list of what I would consider premium shows — so just a suggestions of topics. If you haven't listened to any of these, consider using our hiatus as an opportunity to catch up and these are some of my favorites.

If you're a new mom or dad, so you have a baby at home, I would encourage you to check out PediaCast 241. That's "Parenting 101: Baby Basics". And we basically spent an hour going through everything a brand new mom or dad — well, a new mom or dad with a brand-new baby at home — all the things that you would really need to know to take care of a new baby at home. It's "Parenting 101: Baby Basics", Episode 241. So, if you haven't heard that, check it out, especially if you have a little one at home.

If you have school-aged kids, you might want to check out Episode 246, "All About ADHD". That's a big issue with a lot of kids these days. So if you want to know more about that, check out Episode 246.


"Eating Disorders", so for the adolescent crowd out there. It's not just girls. We're seeing more and more boys with eating disorders as well. So that particular program covers anorexia nervosa and bulimia and other eating disorders as well. So, if you want to check that one out, it's Episode 249.

And then, I threw this one in. It's one of my personal favorites, the "Leave No Child Inside." And that one is Episode 254. "Leave No Child Inside", I'll let you listen to that to find out what that's all about.

And then, this one, if you're more… Of course, if you have a kid at home who has seizure disorders or you know someone in your extended family or friends who have epilepsy, this is going to be an interesting show for you — Number 256. If you don't know anyone with epilepsy or seizures, but you're interested in science, this is a pretty good one where we talk about exactly what causes seizures. And I think it's an interesting show. We've, as usual, put it into language that moms and dads can understand but without dumbing it down. So we really talked about all of the scientific issues, but we do explained as we go along to make it a bit easier to understand. So if you're interested in learning more about seizures and epilepsy, tune in to Episode 256.

So there are five good ones to get you started. And again, to make it easy, I'll put links to those five episode in the Show Notes for this episode, Number 260, over at

OK, what do we have lined up for you today? We're going to start out with sibling rivalry. Sibling disagree and argue and fight. But how much is too much? How far is too far? Could sibling rivalry affects your child's mental health? We'll let you know.

And then, we're going to talk about antibiotics and eczema. Could antibiotic use during the first year of life increase your child's risk for suffering from eczema and allergic skin condition down the road. And likewise, could antibiotic use increase your child's risk of food allergies or asthma. We've talked about allergies a lot on PediaCast here recently, and we know the incidents of allergic disorder has increased in recent years. So the culprit be antibiotics? But are antibiotics also important during the first year of life, especially if babies have a serious infection?


So we'll look at all sides of the antibiotic and allergy debate. That's coming up.

And then, irregular bed times — a recent study showed that kids who have regular bedtime do better in school than kids who have irregular bedtimes. OK, that sort of makes sense. But could having an irregular bedtime during the preschool years — so like when you're three years old — could that affect school performance down the road at age seven? Even if they do have regular bedtime at age seven. So, how important is it for them to have regular versus irregular bedtimes at age three? We're going to a look at that and see what the long-term effects of that would be.

And then, I got a great one for you — vaccines and robots. Yes, vaccines and robots. And it's all I'm going to say about this one. If you want to know more, you just got to have to stay tuned. But trust me, the story is worth the wait.

And then, boosting vocabulary, research shows kids who enter kindergarten with the largest vocabulary have the best success in their academic pursuits for years to come. So how can you boost your child's vocabulary and give them a better chance for success? We'll explore those answers.

And then, I'm going to wrap things up with a final word that's sort of related to last week's program on food allergies. And that's EpiPens. Lots of moms and dads carry EpiPens around with them. Caregivers may have them as well. So if you're caring for a kid or you're the parent of the kid who has a severe allergic reactions and you're worried about anaphylaxis, you carry about an EpiPen. But do moms and caregivers use EpiPens correctly?


It turns out the answer is often no. In fact, very often, more than half the time, EpiPens are not used correctly, which puts the lives of kids with severe allergic reactions at risk. So I'm going to share the scope of the problem and let you know how you can feel confident using an EpiPen correctly.

And, by the way, for those of you who don't have kids with severe allergies, so you don't have EpiPens at home, I think this information is important for you, too. Because you never know when you'll be in a situation where somebody nearby is having a severe allergic reaction and a panicked caregiver — or if it's an adult, the panicked adult may be fumbling around and not sure what to do with the EpiPen, they're panicked, they're worried — you could save the day. You may be the most well-qualified person to do it, if you're up to snuff on using EpiPen. So, that's coming up as well.

Before we get started with all this, I do want to give you a quick reminder. If you have a topic that you would like us to talk about here on PediaCast or a question for me that you'd like answered, or you want to point me in the direction of a new story or journal article, it's easy to get in touch. Just head over to and click on the Contact link.

Also, I would like to let you know, 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. If you do 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

So let's take a quick break and I will back to talk about sibling rivalry and the rest of the news right after this.



Dr. Mike Patrick: All right, we are back. If you have more than one child at home, and if your children are old enough to talk, then you've probably phrases like "That's not fair!' or "You're not the boss of me!" or "She hit me" or "He started it". Fights between siblings, from toy snatching to exchanging punches in the back seat to vanishing one another from one another's bedroom, these fights are so common that they're often dismissed as part of growing up. But is sibling rivalry really benign? Or can it leave long-lasting scars?

These are the questions before researchers at the University of New Hampshire. Their study published in the July 2013 issue of The Journal of Pediatrics looked at sibling aggression across a wide range of ages and locations. Researchers analyzed data from the National Survey of Children's Exposure to Violence with a sample of 3,559 children from all parts of the United States between the ages of one month and 17 years.

Now, for children and teens — so those 10 to 17 years of age — and the parents of those 0 to 9 years of age, these people were asked questions pertaining to physical assault among siblings with and without a weapon, property aggression like stealing something or breaking an item on purpose, and psychological aggression like saying things to make a sibling feel bad, scared or not wanted.

Aspects of each child's mental health was also recorded with questions centered around feelings of anger depression and anxiety. And, exposure to non-sibling forms of aggressions was also measured, including non-sibling assault, non-sibling property abuse, non-sibling psychological bullying, child maltreatment from adults, sexual victimization, school and Internet bullying, and witnessing family and/or community violence.


So what did the researchers find? Well, first, sibling aggression is common with 32% of children or parents reporting one type of sibling aggression in the past year and 8% reporting two different types. Those who experienced one type of sibling aggression are more likely to suffer from feelings of anger, depression and anxiety. And those who experienced two or more types of sibling aggression were much more likely to feel angry, depressed, and anxious.

In fact, the more types of sibling aggression and the more frequently the aggression occurred, the more significant the mental distress. And these relationships held true even when forms of non-sibling aggression and exposure to family and community violence were factored in. So, those seemingly harmless negative interactions between siblings turns out they're not so harmless after all.

Dr. Corinna Jenkins Tucker, associate professor of Family Studies at the University of New Hampshire and lead author of the study says, "Even kids who reported just one instance of sibling aggression had more mental health distress. Our study shows sibling aggression is not benign for children and adolescents regardless of how severe or how frequent."

OK, so sibling aggression negatively impacts a child's mental health. Come on, it's not as bad as being bullied at school, right? Wrong. The mental health effect of physical, property and psychological aggression was the same regardless of the source of the bullying, home or school, family or acquaintances at school.

Dr. Tucker says an important implication of this research is that parents and caregivers should take sibling aggression seriously. If siblings hit one another, there's often a much different reaction than if that happened between peers. It's often dismissed, seen as something normal or harmless. Some parents even think it's beneficial as good training for dealing with conflict and aggression in other relationships. But this research paints a different picture and indicates that sibling aggression is related to the same serious mental health effects as peer bullying.


In addition to parents, the researchers also put pediatricians on alert with a call for them to play a role in sharing this information at office visits. Parent education programs can also make an impact with greater emphasis on sibling aggression and the inclusion of practical approaches to mediating sibling conflict.

So, moms and dads, the next time you hear phrases like "That's not fair," or "You're not the boss of me," or "She hit me," or "He started it," don't shrug it off. Make it your business to find out what's going on. Now, once you find out, it may be nothing at all. It could be your kids are playing or there's a minor frustration between them and one that's easy to work out. On the other hand, it could be the surface of a deeper problem, one of which you're unaware, one that does involve an ongoing pattern of physical assault, property damage or psychological bullying.

So don't shrug it off. Find out what's going on. Make it your business to know their business and if it needs to be dealt with, deal with it. Don't put it off. Your child's mental health may depend on you doing the right thing.

Use of antibiotics in early life may increase the risk of developing eczema by up to 40%. That's according to researchers at Kings College London and recently published in The British Journal of Dermatology. The research also found that each additional course of antibiotic during the first year of life further raises the risk of eczema by an additional 7%.

Investigators from King's College London, Guy's and Saint Thomas' NHS Foundation Trust, the University of Nottingham and the Aberdeen Royal Infirmary reviewed existing data from 20 separate studies that explored the link between antibiotic exposure prenatally, and in the first year of life and the subsequent development of eczema, an allergic skin condition.


They also examined whether the number of antibiotic courses affected the chances of developing the disease. In doing so, they found children with eczema are more likely to have been treated with antibiotics in the first year of life, while prenatal antibiotic exposure — so exposure when the babies were still inside mom, because the mom took the antibiotic — that did not make a difference.

Dr. Carsten Flohr, professor at King's College London and senior author of the study says, "A better understanding of the complex relationship between antibiotic use and allergic disease is a priority for clinicians and health policy makers alike, as determination of a true link between antibiotic use and eczema will have far reaching clinical and public health implications."

Another of the study's author, Dr. Teresa Tsakok adds, "One potential explanation is that broad spectrum antibiotics alter the gut micro flora and that this in turn affects the maturing immune system in a way that promotes allergic disease development."

A statement from the British Association of Dermatologists, in response to these findings, says, "Eczema is our most common skin disease affecting one in every five children in the United Kingdom at some stage and causing a significant burden to the patient and the health service. Allergic diseases including eczema have increased over the past decades, particularly for children in high income countries, but the causes for this are not fully understood. The evidence in this study is not conclusive and the researchers are not suggesting that parents should withhold antibiotics from children when doctors feel such treatments is necessary. But studies like this give an insight in the possible, avoidable causes and may help to guide medical practice."

The researchers also add a note of caution to their findings, explaining that the use of antibiotics may in fact be a consequence of an increased occurrence of infections in children with eczema. Further research is needed that carefully examines the sequence of events between antibiotic exposure in the first year of life and the onset of eczema.


So, this is an interesting study that follows along quite nicely with some of our recent discussions on PediaCast. We know that allergic disease — so like seasonal allergies and eczema and asthma and food allergies — we know these things are increasing in frequency, particularly in developed countries.

And we recently discussed a study that looked at parents who pick a fallen pacifier off of the floor, lick it or clean it off in their mouth before they give it to their baby — we talked about that recently — and how doing that appears to increase the numbers and varieties of mouth bacteria in babies, which you think would be a bad thing. But as it turns out, it appears that doing that and increasing the mouth bacteria in babies appears to decrease the incidence of eczema.

So, it seems that the presence of the bacteria may play a role in the normal maturation of the immune system and a decreased incidence of eczema. And we recently had a pediatric allergist on the program who hinted at the relationship between gut bacteria and food allergies and how the presence of bacteria in the GI tract might somehow play a role in the normal maturation of the immune system, resulting in decreased incidents of food allergies.

So it really comes as no surprise that we have a study that shows that antibiotics which kill mouth and gut bacteria might play a role in the development of eczema, which is an allergic skin condition. Of course, if the presence of bacteria in the mouth and GI tract, if their presence does play a role in helping the immune system to mature normally, and if their presence makes the development of allergic disease less likely, then that interaction is occurring by a yet to be determined mechanism.


Now, recall that the use of Tylenol has also been implicated in an increased incidents of asthma. Tylenol affects certain workings of the immune system and that's how it reduces fever. But is Tylenol really causing asthma? Or could it be that kids who are given antibiotics are also kids with fever, and kids with fever get Tylenol?

And there's also this to consider, we've recently illustrated how associations are not always causal relationships. Just because two things are associated does not mean that one thing caused the other, right? So does antibiotic use in the first year of life really cause an increased occurrence of allergies, asthma and eczema? Or could be that those more likely to develop allergic conditions are also more likely to suffer from skin infections and ear infections and other infections which results in these children being given antibiotics and Tylenol more often?

We don't know the answers to these questions. And until we do, the practical advice in my mind is simply this: if your baby truly needs and antibiotic and your doctor is urging you to give one, you should. But if your baby doesn't need an antibiotic and your doctor isn't suggesting you give one, you shouldn't. And it's probably best not to keep pushing for one as some parents are prone to do. Because while antibiotics are helpful and lifesaving in some situations, they do have risks and potential problems. Meaning, you and your child's doctor must consider the benefits and the risks of giving an antibiotic as those benefits and risks relate to your child's unique situation. Which further proves the point that medicine cannot and should not be practiced in a vending machine or cookie-cutter fashion.

I got another story for you from the United Kingdom. Going to bed at different times every night throughout early childhood — so having an irregular bedtime — appears to diminish a child's brain power. That's according to a large long-term study by researchers at University College London and reported in The Journal of Epidemiology and Community Health. And given the importance of early childhood development on an individual's health later in life, researchers say the implications of their findings may have broader consequences, ones that last a lifetime.


The authors looked at whether bedtime in early childhood was related to the outcomes of academic testing in more than 11,000 seven-year-olds, all form a part of the UK Millennium Cohorts Study. Now, the Millennium Cohort Study is a nationally representative long-term project comprised of children born in the United Kingdom between September 2000 and January 2002. Investigators examined the surveys and home visits which included information on family routines, including bedtimes when the children were three, five and seven years old.

The authors wanted to know whether the time a child went to bed and the consistency of bedtimes had any impact on intellectual performance as measured by validated test scores for reading, math and spatial awareness. And they wanted to know if the effects were cumulative and if any particular periods during early childhood were more critical than others.

Professor Amanda Sacker, director of the ESRC International Centre for Lifecourse Studies at the University of College London, says, "Early child development has profound influences on health and well-being across the lifespan. Therefore, reduced or disrupted sleep, especially if it occurs at key times in development could have important impacts on health throughout life."

So what did they find? Well, you know, actually, before we get to the findings, let's define irregular and regular bedtimes. That would help. According to the researchers, a regular bedtime was defined as going to bed every night at around the same time within a one-hour period. With 9pm being the latest time. An irregular bedtime vary by more than an hour each night or was routinely after 9pm.


OK, so with those definitions in mind, what did the researchers find? Well, seven-year-old girls with irregular bedtimes had lower scores on all three tests — math, reading and spatial awareness — when they were seven years old. However, this finding was not observed for irregular bedtimes in seven-year-old boys. OK, what if the irregular bedtimes occur at age five? How did that affect test scores when those kids were seven? It didn't.

OK, so irregular bedtimes at age five did not appear to affect test scores at age seven for girls or boys. OK, so what about age three? What if irregular bedtimes occurred then, would that affect tests scores when those three-year-olds turned seven? And the answer to that question is yes. Irregular bedtime at age three did have a significantly negative impact on reading, math and special awareness scores at age seven. And the relationship held true for boys as well as girls, suggesting the age of three years maybe a sensitive period for cognitive development.

The impact of irregular bedtimes also appears to be cumulative. Girls who never had a regular bedtime at ages three, five and seven had significantly lower reading, math and spatial awareness scores than girls with consistent bedtimes throughout the period. And the impact was the same for boys.

The authors point out that irregular bedtimes could disrupt natural body rhythms and cause sleep deprivation which may undermine the plasticity of the brain and the ability to acquire and retain information. Professor Sacker says sleep is the price we pay for the development of brain plasticity in early childhood, like at age three, and the investment needed to allow fresh learning during the school years. "Early childhood development has profound influences on health and well-being across the lifespan. Therefore, reduced or disrupted sleep, especially if it occurs at key times in development could have important impacts on health throughout life."


Researchers do point out that children with irregular bedtimes were also more likely to come from socially disadvantaged backgrounds which could also play a role in lower test scores.

So that last point is important. This is not the perfect study, because lower test scores were not the only difference between the irregular bedtime group and the regular bedtime group. There's also a difference in socio-economic backgrounds which opens the possibility of many confounding factors that could potentially affect test scores.

Now, on the other hand, the hypothesis and the points raised by the researchers, they make some sense. They aren't harmful and they're easy to implement. And I think most parents of three, five and seven-year-olds would like their kids to have a regular bedtime. But they may not follow through with that for a variety of reasons.

Maybe someone else is watching your child at bedtime because you have to work. And so you feel like you don't really have any control over it. You did not really pushed it.

Maybe you just have other priorities in the evening. You'd like your kids to get to bed at a regular time but you're busy doing something else. Maybe, bedtime is such a hassle, it's just easier to let the kids go to bed when they want to go to bed. And you've been doing it for so long anyway, they're going to really put up a fuss if you change things now.

Maybe you enjoy spending time with your kids late into the evening. You know they need to be in bed at a regular time but you'd rather spend time with them. Or maybe you had a strict bedtime as a child and hated it, and you feel guilty making your kids have one.

So regardless of the reason, maybe your three, five or seven-year-old isn't going to bed at a regular time, but in your heart you want them to. For those of you in that situation, I think the study provides a nice excuse for following through and implementing a regular bed time. And if your kids, especially the older ones, if they asked, "Why the change?" you can say, "Because it will make you smarter when you grow up. Dr. Mike said so."


That's right. You can blame me and that takes a little pressure off of you. But just between the two of us, OK, just between me and mom and dad out there, that claim does not come with a guarantee.


Dr. Mike Patrick: So, not the best study, but hey, regular bed time is not a bad idea.

All right. Let's move on to the robot story that I alluded to and it's not the first one we've covered. In the previous episode of PediaCast, Number 250 to be exact, we talked about robotic seal, as in the animal.

OK, so, a robotic seal helping hospitalized patients deal with the pain and stress of a serious illness. Well, a new study transforms the seal into a humanoid and moves up from the hospital setting to the clinic to see if their robot might help children cope when it's time for shots. Well, it turns out, a child-like humanoid robot does have the potential to comfort young patients during medical procedures and can make pain more tolerable.

Researchers at Alberta Health Services and the University of Calgary report in the June 2013 edition of The Journal of Vaccine that 57 children between the ages of four and nine were able to interact with the robot while receiving their seasonal influenza vaccine at Alberta Children's Hospital.

These children reported they experienced little to no-pain when compared to youngsters who look at images on the clinic's wall during their vaccination.

So, let me pause here for a minute. I have to say I would be a little bit disappointed if my kid get randomized to the look-at-the-picture-on-the-wall group rather than the you-get-to-play-with-the-robot group. Did they invite the picture-on-the-wall kids back to play with the robot once the study was over? I would hope so.

Lead investigator Dr. Tanya Beran says, "These results really do show the potential and benefits of using robotics to help manage a child's pain while having a medical procedure done. For instance, robotics can be used to help manage children's pain during blood tests and IV starts, and other painful procedures such as getting stitches or setting a broken bone. The opportunities are endless."


The robot named MEDi which stands for Medicine and Engineering Designing Intelligence was purchased by the University of Calgary's Schulich School of Engineering. MEDi can mimic many childhood activities. He can be programmed to walk, dance, talk with children, play games, make eye contact and even give a high-five.

Dr. Beran says, "From our earlier research, we found that children are curious, imaginative and receptive to interacting with a robot. They may see it as an extension of themselves or they may see the robot as a companion or even a friend."

Dr. Susan Kuhn, Chief of Infectious Diseases for Alberta Children's Hospital, says, "The MEDi robot could be a valuable tool for health providers who offer children vaccinations. Studies show half of all young children experience severe distress and anxiety when it comes to getting vaccinations."

She says, "Getting poked with a needle is uncomfortable and is often associated with pain, so children usually arrive crying and literally kicking and screaming. And any distress a child experiences early on carries over into adulthood. We want to create a more positive vaccination experience for children now so they can have a better experience later in life. We also found parents were more relaxed when their children were interacting with a robot during the vaccination visit."

This proved true for Jennifer Crawford, mother of five-year-old son, Jacob, who participated in the study. She says, "Anything that causes my child stress causes me stress but we were put right at ease after meeting the robot. Annual flu vaccines had always been a traumatic experience for Jacob. We used desensitizing lotion on the area of arm where the needle goes, but he would still be stressed before getting shots, and would have negative comments afterward.

But this year was different. The vaccine wasn't a big deal at all. You wouldn't even know he got vaccinated because all he would talk about for the rest of the day was the robot. The vaccination itself was almost like an afterthought as he told family and friends his robot story."


Dr. Beran is quite pleased with MEDi's performance and says he can also be programmed to deliver health information to children at a vocabulary level they can understand.

OK. So, I have robot envy now. That's what we need in our emergency department — a cool humanoid robot to help kids who are anxious. That would be great. And I'm sure many other doctors and moms and dads and children out there share my feelings.

All right, our final news story today comes from the proceedings of the National Academy of Sciences, which provide some advice on boosting your child's vocabulary without using additional words. Cues that parents give toddlers about words as it turns out can make a big difference on how deep their vocabularies go when they enter school. So says research out of the University of Chicago.

By referencing objects in the visual environment, parents can help young children add new words to their vocabulary. The study also explores the difficult-to-measure quality of non-verbal visual cues to word meaning during interactions between the parent and the child who's learning to speak. For example, saying, "There goes the zebra" while visiting the zoo and actually seeing the zebra helps the child learn the word "zebra" faster than saying, "Let's go see the zebra" when the child is home or in the car.

Differences in the quality of parents' non-verbal visual cues to toddlers — in other words, what a parent says in response to what their child is seeing — results in differences and vocabulary depth as kids in their kindergarten, with children whose parents provide high-quality cues having a vocabulary that is 22% greater than children whose parents provide low-quality cues.

Dr. Erica Cartmill, lead author of the project and a postdoctoral scholar at the University of Chicago, says, "Children's vocabularies vary greatly in size by the time they enter school. And because preschool vocabulary is a major predictor of subsequent school success, this variability must be taken seriously and its sources understood."


Now, previous studies have shown the number of words that youngsters hear greatly influences their vocabularies. And parents with higher income and more education typically use more words and talk to their children more frequently, which boost their children's vocabularies. However, that advantage for higher income families does not show up in the quality research.

Susan Goldin-Meadow, the Beardsley Ruml Distinguished Service Professor in Psychology at the University of Chicago says, "What was surprising in this study was that socio-economic status did not have an impact on quality. Parents of lower socio-economic status were just as likely to provide high-quality experiences for their children as were parents of higher socio-economic status."

Although scholars have amassed impressive evidence that the number of words a child hears — the quantity of their linguistic input — has an impact on vocabulary development, but measuring the quality of the verbal environment, including non-verbal visual clues to word meaning, has proved much more difficult.

To measure quality, the research team reviewed videotapes of everyday interactions between 50 primary caregivers, almost all mothers, and their children who were between 14 and 18 months of age. The mothers and children came from a wide variety, wide range of social and economic backgrounds. And these mother-child pairs were taped for 90-minute periods as they went about their day playing and engaging in other activities.

The team then showed 40-second vignettes from these videotapes to 218 adults with the sound track muted. And based on the interaction between the child and parent, the adults were asked to guess what word the parent in each vignette used when a beep was sounded on the tape.


Just for an example, just to give you an idea what exactly is happening here, that beep might occur when a parent's silenced speech for the word "book". OK, so the parent says the word "book". The adults who are watching these vignettes hears a beep, but the soundtracks have been silenced. So they have to guess what word the parent just said. And in the case of "book", the parent might have said it as a child approached the bookshelf or when the child brings a book to the mother to start story time. And in this scenario, the word was easy to guess because the mother labeled objects as the child saw and experience them so the adult could figure it out.

But in other tapes, viewers were unable to guess the word that was beeped during the conversation, as there were few immediate cues to the meaning of the parents' words. And vignettes containing words that were easy to guess were considered high-quality with regard to the non-verbal visual cue and the word meaning. And that those that were considered low-quality was when those adults couldn't guess what the parent was saying.

Although there were no differences in the quality of the interactions based on parents' socio-economic background, the team did find significant individual differences among the parents studied. Some parents provided non-verbal clues about words only 5% of the time, while others provided non-verbal visual clues 38% of the time.

The study also found the number of words parents used was not related to the quality of the verbal exchanges. Both early quantity and quality accounted for different aspects of the variance found in vocabularies of those entering kindergarten. In other words, how much parents talk to their children — quantity — and how parents use words in relation to the non-verbal environment — quality — provided different kinds of input into early language development.

The researcher say parents who talk more are, by definition, offering their children more words. And the more words a child hears, the more likely it will be for that child to hear a particular word in a high-quality learning situation. This suggests that higher-income families' vocabulary advantage comes from a greater quantity of input, which does leads to a greater number of high-quality word-learning opportunities. Making effective use of non-verbal cues may be a good way for parents to get their children started on the road to language.


OK. So, if you're confused by all these quantity and quality talk, the bottom line is this. Talk to your preschool kids, talk to them a lot. Use lots of different words. That's quantity. And when you're out and about and even when you're home, talk to them about what you and they are seeing. That's the quality part. Match the visual with the words and the words will stick better. Their vocabulary will grow and your child will have an educational advantage when they enter school. It's another practical idea and it's one that's easy to implement.

All right. That does wrapped up our News Parents Can Use this week. Let's take another break and I will be back with a final word right after this.


Dr. Mike Patrick: All right, we are back with the final word. Last week, we talked about food allergies and I know Dr. Rebecca Scherzer made it a point several times to say if your child is having a severe allergic reaction using epinephrine in an auto injector like in EpiPen is the most important thing you can do.


Well, it turns out that many parents and caregivers of children with severe allergies — whether that be food allergies or other allergies — many parents and caregivers have difficulty using devices to inject epinephrine effectively. And that's according to research from Imperial College London and presented at the annual meeting at the British Society for Allergy and Clinical Immunology.

An extreme and rapid allergic reaction, again, known as anaphylaxis can result in swelling the throat and mouth, difficulty breathing, collapse and loss of consciousness. Sometimes it leads to death. An adrenalin also know as epinephrine auto injector like an EpiPen can reverse this and other symptoms if it is used correctly. And when EpiPens are used incorrectly, researchers say children who suffer from anaphylaxis are at risks of the treatment failing.

Their project involved a 158 children with severe food allergies and their mothers who are given training in how to use an EpiPen. Six weeks after the training, more than half of the mothers were unable the EpiPen effectively in a scenario using a dummy.

Dr. Robert Boyle, a pediatric allergist at Imperial College, believes the EpiPen design is confusing for parents and caregivers. He says the design is not intuitive, especially in stressful situations where for example a child suddenly has difficulty breathing, or loses consciousness due to an allergic reaction to food. It is easy for parents and carriers to panic when their child has a severe allergic reaction, and so more effective training in how to administer epinephrine is essential.

The design of auto injectors is gradually getting better but it is still not completely obvious how to use one, taking into account the stress and suddenness of the situation. He adds, "Manufacturers must make more effort to design the EpiPen with the parent in mind at a time when they and the child are scared."

The mothers involved in the study were taught using an auto injector training device and were given written information, a consultation with a nurse and a treatment plan, as well as access to a relevant website. Six weeks later, the volunteers returned for a further assessment of their ability to use the auto injector and were filmed in a typical scenario, using a dummy.


It went something like this, over lunch the dummy child starts coughing and wheezing, demonstrating the signs of a severe allergic reaction. The mother gives the dummy child the epinephrine shot, administers basic first aid and calls the ambulance. More than half of the volunteers (58%) were unable to use the EpiPen effectively. The most common problem is not removing the caps. Others could not activate the auto injector or did not use the correct end of it. And using the incorrect end occasionally resulted in the mothers injecting themselves with the epinephrine instead of the dummy.

So, this is a serious problem even for mothers who have children with severe allergies at home who are carrying an EpiPen on their purse and who have had training.

So, here's my advice. If you are carrying an EpiPen, make sure you have played with a training device and feel comfortable with it. Many doctors and pharmacist have one or can get one. Second, watch a video every month or two as a reminder of the proper technique.

And even if you don't have a child with severe allergies and you don't carry around an EpiPen, as I mentioned at the beginning of the program, I think it's a good idea for you to watch this video as well so you aren't totally clueless in an emergency situation. And having watched the video it is possible that you'll be the most qualified person at the scene. That may seems scary to you but it could save a child's life.

And where do you find such a video? I have a fantastic one for you with a bunch of a really cute kids and it's produced by the good folks here at Nationwide Children's. I'll put link to it in the Show Notes for this Episode 260 over at So make sure you watch that. It's a really good video. Again,, find the Show Notes for 260 and I'll put a link to that video in YouTube for you. Then, you can share it with your social media network.

So make sure that you are comfortable with EpiPens whether you have a child with severe allergies or not. And that's my final word.


All right, I do want take a moment to thank each and every one of you for making PediaCast a part of your day. Also, I want to remind you that a two-week vacation is coming up, so we will be back with a new show in three weeks.

So, check out the archives in my absence. As I mentioned, I'll put a handful of my favorite shows in today's Show Notes for you. And I'll be back three weeks from today, August 14th, with a big, gigantic exciting announcement. So make sure you stop back by, again, August 14th.

Other reminders, iTunes reviews are helpful. A lot of you may have found the PediaCast because of iTunes reviews. And I would just ask that, basically, if you have not written an iTunes review, just please take the five minutes — probably not even that long — to head over to iTunes, find PediaCast and just write a quick review for us. It's really helpful in helping to keep PediaCast in front in the "What's Hot" list, so the parents who are looking for podcasts can find it.

So if you could continue to write those reviews, I'd really appreciate it. And those of you who have taken the time to write a review and there are several hundred of you who have done that, I just want to say thanks. Thanks for taking the time and writing that. I really, really appreciate it.

Also, links, mentions, shares, retweets, repins, all those things are appreciated. PediaCast is on Facebook, Twitter, Google+ and Pinterest. We also have a News Parents Can Use board on Pinterest that has some stories on it, that we add every week that aren't necessarily on the show. So, you'll find more News Parents Can Use than that's just on the podcast over on that Pinterest board.

And then, also, be sure to tell your family, friends, neighbors and co-workers about the program. We don't have a big marketing budget here. We just really rely on your endorsement and word of mouth to tell folks about the show.


And make sure you tell your child's doctor. So whether you're going in for a sick office visit or a well child check, make sure you let him know, "Hey, there's an evidence-based podcast that is, it's not dumb-down but it is in a language that parents can understand. It's really aimed at moms and dads." And hopefully, your physician will share the information about PediaCast with their other patients. And, we do have posters available to help them with that under the Resources tab at

Also, I want to remind you one more time, the Contact link is available for you at It's easy to find on the Show Note. It just says "Contact Dr. Mike," and you can click that link and ask questions, provide comments, suggest show topics.

You'll also find a link that says "Connect Now With the Pediatric Specialist from Nationwide Children's". This is for referrals and appointments. So, if you're interested in seeing one of the specialists here, it is the gateway in to the system. Because sometimes it's like, "Yeah, I'd really like to see one of the specialists, let's say, that we interviewed here on the show." Or your child has an issue that you would really like a second opinion on. Or you just really want an expert on the field to let you know what they think is happening. But, you know, how do you get connected with that person?

And so this provides an opportunity where you can connect now with the pediatric specialist by clicking that link. You provide your contact information. And then, someone from that specialty will get back in touch with you in terms of what you need to do to get an appointment. Sometimes that's going to mean going back to your primary care doctor and getting an official referral but they'll talk you through and tell you exactly how you go about doing it.

That referral maybe necessary for your insurance. So, it kind of is insurance-dependent. You may find someone who, a particular clinic, "Hey, they got in without needing a referral, but I need the referral?" That's because your insurance company. So, the folks here at Nationwide Children's in the Welcome Center, they know which insurance companies need a referral, which ones don't. They can just help guide you through that process and just make it friendly and easy so that you can see a specialist here.


So, take advantage of that link as well. It is a special link just for listeners of this program.

All right, so that wraps things up. Again, I'm going to be gone for a couple of weeks, back August 14th. And until then, 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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