Vending Machines, Video Games, Schoolyards – PediaCast 294

Join Dr Mike in the PediaCast Studio for more news parents can use. Topics include premature babies & brain growth, healthy snacks & vending machines, video games – good news & bad news, schoolyards & stress relief… and lacrosse injuries.


  • Premature Babies & Brain Growth

  • Healthy Snacks & Vending Machines

  • Video Games – Good News

  • Video Games – Bad News

  • Schoolyards & Stress Relief

  • Lacrosse Injuries



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 September 3rd, 2014, Episode Number 294, and we're calling this one "Vending Machines, Video Games, and Schoolyards".  

I want to welcome everyone to the show. It's another News Parents Can Use edition of the program. So, we've got lots of topics to cover and I'll get to the entire lineup in just a couple of moments. 

First, a little word of warning for you. Tooth number 14, and yes, a person's teeth are numbered in their mouth. In fact, actually, they're lettered if they're baby teeth and they're numbered if they're adult teeth. And I've had a little problem with tooth number 14 for a about a decade now. Not a cavity, as it turns out, it's something called internal resorption. It's where your immune system decides to attack a tooth. We don't exactly understand why that happens, maybe related to some trauma during childhood, but something happens and your immune systems decides that it doesn't like that tooth anymore. 

And so, this process ran its course over the last ten years, and I had to have tooth number 14 extracted, which actually wasn't as bad as I thought it was going to be. I know it just  sounds terrible. It's the first time I've ever had to have a tooth extracted. It's a molar on the left upper part of the jaw. I have to wait 12 weeks for the bone to heal, and then, I get an implanted post and then a crown put on it. 


Now, why in the world do I mention this in the course of a pediatric podcast? Not to garner your sympathy, although that's always appreciated. But I mentioned it, because you might hear a little occasional whistle in my voice the next few episodes, as air is not used to going between teeth number 13 and 15. There's a space there. It's a molar, it's in the back, it's not really all that visible. But you can hear it a little bit. I can, anyway. So I mentioned it, so you'll know why. 


Dr. Mike Patrick: So let's move on. A little too much information there, right? 

We'd like to remind you, we do have a sibling blog, the 700 Children's Blog at Nationwide Children's Hospital. You can find it Some recent topics, warning, we're going to talk about poop. See in my constipation episode, I said poop is an industry term in pediatric, and here's proof because our 700 Children's blog is using that terminology as well. So, if you'd like to a little bit about poop and kids, you can check out the 700 Children's Blog. 

Also, Five Ebola Facts, we want you to know. Back to School with Asthma, and speaking of asthma, our next show, Number 295, we're going to cover the nuts and bolts of asthma as well as mobile technology, mobile apps that you can use to manage your child's asthma. That's coming up next time. 

All right, what are we talking about today? Premature babies and brain growth, lots of preemies have school difficulties especially in the elementary years. But do those  problems persist into the middle school and high school years? And if they do persist, can you expect them to get worse or will they get better? We will take a look. 

And then, healthy snacks in vending machines. Traditionally, vending machines had been an outlet for mostly junk food. But what if that junk food was replaced with healthier options? Would sales plummet? Would consumers be satisfied? What would that look like in schools, college campuses, and the workplace. I'll fill you in on those details. 


And then, video games, good news and bad news. First, the good news, and you've probably seen this report because mainstream media picked it up and went with it.  Playing an hour of video games maybe beneficial. But just how beneficial and beneficial in what way? We'll dive deeper into the story, a little deeper than the 30-second news teasers that you've probably heard. 

And while this is good news for many teenage gamers, we do have some bad news, too.  Mature-rated, risk-glorifying video games, they aren't so good, even for only an hour a day. It's not just violent behavior you have to worry about; there are more associations that you should know, and we'll cover those as well. 

And then, schoolyards and stress relief, this is a cool story. Last summer, we talked about the benefit of getting kids outside to play. PediaCast, it was Episode 254, "Leave No Child Inside, Playscapes and Nature Camps", you might want to check that one out. It was a fun one to do. Today, I'll cover a new study that looks at the benefits of natural playscapes  and learning areas in elementary schools, middle schools and high schools. There are some school districts that are doing some pretty cool things and we'll talk about those. 

And then, finally, I'll have a final word on lacrosse injuries. We have some numbers on lacrosse injuries. As more boys and girls are playing lacrosse, guess what? More are getting injured. I'll let you know what kind of injuries and what you can do to prevent them. So that's coming up as well at the end of the program. 

Don't forget, PediaCast is your show, so if there's a topic that you'd like me to talk about, if you have a question for me, or you want to point me in the direction of the news article or journal article, it's easy to get in touch, just head over to Click on the Contact link and you can get in touch with me that way. Again, really easy to do, and I read each and every one of those that come through. 


Also, I want to remind you the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So, if you have a concern about your child's health, be sure to 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

Let's take a quick break and I will be back with News Parent Can Use right after this. 


Dr. Mike Patrick: All right, we are back. There are some good news for parents of pre-term babies. Latest research from the University of Adelaide in Australia shows that by the time they become teenagers, the brains of many preterm children can perform almost as well as those born at term. A study conducted by the university's Robinson Research Institute  has found that as long as the preterm child experiences no brain injury in early life, their cognitive abilities as a teenager can potentially be as good as their term-born peers.

However, the results of the study — published in The Journal of Pediatrics — also highlighted the quality of the home environment at the time of the child's birth plays an important role in their cognition later in life. Dr. Julia Pitcher, one of the lead authors of this study, says, "Every year, 10% of Australian babies are born preterm, and many studies have shown that these children often have cognitive difficulties in childhood. But this new study has some positive news. We looked at the factors that determine cognitive abilities in early adolescence, and found that whether or not you were born preterm appears to play a relatively minor role. Of significantly more importance is the degree of social disadvantage you experienced in your early life after birth, although genetics is also important." 


The study, conducted by Research Officer, Dr. Luke Schneider, assessed the cognitive abilities of 145 preterm and term-born young people who are now over 12 years of age. He also assessed data on social disadvantage at the time of birth and at the time of the cognitive assessment.

Dr. Schneider says, "The results of our study provide further proof that those born at term tend to have better cognitive abilities such as working memory, brain processing efficiency and general intellectual ability. But the postnatal environment seems to be playing an important role in whether or not a preterm child is able to overcome that initial risk of reduced brain development," 

He adds, "Reduced connectivity in the brain, associated with microstructural abnormalities from preterm birth, is likely contributing to the cognitive deficits in these children. But these abnormalities seem to be amenable to improvement depending on the environment the child grows up in, particularly as an infant, and might account for why some preterm children do better than others."

Dr. Pitcher concludes by saying, "What we don't yet know is how different factors in the home environment drive specific aspects of brain development. But early nutrition and enrichment through physical and intellectual stimulation are likely to have key roles."

So parents of preterm babies out there, especially preterm babies that grow up to be school-aged kids with some learning problems, you may see significant improvement in the teenage years. Maybe not quite on par with children born on time — ones who didn't have to face the challenge of premature birth — but perhaps close. As long as there wasn't a significant brain injury associated with the preterm delivery. 


Researchers say they believe nutrition and both physical and intellectual stimulation during the early years of development may play a role in cognitive ability by the teenage years, but we need additional research to prove those relationships. In the meantime, nutrition and stimulations certainly won't hurt, so if you have a preterm baby at home, be sure to talk to your pediatrician about important measures you can take to provide adequate nutrition along with worthwhile physically and intellectually stimulating experiences.

All right, from birth to a college. College students do not mind buying healthier snacks from vending machines. This, according to research published in the International of Food Safety and Nutrition and Public Health. The findings could have implications for campus health initiatives as well as vendor profits. The common stereotype of the busy college is of someone who grab a junk food snacks between lectures and one who rarely chooses a decent hot meal over a chance to share a beer or two with fellow students. Of course, we are talking about those who are 21 years of age or older. If the stereotype is an obvious generalization, one point remains true — snacks from vending machines on college campuses are popular.

Drs. Julia Lapp and Amy Prith of  Ithaca College have carried out an experiment on two campus vending machines in which they swapped out unhealthy, high in sugar, salt and fat snacks for healthier items, and then surveyed 200 students on their satisfaction and perceptions regarding the choices. No promotions or incentives were used to entice students to purchase the healthier options and the foods sold were not labeled as healthier.

The researchers found out that the environment and context in which consumers make dietary choices is important regarding perception of the foods being sold and the nutrition and related health risks. Moreover, vending machines snacks — available in schools and college campuses, and in the workplace — have been the object of scrutiny and criticism by public health experts, with a particular concern regarding the high levels of sugar, salt, fat and overall calorie content of the foods.


The team's study compared college students' perceptions and self-reported behavior regarding the food in vending machines before and after replacing a portion of the conventional food items with healthier options. 

So what constituted healthier options? The included vending machine snacks having fewer calories (less than 400 calories and for snacks and cereals, and less than a 150 calories for candy), limited added sugar (less than 5 grams), lower fat (less than 3 grams per serving), healthier fats, no trans fats, no artificial colors or flavors, and lower sodium (less than 140 milligrams per serving).

The key finding was that sales from the vending machines did not decline when healthier options were added. Moreover, students made aware of the healthier options were quite happy to have purchased those options, and the more athletic among them felt it was a positive change. Researchers say, "Results offer insights for promoting healthier choices and suggest that improving the healthiness of vending machine selections can serve all stakeholders: consumers, companies, and institutions." 

The findings suggest that there are significant benefits to students in offering healthier snack options without compromising convenience or taste. For the educational institution or the workplace, a healthier food offering boosts their social responsibility and supports institutional image, as well as improving student or staff wellbeing. And, for the vending machine companies, healthier and more options may translate into increased sales. The research team concludes by saying, "Results of our study suggest that introducing healthier choices to vending machines can indeed be a win-win-win proposition." 


So a healthier options in vending machines may be coming your way. But let's face it, you only live once and sometimes, a couple of Reese's  cups or whatever your bad-for-you snack maybe, sometimes that hits the spot. You know what I mean? Not every day, of course, but sometimes. Just keeping it real, got to keep those options in there too, in my opinion. 

I'm going to get myself in trouble over that one, but you know what I'm saying. Definitely, your daily choice ought to be healthier, but sometimes you need the Mars part, them part of the M&Ms.  OK, yes let's move on. 

A new study suggests that video game-playing for less than an hour a day is linked with better adjusted children and teenagers. See, I'm really going to get myself in trouble now. This research was carried out by Oxford University and found that young people who indulged in a little video game-playing were associated with being better adjusted than those who had never played or those who are on video games for three hours or more each day. 

Investigators found no positive or negative effects for young people who played moderately between one to three hours a day. However, the study which was recently published in The Journal of Pediatrics suggests that the influence of video games on children, for good or for bad, is very small when compared with more enduring factors such as whether the child is from a functioning family, the quality of their score relationships, and whether the child is materially deprived. 

This is thought to be the first study to examine both the positive and negative effects of gaming using a representative sample of children and adolescents. It involved nearly 5,000 young people, half male and half female, drawn from a nationally representative study of households in the United Kingdom. Participants, between 10 and 15 years old, were asked how much time they typically spent on console-based or computer based games. The same group also answered questions about how satisfied they were with their lives, their levels of hyperactivity and inattention, empathy, and how they got along with their peers.

The results suggest that three out of four British children and teenagers play video games on a daily basis, and that those who spent more than half their daily free time playing electronic games were not as well adjusted. Researchers speculate this findings could be the result of children and teens missing out  on other enriching activities and possibly exposing themselves to inappropriate content designed for adults when they spend too much of their free time engaged with video games. 


Meanwhile, when compared to non-players and those who played very frequently, those who played video games for less than an hour (estimated to be less than one-third of their daily free time), were associated with the highest levels of sociability and were most likely to say they were satisfied with their lives. They also appeared to have fewer friendship and fewer emotional problems, and reported less hyperactivity than the other groups.  

Study author, Dr. Andrew Przybylski, from the Oxford Internet Institute says, "Our results support recent laboratory-based experiments that have identified the downsides to playing electronic games. However, high levels of video game-playing appear to be only weakly linked to behavioral problems in the real world. Likewise, the small, positive effects we observed for low levels of play on electronic games do not support the idea that video games on their own can help children develop in an increasingly digital world."

Some of the positive effects identified in past gaming research were mirrored in these data but the effects were quite small, suggesting that any benefits may be limited to a narrow range of action games. Further research needs to be carried out to look closely at the specific attributes of games that make them beneficial or harmful. It will also be important to identify how social environments such as family, peers, and the community shape how gaming experiences influence young people."

Past research on non-interactive forms of entertainment have led to recommended time limits for how long children play video games, yet this study argues that such guidelines have little scientific basis. It suggests the relative benefits or risks of games vary widely in how they are structured and in the incentives they offer players.


Previous research suggests that roughly half of young people in the UK are light players, meaning less than an hour a day. Nearly one-third of children spend one to three hours, or roughly 10 to 15% of young people invest more than three hours daily or more than half of their free time each day playing electronic games. 

So we talk a lot about the importance of limiting screen time here on PediaCast, and I stand by that. But as with so many things in life, it becomes easy to go overboard on our recommendations, just like the vending machines. As it turns out, this is a quality-of-life issue for many kids, just like an occasionally Reese cup is a quality-of-life issue for me. And it does appear, at least according to the results of this study, that game-playing in moderation in about an hour a day range, in that amount of game playing may decrease stress and increase quality of life for our children. 

So that's some good news as it relates to video games, but I also have some bad news to report. Previous studies have shown that violent video games increase adolescent aggressiveness, but a new Dartmouth research finds, for the first time, that teenagers who play mature-rated, risk-glorifying video games are more likely, subsequently, to engage in a wide range of deviant behaviors beyond aggression, including alcohol use, smoking cigarettes, delinquency and risky sex. 

More generally, such games — especially character-based games with anti-social protagonists — appear to affect how adolescents think of themselves, with potential consequences for their alter-ego in the real world. The study from researchers at Dartmouth and published in the American Psychological Association's Journal of Personality and Social Psychology shows that mature-rated, risk-glorifying video games may also lead teens to try recklessly and experience increases in  automobile accidents, police stops, and willingness to drink and drive. 


Dr. James Sargent, a co-author of the report, says "Up to now, studies of video games have focused primarily on their effects on aggression and violent behaviors. This study is important because it is the first to suggest that possible effects of violent video games go well beyond violence to apply to substance use, risky driving, and risk-taking sexual behavior."

Dr. Jay Hull, lead author and chair of Dartmouth's Department of Psychological and Brain Sciences, adds, "With respect to playing deviant video game characters, we feel it best to follow the admonition of Kurt Vonnegut in Mother Night: 'We are what we pretend to be, so we must be careful about what we pretend to be.'"

Researchers conducted a longitudinal nationwide study involving more than 5,000 randomly sampled US teenagers who answered a series of questions over four years in telephone interviews.

They looked at a number of factors, including the playing of three violent risk-glorifying video games (Grand Theft Auto, Manhunt, and Spiderman), along with other mature-rated video games. They found that such games are associated with subsequent changes and a wide range of high-risk taking behavior and suggested this is due in part to changes in the users' personality, attitudes, and values, specifically making them more rebellious and thrill seeking. Effects were similar for males and females and were strongest among the heaviest game players — not weight-wise, but heaviest in terms of how long they played video games — and those playing games with anti-social protagonists.

So, as we saw in previous study, an hour a day of video games may be beneficial. But mature-rated, risk-glorifying video games, these are not beneficial and in fact may be harmful. So parents, don't only keep an eye on how long your children are playing video games but also pay attention to what they're playing. Even if they're  teenagers, you still want to be in their business and know what they're playing and how long they're playing that game. 


All right, let's move on. Playing in schoolyards that feature natural habitats and trees — and not just asphalt and recreational equipment — reduces a child's stress and inattention. This is according to a University of Colorado-Boulder study published in the journal, Health & Place. The study, one of the first of its kind to focus on the relationship between student access to green settings and stress also shows that working on class assignments or gardening in such settings provides stress-reducing benefits for you. 

Dr. Louise Chawla, lead author of the study and professor of environmental design at CU-Boulder, says "Many schools already offer stress management programs, but they're about teaching individuals how to deal with stress instead of creating stress-reducing environments. Schools are where children spend a major part of their life hours, so it's an important place to look at for integrating daily contact with the natural world because of the many benefits it brings."

Researchers found that natural-terrain schoolyards — with dirt, scrub oak and water features, for example — foster supportive relationships and feelings of competence. So, dirt, scrub oak and water features. Dr. Chawla says combination schoolyards that have at least some natural-habitat landscaping, even if they include built structures as well, can have positive impacts on children.

For the study, a variety of settings were observed including elementary-school students' recess in wooded and built areas; fourth through sixth-grade students' use of a natural habitat for science and writing lessons; and high school students' gardening for volunteerism, required school service or coursework.

The sites were located at a private elementary school in Baltimore that serves children with dyslexia and other learning disabilities, a public elementary school in suburban Denver with students from a range of socioeconomic backgrounds, and four public and private entities for teenagers — a college preparatory school, a public high school, an alternative school and an after-school program — all in Colorado.


Together the researchers logged more than 1,200 hours of observation. They interviewed students, teachers, parents and alumni and coded keywords from their interviews for their findings, among other methods.

Over three school years at the Baltimore elementary school recess site, 96 percent of students in the first through fourth grades chose to play in the woods when they had the option of heading either there, to a playground or to an athletic field. Wow, 96% of them chose to play in the woods. That's amazing. In the woods, the younger children freely engaged in exploratory and sensory-based activities. The older children cooperatively organized activities like building forts and trading found objects. 

Teachers at the Baltimore elementary school reported that the students returned from recess with longer attention spans. Some parents said the experience was empowering and critical to their child's well-being and social and emotional balance.

See, spending time in the woods is important. Just on a recent vacation, we went camping and really, it is relaxing. So I can totally see where this would be beneficial. That's anecdotal, of course. Students at the Denver Elementary School who completed assignments in a natural habitat found the process to be an escape from stress in the classroom and home. That's according to this study. Twenty-five percent of the students spontaneously described the green area as "peaceful" or "calm".  
There also were anecdotal observations — like mine — at the Denver school. In one case, for example, a group of menacing schoolmates were unable to provoke a student in the green space whose temper normally was quick to escalate.

According to Dr. Chawla, "In more than 700 hours of observations at the Denver school's green outdoor space, zero uncivil behaviors were observed, but there were many incidences of arguments and rudeness indoors, as there are at many schools."

Among the teenage participants throughout Colorado who gardened, 46% referred to calm, peace and relaxation in addition to other positive descriptors when reflecting upon their experience. They also gave four main reasons for their favorable reaction: being outdoors in fresh air, feeling connected to a natural living system, successfully caring for living things, and having time for quiet self-reflection.


See, these are things that are important not only to us, but to our kids as well. 

For schools that are interested in providing natural habitats for students but who only have built outdoor spaces, Dr. Chawla suggests tearing out some areas of asphalt or creating joint-use agreements with city parks and open space. She says, "Schools are really prime sites for an ecological model of health and for building access to nature into part of the school routine as a health measure."

So a great ideas with lots of benefits. The only drawback is probably funding. I should also mention, the outdoors and nature can be a bit dangerous on its own. So I was just mentioning that we went on a camping trip. And that was fun. It was relaxing; it was great. My wife on the other hand, she may beg to differ w with that assessment. As we were on a boat by Lake Erie, as part of it, and in the marina, she actually fell on the boat and on the dock and didn't break anything. No serious injuries, just bruised skin, lots of bruised skin, and of course, bruised pride as well. 

The more time you spent outdoors, in general, we can say it's more relaxing and stress-reducing but there are situations in which it may be actually stress-provoking. So, they didn't mention what the injury rate in the woods of that elementary school was. That would be an interesting thing to know. 

All right, that concludes this week's edition of PediaCast, our News Parents Can Use. I will be back with a final word on lacrosse injuries. We'll do that right after this. 



Dr. Mike Patrick: Yes, it's true. She actually fell off the boat into the marina. And luckily, there was a rescue attempt. I hurt my thumb in the rescue, but she didn't really take too much to that, considering her injuries as she bounced off of the dock and into the water. 

Never a dull moment. Let's move on. Lacrosse is one of the fastest growing high school sports in the United States, with more than a 170 students now playing the sometimes hard-hitting game. The growing participation numbers however mean that more young people than ever are at risk of injury in lacrosse practice and competition. In the study published by The American Journal of Sports Medicine, researchers from the Center for Injury Research and Policy here at Nationwide Children's Hospital and the Colorado School of Public Health, found that high school players experience 1,406 injuries over the four academic years from 2008 to 2012.  The overall injury rate was 20 per 10,000 lacrosse competitions and practices. 

More than 22% of those hurt had concussions, making that the second most common injury behind sprains and strains, which represented 38% of injuries. 

Researchers also found that while the rules for girls' lacrosse largely prohibit person-to-person contact, almost 25% of concussions in girls' lacrosse were a result of players hitting another player. Another 63% of concussions resulted from being struck by lacrosse sticks or balls. Most high school girls' lacrosse players are only required to use protective eyewear and mouth guards, and not the helmets and additional padding required for boys' lacrosse.


Dr. Lara B. McKenzie — one of the study's authors and principal investigator in Center for Injury Research and Policy at Nationwide Children's — says, "Lacrosse is becoming more and more popular across the United States, and it's a great way for high school students to be active. Still, we see injuries in the sport every day during the season. Our research shows that we need to do more and can do more to prevent those injuries."

Boys' and girls' high school lacrosse have different rules regarding person-to-person contact, and the study found that the number and kinds of injuries differed between the genders. Boys sustained 67% of the total injuries, and boys had a higher overall injury rate than girls. The most common mechanism of injury did not involve player-to-player contact. Typical examples include a foot pivot leading to a pulled muscle, and contact with playing equipment. For both boys and girls, injury rates were higher during competition compared to practice.

Dr. Dawn Comstock, another author of the study and professor of Epidemiology for the Pediatric Injury Prevention, Education, and Research program at the Colorado School of Public Health, says "Our findings contribute to evidence-based discussions of ways to prevent injury, including the current debate over whether girls' lacrosse players should wear helmets as boys are required to do. Concern over concussions in both boys' and girls' lacrosse underscores the need to learn more about these injuries, and further study will help those working to develop and implement effective injury prevention programs."

Players, coaches, officials, athletic trainers and parents can help make lacrosse a safer game by following these tips from the researchers in lacrosse organizations: one, strictly enforce all rules, especially those limiting player-to-player contact in both boys' and girls' lacrosse; two, learn the symptoms of concussion — any athlete suspected of having a concussion should stop play immediately and be evaluated by a certified athletic trainer or other medical professional; three, warm up properly, drink plenty of water, and rest after practice or competition; four, wear well-fitting protective equipment; five, be prepared for injuries before they happen by making sure procedures, such as emergency action plans, are in place to handle them. 


So keeping your kids safe as they play lacrosse is an important to do. And that's my final word. 

I want to thank all of you for taking time out of your day to make PediaCast a part of it. We really do appreciate you participating in the audience. Don't forget, we really also appreciate when you send your questions in or you have a topic that you'd like us to talk about, or want to point me in the direction of an article, whether it's a news article or a journal article. Either one's fine, and in just a moment, I'll let you know exactly how you can write in.

That does wrap up our time together. PediaCast is a production of Nationwide Children's Hospital. Don't forget PediaCast and our single-topic short format program, PediaBytes are both available on iHeartRadio Talk, which you'll found on the Web at and the iHeart mobile app for mobile devices. 

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We also appreciate you talking us up with your family, friends, neighbors and co-workers, anyone with kids or anyone who takes care of children. And as always, be sure to tell your child's doctor about the program. Posters are available under the Resources tab at 

And again, if you do want to write in, because you have a question or you want to point me in the direction of a news article, any of those things, it's easy to do, just go to and click on the Contact link. Just contact and a little form there, you fill it out, and I do read each and every one of those that come through. 


All right, that wraps things up. 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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