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  • Introduction
    Welcome. Doc Smo here, your pedcast host. I had an amazingly gratifying experience recently that I want to share with you, especially if your child is struggling in school. In today's pedcast, we are going to talk about some simple parenting task that is bound to help your children. Curious about what those tasks could be?  Then stay tuned to learn more in today's installment of Portable Practical Pediatrics. 
    Musical Introduction
    A Routine Talk Turns Extraordinary
    Recently, I was asked to speak to a group of parents of “at risk children” who had come to a family education evening to talk about how to maximize their children’s performance in school. We talked about the research that has been discussed on this blog many times. Specifically, I wanted to stress the factors that parents have control of that have been shown to improve a child's academic achievement;

    -Keeping TV’s out of a child’s bedroom and limiting screen time

    -Getting an adequate amount of physical activity and unstructured play

    -Having a diet rich with unprocessed foods

    -Getting an adequate amount of sleep.

    Well, the night this event occurred was actually the second time I had spoken at this church and talked about this topic.
    A Testimonial
    I thought my first talk with this group of parents had gone pretty well but I had no idea of how well.  At the onset of my next visit with these parents, an amazing thing happened.  Before we got into the talk, an older gentleman raised his hand and told me he had a testimonial to share. That's what he called it, a "Testimonial". He told the audience and me that he and his wife were raising their grandson who was currently in 4th grade and not doing very well academically. He said that he and his wife had decided, after hearing my first talk, to try getting their grandson a structured regular bedtime, free of screens and junk food to see what would happen. Specifically, they wanted to get him to bed early enough for him to get up the next morning without a fight. That was their goal. To do this, they completely restructured his bedtime: they removed the TV from his room and cut off screen time after 7pm. they insisted that he was to eat all of his food at dinner and was to get nothing no more after that. Bedtime was set at 8pm and enforced. Lights out and time to sleep.

     

    After doing all of this, they said the transition was nothing short of miraculous. He almost immediately stopped fighting about getting ready for school in the morning and actually woke up in the morning on his own. He also stopped fighting about going to sleep.  And the best thing is that his grades showed an immediate improvement. Whereas he had been struggling to keep up in school, now he was getting good grades! They said even his personality was more pleasant. They attributed all of this great stuff to him having a regular bedtime and adequate sleep. They had no idea that not having a structured bedtime, letting him play video games late into the evening, eating junk food at night, and falling asleep in front of screens was so detrimental to him.

     
    An Amazing Statistic
    Some of you may have read the book Nurture Shock. I wrote a book review about it a few years ago.  Listen to this shocking statistic that the authors of Nurture Shock discovered: a school aged child who has a one hour sleep deprivation on a chronic basis will, on average, perform 2 years younger than their chronologic age cognitively. That means that a 6th grader will perform like a 4th grader academically if they get 1 hour less sleep at night on a chronic basis.  Clearly, sleep deprivation is having a major impact on a young child's brain. Case closed and the young man in this story was probably a good example of sleep deprivation that was cognitively impairing. Whatever it was, it is great to see him doing so much better in school.
    A Parents Call to Action
    So here is my call to action for parents who have not developed a structured an...

  • Introduction
    Hello and welcome, I am your host, Dr. Paul Smolen, a board certified pediatrician with 37 years of practice. The other day, I was having a conversation with a mother about fever seizures. Her child had had one of these seizures and she found it extremely frightening. That's understandable. Anyone who has seen a child have a generalized convulsion can understand this mom's dread. During a seizure, it looks like the child is dying right in front of you.  I was explaining to this mom that fever seizures are almost always benign, are almost never harmful to the child, require no treatment, and are not even considered epilepsy. That led us into a discussion of a whole host of illnesses and symptoms that just 40 years ago were felt to "require” treatment but that was then and today is now! Today many symptoms and conditions don't require treatment and are recognized as temporary states that will resolve with time.  In today's pedcast, I thought it might be fun to go over some of the conditions and symptoms that pediatricians no longer recommend treatment for. Oh, what a difference a few decades can make. Stay tuned for about 10 minutes and I will show you just how much change there has been.
    Musical Introduction
    Less is More
    "Less is more." Have you ever heard people say that? Well, it is very true, especially, when it comes to treating the most common medical conditions children present to their parents. Take cough for instance. Yes, cough is a sign that something is wrong with the child and yes, it can be associated with very serious medical conditions but most of the time, it is simply the child's way of keeping their lungs clean during a viral respiratory illness; a useful but annoying way to prevent the child from contracting pneumonia.  Stopping this reflex is exactly the opposite of what parents should want to do but... I can't tell you how much cough syrup I prescribed at the onset of my career to stop this very useful reflex. After taking cough syrup, maybe the children who took it slept better when they were sick, but it certainly wasn't curing anything. It may have actually been doing some harm. In today's world of pediatrics, treating a cough is considered poor practice and even dangerous as we have talked about in many pedcasts in the past.

    And how about fever, the great buggy man for parents. Again, fever almost always means something is wrong, usually an infection, and certainly should not be ignored but not panicked over either. It turns out that fever accelerates healing and reducing a child's temperature can prolong the illness! I know this is a radical concept but fever actually helps a child get well! For most children, no fever medicine is needed at all unless the fever is extreme or the child is very uncomfortable. How refreshing is that!  In the era of almost no invasive bacterial illnesses thanks to vaccines, parents can simply "back away from the Tylenol bottle and take a more relaxed attitude about fever".

    And how about diarrhea, is that a useful thing for sick children as well? Of course it is! How else is your child's body going to get rid of germs and toxins that they have inadvertently put in their mouth? Creating a tsunami of fluid hosing down the inside of their intestines is a very effective way of ridding them of germs that can cause disease. We don't want to stop that and as you might expect, doing so with diarrhea medicine, prolongs the illness just like with fever meds. Again, mom, "back away from the diarrhea meds".

    This minimalist approach as I like to call it has now spread to the treatment of many of the classic pediatric disease: bronchiolitis previously treated with steroids and bronchodilators, bronchitis previously treated with antibiotics, fever seizures previously treated with strong anticonvulsants, gastro-esophageal reflux in babies previously treated with very potent antacids and anti-reflux medications, colic previously treated with narcotic drops,

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  •  
    Introduction
    I must say, that for the first half of my pediatric career, I was oblivious to the knowledge of how frequently and seriously bullying harms children. I just wasn't aware that bullying was at the root of a lot of the illness in school age children that I was seeing...until I began to ask. When I ask a child with a recurring stomachaches or headaches if anyone is bullying them and I see that tense facial expression form or possibly a little moistening of their eyes, then I know. I have learned in recent years to routinely ask about this important issue!  It is not surprising to me that I recently saw bullying on a list of the most frequent concerns of parents. In fact it was the number one worry among parents with school-aged children. Sounds pretty important and a topic that deserves an entire pedcast so in today's installment of Portable Practical Pediatrics, I’m going to bring you up to speed on some of the newest information about the important topic of childhood bullying.  Stay informed, stay engaged, and most importantly, stay tuned to hear this important edition of Portable Practical Pediatrics.
    Musical introduction
    Defining bullying
    Let's begin this discussion by defining what constitutes bullying behavior. Of course, there is a line between bullying, teasing, or practical jokes.   More on that in a few minutes. First let's talk hard-core bullying. Behavior that everyone agrees crosses the line into bully land.  These behaviors have to have the following features, what I will call the core features of bullying.

    Core Features:

    -To qualify as bullying behavior it needs to be repetitive  and delivered over an extended period of time.

    -Bullying behavior intends to inflict some type of harm to a victim. 

    -And finally, the target of the bullying behavior pits the stronger against the weaker.

    As it turns out that bullying is very very common among children, happening to 35% of children sometime between their school age years and their high school graduation. That means that one out of three children will be bullied during their primary school years. Given that as a backdrop, it is not surprising that 75% of school shootings are linked to bullying or harassment of the shooter and 15% of absenteeism from school on any given day is thought to be due to the bullied victims avoiding school. Mix together a bullied victim with some mental illness, and you may just get a school shooter.

    As for the methods that bullies use, there are four primary methods that they deliver their control over their victims:

    Method 1: Physical - This consists of hitting, slapping, pushing, pinching etc.

    Method 2: Verbal - Demeaning talk, manipulating relationships, threats, and verbal abuse.

    Method 3: Cyberbullying- Obviously a growing category of bullying behavior and one that parents need to be particularly aware of; things like using social media, a very public forum, to send cruel or threatening messages, posting lies about the victim or even embarrassing pictures.  Repeatedly sending threatening texts to a victim would also be an example of cyber bullying.

    Method 4: Ostracism- Purposefully targeting a child victim to be excluded socially from their peers by spreading lies and rumors or encouraging others to ignore the victim would fall into this category, something that children seem particularly good at.

     
    What is the difference between just being mean to someone and bullying?
    Is teasing bullying?  Well, it depends. Most teasing is not bullying but yes if it rises to the level to meet the three essential ingredients of bullying (repetitive, intended to harm, and delivered by a stronger child to a weaker one).

    Is saying something negative about someone behind their back bulling?- Well again, it depends. Most negative gossip is not bullying unless it meets the essential ingredients criteria of repetitive over an extended period of time, intended to harm,

  • Introduction
    Welcome. Doc Smo here, your pedcast host. I had an amazingly gratifying experience recently that I want to share with you, especially if your child is struggling in school. In today's pedcast, we are going to talk about some simple parenting task that is bound to help your children. Curious about what those tasks could be?  Then stay tuned to learn more in today's installment of Portable Practical Pediatrics. 
    Musical Introduction
    A Routine Talk Turns Extraordinary
    Recently, I was asked to speak to a group of parents of “at risk children” who had come to a family education evening to talk about how to maximize their children’s performance in school. We talked about the research that has been discussed on this blog many times. Specifically, I wanted to stress the factors that parents have control of that have been shown to improve a child's academic achievement;

    -Keeping TV’s out of a child’s bedroom and limiting screen time

    -Getting an adequate amount of physical activity and unstructured play

    -Having a diet rich with unprocessed foods

    -Getting an adequate amount of sleep.

    Well, the night this event occurred was actually the second time I had spoken at this church and talked about this topic.
    A Testimonial
    I thought my first talk with this group of parents had gone pretty well but I had no idea of how well.  At the onset of my next visit with these parents, an amazing thing happened.  Before we got into the talk, an older gentleman raised his hand and told me he had a testimonial to share. That's what he called it, a "Testimonial". He told the audience and me that he and his wife were raising their grandson who was currently in 4th grade and not doing very well academically. He said that he and his wife had decided, after hearing my first talk, to try getting their grandson a structured regular bedtime, free of screens and junk food to see what would happen. Specifically, they wanted to get him to bed early enough for him to get up the next morning without a fight. That was their goal. To do this, they completely restructured his bedtime: they removed the TV from his room and cut off screen time after 7pm. they insisted that he was to eat all of his food at dinner and was to get nothing no more after that. Bedtime was set at 8pm and enforced. Lights out and time to sleep.

     

    After doing all of this, they said the transition was nothing short of miraculous. He almost immediately stopped fighting about getting ready for school in the morning and actually woke up in the morning on his own. He also stopped fighting about going to sleep.  And the best thing is that his grades showed an immediate improvement. Whereas he had been struggling to keep up in school, now he was getting good grades! They said even his personality was more pleasant. They attributed all of this great stuff to him having a regular bedtime and adequate sleep. They had no idea that not having a structured bedtime, letting him play video games late into the evening, eating junk food at night, and falling asleep in front of screens was so detrimental to him.

     
    An Amazing Statistic
    Some of you may have read the book Nurture Shock. I wrote a book review about it a few years ago.  Listen to this shocking statistic that the authors of Nurture Shock discovered: a school aged child who has a one hour sleep deprivation on a chronic basis will, on average, perform 2 years younger than their chronologic age cognitively. That means that a 6th grader will perform like a 4th grader academically if they get 1 hour less sleep at night on a chronic basis.  Clearly, sleep deprivation is having a major impact on a young child's brain. Case closed and the young man in this story was probably a good example of sleep deprivation that was cognitively impairing. Whatever it was, it is great to see him doing so much better in school.
    A Parents Call to Action
    So here is my call to action for parents who have not developed a structured an...

  • Introduction
    Welcome, I am Dr. Paul Smolen, also known as Doc Smo and this is Portable Practical Pediatrics. Every once in a while I like to give my listeners a glimpse of what is new in pediatric research that can translate into practical knowledge.  I'm not talking about new high tech treatments for exotic diseases but rather new information that most parents can use in their everyday parenting. So here goes with a conversation about four, high quality, peer reviewed articles that I think you will find interesting. Stay engaged, stay informed, and of course, stay tuned.  Today's pedcast is brought to you by audible, the new way to digest books. For me, Audible has become my preferred method of exploring books, whether I am cutting the grass or driving in the car. Expand your world today by subscribing to audible. Just hit the link that accompanies this podcast to get started.
    Musical Introduction
    Article #1- Every year, most parents are put in the position of deciding if their children should get a flu shot or not. Is that flu shot important for your kids?  Is it worth all the effort, hassle, and expense to arrange for them to get vaccinated? It's only the flu, right? Besides, many parents claim that flu shots can give the flu to their children (not) and worst of all, my little junior hates shots. Why do I have to deal with this every year you may be asking? Which brings us to a recent excellent article by Dr. Mei Shang et al at the CDC.  Dr. Shang analyzed all the known pediatric deaths from influenza in the U.S. between the years 2010 until 2016. He discovered that 70% of those children who died from flu had not been vaccinated and that 1/2 of the those deaths occurred in children who were perfectly healthy prior to the having the influenza infection with no sign of asthma, diabetes, neurologic disorders, immune deficiencies or any other underlying complicating factors. This is new information since previously; we thought that most pediatric deaths from the flu were in children with pre-existing medical conditions. No, fully 1/2 of the deaths occurred in previously healthy children, most of whom were not immunized. What a shame. You can't do much to prevent your children from heaven forbid coming down with leukemia but according to Dr. Shang, you can likely prevent them from having a severe life threatening case of influenza. Dr. Shang's study also revealed that the most vulnerable children were those infants less than six months of age, too young to be vaccinated. Protecting them depends on vaccinating those around them and especially mom during pregnancy. Again, according to Dr. Shang, we are not doing too well at getting pregnant moms vaccinated, with only a 50% success rate in his sample.  I want you to factor all this into your decision whether or not to get your children vaccinated this fall.

    Take home message:  Is the flu vaccine perfect-no/ is the flu shot some seasons not very protective-yes/ but in most seasons, it is about 70% protective. If I knew that 7 out of 10 times I visited Las Vegas I would win money, I would go regularly. I'd be in. In the same way, you should plan on a seasonal flu shot for all your children since there is a very good chance, it will protect them from a severe influenza infection.

     

    Article #2- There has been a lot of talk about the safety of cough and cold medicines in children. We have talked about it quite a few times in the past on Portable Practical Pediatrics.  Yes, there have been deaths from children taking these medications and the CDC is strongly opposed to their use in children but how dangerous are they really?  To answer that question, Dr. Green from The Rocky Mountain Poison Control Center, looked at 4202 "events", where a child or their family sought treatment and evaluation for a specific symptom or symptoms that was related to taking cough and cold medicines.  67% of these events occurred when a child had an unsupervised ingestion and 13% of them were at...

  • Introduction
    Sometimes reality is so counter-intuitive, isn't it? If you had told me 20 years ago that some of the keys to raising healthy children would be whether a the child's family owned a dishwasher, whether they had a lot of people living in their home, whether there were pets living inside the house, or whether the children visited or lived near a farm, I would have thought you were a little crazy. It turns out that these factors, along with others, are super important to your children's ultimate good health. Interested in learning more? Then stay tuned for this fascinating edition of Portable Practical Pediatrics. But before we get started, I want to take a moment to thank today's sponsor, The TheChildrensTable.com, a food blog specifically designed for parents who have the important responsibility of feeding the little people in their lives. Take your food knowledge to the next level by following TheChildrensTable.com today.  I love it. I know you will too. Now onto today's post.
    Musical introduction
    Evidence for the Hygiene Hypothesis
    Every once in a while, someone just nails a new idea that explains a lot of things that many other smart people just couldn't see or figure out. One of those people is David Strachan who first noticed the relationship between the lack of germ exposure in early childhood and a child's ultimate chance of developing allergic diseases like asthma, eczema, food allergy, and hay fever. Since he first proposed this idea in 1989, numerous epidemiological studies have confirmed his observations.  Here is some of the evidence that has led to the conclusion that he was right and that babies need a broad exposure to lots of microbes, early in life, maybe even before birth, to avoid suffering from allergic diseases:

    Observation 1:  The more a young child is exposed to dust containing a diversity of fungus and bacteria in infancy, the smaller the chance they have of developing asthma

    Observation 2: Children growing up on farms or with indoor pets, who presumably are exposed to more animal waste and danders, have a lower incidence of asthma and allergies than populations of children growing up in cleaner urban environments.

    Observation 3: Children who are born by C-section and who are not exposed to as many microbes as children who come through the birth canal, are more likely to have allergic diseases. Many experts think this is due to the infant not getting inoculated with their mother’s microbes right from the moment of birth.

    Observation 4: Children who eat off of dishes that are cleaned in a high temperature dishwasher regularly are more likely to have allergic diseases. Again, sterilizing dishes reduces the kinds and amount of microbes that a child is eating and therefore changing the kind of bacteria and fungi that the child will carry in their gut.

    Observation 5: Children who get multiple courses of antibiotics or take a lot of antacids in the first six months of infancy, have a greater risk of becoming allergic, presumably because the diversity of germs is lessened by exposure to the antibiotic and antacids.

    I think you will agree, that this is all compelling evidence that the germs that a child does or doesn't carry, has a strong impact on how their immune system reacts to the world, especially when that exposure occurs early in life. To me that only makes sense. For thousands of years children have adapted to their environment by learning to ignore countless things that are foreign to them; things that they eat, breathe, and touch.  Only in the past 100 years or so, has the diversity of that environment been drastically changed. It seems like for children's immune system to learn to become "tolerant" and non-reactive to a wide variety of plant pollens, foods, and molds. To do this a child needs to have exposure to them frequently, early, and in exposures in great quantity and variety.
    Question 1
    But Doc Smo, why do allergists want to avoid exposure to dusts,

  • Pale Rider

    By Laura Spinney

    Hachette Books

    Help support DocSmo.com by buying this reviewed book or joining Audible.com using these affiliate links. You get Amazon’s best price and DocSmo.com earns a small affiliate marketing fee.  Thank you.








     

    Introduction

    Welcome to this book review edition of Portable Practical Pediatrics. I'm your host, Dr. Paul Smolen also known as Doc Smo. I just finished reading a fascinating book titled, Pale Rider, by British journalist Laura Spinney, a work in which she gives her readers a detailed look at the effect of a global influenza pandemic that is known today as The Spanish Flu of 1918. Ms. Spinney makes the case that this single event was the worst human tragedy in human history, killing an estimated 50-100 million people; a number greater that the number of deaths in both WW1 and WW2 combined! How did this tragedy happen and could it happen again?  Is this tragedy relevant for today's world population including your children? Find out and hear my review of this Pale Rider in this edition of Portable Practical Pediatrics, which is being brought to you by Audible, a place where you can sit back, rest your eyes, rev up your imagination, and listen to great books like Pale Rider. Consider joining today by clicking the banner displayed on my website, accompanying this post.

    Musical Intro

    The Spanish Flu From Every Angle

    Readers of Pale Rider will quickly realize that the author is a journalist due to her attention to detail and historical context. She points out that the Spanish Flu occurred within the backdrop of WW1, contributing to the spread and intensity of the disease. Ms. Spinney ferrets out an amazing amount of detail about the route of spread, susceptibility of different populations around the world, survival rates of different ethnic groups, available medical therapies of the time, and mortality rates. The author also goes to great length to describe the discovery and isolation of the influenza virus, its biology, and the history behind the development of an effective preventative vaccine. I have a medical degree and have more than a cursory understanding of the biology and natural history of viral infections, yet I found that the author's description of the basic science behind of Spanish influenza infections absolutely fascinating and quite informative. Readers will also learn how influenza got its name, how it help usher in the concept of universal healthcare, and how the Spanish Flu helped push scientist's and physician's understanding of disease, culminating in the modern paradigm of the germ theory.  Come to think about it, there are very few questions about the Spanish flu that Ms. Spinney did not address. Her book is very rich with detail and insight.

     

    The Magnitude of the Disease

    The Spanish Flu has been earned the title of the greatest human tragedy in known human history and many fear that it could happen again on an even bigger scale.  According to infectious disease experts of today, the world's next influenza pandemic is not a matter of if  but when.  Understanding as much as possible about how the Spanish flu was able to slaughter 2.5%-5% of the world's mostly young healthy population is crucial to keeping it from happening again.  Think about the magnitude of the crisis if 5% of today's 7 billion inhabitants of earth were to succumb to a global influenza pandemic; a disaster that translates to an increase in world deaths from the current 55 million/year to a whopping 350 million deaths/year.

    Critique

    Overall, I found Pale Rider a book that is very informative, thoroughly researched, and extremely relevant to today's world; a fascinating read and a book that will be very appealing to inquisitive readers with a strong interest in the history of disease and world history. But, readers who aren't ready to digest a great amount of historical detail may want to shy away from this book, however.

    Ms.

  • Introduction
    News flash-the world that your children are growing up in is a world full of chemicals.  We are just beginning to understand what these chemicals do to your children's health. Pesticides, manufacturing chemicals, jet fuel, chemicals in sunscreens and cosmetics, household chemicals, flame retardants, plastic packaging, medicines etc etc.   The EPA requires that manufacturers log their manufactured chemicals in a database and by 2012; they had logged 82,000 chemicals being manufactured and used in the U.S.!  Very worrisome, since many of these chemicals have strong biologic effects on children, persist in the environment long after use, have potentially damaging effects on a child's nervous systems, have the potential to alter a child's delicate hormone balances that regulate much of their physiology, and can even triggered some cancers. More on all that in a moment. In today's pedcast you are going to hear a discussion about one family of chemicals that you definitely need to be familiar with, namely pesticides.  Your child's long-term health may be on the line from exposure to these chemicals so it is upon you to familiarize yourself with these chemicals.  Stay tuned and I am going to fill you in on some of the essential facts parents need to know about the adverse health effects of pesticides on children and how you can avoid your child's exposure to them. Stay informed, stay engaged, and of course, stay tuned.

     
    How do pesticides work?  A Trip Down Science Drive.
    First let's define the type of products that make up the pesticide category; these include insecticides, herbicides, fungicides, and fumigants- all meant to kill or keep pests away. To understand the damaging effects of pesticides, we are going to need to take a brief trip down Science Drive to understand how pesticides work. Let's start with a quote from the World health Organization's 2008 report on Toxicity of pesticides on children:

    "Pesticides are toxic by design – they are BIOCIDES, designed to kill, reduce or repel insects, weeds, rodents, fungi or other organisms that can threaten public health and the economy. Their mode of action is by targeting systems or enzymes in the pests which may be identical or very similar to systems or enzymes in human beings and therefore, they pose risks to human health and the environment. Pesticides are ubiquitous in the environment and most are synthetic. There is growing concern about children's exposure to pesticides and their special susceptibility. Children are not little adults, and may have higher exposures and greater vulnerability at both high and low levels of exposure."

    In other words, in order for pesticides to work, they need to be toxic to living things like insects, fungi, weeds, and rodents. Unfortunately, the biochemistry and cellular machinery of insects, fungi, weeds, and rodents, isn't all that different from that of you and your children. Your children can become collateral damage in our war against pests, mainly by three mechanisms:

    Mechanism #1-By interfering with critical enzymes in the nervous systems of pests. To see this in action, just spray some insect repellent on some ants and watch what happens... first they stop moving, then they start shaking with convulsions, and then they die. This all happens within minutes of exposure. The ant's nervous system has been short circuited by the pesticides, the pesticide interfering with neurons talking to neurons. News flash, these are the same enzyme systems that control your children's nervous systems.

    Mechanism #2- By interfering with the organism's critical enzyme function such as enzymes that are needed to produce and use chlorophyll or even cellular energy itself. A cell that can't produce energy, no matter what type of organism it lives in, is destined to be a dead cell.

    Mechanism #3- By causing oxidation within the cells of the targeted organisms. Remember that word oxidation from chemistry class?

  • Introduction
    I hope you learned in part one of this series, how addicting and attractive social media and screens are to children. Addiction too strong a word you think? Think again.  Just watch many of today's teens with their smart phones. They are regularly having intrusive repetitive thoughts of checking their phones for updates and clearly become distressed when the phone stops working or is taken away.  In the addiction world that is called withdrawal. And once the addiction has taken hold, others can use it to strongly influence a child's specific thoughts, feelings, and actions, a process called "Brain hacking". Today, as promised, we are going to get into some specifics of what parents can do to guard against Internet addiction and brain hacking. Stay informed, stay engaged, and of course, stay tuned to this edition of Portable Practical Pediatrics.

     

     
    Screens are addicting and can become intrusive
    I know some of you are thinking that I am exaggerating the addictive quality of digital technologies and that I am blowing this issue out of proportion. I really don't think so and here is why.  Let me explain by using an analogy that makes sense to me. If you are a parent, you remember the tremendous, life-changing shift in your thought patterns that occurred the day your child was born. From the moment of your child's birth, you began to worry about the well-being of your child, constantly. Were they safe? Were they hungry or cold?  Were they, just OK?   After your child's arrival, your brain quickly became refocused and trained to be vigilant about this little person's well-being 24/7. These thoughts became automatic, intrusive, and constant in your head.  Like an itch that has to be scratched. Well, this is exactly what happens to a child who has become addicted to their smart phone and social media. They have developed an automatic, intrusive, and constant need to keep up with what is happening in cyberspace, just like a parent's need to always be vigilant for their child's well-being. But whereas, a parent's worry serves a greater purpose, social media doesn't and can become a major distraction for a child.
    How does a child's develop personal narrative and how do screens relate?
    So what's the big deal if a child spends a great deal of time with digital technologies and communication? They are still children, right? Yes, that's true but remember what is happening during childhood; your child is developing their worldview, learning to interpret the meaning of events they experience, and making sense of everything. They do this by taking note of the consequences of events and by watching how those around them react to these events.  This is the fundamental way our brains work; we learn to interpret the events and attach feelings to those events based on event outcomes and by observing the way in which trusted people around us are affected.

    Psychologists call this process, the development a child's  "personal narrative".  Of course, one's parents traditionally have the biggest input into this process...that is, until recently.  Prior to the 21st century, one's personal narrative was mostly about a child's family but not today; cyber based technologies have eroded that influence, devaluing the influence of parents and elevating that of peers and our culture at large.

    To quote well-known psychologist and physician, Dr. Leonard Sax, in his blockbuster book, the Collapse of Parenting, 

    "We now live in a culture in which kids value the opinion of same-age peers more than they value the opinion of their parents, a culture in which the authority of parents has declined not only in the eyes of children but also in the eyes of parents themselves."

    Sax, Leonard (2015-12-29). The Collapse of Parenting: How We Hurt Our Kids When We Treat Them Like Grown-Ups (Kindle Locations 355-356). Basic Books. Kindle Edition.

     
    How has technology affected parenting?
    You may be wondering.

  •  
    Introduction
    I don’t know about you, but I am saddened when I look at many of today's American children because so many are either overweight or frankly obese. Stop and think about how obesity can fundamentally change a child's entire childhood. Talk to a very overweight child and you are likely to hear a description of not being chosen to participate in sports with other kids, feeling chronically like a failure, having severe bouts of sadness and guilt, being embarrassed by their bodies, and resenting other children who are normal weight. For many of these overweight children, their childhoods are filled with isolation and shame rather than optimism and joy. Fact: America is now up to 35% of children being overweight, 20% of which are morbidly obese, tripling since 1970! What a tragedy.

     

    What has happened to us to make obesity rates far higher than they were just a generation ago? The major health problems for today's children aren't meningitis, pneumonia, or sepsis like in the past but rather obesity and the metabolic difficulties that extend from being overweight. So, the question that often pops into my head is, what changed in our culture that made this state of affairs happen and who is responsible for these changes? Why are children so much heavier than they were just a generation ago and most importantly, what can we do to reverse this horrible trend? Weighty important questions and topics that we are going to tackle in today’s pedcast. Stay informed, stay engaged, and of course, stay tuned.

     
    Musical Intro
     
    Moving in the Wrong direction
    For the first time in my lifetime, life expectancy of Americans is beginning to decline.  Many fear that when today’s obese children reach adulthood, they will suffer from a litany of degenerative diseases that come along with obesity shortening their life expectancy.  Don’t think obesity is associated with various diseases? Think again. It is now well accepted that heart and vascular diseases like stroke and heart attack, adult onset type 2 diabetes, hypertension, liver/gallbladder diseases, and some types of cancer are all associated with obesity in adults and children.  Look at the trend toward obesity over the past fifty years and you can't help but be scared about the future for today's children.

     

     
    How did we get here?
    Assuming that the physiology and metabolism of children today is the same as it has been in children for thousands of years, you have to conclude that something in the way we are raising our children is causing them to become ponderous.  Experts and researchers have many theories about what is causing many of today's children to become overweight and obese. It is likely that many factors are to blame.  As you will quickly see, there are a multitude of shifts and changes in 21st century childhoods that have converged to put more weight on children. Three major trends have been game changers however-- less physical activity among children, greater quantities and different kinds of foods being served to children, and what I call miscellaneous factors. Let's break these down a little further and see what caused the changes.

     

     
    Trend #1-Lack of exercise   Children today are spending, on average, 50% less time outdoors exercising than their parents did just a generation ago. Why is this so you ask?  Because of unintended consequences stemming from decisions that adults are making. Let me explain by showing you some examples:
         News Organizations such as cable news and newspapers:  In recent years, media outlets have been obsessed with childhood abductions leading all of us to develop a heightened fear of childhood kidnappings. We talked about this in my last pedcast about "Free Range" childhoods, where I pointed out that the risk of a stranger abduction is very low, but media exposure to these events is very high. Today’s parents have developed an irrational fear of letting their children outdoors unsupervised because of a what ...

  • Introduction
    Still not sure about if or when to get your children a smart phone or allow them access to social media? Dr. Paul Smolen here and I’m about to make that decision a little easier for you. In today’s podcast, I am going to give you my own insights as well as the insights of tech expert Roger McNamee, an insider in the creation of Facebook.  He has an interesting perspective about the power these tech giants have over your children.   He introduced me to the term “brain hacking technologies" that he says were designed to maximize and sustain the attention of both you and your children. Don’t you dare even think about not listening to Are Your Children Being "Brain Hacked", a vital edition of Portable Practical Pediatrics.
    Musical Introduction
    What is Brain Hacking?
    I have a link to Mr. McNamee’s full article in USA Today so you can read it for yourself, but I am going to introduce you to some of his insights in today’s pedcast. Every parent needs to take note of what he and many other experts think. Long time listeners of Portable Practical Pediatrics will recognize some of the themes, we have talked about them many times in previous posts. Here are the big ones from Mr. McNamee's USA Today article:

     

    Point # 1: Facebook took their lead from the gambling industry, using their techniques to “addict” its users to their content. I’m quoting from Mr. McNamee’s article now, “Like gambling, nicotine, alcohol or heroin, Facebook and Google-most importantly through its YouTube subsidiary-produce short-term happiness with serious negative consequences in the long-term user.“ The companies running social media are in the business of grabbing the attention of your children and they have learned to do it very effectively. Many of today’s children are becoming consumed by their smart phones, social media sites, and on-line chatting. You know this is true. Just go to any restaurant and watch the older children during their time there. They seem to be more focused on the texting and chatter in cyberspace than engaged with the people sitting right in front of them. And it doesn't just happen when they are with their families-the same behavior occurs even when they are with their friends. For this generation, social interaction seems to be much safer and preferable digitally than face to face. Whether it be video game, virtual athletics, a conversation with a friend, or flirting, social interaction seems to be happening for today’s children virtually-separated from the people they are interacting with. Children seem dependent and addicted to these devices.

     

    Point # 2: Big Internet companies like Google and Facebook know a lot about your children. Each word your child chooses to use on Facebook reveals things about your child’s education, socioeconomic class, buying habits, favorite stores, wants, and desires. Knowing these things, allows the tech companies to target your children like a cruise missile closing in on its target. As your children’s wants and desires change, so does their data and marketing campaigns social media giants focus at them. Your child’s online behavior allows these media giants to know what makes your children tick and leverage that information to their own advantage.

     

    Point #3: Once addicted, Internet companies can manipulate the moods of its users with the “News feed” it chooses to expose your children to. Your child is having a day when they are angry at authority figures in their life, we have a news feed for them that will justify and intensify those feelings. Your child is feeling depressed or sad one day, advertisers can take advantage of that by marketing products and services to them that will resonate with those feelings as well. The point is, once the addiction has occurred and the supplier of the digital content know your children's motivations and interests, your children becomes susceptible to the influence and manipulation of others,

  •  

     

     
    Introduction
     

    Doc Smo: Today's pedcast features child food expert Dr. Charlotte Rouchouze. Long time listeners to Portable Practical Pediatrics will recognize that name. She has been a guest on my show many times. She is also the force behind an excellent food blog called "The Children's Table". Recently I talked to Dr. Rouchouze about a topic that many parents and myself find confusing; how to read and understand a food labels. Artificial versus natural flavorings, this preservative or that preservative, artificial colors and sweeteners are among the things readers of food labels need to begin to understand. I thought my listeners might enjoy an opportunity to improve their food IQ with an expert like Dr. Rouchouze to guide them so don't go anywhere, here comes Dr. Rouchouze.
    Musical Intro 
     
     Why is important to learn to read food labels?
    Doc Smo: Why is it important for parents to know how to read and understand food labels?

     Let me just say I am the biggest proponent you will find of making food yourself, for a whole variety of reasons, but I am also very suspicious of terms like “unnatural” and “toxic” that are tossed around in the organic food world. Anyone who has ever tried to define “natural”, whether it be in the area of people, plants, food, chemicals, or anything else, knows that it is often a maddening endeavor. Just the other day, I was engaging in a fruitless debate with someone on a parenting blog about whether petroleum jelly was “natural” and whether that even had any relevance whatsoever. It’s unnatural! She said. Well, it’s derived from petroleum, which is natural, right? I said. (I like to stir the pot!) Does that mean it’s safe? No! Does that mean it’s bad? No!

    So when I read, on that same blog, an article about Target setting a goal to eliminate artificial ingredients from the children’s food at their stores, my ears perked up. When food companies use the term natural, what does it really mean? To be clear, I VERY MUCH in favor of food companies eliminating ingredients we know to be harmful, such as transfat. But this is a bit hazier. So lets take a look at some artificial food additives and see what we find.

     

    To be clear: any food additive that is present in packaged food has the FDA’s general stamp of approval called GRAS (generally recognized as safe). This is a given. At the same time, any food additive will undoubtedly also have a rabid base of detractors in self-help books and on natural lifestyle sites. Making sense of all of this is not easy. So let’s take a look.
    Preservatives
    Nitrates/Nitrites: it’s unclear whether nitrate-free has any meaning, considering the celery seed they use is also high in nitrites. “Natural” perhaps, but whether that means better is still a question. Consume cured meats, and that includes sliced turkey, with moderation since there is some evidence that nitrates can be carcinogenic.

     

    *What about sodium benzoate?

    https://en.wikipedia.org/wiki/Sodium_benzoate

    Safe but to be avoided- GRAS

     
    Natural versus Artificial Flavor:
     First there’s the question of natural vs. artificial flavors. I know that the last time I browsed the baby food section of my grocery store (which was last week), almost every mainstream product on the shelf contained “flavors.” I’m always wondering why the banana puree that it is supposed to contain doesn’t provide the banana flavor, but alas, most products do contain what they call flavors. Look no further than the Gerber Graduates products on the Target website, and see that all of them include flavors. I especially like the description of the Gerber Yogurt Melts, which states on the package that it is “naturally flavored with other natural flavors.” Ha! That sounds awfully complicated for something so natural! With the term “natural” flavors, people assume it just comes naturally from the food, but natural flavors are compounds isolated by food scientists from a wide variety of sources,

  • Introduction
    Recently, I was walking back from the tennis courts on a crisp winter day when I had a flashback to my youth. Suddenly, in that moment, I recalled the wonderful sensation of my childhood, being outdoors, free of immediate demands and responsibilities. I was just enjoying the air, the green, and the sky all around me. I could feel my mental state improve and my body and mind relax. You see, during my childhood, the only entertainment we had after school was to go outside and find things to do.  My memory of childhood was outdoors, walking, experiencing whatever the weather was serving that day along with whomever I could find to play with. My walk from the courts reminded me of the joyous feeling that my experiences of youth had created.  On that walk home, I began to wonder, what the children growing up today will remember as their happy place? Where will that place be that brings out the relaxation reflex in your children, twenty years from now? An interesting question and one that every parent should ponder because you have a lot to do with the kind of childhood your children have.  So stay tuned, for the next edition of Portable Practical Pediatrics where we will ponder the question of where your children will recall the joy in their childhood?  
    Musical Introduction
    Quick Detour Down Science Lane
    In the past few years, there has been an increasing recognition that for children, being surrounded by nature, improves many aspects of their psychological functioning. And, it turns out that this is especially true for children with ADHD. Here is a list of a few ways exposure to outdoors has been found to benefit children:

    -Being outside improves a child's mood

    -Being physically active outdoors reduces a child's chance of obesity

    -Being outside can often increase a child's feeling of well being and relaxation.

    -Exposure to the outdoors also has been shown to improve a child's ability to concentrate and control impulses that need to be controlled.

    -And finally, outdoor time has been shown to be restorative psychologically for children- the evidence is clear on that point.

     
    What is the reality of childhood today for many children-screen time is filling more and more of a child's day.
    What is the reality of a modern childhood today for many children? In a nutshell, the trend is striking and involves screens of all sorts, substituting for what previous generations called play. I know you probably get tired of me talking about the current generation of children as victims of digital technology and how this is changing their childhoods but I believe it is true. Sadly, the evidence is on my side. Don't believe it, consider these current facts:

    The average preteen spends six hours on entertainment technologies per day. For teens, the figure is nine hours. Digital crack.

    More than 50% of children consider themselves "addicted" to their smart phone.

    40% percent of children have difficulty falling sleeping. a problem that has been clearly linked to screen exposure.

    The average child spends only 50% of the time that their parents did outside despite the fact that the majority of parents feel outdoor time is important for their children.

    91% of today's children regularly play video games

    Between 50-70% of children in America have a TV in their room

    I think you can see that with increasing wealth along with other factors, childhood is being fundamentally changed for the next generation. How this will work out for them, only time will tell. Before you make up your mind about the new screen reality for today's children however, there are a few things I want to remind you about that we now understand about screen time and children:

    -Screens are isolating for children. They generally draw children away from social interaction and into a lonely place of gaming.

    -Screen time for children does not teach children needed social skills that real interpersonal interactions would.

  • Introduction
    Today's pedcast will be shorter than normal but of course, no less important or practical. Recently, I found an article that revealed some wisdom about how parents can improve the accuracy in their measuring of liquid medications that they give to their children. Getting the dose just right is an essential skill of parenting and one you must master. So stay tuned.  You don't want to miss this important installment of Portable Practical Pediatrics.

    Today's pedcast is being brought to you by the wonderful musicians who created the introductory music for Portable Practical Pediatrics, Duo Musagete- You can hear this track and other music, beautifully performed on their album, Bach to Beaser. I recommend that you get a copy today. I am sure that you and your family will enjoy their music. Find it on Amazon.
    Musical Intro
    It is Really Important to Measure Your Children's Medicine Doses Accurately?
    Ok, you are probably wondering why is it so important to measure medications accurately for your children? Because they contain biologically active ingredients that cause physical changes in your child's metabolism. That's why! And you only want to cause the changes that you intend. Get the dose too low and you won't get the therapeutic effect you want. Get the dose too high, and you are much more likely to cause side effects of that particular medication. No, we want to get the exact effect that we are after. If that is lowering your child's body temperature, let's do that correctly. If it's changing the bacteria that is growing in their middle ear causing an ear infection, let's make sure we get that peak antibiotic blood level where it needs to be to be most effective, but no higher. A lot of effort and energy has gone into determining the exact right dose for your child's weight and size for all medications so you need to do your part and make sure you follow the directions and deliver the medication as accurately as exactly as possible.
    Think Metric
    If your child's prescription is written using a certain number of teaspoons of medication to be administered, ask your child's doctor why they are writing the prescription that way. This method is very 20th century and old fashion. Prescriptions need to be written only using the metric volumes of milliliters or cc's. If they are still writing prescriptions using English measurements, your child's pediatrician needs to move into the 21st century. Yes, in the past decade, there has been a concerted effort to have all healthcare professionals write medication directions using metric volumes. English measurements of ounces are just not accurate enough. You learned those metric volumes and weights in elementary school. Put that education to work. Make your 5th grade teacher proud of you. Milliliters and milligrams for you guys, all the way.
    What Is the Best Device to Measure Medications for Your Children?
    OK, I have a confession- that article that I told you about in the introduction, it was actually written in 2008.  I admit, it is not hot off the presses but important, nonetheless.  In the article, the authors looked at how parents administer medications; spoon, dropper, measuring cups, or oral syringes. As I said before, spoons are totally out for measuring medications for children because they are totally inaccurate. Your great grandma did things that way but I want you to forget about using her method of measuring medications. Measuring with a spoon gives very inaccurate measurements.  As this article pointed out, spoon measured volumes varied from 1.5ml all the way to 9ml- a 600% difference. Don't even think about getting out a spoon to give your child a medication. Fortunately, most parents in the study chose to use either a measuring cup or an oral syringe, not spoons. Here is the big point of the study; it turns out that parents got the dose right much more often using the oral syringe than they did using the oral cup to give their children medications.

  • Topic Introduction-Story
    Doc Smo here. Thanks for joining me today for a lively discussion about children, food, and mealtime. Let's face it, parents with young children are expected to buy a lot of equipment. Here is just a short list: strollers, cribs, pack and plays, stair gates, changing tables, and maybe, just maybe, a high chair? This is just the tip of the iceberg of equipment that is marketed to young families. I've done a previous pedcast about rolling baby walkers in which I came down hard on these devices. I think you can save the $40 you would spend on a walker and instead, put it his or her college fund. But what about high chairs?  You know those sit on the floor, free standing chairs with trays, and straps, and a wide base?  Generally, pediatricians get involved with high chairs for two reasons;  when a toddler or older child falls out of their high chair or when a child has poor food intake because of a feeding problem.  Like the child I saw recently who had such poor caloric intake that he was falling off the growth curve at his 15 month checkup. (a condition that pediatricians call failure to thrive).  Poor oral intake of food is only one cause of failure to thrive but in this child, it was the big one.  When I asked the mother of this child how meals were served in her house, she told me that little Johnny, sat at his little table and chair, separate from the family and ate.  She tried to feed him down there but admitted that he wouldn't sit still for more than a minute or two before he gots up and ran around the house. He also was not interested in eating at mealtime, instead, snacking all day, mostly on crackers and milk. Most of the time, he ate by himself, not with the family and he didn't feed himself anything. I thought everything about his eating indicated trouble so I thought it might be useful to discuss, in today's pedcast entitled "Are High Chairs Needed for Today's Kids",  two questions: are high chairs needed today and are high chairs safe? Stay tuned and find out. Today's pedcast is being sponsored by one of my favorite blogs,  The ChildrensTable.com. There, you will hear a lot about the and savvy and sophisticated feeding of children. The site has been a featured link on my website for years. I love it. If you haven't heard about this wonderful blog, please... take a moment and check it out.  Always worldly, fascinating, well written, and informative. That's thechildrenstable.com.
    Musical Introduction
    Reasons to use high chair
    Let's start this discussion with a list of the reasons you should consider feeding your little ones in a high chair:

    The Convenience - Having a safe place to feed your older infants, toddlers and young preschoolers is fantastic. Pop them in and mealtime is on. No struggling to keep them still, no trying to hold them down in anyway!

    Parent Freedom- Having junior safely ensconced in the high chair allows the feeding parent a little freedom to organize, multitask, and serve the food.

    Supports Younger Feeders- Allows younger eaters to sit up since there is some support from the chair. This is useful for children from about 7months to 9 months of age.

    Puts Parent and Child Eye to Eye-I think this is a big one. High chair feeding gets a child at the right height to feed and communicate with them. This is very important since we now know that parent's transmit attitudes about food to infants by their body language. Parent and child being face to face allows this communication to happen. And while we are talking about it, having mom or dad eating the same food that baby is consuming also transmits the message that the food is good!

    Safety-This is one of the most obvious reasons to pull out the high chair-stability and safety, as long as child not left alone and is properly restrained. More on that in a moment.

    Reduces Chance of Choking-I don't have stats or studies to prove this but my intuition tells me that having a young,

  • Topic Introduction
    I read a lot of articles about child health and one that caught my eye recently came from a weekly newsletter that is created by the staff of fellow North Carolina pediatricians, the Salisbury Pediatric Associates. The article that I am going to discuss today was written by pediatrician Dr. Christopher Magryta. In it he posted ten goals for parents and children for the New Year. I thought his goals were so useful, practical, and full of wisdom that I wanted to share them with you.  I think each of Dr. Magryta's goals will help you kick off the New Year in a great direction, for both you and your family. So here goes, straight from Dr. Magryta in his own words.  I hope you find it as inspiring as I did. Don't miss today's post, 10 New Year Family Goals
    Musical Introduction
    Dr. Magryta's Ten Family Goals for the New Year
    I am going to read you, Dr. Magryta's ten personal and collective goals he thinks we should all set for both ourselves and our families that he laid out in his December 11th, 2017 post. So here goes as I read from the newsletter:

    "What are some goals that we can set for personal and collective growth this year?

    1) I think that meditation/prayer is a unique human need to balance and calm the modern monkey mind of negativity and self doubt. The world will not get less complex or easier from a stress perspective. Let us teach our kids how to balance at young ages.

    2) Let us spend much time teaching our children to see the individual first and not the peripheral biased opinions of color, creed or gender. Expect people to be good until they prove you right or wrong. Make it a point to be nice to anyone who is unlike you. Make others feel accepted. That pay it forward attitude can only grow.

    3) Keep working hard on your families eating habits with the goal of moving towards a whole food, limited refined foods organic local farm fresh diet. Read Michal Pollan's Food Rules.

    4) Exercise as a family daily. Family walks are a favorite in our house as it offers collective conversation, movement and unity all at once.

    5) Say you are sorry when you mess up! Let your kids know that you are human. Perfection is unattainable and anxiety over it is unnecessary. Parenting is very very difficult for me and I am supposed to be an expert! Do your best and love yourself and your kids daily, especially in the storm.

    6) Read as a family every night!. Try to keep screens off during the school week. Sunday night at 5 until Friday night at 5 is a 120 hour period of family time uninterrupted by the screen babysitter. Please do not bring your phone, ipad or other device to the dinner table ever! It hurts me to see kids on screens at dinner siloed in their lost world of useless games.

    7) Consider joining a mission trip, community or church giving experience to teach your family the act of giving and living with others regardless of who they are.

    8) Aim to sleep in adequate amounts nightly. Consider melatonin if you have trouble falling asleep. Avoid screens at night.

     

    9) Spend time with an elder person to tap their wisdom, exchange conversant energy and be a part of their life.

     

    10) Keep setting goals and aiming higher overtime. You are worth a moon shot every year!"

     
    Comment
    One of the things I really enjoy about Dr. Magryta's perspective is his sense of optimism and understanding that we are, to a large degree, in control of our children's health by the decisions we make about their nutrition, sleep habits, exercise frequency, screen time, attitudes toward life, and their mindset.  Their overall worldview. He doesn't dwell on negativity but rather stresses what positive actions parents and children can do to make their lives better and more meaningful.  What could be timelier than to consider Dr. Magryta's ten goals for 2018? Let's all try and live them, shall we? I know I will.
    Outro
    Thank you for sharing a few minutes with me to discuss your children's health and w...

  • Topic intro
    21st century pediatricians are getting used to being consulted about child health problems in new and unique ways- via email, by way of video calls, and yes, with texts.  So it was the other day when I got a few texts, with photos, about my 9-month-old great nephew's outer ear and scalp. These texts were sent by my niece, the baby's mother. Her son had developed some redness behind his ear that looked angry to his mom. Interestingly, the previous week, both his six-year-old brother and mother came down with culture proven strep throat.  Very interesting, now little Elliott has a skin infection behind his ear. Could they be related, my niece asked? And my answer was... you bet they're related. Which brings us to today's pedcast topic-skin infections in children.  Specifically we are going to address the following questions:

    Why do children get more skin infections than adults?
    Are there different kinds of skin infections in children and if so, how are they classified?
    What are the best treatments for common skin infections in children?
    Can skin infections be prevented?
    And, was there a reason that Grandma insisted that her children wash behind their ears?

    So sit back and take a listen to today's pedcast that I call, "Grandma Knew, Wash Behind Those Little Ears".

     
    Musical intro
    Why do kids get skin infections?
    Let's start with the first question, why do children get more skin infections than adults. If you think of your skin as a barrier to the germy outside world, the answer becomes obvious. Any situations that break that barrier and introduce germs to a broken outer protective layer of skin, you, know, the epidermis of the skin, increases the chance that the child will develop a skin infection. Remember, kids are different than adults in a number of ways: they have thinner skin than adults that is easily torn, they are much more active than adults  making injuries more likely, they definitely have more abrasions and cuts than adults because they move way more, they hang out with children who carry lots of mean germs making inoculation of their broken skin more likely, and they are just dirtier. Their fingers are in their noses, in the trash and dirt, and scratching dirty parts of their bodies far more than adults.  All of these factors increase a child's chance of contracting a skin infection.
    What germs cause most skin infections?
    Which germs are most likely to infect a child's skin you may be wondering? It turns out that two nasty germs account for almost all the skin infections in children and their names are probably familiar to you...staph aureus and streptococcus pyogenes. Yes the same strep that causes so much misery in the form of strep throat in children. Both are bacteria that have the ability to latch onto broken skin or even invade the skin and tissues below. In very rare cases, they even make it into the child's blood and cause overwhelming life threatening illness. Fortunately, this is rare. Usually staph and strep infections of the skin stay fairly superficial. When strep is the cause of the infection, crusting of the skin is the most common feature, often with a dried honey look. Staph, on the other hand, tends to go deeper faster, causing pustules and boils along with blistering of the skin, the so-called bullous (meaning blister) type of skin infection. To be complete, I should mention that there are viruses and fungi that can infect skin but these types of infections are much less common. Staph and strep are the big bad players when it comes to skin infections.

     
    How are skin infections classified?
    Now we are going to talk about how doctors classify skin infection but to do so, we are going to get a little more technical. I'm going to teach you some doctor speak. Impetigo, or infantigo as some people call it, refers to a condition where the very surface layer of the skin becomes infected... you know, the epidermis. Actually,

  • [display-podcast]
    Topic Introduction
    I've got a very interesting subject to talk to you about today that I discovered while listening to a podcast! Yes, not only do I make podcasts but I am an avid listener of them as well. In this particular podcast, I heard Dr. Cal Newport, a computer scientist, interviewed about the negative effects  of interruptions on learning, memory, and creativity. I thought that what he was saying had so much relevance for your children that I couldn't wait to introduce my listeners to his research and ideas. Please take a few minutes to listen to this post that I call Distraction Free Thinking Vital for Kids. The message is so vital for all parents to hear that I don't want you to miss it.
    Musical Introduction
    The Essence of Dr. Newport's Research
    First, a confession. I have not read Dr. Newport's book, Deep Work, Grand Central Publishing, 2016, but I have heard him speak in a fairly extensive interview and I feel I have a good grasp of his main idea! He has coined the term "Deep Work" to describe the kind of quiet uninterrupted thinking time that scientists tells us unleashes our brain's best creativity and important thoughts. The kind of quiet contemplation that so many great thinkers have used to create great works. Dr. Newport says there is  good evidence that any interruption to deep work thinking derails and diminishes the creativity of the work we do and degrades our learning ability. I am sure that includes not only your best thinking but also your children's. In fact, deep work is probably more important for your children to achieve than it is for you since you have likely completed your education and they have not!
    Your children live in a super distracted world
    Now, let's consider the distracted world your children are immersed in today and how it can negatively affect them.  Even in the quiet of their bedrooms, they likely are having their studies and thinking time interrupted by texts, cell phone calls, and popup instant chat requests on their computers. They have likely fallen prey to the idea that multitasking is efficient and desirable. It's not! Working with frequent interruptions is rapidly becoming the reality for today's children. Unfortunately, not only does this short attention span work lead to sloppy thinking, but likely contributes to the growing incidence of ADHD. Let me remind you, frequently interrupted learning is totally new. Just a generation ago, most children's study place  (likely their bedroom or library) was devoid of all electronics and communication devices. Likely a much quieter place than the bedrooms of today. A place that was much closer to an environment conducive to producing what Dr. Newport describes as deep work.

     
    Limiting access to technology is often unpleasant but necessary
    I think it is safe to say that every parent want their children to get the most from their education. But for today's children, the constant distraction of technology limits achievement.  This is the point Dr. Newport is making.  I'm sorry, but you can see that this forces parents to be at odds with their children's wishes to immerse themselves with technology.  It's my opinion that you must deal with this issue.   If parents keep the goal of maximizing their children's education as their overarching goal, they just can't avoid putting their mark on their children's study environment. Unfortunately, that intervention is likely to lead some conflict. More on that in a moment.

    I think Dr. Newport's research has illuminated the fact that the fewer interruptions your children have when they are doing their schoolwork, or mastering cognitive tasks or just being creative, the better. Their learning, memory, and creativity will be better without distractions. That means limiting all electronics, phones, tablets, TV's, and possibly even some types of music in the places where they study and think.
    The current smartphone addiction

  • Topic Introduction
     

    Recently my son called me to ask me if I recommended that children grow up and live with pets, specifically dogs? Interesting question Benjamin. Actually, there is a lot of new interest from by both psychologists and immunologist around this question. Since I'm always looking for subjects that parents will find both practical and informative I thought this would be a good topic for a post.   So today, we are going to take on the following questions; are there emotional benefits from children growing up around dogs and does the presence of a dog in the home improve the health of babies and children?  Stay tuned for this thought provoking and informative pedcast I have called, 6 Reasons Babies Benefit Living w/ Pets.

     
    Musical Introduction
    Emotional benefits children get from pet ownership
    Let's start with the emotional benefits of living with and being responsible for the well being of a dog. Recently I saw an article in INC. magazine that claims there are scientific, proven advantages for children when they live and grow up with pets, specifically, dogs. Glenn Leibowitz, the author of the article, enumerated four strong emotional reasons for parents to consider dog ownership when their children are growing up.

    Dogs make children happy-This reason is pretty easy to see when most children are near dogs. They light up. Yes, there may be a little fear but also a strong urge to touch, pet, and play with.
    Dogs help children learn to care for others- Children from a very young age understand that dogs require care and living with them gives the child a chance to flip the roles from being the one who is cared for to the one who is actually providing the care. Invaluable!.
    Dogs make children gentle-Every child who plays with dogs eventually crosses the line between play and actually hurting the dog. Recognizing that they need to be gentle and that the dog can be hurt with rough play is an important lesson for any child to learn.
    Dogs foster independence-This just makes sense. Dog ownership demands that everyone in the family accepts some responsibility for the care of the dog. Mastering these tasks allows children to learn to become self-starters, learn new skills, and develop future thinking and judgment skills; all prerequisites to independence.

     

     
    Science Drive: Physical Benefits of having pets in your home
    Fair enough.  I think most of us would agree that children get emotional benefits from pets but Doc Smo is going to take Mr. Leibowitz's arguments one-step further. Now we are going to shift gears and discuss the emerging medical research that has found strong physical reasons for parents to consider having a furry creatures living under their roof, especially when their children are babies. To do that, we need a quick tour down "Science Lane" to get some basic science concepts nailed down for you. Let's learn about your baby's immune system's development.

    We live in a very germy world so it is vital that babies be born with some ability to recognize and defend themselves from germs that they will encounter. At birth, although fairly weak, they are able to turn on what is called their innate immune system when presented with an infection or threat from the outside world. The innate immune response consists of fever and increased numbers of killer white cells. After a few months of age however, babies begin to use a much more targeted and powerful part of their immune system called the adaptive immune system, that can, as the name implies, adapt and target invading germs. So you can see that a baby’s immune system, both innate and adaptive is developing when they are very young. More and more pediatricians are realizing that having a healthy immune system development is critical for the child's long-term good health. Those early experiences with a variety of germs is literally teaching your baby's immune system what is friend and what is foe!

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    What to Do if You Worry Too Much

    by Dawn Huebner, PhD.
    Topic Introduction
    Doc Smo here. Thanks for joining me today. Recently, I found a good book to help an anxious kids that I am going to share with you today in this book review pedcast. I must say, I love doing book reviews for my listeners because I learn so much in the process of exploring the catalogue of contemporary parenting books and at the same time I give my listeners a little taste of the author's wisdom. Today, I am going to do a review of a book that a mother of one of my patient's introduced me to when the subject of her son's anxiety came up at his checkup recently.  This mom and her son had found the book titled, What to Do When You Worry Too Much, very useful and I hope you will too. And don't be fooled; even though child doesn't appear in the title, this book is written for children. If you have a son or daughter that worries more than you think they should, you won't want to miss today's book review pedcast. Stay tuned.
    Musical Introduction
     
    What questions are answered in this book?
    As I said, today's book is titled, What to Do When You Worry Too Much, by clinical psychologist Dawn Huebner. The book is one of a series of books published by the American Psychological Association in their What-to Do Guides for Kids series. Obviously, this one focuses on anxious children and answers two important questions:

    How can a child learn to recognize that they worry too much?
    How can an anxious child learn to cope with their own excessive worries?

    Recognizing that a child worries too much
    First, how does a child or the child’s parent know if the worry is out of the boundary of normal? All children worry some, right?  Dr. Huebner says this comes down to two factors; recognizing that physical symptoms like stomachaches, headaches, dizziness, or fatigue frequently are manifestations of childhood anxiety and, admitting that the level of worry is affecting the child's friends and family in not such good ways; things like not being able to sleep by themselves or sleep at other children's homes, being irritable for no reason, clinging to parents especially in public, and getting frustrated more easily than their friends do. More on this subject in a very recent pedcast by yours truly.
    Helping Anxious Kids
    Once the child recognizes that they worry excessively, Dr. Huebner offers three strategies to teach the child to manage their worry. She describes these strategies in a way that a child can understand and practice, all illustrated with kid friendly drawings. I think that the techniques that she offers are quite doable, realistic, and practical for school age children who are motivated to learn to manage their own anxiety.
    Doc Smo's opinion
    I found the book nicely written with language appropriate for children between about 6-12 years of age. I think you will find it practical, fun to read, and overall a useful resource for anxious children and their parents.  I think because of the way it is written, this book is best suited for elementary age children. I also think the publisher made a mistake however, in not making the illustrations color. I think this would have made the book much more visually appealing and interesting.  That being said, if you have a little one in your house who seems to worry more than you think they should, I recommend that you pick up a copy of What to Do if You Worry Too Much.  I think you will find it a good place to begin helping your young worrier. I give it 4 out of 5 Doc Smo stars.
    Outro
    Enjoy learning about pediatrics with pedcasts and don't want to miss my new podcasts? Take the plunge and subscribe on iTunes or at my blog at www.docsmo.com. I would appreciate a review or like on my Facebook page, DocSmo.