Archive for the ‘Pediatric Insider information’ category

Homemade slime isn’t hurting your child

March 20, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

Another day, another internet scare. This time it’s about that homemade slime, and all the toxins and poisons in it – the ones that are pretty much killing our kids. Except there aren’t any toxins, and kids aren’t getting sick.

This rumor started with an article from the Daily Mail, a British “newspaper” that Wikipedia has deemed “generally unreliable.” In the fine tradition of crappy supermarket tabloids, the Daily Mail is on a par with the National Enquirer, the Star, the Sun, and Weekly World News – it’s a site that makes stuff up, or blows things crazy out of proportion to sell newspapers. Admit it – you were tempted to buy that cheap paper that proclaimed that Hillary was from Venus, or that there’s a Miracle Cream that Allows People to Grow a Sixth Toe. The story was amplified by a blog post at “This talk ain’t cheap”, where the author points out in the second sentence that she’s “not a doctor or a scientist or a chemist.”

As is the manner of clickbait about things hurting children, this one has been posted -n- reposted on Facebook and parenting blogs. In an effort to make sure the barn door is firmly bolted shut now that the horses are long gone, let me give you the quick version: there’s nothing in homemade slime that’s likely to hurt anyone, as long as it’s “used as directed.” Don’t eat the stuff, rub it in your eyes, or lie in a bathtub of it for an hour. Other than that, it’s safe.

We’ve still got an unopened box of borax and bottles of glue downstairs from my youngest’s “slime phase” last year. You mix up a bunch of chemicals (See! Chemicals! That’s your first warning, right there!!) to make a sort of gooey, hand-clinging, squishy mess. It even makes comical sounds when you squarsh it around between your hands. Harmless fun?

The Daily Mail article focuses on one ingredient in homemade slime, pointing out that boric acid (Borax) is labeled by the European Chemicals Agency as ‘toxic to reproduction’, and potentially irritating to eyes and lungs. The box in my basement says those things, too. Don’t eat it, and don’t rub it in your eyes, and don’t stick your face in the box and whiff it. If your children are too young to handle this on their own, they probably shouldn’t be making slime without supervision. Apart from the breathless and frightening tone, The Daily Mail’s critique of Borax is at least reasonably close to the truth. It’s conceivable that an unsupervised or particularly reckless child could get hurt by the stuff. It’s also possible that some kids could have more-sensitive skin, and could end up with a rash or the itchies (do I need to say: if your child gets irritated skin after playing with slime, he or she should stop playing with slime. The same is true if your child gets itchy skin after petting a cat or eating finger-fuls of cookie dough.)

But the blog post goes a step further, heading off the rails of the worry train. The blogger points out imaginary dangers of other ingredients, like glue. She says white glue – essentially, Elmer’s – can cause anxiety, convulsions, seizures (both convulsions AND seizures!), respiratory failure, and loss of appetite. Except none of this is true. In the manner of googlers-who-call-themselves-researchers everywhere, the author mistakes one kind of glue for another. Elmer’s white glue causes sticky hands, but is otherwise non toxic. What she’s quoting are side effects of huffing industrial glue or model cement, which is a different product entirely, and is not an ingredient in homemade slime.

There’s also shaving cream – which the blogger implies contains carcinogens and “very controversial” ingredients. I think of it as something people rub on their faces (men, typically), legs (often women), or all over the walls of the shower (children). If you’re afraid of your children touching shaving cream, I cannot help you.

By the way, homemade slime also contains water (AKA deadly dihydrogen monoxide) and often food coloring (I believe green is best, but mixing green and purple makes a hideous and wonderful color called “ocky” that has a certain charm.) A complete recipe is here. You can also make it with other, non-borax compounds like cornstarch or laundry detergent.

Parents, if your kids are taking a break from their iPhones to do something fun and icky with their hands, let them enjoy themselves. It may get messy, and you don’t want them (or the dog, or even the cat) eating their homemade slime. But it’s pretty much harmless fun. Today’s lesson: don’t let the internet scare you.

Fight the Fearmongers: MTHFR variants are nothing to worry about

March 13, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

Another day, another scare. Honestly, if you take Facebook and The Interwebs seriously, we’d all be dead three times over already.  (By the way: Facebook and the Interwebs would make a good name for a 2000’s cover rock band.)

Here’s one that’s come up a few times at my office this month: parents worried about MTHFR “mutations” that are making themselves and their children sick and vulnerable to all kinds of diseases. It’s another example of alarmists taking advantage of a tiny speck of science to scare you and sell things. Don’t believe any of it.

Background: MTHFR stands for…. Ah, forget it. Who cares what it stands for. It’s a shorthand name for a gene that encodes a protein that does important things involving the metabolism of the vitamin folic acid.

It turns out that there are hundreds of variations in the MTHFR gene we all carry. Genes, actually, with an “s” – we all carry two copies. Some variations work more or less efficiently, and a few very rare ones don’t work well at all. But the important thing to remember is that these are examples of the normal variation of our species. Having a different MTHFR gene from your neighbor doesn’t make you strange or broken.

In fact, having these variations is very common – so common, that variation is the rule, not the exception. As we learn more about these variations, the percentage of people with “variants” continues to go up – maybe about 60% of us, now, have at least 1 copy of a “variant.” And since almost all of the variants work just fine, this doesn’t matter at all.

 Part of the problem comes from the language of genetics, and the way gene science is depicted in the media. Use the term “mutant” and you think Patrick Stewart lifting things with his mind. A mutant is changed gene – and in science, that term is used for one-time or rare events. These MTHFR things are NOT mutants, at least not in the way a genetic scientist would use the word. Having one of them will not give you a tail, allow you to change the weather, or make lasers shoot out of your eyes. It also won’t make you or your child more likely to get sick.

The correct, more-specific word for what I’ve been calling “variants” is “polymorphisms.” These are genes that are different in subtle ways, and have become fairly common in a population. Hint: if a polymorphism made you sick, people with it wouldn’t reproduce, and the polymorphism would become rarer. Polymorphisms that don’t change health (like these MTHFR polymorphisms) can spread and linger in a population, like blue eyes or the ability to taste a tiny speck of cilantro.

Nonetheless, there are scads of web sites out there pushing MTHFR testing, and trying to sell books and products to people with these polymorphisms (which, as I mentioned, are most of us.) This is called “fear-mongering” –creating fear of a non-existent disease to get attention and make money. I’m not going to link to any of these sites, but here’s a sampling of some of the headlines and what the sites are pushing:

  • The MTHFR Gene Mutation And How To Rewire Your Genetics – Note the use of the scare-word, mutation. And, of course, you cannot rewire your genetics. Nonetheless, this site pushes worthless genetic testing, suggests treating non-existent yeast infections, encourages the use of a dozen supplements you don’t need, and suggests “detoxing” with coconut charcoal. Absolute, bat-shit nonsense – all for a made-up health scare.
  • Someone calling themselves “Your Functional Medicine Expert ®” (followed by 16 letters – do not trust anyone who has more letters in their “degrees” than in their own name) has her own top ten list of things to do for what she calls your “mutation.” Some of these are perfectly healthy for all of us: get exercise, eat leafy greens, spend time in the sauna. But she goes off the rails, too, referring people to a “trained biologic dentist” and “dry skin brushing” to detox da chemicalz dat’ll killz ya.

There are also alt-med freakshow sites that somehow link MTHFR variants as a warning against (of course) vaccines. This is an absolute crock.

Bottom line: genuine medical geneticists do not recommend MTHFR testing. Just because something sounds sciency doesn’t mean it’s something that is going to kill you. Don’t worry about things because you read about them on the internet. Go hug your kids, enjoy some sunshine, and take a break from Facebook and the Interwebs. Their show is starting to get old, and you’ve got better and healthier things to do with your time.

What’s the exact, best age to start solids for your baby?

March 9, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

A commenter objected to advice I’ve given about when to start complementary foods in infancy:

Why, when the WHO, UNICEF, and the AAP all recommend exclusive breastfeeding until 6 months of age, do you still have the introduction of solid foods at 4 months. It’s confusing for women who want to do the right thing for their child to come across your articles on starting solids at this age. Study after study show the benefits for both mother and child of exclusive breastfeeding until 6 months.

I wouldn’t rely on WHO and UNICEF recommendations. I’m not so sure that what they say is entirely relevant to babies in the developed world. I’m going to focus here on the AAP recommendations, which reflect the needs of babies in the USA and other highly developed countries.

Current AAP recommendations are deliberately vague about the precise timing of introducing solids. They say that complementary foods shouldn’t be introduced “until 4 to 6 months” – see the phrasing in this abstract and under point 2 of this article. Since AAP recommendations automatically expire 5 years after they’re published, there isn’t a valid AAP published statement on this exact issue right now. These two citations reflect the most-recent recommendation: solids can be introduced during a window of time, from 4 to 6 months.

Why then? Earlier solids are associated with obesity and nutritional problems; later solids are associated with feeding issues, iron deficiency, and an increased risk of allergy. The 4 to 6 month window maximizes nutrition while minimizing allergy risk, and works well for most babies.

But it is a window, not an exact time. We don’t have any research that says 4 months is perfect, or 5 months is perfect, or 6 months is perfect. I know of no studies from a developed country that show an important health advantage of starting to feed at six months rather than four, or starting at four months instead of six.  Probably all of these times are fine. The absolute best time depends on a baby’s development and temperament (as well as the family’s style and feeding preferences.) There’s no perfect, one-size-fits-all answer here.

When I talk about this with families, I try to figure out what the baby thinks about all of this. A 4-month-old baby who’s watching his siblings eat intently, or lunging at their food, or becoming disinterested in the breast or bottle – that’s probably a baby that’s ready to be fed solid foods. Babies of the same age who aren’t so interested in food, those babies can wait another month or so. And if solids aren’t going well at first, it’s fine to stop and wait a few weeks before trying again. We can make all of the plans we want, as parents and pediatricians – but the bottom line is that this is one of many decisions that babies help make on their own. Good for them!

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When to start solid foods, and what to start with

Want to avoid celiac? Don’t delay wheat past six months

Beware melatonin supplements – their labels lie

February 27, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

About 36 billion dollars will be spent on vitamins and nutritional supplements in the US this year. It is a huge industry, with big advertising and PR budgets. Maybe it’s time for the manufacturers to spend a little money figuring out how to deliver honest and accurate products.

Tests on a variety of supplements have already shown that most of them are contaminated – many with toxic metals, like lead and arsenic. And a new study of one of the most popular supplements, melatonin, shows that most of the brands available have doses far different from what’s on the label.

Researchers in Canada purchased 31 melatonin products from stores in Guelph, Ontario (IKR! I didn’t know there was a Guelph in Ontario!) They analyzed the content of tablets, liquids, and chewables, and found that few of the products contained their labeled dose. 71% of the products were off by more than 10%, with the actual content of melatonin ranging from 17% to 478% of the labeled dose. There was a huge variability even among the same brand, with different bottles varying by 465% in content. Their research was published in the February, 2017 edition of The Journal of Clinical Sleep Medicine.

Potentially worse: 26% of the samples contained serotonin, a contaminant that can cause serious side effects, especially when combined with a variety of medications.

Though these samples were purchased in Canada, there’s no reason to think melatonin products sold in the US would be any more consistent. Neither country has any laws or standards established to regulate, test, or ensure the quality of “dietary supplements” including melatonin, vitamins, or any so-called “natural” or “herbal” products. In other words, there’s no reason to think that you’re getting what you think you’re getting.

There are some voluntary industry standards, and at least that’s a start. The press release about the melatonin study suggested that consumers from the USA look for a “USP Verified” logo certification from the “United States Pharmacopeial Convention.” I could only find one brand on the USP website of melatonin that’s been certified – “NatureMade” (scroll down the bottom, here. Oddly, the Amazon entries for these products don’t indicate that they’re USP certified.)

Many people purchase herbs and supplements for a variety of reasons – and there are some good clinical studies showing that some of them may help (many others, not so much.) But it doesn’t matter what the studies show if what you’re taking isn’t what’s labeled on the bottle. If the supplement manufacturers want to genuinely help people stay healthy, they need deliver a consistent and reliable product. Otherwise, it’s just smoke, mirrors, and empty promises that might make you sick.

Welcome to Guelph

Ibuprofen or acetaminophen: Which is better for treating a kid’s fever?

January 30, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

Ask babies with fever how they feel, and they’ll say… well, they probably won’t say anything, because they’re babies. But ask older kids, and they’ll look at you funny, and maybe say “Why are you asking me?” Kids these days, am I right?

Fevers make kids feel bad. Achy and miserable and bleh. So for comfort, I think it’s a good idea to treat fever in a child who’s uncomfortable. What’s important isn’t the number – how high the fever is – but how the child feels. Feeling bad? Let’s help you feel better.

(By the way, even though they make your child feel miserable, fevers will not harm your child in any way. Don’t be afraid of fevers.)

To treat a fever: first, offer extra fluids. Fevers are dehydrating, and a popsicle tastes good. Then reach for a fever reducing medicine, typically a brand of acetaminophen (like Tylenol) or ibuprofen (Advil or Motrin.) But which one’s better? A November, 2016 study in Clinical Pediatrics gives ibuprofen the edge, though not by much. Ibuprofen worked a little faster (peak effect in 90 minutes, versus 2 hours for acetaminophen), and lasted somewhat longer (by about an hour, though there was a lot of variability.) My usual advice is to use whichever one you’ve got at home and what’s seemed to work best in the past.Although serious side effects are rare, either medication can cause serious problems. Acetaminophen, especially in overdoses, is toxic to the liver (so be careful using this in a child who already has liver disease.) Ibuprofen, especially with prolonged use, can cause gastric irritation and bleeding, and rarely kidney problems. It’s important to use what you’re using correctly, at the correct dose and at the correct interval (both can safely be given every 6 hours.)

Which brings us to another idea: if either is good, can a combination of them be better? In an alternating strategy, one drug is alternated with the other, so something is given every three hours, and the same drug comes around for a dose every six. Several studies (summarized here) have shown that this can reduce fever somewhat better than either drug alone, but with a much greater chance of medication errors and overdoses. If you want to try this, write down what you’re giving and when, and make sure you (and your spouse) understand the schedule.

There are a lot of myths about fever. 98.6 F is not and has never been the “normal” temperature. Fevers, themselves, cause no harm. They also don’t help very much. In the modern world, fever is not a necessary or particularly useful part of your immune response. If a fever is making your child feel bad, treat it. With acetaminophen or ibuprofen, your choice.

Not feel good by Sophie

Most natural remedies aren’t

January 17, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

Rachel wrote:

My daughter and I were talking the other day and saying we would like to ask a doctor what his thoughts are about all these ‘natural’ remedies that are available. Recently a friend made the remark, ‘I do everything I can to avoid a doctor.’ I lean more toward the medical system and the knowledge they have acquired over the years rather than relying on these home remedies. What are your thoughts?

A great question, Rachel. It turns out that many of these “natural” remedies aren’t very natural at all. Something should be considered “natural” if it exists in the world around us – if it’s a part of the observable, real world we live in – and a part of our world that we didn’t create or imagine. Trees and rocks and wind are natural. Ghosts and voodoo curses are not (they only exist in our imagination). Bridges, ovens, clothing, and books are not (we made those things.)

When you think about it, a lot of what passes for “natural” remedies are not natural. Homeopathic remedies rely on an entirely imagined mechanism of chemistry invented by Samuel Hahnemann around 1796. He thought that by diluting and shaking substances, a vital essence of their properties could be captured, which upon further dilution could alleviate the symptoms that were caused by ingesting that same substance. Acupuncture relies on changing the flow of a life-energy, Qi, through channels in the body that do not, objectively, exist. Chiropractic (invented by DD Palmer in 1895) relies on identifying and treating “subluxations” that do not exist on x-rays or any other objective test. Modern chiropractors have acknowledged that their subluxations are more of an idea than a real thing, but most of them insist that treating these nonexisting things is helpful. (Not all chiropractors subscribe to this belief – a small group is trying to distance themselves from the dogmatic belief in Palmer’s subluxations. I wish them well.)

Many other kinds of healing supported by “naturopathic doctors” are not at all natural. Reiki, Ayurveda, “detoxification”, iridology, reflexology, kinesiology, and many other ideas are like homeopathy, chiropractic, and acupuncture. They all  “supernatural”, like ghosts and voodoo and magic.

What about herbal medicine? Herbs, themselves, are natural (and, often, tasty!) But what’s sold at drug and what used to be called “health food” stores is not. Many herbal supplements do not in fact contain the labeled herbs. The herbs are imaginary and un-natural. Even if the herbs are indeed contained in the supplement, by the time they’ve been processed and turned into capsules, are they any more natural than the “medications” on the shelf nearby?

I think the wisest way to think about Rachel’s question is to reject the false dichotomy between what’s “natural” and what’s not. There’s nothing inherently safer or better about natural things. Smallpox is natural, earthquakes are natural, heart attacks and strokes and cerebral palsy are all natural. Poisons from pufferfish and venoms from rattlesnakes are natural. On the other plenty of good and necessary things are “unnatural.” The food we eat has been grown with fertilizers and pesticides (including organic foods, which use all kinds of substances you wouldn’t consider “natural” at all), brought to stores by trucks on roads driven by people wearing wristwatches and clothes. None of these things are natural. And that’s OK.

 

Coming up next post: OK, fine, natural remedies aren’t natural. But do they work?

Who you gonna call?

What can be learn from vending machines and casinos to stop childhood whining?

December 19, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

Megan, like all parents, hates the whining and nagging:

It’s driving me crazy. My children whine and complain until they get what they want. I try not to give in, but sometimes it’s just impossible. What can I do?

(That’s an excerpt from a much longer message. You get the idea.)

Let’s look at whining from a classic behavioral approach. Stay with me, here – behavioral theory is a big part of why we do the things we do, children and adults alike. It’s worth understanding.

What we’re talking about here is called “operant conditioning.” Basically, whether people continue to do something depends on the consequences. If complimenting your spouse gets you a friendly smile or peck on the cheek, you’ll keep doing it (assuming you like smiles and kisses.) If your child’s whining means she gets what she wants, she’ll keep doing that, too. A related term is “positive reinforcement” – that’s a reward or benefit that comes after a behavior. Positive reinforcements (giving a child exactly what she wants) make it more likely that the behavior (whining) will happen again.

So: step one of dealing with whining (or many other undesirable behaviors) is to remove the positive reinforcement. But there’s a twist, here – it turns out that the schedule of the positive reinforcers can change how well it works. This might not be intuitive, but it turns out that regular, always-given, predictable positive reinforcements are not as lasting or powerful as irregular, unpredictable, changing positive reinforcers.

Think about vending machines and casinos. With a vending machine, you always get exactly what you ordered (assuming the stupid thing isn’t broken – there’s an interesting behavioral lesson about that situation, too, but we’ll save that for another time.) People who get things from vending machines are positively reinforced, but they don’t typically crave vending machines. And: when the positive reinforcement ends (say, for 1 or 2 times you don’t get your bag of Funyuns), you’ll quickly stop using the vending machine.

But at a casino, you don’t know what your reward will be, or even if you’ll get one. In fact, most of the time, you get nothing at all. But that kind of reinforcement, the “sometimes-surprise” schedule, reinforces the behavior even more effectively. Think about people pumping money into slot machines, only to get occasional, unpredictable rewards.

Let’s come back to whining. If you reinforce the whining sometimes, or in an unpredictable way (“Here! Just have the whole bag of lollopops!”), you’ll unintentionally be encouraging the behavior even more than if you always said “yes.” If Megan is serious about stopping the whining, she has to stop reinforcing it, and shouldn’t give in. Ever.

What about punishment to stop whining? A punishment is an action you take after the behavior, a consequence that’s designed to stop the behavior. It turns out that behavioral studies in animals, children, and adults show that punishment is typically only temporarily effective. Yelling at your child for whining, or restricting privileges, or some other punishment – none of these will work well. That’s like the vending machine giving you a bag of stale chips. You’ll be mad, and might avoid the vending machine for a few days, but you’ll be back. Or, imagine, if a casino sometimes just took your money away from you. That’s a valid punishment, but it doesn’t really change a behavior as well as completely stopping the positive reinforcements (in a casino, the occasional big payouts.) If the punishment of losing money at casinos actually worked, they’d all be out of business.

Sometimes, there’s more to whining than just behavior and consequences. I’d consider the child’s development and communication skills, and overall parenting style, expectations, mental health, resource scarcity — lots of things beyond behavioral theory. But a straight-up behavioral approach is sometimes the simplest, best way to get children to stop with the whining. And if it works, Megan owes me a trip to Vegas. Or at least a bag of Funyuns.

Red wine pouring into wine glass, close-up

Red wine pouring into wine glass, close-up