Healthcare Then and Now (Pedcast)


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Get comfortable and get ready for another installment of the best pediatric blog available, I am your host, Dr. Paul Smolen, a board certified pediatrician with 33 years of practice to date, here to bring you a discussion of kids, pediatrics, parenting, and frankly, things I think parents are interested in.



Sometimes I daydream about my career and how things have changed during my time in pediatrics… and boy, have things changed. When I started in pediatrics in 1982, I wore a lot of doctor hats: I functioned as office pediatrician, delivery room doctor, neonatologist, PICU doctor, a pediatric hospitalist, a pediatric ED physician, an after-hours phone triage nurse, and occasionally an assistant doctor in the operating room. A child came down with meningitis…they were mine to care for. An infant was born prematurely and needed NICU care…Doc Smo was on the case. Johnny had a near drowning event at the local pool and needed care in the pediatric ICU… you got it, they were mine as well. Well, you get the idea.


I am board certified, I meet national standards of care, and I participate in continuing education of all sorts, but I am not a sub-specialist. I was trained in general pediatrics. I provided general pediatric care. In 1982, my patients got good care that met the standards of the day, but you could argue it was not the kind of care children get in the same community 32 years later. Let’s break that down a little further, shall we? Specifically, let’s compare the healthcare world of 1982 with the healthcare world of 2014.


Better pay in 2014:

First let’s start with salary. My starting salary in 1982 was $36,000; fairly good for the time. I was working a minimum 60-80 hours a week and taking a lot of risk in a difficult, physically demanding job. When my partners hired me, my senior partners were making $60,000/ year in 1982. Using an inflation calculator, my partner’s $60,000/ year in 1982 would need in 2014 dollars to be paid $147,000. Today’s pediatricians actually have are making an average of $177,000/year. That translates to an annual 1% raise over their 1982 counterparts.



Sickness down, Diagnostics better:

Here’s another big difference…children aren’t nearly as sick as they used to be in 1982. Vaccines have taken almost all septic illness off the table for children, which is a great thing. Children today rarely get bacterial meningitis or other “septic” life-threatening illness. And if they do get sick, office diagnostic tools are far better at assisting pediatricians with diagnosis. Automated blood counting machines, sophisticated hospital labs with couriers, and easy access to X-ray and ultrasound studies have really improved things for doctors and sick children.


Better informed patients and doctors:

Rapid access to the latest information has revolutionized the practice of medicine for both doctors and patients. With a few strokes of the computer keys, I can get access to the best and most recent information on really any topic I wish to explore. And patients can get the same thing. My patients are much better informed than a few decades ago, when they had to rely on me and my research for guidance. Often in today’s world, families know more about a particular disease of condition than I do. I feel like instead of providing information, perspective, and judgment like I did in 1982, today all I have to offer families is perspective and judgment…still useful, but my knowledge is not as much in the center of the vortex as it used to be.



So what does this all mean? I was providing a lot of care in 1982, but not of equal quality and sophistication as that being provided in 2014. I was a bargain however. In today’s dollars, I was being paid $49/hour in 1982 compared with current pediatricians, who are being paid $62/hour.


So how has healthcare changed during my pediatric career? I think by looking at tenure in medicine in the US, you can see the big trends healthcare.


  1. Overall, healthcare is just a lot more expensive because of increased sophistication and technology that is being offered today. We are just not comparing 2014 apples with 1982 apples. The technology and expertise you are buying when you walk into a healthcare facility is much more sophisticated in 2014 than it was in 1982…you are literally getting more! In a town like Charlotte, rather than seeing little old me when you are sick in the ED or give birth to a premature infant, now you are greeted by subspecialty trained and certified specialists, ready with the latest equipment and support staff…Cha-ching, cha-ching.


  1. Vaccines have revolutionized pediatrics, pure and simple. Children just don’t get the terrible bacterial infections that were so common a generation ago, because vaccines have done such a great job of protecting them.


  1. Parents and doctors have much better access to cutting edge information about diseases and therapies. Literally within seconds, the latest information on *whatever* can be delivered to the bedside. Amazing.



  1. Unfortunately, the widespread practice of defensive medicine continues to be felt as much by today’s doctors as it was in 1982. Ordering tests and procedures that are unlikely to yield useful information for a patient, but rather serve to protect a physician continues to be a tremendous drain on our resources. Plaintiff’s attorneys continue to be the boogie-men in every doctor’s closet. Cha-ching


  1. And finally, in the name of good intentions, government regulation has exploded… electronic medical records, privacy compliance, laboratory standards compliance, licensure, board certification, maintenance of certification, just to name a few. Money well spent… maybe, but I’m not so sure? Cha-ching.


So here we are, in 2014, with healthcare almost unaffordable for everyone. Are we better off than we were in 1982 world of healthcare with little old me doing the heavy lifting? In many respects yes, but in others, I am really not so sure. I have been joking with my friends for years that in the future, we will be able to cure the horrible cancers and diseases of today, insert new genes into children with genetic diseases, and regenerate malfunctioning organs with stem cells, but will anyone be able to afford these cures? I certainly hope so.


Thank you for joining me today for this edition of I would love to hear your perspective on healthcare, pediatrics, and the future of pediatrics. Take a minute to send me a comment via Facebook, Twitter, or at my blog, This is Doc Smo, hoping we all take great care, when we design the future of healthcare. Until next time.





Surgical Cure for ADHD? Probably Not (Article)

Recently a new study called CHAT (Childhood Adenotonsillectomy Trial) was published with results that will interest anyone who knows a child who has ADHD (Attention Deficit Hyperactive Disorder). The investigators set out to answer whether children with ADHD, large tonsils and adenoids, and associated obstructive sleep apnea (severe snoring with interruption of breathing in their sleep) would benefit from quick removal of their tonsils and adenoids (a procedure known as T+A), or whether watchful waiting would be the best course of action. Said another way, does obstructive sleep apnea from big tonsils and adenoids contribute to the cognitive impairment ADHD, and would removing the tonsils and adenoids by T+A improve core ADHD symptoms?


The authors designed an elegant, well-done study that yielded clear results. Let me summarize their conclusions:


  1. Children who received early T+A, what they called the “surgical group,” dramatically reduced the symptoms of sleep apnea relative to the non- surgical group. Sleep quality was dramatically improved in this group.
  2. Children in the early T+A group also demonstrated improved behavior post surgery relative to the non-surgical group.
  3. BUT, unfortunately, attention span and cognitive ability did not show improvement in the surgical group relative to the watch-and-wait group.


The authors concluded that a T+A benefited the surgical group’s sleep quality, daytime behavior, and general quality of life…but did not improve their core ADHD symptoms. The hopes of finding a surgical cure for ADHD did not materialize.


So, it looks like the decision to perform a T+A on a child with ADHD and large tonsils and adenoids, a procedure not without it’s own risks, should be decided mainly on the basis of the child’s sleep apnea and not on the hope that the surgical procedure will improve the child’s cognitive difficulties. The conclusion of this study is that ADHD or no ADHD, if a child has severe sleep obstructive symptoms from large tonsils and adenoids, they should have their tonsils out earlier rather than later. Stay tuned, however. This may not be the final word on the controversy about the interaction of poor sleep, large tonsils, and ADHD. If you have a child with ADHD and poor sleep along with heavy snoring, discuss these symptoms with your child’s pediatrician.


Your comments and stories are welcome at my blog, Until next time.


Smo Notes:

  1. Marcus, et. al., A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea, NEJM, 2013.

Written collaboratively by Jonathan Ferguson and Paul Smolen M.D.

Cranial Bands (Pedcast)

Welcome to the home of portable, practical pediatrics: For those of you who are new to my blog, I am Dr. Paul Smolen, a board certified pediatrician who has practiced in Charlotte, NC for the past 32 years. I was reading my journals the other day and came across a gem of an article about cranial helmets that are designed to prevent a baby’s head from becoming flat during infancy. All that back-laying can do a number on a baby’s head, you know. This idea of putting a rigid helmet on a baby during infancy to prevent deformation of their skull actually started with a group of neurosurgeons in Charlotte. I remember the grand rounds when they tried to convince the pediatric community that this was a big health problem. The pediatricians in the room, myself included, believed that heads do get lopsided in many babies, but that after a child gets up and starts crawling this usually disappears. They persisted, however, and helmets became common in children around Charlotte; an industry grew up around the technology. The thinking had a great story line…effective therapy, preventing future problems, earlier is better.


Now, let’s fast forward to a recent article I saw in the British Medical Journal. The researchers studied a large number of children for 2 years, dividing them into helmet and non-helmet groups. Their conclusion after two years of watching and measuring? The helmet group’s heads weren’t really any better shaped than the non-helmet group. Maybe the helmet wasn’t really necessary after all. In addition, they found a number of side effects from the helmets that I really never considered: pressure sores on the head, skin infections on the scalp, sleep difficulties, not to mention the cost. This is only one study, and I know it will start a stir among parents who feel these helmets are effective and necessary, as well as among the providers of the cranial band services. The study certainly needs duplication before we can make too much of the results, but the information presented in this study from the BMJ seems to be a strong argument against helmets. And here are the lessons I learned from this study:


  1. Just because a therapy is logical doesn’t mean it is effective.
  2. Just because things improve with a therapy doesn’t mean that the therapy is causing the improvement.
  3. Sometimes the most effective treatment costs nothing… tummy time: use it!
  4. The natural history of a lot of things in pediatrics is that conditions get better with time… like otitis media with effusion, many developmental delays, eczema, etc.
  5. Every once in a while it’s good to put our therapies to the test.
  6. And, that time tested truism…”Doctor, do no harm.”


As always, thanks for helping make one of the fastest growing pediatric blogs on the planet. I appreciate your trust and loyalty. Make sure to take a moment to tell friends and family where they can get their free pediatric education, right here at Remember, we love comments on Facebook and on my blog. My staff has made it easy to send a podcast via email to friends, so go ahead and send away. Soon, you will be able to send from my new website, so be on the lookout for that. This is Doc Smo, hoping you won’t need to cover your babies head that is flat, with some silly hat.  Until next time.

Allergy, An American Disease? (Article)

One of the great medical mysteries of the 20th century is to explain why children are suffering from more allergic diseases, at least in America. Asthma, hay fever, eczema, as well as peanut allergy are becoming very common conditions among children in the US. It is estimated that 10% of American children now have asthma, and 20% suffer with eczema. Once uncommon conditions are becoming the norm for our children. What is going on?

A new study, published in the Journal of the American Medical Association (JAMA), helps us get a little closer to understanding the explosion of allergy in America. The authors collected data on 92,000 American children who were born outside the U.S. and compared them with children born and living in the U.S.. The conclusion was startling: American children, born and living outside the United States, were much less likely to suffer from allergic disease than their peers born and living in the States. Furthermore, the researchers found that foreign-born American children who came to the U.S. to live showed a consistent rise in allergic disease after just a decade of living in America. Said another way, something about living in America seemed to promote allergic disease in a dose-dependent manner: the longer a child lived in the U.S., the more likely they developed allergy!

The results of this new study add additional information to a growing body of research that indicates that something about life in a Western country promotes allergy in children. But why? What is the environmental factor that triggers the aberrant allergic response in children? Some believe it is our reliance in the U.S. on processed food that often contains genetically modified grains, preservatives, and artificial flavors and colors. Other researchers think the big factor is pollution and unnatural chemicals in our environment. Others believe that the obesity epidemic is to blame. Currently, the leading theory is what researchers call the “hygiene hypothesis” is to blame. This theory points to the lack of microbial diversity that children are exposed to when they are infants, therefore permanently changing these infant’s immune response to common allergens like peanut protein and house dust.

Researchers are getting closer to answering the great allergy mystery, hopefully soon. Life for children with asthma, severe eczema, and food allergy can be miserable. Hopefully, we can not only explain these diseases but also, more importantly, prevent them. Being born and raised in America should be an incredible blessing, not a ticket to allergic disease.

I welcome your comments and insights at my blog, While you are there, take a few minutes to explore the hundreds of podcasts and articles I have created about children, pediatrics, and parenting. I think you will be glad you did. Until next time.

Smo Notes:

  1. Prevalence of Allergic Disease in Foreign-Born American Children

Jonathan I. Silverberg, MD, PhD, MPH; Eric L. Simpson, MD, MCR; Helen G. Durkin, PhD; Rauno Joks, MD

JAMA Pediatr. 2013;167(6):554-560. doi:10.1001/jamapediatrics.2013.1319.

Written by Paul Smolen M.D.

Annual Holiday Message 2014 (Pedcast)


Welcome to a very special edition of For new listeners, I am Dr. Paul Smolen, a board certified pediatrician with 33 years of clinical practice, excited and ready to share what I have learned through my professional journey with children and parents. Portable, practical pediatrics is what we promise and what I always strive to deliver with each and every pedcast.


I’ve got to tell you, I look forward to my holiday podcast all year, I guess because holidays are special and a time for reflection. Being a little older person, I think gives me a perspective that younger parents just can’t have. I often ask myself strange questions…like the other day when I was wondering, “What is a child’s most valuable asset, their most important possession? Their place in the family will, their social security number and future benefits, their citizenship? No, I believe these these are all wrong. I think the answer is you…their parents. You are their rock, their everything, their foundation. You shape their world-view. You teach them to trust others. You teach them how to share. You teach them their language. And most of all, you teach them how to love themselves and others.

So it is you, the parents of your children, that I want to concentrate on in this year’s holiday message.


We have this concept in this part of the world that the best parents are the ones that can provide the most things for their kids. This is clearly wrong.   Many also believe that the best parents are those parents who devote the most time and energy to their kids. Again, I think this is exactly wrong. Yes, we need to provide things for our children and yes, we need to devote a lot of time and energy to their needs, but in my opinion, just as important for a child is to have parents who have some time to cultivate their own interests, who can grow in their own adult development, and who can be in emotionally satisfying relationships that are healthy and positive. Spending all of your time and energy on your children impedes these goals. Having parents that sacrifice all of their time, energy, and money for their children, in my opinion, is a mistake. Parents need to make sure they not only take care of their children, but also take the time to take care of themselves


So here is my holiday wish for you and your children:

Make it a priority to brush off your relationship with your significant other and up your romance and relationship game. Invest a little more time and energy into the love of your life, and I think you will find that it pays tremendous dividends for your children.


And while you’re at it, don’t forget to throw some more capital at your own intellectual, spiritual, and physical development. Take a class in something that interests you, join the gym and go regularly, read a novel, or simply visit places and people nearby who interest you.


Your children are watching and learning from everything you do…and they learn mainly by imitation. Remember that DocSmo pearl: Children are little machines of the vacuum and copy variety. And it’s corollary… It’s not an accident that interesting parents have interesting children.



This is Dr. Paul Smolen, broadcasting from studio 1E; you know, the first child’s bedroom on the east side of the house…hoping this holiday you remember that life is never ho-hum, if you live each day like the best is yet to come. Until next time.

Best Bathing Practices for Kids (Pedcast)


Sit down and get comfortable…here we go with another edition of, where parents can get a free pediatric education on their schedule about topics they are interested in. I am your host, Dr. Paul Smolen. Thanks for joining me today. Longtime listeners know that I love the advice Grandma had to give out, and grandma loved daily baths for her kids. Scrubbing with wash clothes, soap, and hot water was her recipe for skin health. But today we are going to look at her advice through the lens of modern children’s skin. Very interesting.

What got me started on this subject was a recent article I read about the ideal skin care for children with AD (eczema). I had no idea that the simple task of bathing children was this controversial. I have known for a long time that certain things about bathing are important to children with AD like the following:


  • Pediatricians are taught that…when bathing a child with AD, the water temperature should not be too hot and the use of soaps, especially with perfumes, is a no-no.
  • We are also taught that keeping a child’s skin clean with frequent baths is important but shouldn’t be done too frequently.
  • We are also taught to advise oils and moisturizers be put on just after bathing, because this locks in the moisture of the bath into the skin.


My experience tells me that much of this wisdom is correct. Last winter, I saw a young man who had a severe eczema flare-up on his face. After we discussed his dermatitis, I found out that he loved long hot showers with perfumed soaps and lotions that had lots of fragrance. He had quickly learned that his skin could not tolerate this, especially in the winter when the ambient temperature was low outside. He had removed much of the protective oils his skin had made and then put very allergenic chemicals deep into his skin…and he reacted. Simply reducing the temperature of his bath water, lowering the frequency of his bathing, and stopping the smelly lotions solved his winter skin nightmare.

So, back to the data review article I was reading. These experts were tasked with looking at published research to decide what is the best way to take care of the skin of children with eczema.

Here’s what they found:

  1. The timing of bathing with application of moisturizers doesn’t have strong evidence of effectiveness.
  2. In fact, daily bathing is not necessary for children with AD (or most children, in fact).
  3. Putting moisturizers on frequently to eczema-affected skin does show evidence of help.
  4. Hydrocortisone topically works but has severe limitations for chronic use…skin atrophy and steroid withdrawal
  5. Avoiding things that trigger eczema can be helpful and improve overall skin health.
  6. AD is likely a lifelong skin condition with a tendency to get better with age
  7. For some children, a weekly bath in diluted Clorox ¼ cup/18 gallons,can improve their eczema

So, it looks like for children with the most sensitive skin, dermatologists believe in a minimalist approach, certainly not the hot water, soap, and daily bathing that grandma advocated.  Here are the guidelines from dermatologists for bathing frequency that dermatologists advocate and it is good news for your kids.

American Academy of Dermatologists:

Children ages 6 to 11: Guidelines for bathing

Children in this age group, however, may not need a daily bath. Children aged 6 to 11 need a bath:

  • At least once or twice a week, or...
    • When they get dirty, such as playing in the mud
    • After being in a pool, lake, ocean, or other body of water
    • When they get sweaty or have body odor
    • As often as directed by a dermatologist if getting treated for a skin disease

Tweens and teens: Guidelines for bathing

Thankfully, most kids want to bathe daily once they hit puberty. Dermatologists tell parents that once puberty starts, kids should:

  • Shower or take a bath daily.
  • Wash their face twice a day to remove oil and dirt.
  • Take a bath or shower after swimming, playing sports, sweating heavily.

Dr.Primmer-resident DocSmo dermatologist recommends when child smells bad

So there you have it: Grandma in the 20th century probably got carried away with bathing, hot water, soaps, and rough wash clothes. This seems to be one of the FEW times when Grandma got it wrong, at least for the children of the 21st century. Grandma was a pretty shrewd cookie, but everyone makes mistakes once in a while. I would love to hear what you do with the skin of your little bundles joy…what works and what doesn’t? Send in those comments through social media or to my blog, This is Dr. Paul Smolen, suggesting that you may not want to be so keen on insisting your children always be so clean. Until next time.

Gummies Vitamins Beware (Pedcast)


Hey, hey, and welcome to another installment of I’m your host Dr. PAUL SMOLEN I want to thank you for joining me today and for making this blog such a success. You and your children are the reason that I put so much effort into this blog and let me tell you, it has been a very rewarding experience. This blog is beginning to catch on fire. In August 2014 we had 135,000 pages opened in just that month… fantastic. So here we go with another edition. Your free pediatric education continues. A day doesn’t go by when I don’t see a child who takes gummy vitamins. In my practice it is the norm. Why, I don’t know but it just is. These things are incredibly popular and why not, they taste great so the kids love them, and the moms feel like their doing something that’s helping their child’s health. And there is the rub which we are going to talk about more today.  Let’s break that down a little bit and let’s see if we are really doing something good with the gummy vitamins.


Let me start by saying that there probably are some children who absolutely need vitamin supplementation. Children with chronic illnesses, children with part of their intestines gone, children with chronic kidney and liver diseases, children with cystic fibrosis, and situations where a child has extra need for vitamins. Fortunately, there are very few children like that in the world. Most children who have reasonable variety in their diet, do not need vitamins. I know that’s a controversial statement I know I’m going to get a lot of hate mail over that statement, but my reading tells me this. I believe that. So here is something I want you to consider; a Doc Smo pearl for you ponder;  “Just because of therapy makes sense doesn’t mean that it works or is necessary” . Repeat,“Just because of therapy makes sense doesn’t mean that it works or is necessary” I think this relates to vitamins. Some of my longtime listeners already know this because they will remember in previous episodes, when we discussed the Woman’s Health Study, that has looked at this issue over decades with a large cohort of women and found that women who take supplemental vitamins had no better health than women who didn’t. But they did find that… women who ate lots of fruits and vegetables, overall were healthier. Yes, this was not children being studied and yes, this is an association not necessarily causative relationship but I believe it is important. Now we have the China study that tells us the same thing. Fruits and vegetables are where it is at ladies and gentlemen.


So, with that as background, I have a lot of issues with gummy vitamins for children. First of all I don’t think that the vitamins in the chew are necessary for most children. They need fruits and vegetable’s instead where there’s all sorts of balanced nutrients together along with vitamins in the food.  Most experts feel that food is our best source of vitamins. Additionally there is some sort of sugar in most gummy vitamins, not much I admit, only about 3-4 grams but sticky sugary that can stick to the crevices of a child’s teeth can wreak havoc. I mean havoc. In a very short amount of time, a the enamel on your child’s teeth can be gone, absent, “missing in action”. I don’t think you want your children having expensive painful dental work throughout their childhood just for some potential marginal benefit they might get from taking supplemental vitamins. And finally my last beef with these gummy vitamins are that they contain artificial flavors and colors which I really don’t think can be good for a child. Listen to this one… the other day I was talking to a mom about gummies and she told me that her child was convinced that in order to play sports, he needed some newly marketed sports gummies that he was convinced would give him the edge.  Sure, 24 grams of sticky corn syrup sugar, artificial color and flavoring,  with some B vitamins… yeah, that will do the trick for him, but I’m not sure what trick that might be?


So here’s my advice to you the next time you’re tempted to reach for those colorful gummy vitamins in the grocery store. Stop, and direct yourself over to the fruit and vegetable aisle and buy some good food instead. You are right, your child does need those vitamins, but you are just in the wrong isle to get them. Little mistake, but easily fixed. I think your child’s health will improve far more from fruits and vegetables than any vitamin supplement you can find. And their dentist and teeth will thank you.


Let’s have a conversation on my blog where you in on this issue and I’d love to hear what you think. Again thanks for joining me this is Dr. Paul Smolen recording in studio 1 E, that’s first child’s bedroom east side of the house, hoping you can go ahead and recruit, the awesome power of vegetables and fruit. Until next time.


Why Vitamin K for Newborns You Ask? (Article)


Ask any mother or grandmother who was alive 1900, and they would tell you about a disorder that is rarely seen today, that of Vitamin K Deficiency Bleeding (VKDB) in a newborn baby. A simple single dose of vitamin K, given to almost all babies born in the U.S., made this disease just a bad memory… until recently. Parents today just don’t worry about this disease anymore but imagine you were a mother who had a perfectly normal pregnancy and delivery, had a healthy infant who was thriving at home, and suddenly at about 2 months of age, they had a devastating bleeding event in their brain with seizure and other devastating effects or began bleeding to death from a gastrointestinal hemorrhage. Unfortunately, in today’s hyper informed world, many parents have become more worried about theoretical risks of harm to their newborn from a simple dose of vitamin K that is recommended for newborns at birth, than the known risk of hemorrhagic disease in a newborn who don’t receive this therapy.


Why are newborns at risk of sudden catastrophic bleeding, you ask? Many infants are unable to form adequate blood clots because their store of vitamin K is low at birth and they are unable to manufacture or consume enough vitamin K to bring their blood levels up to healthy levels. To counteract this deficiency and prevent, bleeding a few weeks later, a shot of vitamin K is given to all newborns within hours of birth. This has been standard practice in the U.S. since 1961, unless parents refuse it. This administration boosts reserve levels of vitamin K, allowing a child to prevent bleeding. Babies who receive this treatment are 81 times less likely to develop late VKBD than babies who do not.


Recently in 2013, pediatricians and parents got a reminder of why we give that little vitamin k shot to newborns, when a cluster of four cases occurred among infants born in Nashville hospitals. After the Center for Disease Control investigated these cases, they discovered that in each case of bleeding, the infant’s parents had refused the vitamin K shot for their newborn after birth. Just like grandma had told us, the four babies who bled had thriving normally until they experienced sudden bleeding (mainly in their brain) at 6-15 weeks of age. These cases prompted and investigation to determine how many parents are refusing vitamin K in Tennessee. A random sample of birth records from three Nashville hospitals (3,080 infants) and four major Tennessee nonhospital birthing centers (218 infants) was undertaken. This analysis revealed that up to 3.8% babies born in Tennessee hospitals and 28% of babies born outside hospitals did not get vitamin K at birth. When the parents of the affected babies were asked why they refused vitamin K, they expressed concern about a now debunked association between childhood leukemia with vitamin K administration and a desire to minimize their newborn’s exposure to what they saw as an unnecessary foreign toxin.


As a parent of a new infant, if you perceive no risk to denying a recommended therapy such as a vaccine or vitamin supplement, and you perceive the therapy as toxic, of course you are going to refuse. But if that same parent has more information, I think they will be able to see that rather than a toxin, it might be a life saving vital nutrient that prevents serious disease or death in newborns. The numbers don’t lie. A simple dose of vitamin K at birth reduces a baby’s chance of hemorrhagic disease of the newborn by an amazing 81 fold. Rather than seeing this therapy as toxic, our opinion is that parents should see it for what it is, a miracle.


Your comments are welcome at Until next time.


Smo Notes:


  1. Notes from the Field: Late Vitamin K Deficiency Bleeding in Infants Whose Parents Declined Vitamin K Prophylaxis — Tennessee, 2013

Weekly MMWR

November 15, 2013 / 62(45);901-902


Written collaboratively by Carson Blaylock and Paul Smolen M.D.


Doctors Flunk Pee Pee 101 (Article)

Aside from the common cold and stomach bug, parents should add the term urinary tract infections (UTIs) to their shortlist of worrisome common illness, especially if they have daughters. To effectively treat urinary tract infections, pediatricians need accurate diagnosis and tailored therapy. Unfortunately, this information is often lacking. A recent survey of how healthcare providers diagnose and treat urinary infections in children, published in the journal Pediatrics, found that pediatricians, family doctors, and nurse practitioners treating children frequently do not order the necessary tests needed for accurate diagnosis and treatment. Experts recommend a course of antibiotics to treat a UTI, only after the child’s urine has been analysed and cultured. As it turns out, appropriate laboratory confirmation is only being done in about 50% of the time when various outpatient settings were analyzed. Antibiotics were being prescribed without knowing for sure that a child had a urinary tract infection. Amazing.

The California-based team of researchers stated, “this is the first large-scale study in children evaluating practice patterns surrounding urine testing in antibiotic-treated UTIs.” The team surveyed children (all less than 18 years old) who had an outpatient UTI and were prescribed antibiotics to treat the infection. The research team ultimately found that only 32% of children less than two years age had received outpatient urine culture testing. For children under 18 years of age, only 57% had urine cultures for diagnosis. The conclusions are clear; many providers are prescribing antibiotics to children without confirming their diagnosis of a urinary infection via urinalysis and urine culture.

Why all the concern? Well, there are multiple reasons that are addressed by this study. Firstly, it appears as if healthcare providers are not following established guidelines of experts who recommend urine testing to diagnose urinary infections. Secondly, it is likely that antibiotics are being over prescribed to children with urinary symptoms. This possible over use of antibiotics  contributes to the rise in antibiotic microbial resistance, a growing threat to everyone’s health. Presently, drug researchers are struggling to keep pace with increasingly antibiotic resistant bacteria. Finally, the judicious us of antibiotics, aided by laboratory testing, remains critical if we are to maintain antibiotic the effectiveness of the antibiotics we currently have. The conclusion is clear– practitioners need to only use antibiotics when they know they are clearly needed. All in all, this study reminds this pediatrician of the ageless wisdom of Hippocrates, “Doctor, do no harm”.  Accurate diagnosis of UTI’s let’s pediatricians fulfill this ancient mandate they have sworn to uphold.

Your comments are welcome at Until next time.

Smo Notes:,+morbidity,+and+economic+costs&id=doi:10.1016/S0002-9343(02)01054-9&title=American+journal+of+medicine&volume=113&issue=1&date=2002&spage=5&issn=0002-9343

Written collaboratively by Norman Spencer and Paul Smolen M.D.

Driveway Disasters (Article)

The combination of driveways and your children can be a deadly one. Accidents can happen in the blink of an eye while a parent is performing a mundane task like backing their car out of the driveway; disaster can sadly be just feet away. We all know how much kids love playing outside in the driveway. This puts them squarely in a dangerous zone where they can be injured by a moving car. It’s an alarmingly easy mistake to make that happens frequently. So many families have been devastated when their children are injured or killed by the family car.

In the U.S., fifty children are backed over every week. Of these fifty, two are fatally injured, and most victims are between only twelve and twenty three months old; they are just little innocent toddlers who have no awareness of the danger a moving car poses. They just innocently toddle out into the driveway following their parents, right in the way of the moving vehicle. Most accidents occur when drivers cannot see children in their car’s blind spot, the space behind the car that is not visible from the driver’s seat. Since trucks, vans, and SUVS have the largest blind spots, the majority of accidents are attributed to these vehicles. Fortunately, with more awareness, most of these accidents are preventable.

Here are a few easy tips to ensure that your children are kept safe in your driveway.

  • Always walk all the way around your car before backing out of the driveway. These few seconds could save your child’s life.
  • When young children get in or out of the car, hold their hands and guide them to a safe area where the driver can easily see them.
  • When you’re behind the wheel, remember to back up slowly and always pay attention to your mirrors.
  • Consider purchasing a car that is equipped with a back-up camera and alarm, especially when your children are very young.

Hopefully, all these measures will reduce the number of children who are injured where they should be the safest…their own homes. The prevention of such accidents is possible and in our hands. This is a problem that we can fix!

Your comments are welcome at my blog, Until next time.

Smo Notes:


Written collaboratively by Keri Register and Paul Smolen M.D.

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