Doc Smo Pearls

Dr. M’s Women and Children First Podcast #3 – Dr. Randy Jirtle and the Discovery of Maternal Risk

Dr. Randy Jirtle joins the show today to discuss his groundbreaking research that ushered in the era of epigenetics. Time Magazine nominated him for person of the year in 2007 and had this to say about him: “Dr. Jirtle’s pioneering work in epigenetics and genomic imprinting has uncovered a vast territory in which a gene represents less of an inexorable sentence and more of an access point for the environment to modify the genome. His trailblazing discoveries have produced a far more complete and useful understanding of human development and diseases” — Time Magazine. This interview is ground zero for the Women and Children First Podcast as we discuss the underpinnings or mechanisms of disease risk for all humans as it relates to the environmental inputs of our lives that are driving health or disease at both the pregnancy and post natal periods. We look specifically at how maternal nutrition and later chemical exposure directly affected the health of the agouti mouse offspring. This experiment was the first of its kind and paved the way for a complete shift in human disease understanding. For parents, this podcast is really the beginning of everything that I am trying to convey regarding a healthy pregnancy and childhood. Without this interview, the following interviews will be more difficult to understand. The picture becomes very clear once his research is cemented in our minds.

His biography is as follows: Professor of Epigenetics at the Department of Biological Sciences, North Carolina State University, Raleigh, NC, and a Senior Scientist at McArdle Laboratory for Cancer Research at the University of Wisconsin, Madison, WI. He was previously professor of radiation oncology and associate professor of pathology at Duke University, Durham, NC, where he had been a faculty member since 1977. He graduated with a B.S. degree in nuclear engineering in 1970 and a Ph.D. degree in radiation biology in 1976, from the University of Wisconsin-Madison. His awards list is long but the key to Dr. Jirtle is that he is a curious thinker and we are grateful for this.

Please enjoy my conversation with Dr. Randy Jirtle,

Dr. M

Women and Children First Interview with Dr. Paul Smolen


Paul Smolen is a teacher, a thinker and pediatric pearl generator. I sat down with Docsmo for a wonderful conversation about his lengthy and thoughtful career. He discusses his podcast, learning while on the job and what made it all work. He leaves us with his 10 favorite pediatric parenting pearls. I know that you will find his wisdom most useful. Please enjoy my conversation with Dr. Paul Smolen, aka Docsmo.


Dr. M


Are Your Children’s Brains Getting the Sleep They Need? (Pedcast)


Who would have thought a generation ago that lack of sleep would be a huge health issue for children? I certainly didn’t but the reality is that many children today struggle with insomnia. Stay tuned and I will tell you how you can avoid much of the insomnia trouble plaguing American children.

Photo compliments of Pixabay Continue reading

Can Parents Improve Their Children’s Adult Health and Longevity? (Archived Pedcast)

Can parents improve their children’s longevity? Does physical fitness in childhood predict your children’s longterm health?  Doc Smo answers these questions.

Continue reading

America “super sized” (Pedcast)

Welcome to another edition of, the pediatric blog  that gives parents practical, portable pediatrics on their time framework. I am Dr. Paul Smolen, your pedcast host. Today, I am going to bring you a different type of pedcast. Usually I try to bring you mostly factual information about a pediatric topic sprinkled with some observation from my doctor chair along with a few opinions. Not today… this is going to be “pure opinion.” I am going to get a little preachy about a topic that I feel very strongly about… childhood obesity. I am not going to candy coat the message; it’s coming straight at you like a fastball over home plate… straight and fast. So sit back and listen. Hopefully the message will come through clearly.

Oh boy, do we have our work cut out for ourselves. The obesity epidemic shows no signs of abating anytime soon. Processed foods crept into the American landscape during the 20th century slowly but surely, one soda and sweet cereal at a time. Food companies saw new markets, and they met the need. They created new foods faster than your great-grandmother could darn your parents’ socks. We became enamored by easy, fast, and satisfying. Boy have we paid a price for all this “innovation.” Yes, nutrition on the fly let us spend less time shopping and preparing, but it also has made heart disease, diabetes, and hypertension a way of life in the western world. What I read says these maladies are all about lifestyle, lifestyle, lifestyle, not genes, genes, genes. What I find ironic is that for all the money we spend on antihypertensive medicines, cholesterol lowering drugs, and insulin for our diabetics, we could probably buy groceries for every American. One of the saddest things about my job is that I see many children who have never been and probably will never be in good physical or nutritional condition. I fear that these children will become adults thinking that good food is a side salad with their value meal at the drive thru and exercise is walking to the store to get a candy bar.  What will they provide for their children when they become parents? Less than optimal food, I suspect, and little activity. They won’t know any better… and  the cycle continues. It’s easy to eat junky processed food and it’s hard to buy, cook and serve real food. Providing wholesome food is one of the most important parenting tasks facing parents.

So how are we going to get ourselves out of this nutritional mess we have created? Here is what I suggest: Start by teaching your children the difference between whole food and processed foods…and repeat the message often until they get it! Make sure you are setting a good example of eating for your children by eating the way your grandmother would have wished you would. Make it a priority to have as many family meals as possible with real food. If you have the space, plant a small garden and involve your children in cultivating vegetables. Get your children involved with the shopping and cooking process; it’s fun and you will cherish the time you spend together in the kitchen someday…I promise. Vow to get all the sweet drinks out of everyone in your families diet…no soda, no sports drinks, no sweet tea, no energy drinks, no calorie laden coffee drinks. Limit fast food to no more than once a week… No, make that “eating out anywhere” no more than once a week. And finally, lets stop making every holiday a candy fest, every fund raiser a chance to sell sweets, every celebration a gluttonous festival of food, every sporting event a sugary slurry of drinks, and every accomplishment rewarded by something to be consumed.  We can find other ways of saying good job without insulin levels off the scale. Let’s start paying more attention to what children need rather than what they want. Only then will we get it right. Well, thanks for joining me today. I feel better getting all that off my chest. Who knows, maybe I will inspire a few people to make some big life changes. I always welcome comments from my listeners. To comment, leave your thoughts on Facebook, iTunes or at my website, Who knows, you might see them in print. This is Dr. Paul Smolen, thinking it would really dandy  if our children got less candy. Until next time.

Don’t be passive about pacifiers (pedcast)

Welcome to another edition of  Welcome new listeners and welcome back old ones.  I hope you are having a great day, I am. In today’s pedcast we are going to get into some serious Doc Smo  opinion about a topic that parents often agonize over, pacifiers.  We are going to take on the topics of whether parents should start their children on pacifiers as well explore how and when they should finally say good bye to these devices: you know, the  pacifier’s end game.  How and when should parents consider doing away with the yum yum, the binky, the ya ya.  Let’s do it shall we!


When it comes to pacifiers, everything is controversial.  Emotions are high when it comes to these little pieces of plastic.  Some people, especially breastfeeding advocates don’t think they are ever appropriate for infants or children since some of the infant’s sucking cues can be masked by the paci. The AAP on the other hand, think that there is good evidence that for infants under 6 months, falling asleep with a paci reduces the risk of sudden infant death.  Otolaryngologists are convinced that ear infections are far more common in children who use them. Speech therapists think that language acquisition is slowed by them and orthodontists think they sometimes cause a child’s teeth not to fit properly because the pacifier can change a child’s natural bite. Wow, my head is spinning after reading all these opinions.  I will give you one pediatrician’s opinion, mine, in just a few moments.

There is no right or wrong answer for parents when it comes to starting a pacifier habit. Some babies absolutely refuse them no matter how hard parents try to get them to suck on them. Others babies will use them until they get enough hand control to suck their own thumb.  And others love them and get very attached to them. Go figure. Babies are as different and unique as their parents!  There are arguments both pro and con and ultimately this comes down to a parent’s choice.


I suspect that many of  the listeners to this podcast have children who love their binky and you, the parent, are looking for some information about how to get rid of it.  Maybe you have a 1, 2, 3, or 4 year old? Controversies continue on the best age to stop them just like whether to ever get started. What is the right age to make them go away?  Again, “experts” vary greatly in their opinions about this one as well.  Some say they need to go by 12 months along with the bottles. Others, advocate getting rid of them by age 4 years…you heard me, by 4 years of age.  Most advocate an age somewhere in between 1 and 4 years. Again, my opinion is coming shortly. Stay tuned!


How do you make it go away? Again, there is no consensus about this either. Methods vary greatly.  Here are some I have seen.

– simply making them disappear. Its gone Johnny, get over it!  I call this the direct approach.

-sniping the nipple off and showing the child that the binky is broken and cannot be fixed.  Let them get mad at the binky not the parents. Clever!

-Getting the child to agree to give the binky to a new baby or kitty they know.  Amazingly, this often works with 2.5 year olds and older.

– Then there is the gradual making the binky fade away, limiting it to certain times and places: the method that most parents choose to use.

-I saw one mother once get so fed up with her son’s pacifier that while driving down the road with her crying child who couldn’t get his pacifier to him, she simply rolled back the sunroof, tossing it toward the sky, and declared that the binky was going to “paci heaven”.  That method worked for her.

-One expert that I read said it is crucial to give your child warning that the paci is about to disappear. He is of the notion that you treat children like adults, they will act like them…a definite maybe on that!


So what do I see in my practice? How do I help parents deal with this issue?  First let me say that everything I am about to tell you is based on my experience and is my opinion…lets get that out on the table first. I personally, am not a big fan of pacifiers. I think they can interfere with successful breastfeeding, create too much work for parent, and I think they delay the age when children can learn to sooth themselves.  I also think that children who use pacifiers have far more orthodontic problems their thumb sucking friends.  I can usually tell by age 2, without asking, which children are still using pacifiers.  I think they deform a child’s mouth more than their own thumb.  I also don’t think it matters which type of pacifier a child uses, they all have a tendency to change the shape of a child’s upper teeth, making them not fit properly against the lower teeth.  This malocclusion as dentists call it can cause both speech difficulties, especially a lisp, and an unwanted cosmetic change in a child’s face. Both of these problems can be very expensive to remedy with orthodontic expanders.

I think that pacifiers should be gone by age 2 years. If parents do this, I rarely see a child substitute their thumb for the paci at this age. More importantly, I see any deformity that has developed from the paci disappear fairly quickly.  A child’s natural facial features return to normal without expensive dental appliances. And finally by age two, most children have good enough language to allow them to calm themselves down in other ways other than sucking on a paci.


-As you can see from this discussion, pacifiers can be both a blessing and a curse. On the one hand, they can save lives in  infants and provide mom with a non nutritive sucking outlet for her infants  but they can also greatly increase the number of ear infections in some children, pose a choking hazard, and cause speech delay as well as facial deformity in some children.

– Your call parents.  You can see why pediatricians have trouble giving advice on this issue.  There is no clear answer. What I do strongly believe is,  that if your child is a paci user in the second year, make it disappear by age two. I think you will be glad you did.  Remember, children get more rigid and stubborn not less as they age.  What is hard at 2 years of age may be impossible at 3. Remember that Doc Smo pearl,“Parenting decisions that are easy in the short run may not look so easy in the rearview mirror” or “Parents who chose the path of least resistance are often rewarded with a rocky path”


-Thanks for joining me.

-If this is your first pedcast, take a look at the extensive DocSmo library of pedcasts and articles.

-If you are so moved, send in your comments and join the conversation.

-If you like talking about children, go ahead and subsribe to the feed on my website by hitting the rss feed button or linking to us by facebook or twitter.  We would love to have you.

– This is Dr Paul Smolen, broadcasting from the low country of south Carolina, hoping your little angel doesn’t get too sassy about getting rid of their paci.

-Until next time.


Smo Notes:

Pacifiers: Are they good for your baby? –

BMC Pediatrics | Full text | Predictors of and reasons for pacifier use in first-time mothers: an observational study

Bye-Bye Binky: Ending the Pacifier Habit

Avoiding a potential teenage tragedy (Pedcast)

Most cases of meningitis can be avoided with vaccines.  Listen and learn why Dr. Smolen thinks your child should get a vaccine that can protect children from a horrible infection from a germ called “meningococcus”.  Get ready for your free pediatric education to continue!


-Welcome to another edition of, the blog designed to give parents information they can use as their children progress from diapers to the diploma.

-I am your host, Dr. Paul Smolen, founder of the DocSmo blog

-Thanks you for joining me today.

– Today, we are going to discuss a disease that is extremely frightening, both for families and doctors.

-Fortunately it is rare and usually preventable.

-I thought it would be good for my listeners to learn about a disease process called sepsis: specifically sepsis from a germ called meningococcus.

-So let’s talk kids with today’s discussion of how the germ meningococcus, also known as Neisseria Meningitis, can devastate a child in a matter of hours AND learn what we can do to prevent that from happening.

– We are going to start today’s discussion with a cruise down what I call science lane. … that place where we learn a little biology and pathophysiology.

– So what is meningococcus?  Well I’m glad you asked.  Meningococcus is one of a group of bacteria known as cocci-meaning round, which has a particular affinity to get into a child’s blood circulation and then ultimately into the coverings of a child’s brain called the meninges…hence the name meningo…coccus.

-In most children’s noses, “Meningo””coccus”  is just an ordinary germ among many, but under just the right conditions, it becomes a “pathogen” or a germ that can cause devastating disease.  If this germ is able to enter the blood, it can provoke a sudden drop in blood pressure.  If it reaches the brain, a horrible condition called meningitis.



-And here is the way it usually happens.  A perfectly normal child or teen touches this germ and unknowingly inoculates it into their nose by touch.  Within a short period of time, hours to days, the germ grows to sufficient numbers in the child’s nose, that some of the bacteria start to get into the child’s blood.

-Bacteria in the blood…. A condition called sepsis or septic shock.  Oh my gosh, this child now in serious trouble.  All their defenses are down, pathogenic bacteria have made it into their blood, and this child’s body is about to come unraveled.

-At this point, one of two things are likely to happen.  Either the meningococcal germ provokes a sudden drop in blood pressure by causing leaky circulation which doctors call “shock”or circulatory collapse, or the child evades the shock, and instead develops a brain infection called meningitis.

-Either of these things can and may cause death in a matter of hours.

-Remember, this was a perfectly healthy child just a few hours ago and is now they are clinging to life.


–Fortunately, these events are fairly rare but, as you can see, are devastating to those who experience it.

–By studying a large number of cases of disease caused by meningococcus, experts have determined that teens and young adults are particularly susceptible to an overwhelming infection with meningococcus. In particular, children who first start living in a close, secretion proximity to many other people such as in a dormitory or in a military barracks.

– As I said earlier, the chance of this happening to your child is very low, but when you consider all the children in the US, there are actually about 1000 children who experience this every year. 1 child is too many, much less a 1000.


– The good news is that we are not helpless in our defense against this nasty germ. A vaccine that is currently licensed by the FDA and recommended by the CDC can go a long way at protecting your child. The vaccine is usually given to children 11 years age with a booster just before college.  Soon you will hear about a vaccine that can protect children down to the age of 6 weeks from this form of meningitis.  Great news for little people. So here are things I want you to remember:


-I think it is important for you to follow the recommendations and get your child vaccinated against this terrible disease at the appropriate age. Remember that DocSmo pearl:  Prevention trumps treatment!  Vaccines prevent disease.


-Be aware that the combination of fever, neck pain with stiffness, and a rash should be considered meningitis due to meningococcus until proven otherwise.  Get medical help immediately!  Minutes are important in this situation.


-In fact, fever along with any rash should always be evaluated by a medical professional, especially in children.


-The rate of illness due to Meningococcus is much higher in certain parts of the world than the US.  Get vaccinated before you travel to these places even if you are not a child.


-If your child has been exposed to bacterial meningitis, let your child’s doctor know immediately.  Treatment with antibiotics may be warranted to prevent your child from getting sick.


Thanks you for joining me today. Your tuition free pediatric education continues.

We recently topped the century mark with posts, so take the time to check out other episodes of DocSmo.

Let me remind my listeners that these pedcasts are for informational purposes only.  For specific medical advice for your child, talk to the wonderful person you call their doctor.

Please feel free to comment on my blog, subscribe on iTunes, like us on Facebook or Twitter.  That way you will automatically get all the new content posted like the Lunchroom lowdowns, the memos from the desk of Docsmo, along with all the new pedcasts.

We have made it easy to send episodes of DocSmo on our website so if you think a relative or friend, might enjoy this experience, you have my permission to send it on.


This is your host, Dr. Paul Smolen, recording in studio 1E from Charlotte, NC, hoping that your child’s next infection, goes in the right direction.


Until next time

Smo Notes: