Motors and Kids, a Bad Mix (Pedcast)

You can imagine in 33  years of practice, I have witnessed a lot of events, many terrifying and tragic for the children involved. I was reminded of one of those events recently when I was reading an article about ATVs or All Terrain Vehicles. Remember, I live in the south where ATVs and dirt bikes are popular in areas where there is a lot of open space. Many of my patients ride these vehicles with their very powerful engines. In my mind, powerful motors and children are a very bad mix. More on that in a few minutes. Continue reading

Hearing Loss (Pedcast)

Good evening, and welcome to another addition of, the home of Portable, Practical, Pedcasts dedicated to parents and children. Today we’re going to take on a topic that probably has not been on your radar: the problem of acquired hearing loss in children. There are risks to your children’s hearing in everyday life, and I feel that parents need to know the basics about sound, noise, and hearing loss in order to protect their children during childhood. So, let’s take the plunge and find out more, shall we?

First, a little trip down what I call Science Lane. We’re gonna do a little basic science about noise and sound and how it’s measured. Sound can be measured in two ways: first in terms of volume, how loud the sound is. This we measure with units called decibels. This is a logarithmic scale, so 100 decibels is a LOT louder than 50 decibels. The threshold of human hearing is about 15 dB…very quiet. And we begin to get into the damage zone for a child’s hearing at about 80 dB, certainly above 100 dB. So, that’s volume. The second way we measure sound is in terms of the frequency of the sound. Speech is a low frequency sound, and certain musical instruments like the flute produce high-frequency sounds. Speaking softly is a low decibel, low frequency sound, whereas listening to a flute is a high volume, high frequency sound. Got it?

The most common hearing loss that pediatricians see in children comes along with cold and ear infections. This is a low-frequency sound loss and fortunately is temporary until the child’s ear infection clears up. As we age, we lose our hearing very slowly. Older people and those exposed to a lot of noise tend to lose high-frequency hearing first. If you don’t remember anything else from this lesson on hearing, I want you to remember this: noise exposure that can damage hearing comes in two forms, first being very brief but very loud noises like shooting a gun, the second type being moderately loud noises, in the range of  80 decibels and higher, that go on for long periods of time. Either of these types of noise exposures can eventually lead to hearing loss. More on this in a minute.

So, as I said before, I want to make you aware that noise can damage your children’s hearing. I want you to do everything you can to protect your kids during childhood. This is important. They may not get the hearing loss until they are adults, but it’s still very important to their overall health and well-being. Now, the number one cause of hearing loss in United States is shooting guns such as shotguns and handguns and yes, children do this as well or they are around when this is being done. Additionally, few people seem to know that power tools like nail guns can also permanently cause hearing loss. These devices produce extremely loud noise, in the 120-140 decibel range, but the noise is so brief, our brains can’t perceive just how damaging this kind of noise can be.

And here are some other kinds of loud noises that have the potential to damage your child’s hearing: lawnmowers–a lot of kids run lawnmowers, and use hairdryers, and those teenage girls love t0 dry their hair every day, sometimes multiple times a day, and certain types of musical instruments like in a very loud wind instruments, and recorded music–especially when delivered with their ear bud devices very close to a child’s eardrum, and motorcycles and farm equipment–All these things have the potential to damage your child’s hearing. I think you should insist that your children wear hearing protection when they are around any of these noise generators and limit their exposure. You need to insist on it. You are the adult in the room!

“Hearing protection around lawnmowers and hairdryers and musical instruments Doc Smo, did I really just hear you say that?” Yes, I really just said that, and I also want you to teach your kids the “warning signs” that sound is too loud for their ears, the number one signal being that the sound hurts when you first start listening to it. We’ve all had that experience of getting in the car the radio really loud and it hurts when you first start listening. That level of sound is damaging. Signal one, the sound hurts initially. The second sign is to hear ringing after noise exposure, this almost always means that there’s been some damage to one’s hearing.

So, to summarize, I want you to be aware that either very loud brief noises repeatedly or moderately loud noise over a long period time can damage your children’s hearing. I want you to try to protect them with some kind of hearing protection, and that’s especially important if they cut the grass (95 db), dry their hair with an electric dryer (85-90 db), shoot weapons (140-170 db), are around motorcycles and loud engines (95 db), as well as any other situation that you think might warrant protecting their precious hearing. Let me tell you it’s much easier to keep your kids from losing their hearing than it is to get their hearing back after they have lost it. That’s true for parents as well. Make sure you set a good example for them, won’t you?

This is Doc Smo, thanking you for joining me and hoping you enjoyed my little chatter, about a subject that really matters. Until next time.

Smo Notes:





A True Trampoline Nightmare (Pedcast)

Doc Smo here, your pedcast host. Thank you for joining me today for what I hope will be an interesting edition of, the place where we discuss all things pediatric, all the way  from the “onesie” to the “three-piecie”…and everything in between. Today I’m going to tell you about an interesting experience I had a few weeks ago when I was doing a check up in the office. The patient and his mother was there, the child being about 10 years old. The subject of trampolines came up (as it always does in my checkups with older children), and I was giving this young man my usual warning about not doing flips on trampoline. I never want to see a child have a serious head or neck injury from a trampoline accident, or any other activity for that matter. While I was warning this child not to do flips on a trampoline because the risk of a serious neck injury, this child’s mom got a really pained look on her face. I stopped the conversation and asked her if anything was wrong, and she proceeded to tell me what happened to her when she was 12 years old… in her backyard, jumping on a trampoline.

Here is what she told us: her family had a trampoline in their backyard for the kids to play on. She wasn’t supposed to be on the trampoline, and she certainly wasn’t supposed to do stunts like flips on it, especially when she was home by herself. But she played on it anyway. Then she told us she was doing a somersault and she flipped off the trampoline and came down on the back of her neck and head. She told us that as soon as she hit the ground she knew something terrible had happened. She was not able to move her arms or legs, and she thought she had broken her neck. Remember, she was by herself, laying on the ground, scared to death to move her head, thinking her neck was broken.  Her arms and legs were limp and heavy, not under her control. What a horrible experience, no help in sight, scared to move her neck thinking it was broken, and convinced that she would never move again. What could she do? So she just laid there for what must’ve seemed like an eternity. After about a half an hour of agony, she began to get feeling and movement in her arms and legs. A miracle…perhaps, but more likely the “concussion” to her spine began to clear. After her arms and legs began to move, she finally got up enough nerve to move her neck and she realized that she hadn’t broken neck, but rather she just had a horrible blow to her spine and was temporarily paralyzed.

She had come within millimeters of actually fracturing her spine and being a quadriplegic for the rest of her life, and she knew it. What good fortune she had not to actually break her neck. Finally she got up and kept that fall a secret from everyone, including her parents, until that day in my office! She had never told a soul about her fall until that day in that examining room when she relived every moment of that terrifying event. She knew all too well what I was discussing with her children, and she was glad that we were talking about this subject so that hopefully no other child, especially a child of hers, would ever have to endure such a horrible event… or worse.

So here is the takeaway message from this story for your family: make sure you take the time to share stories of your childhood that might benefit your children, just like this mother did. When your children are old enough, tell them about the people you knew who got into cars after drinking when you were in high school and what terrible things happened to them. Tell them about the kids who got hurt playing with things that they knew they shouldn’t have been playing with like explosives, knives, firearms, or even drugs and alcohol. Tell them what happened to your friends who didn’t take school seriously and do their work, choosing instead to just get by. Make sure you share your treasure trove of life experience with your kids so they can benefit from your experiences. I think you will find that they’re very interested in what you have learned and experienced. Even if they don’t act like they are listening to you, they are probably taking in every word you say. I can guarantee you the kids in that exam room heard every word their mother said that day, and that they will never do flips on trampoline… and that’s a really good thing!

Thanks for sharing some of your precious time with me today. My audience is really growing and for that, I want to thank you. If you are new to the DocSmo blog, take a few minutes to explore literally hundreds of articles and pedcasts. I think you will be glad you did. While you are there or on the DocSmo iTunes site, take a moment to leave a comment or a review. This is your pedcast host, Dr. Paul Smolen, reminding you to move your lips, and tell your kids not to do flips.  Until next time.

Medicines, Help or Harm? (Pedcast)

Come on in, sit back, and get ready for another installment of your free pediatric education at the blog. I’m your host, Dr. Paul Smolen, a board certified pediatrician with 32 years of practice to date, practicing in Charlotte NC. I started this blog to bring parents portable, practical pediatrics delivered on their time schedule. From conception to graduation, if it involves children, we talk about it here. Today, we are going to talk about the topic of medications, specifically, commonly used OTC medications that parents give their children without really ever giving it much thought. I am talking about cough and cold medications, antidiarrheal medications, and fever reducing medications. As you will soon see, these medications may relieve the symptoms they are intended to relieve, but often at the cost of some unintended consequences. It is my job today to inform you about the unintended consequences so you, as a savvy parent, can make an informed decision about whether you wish to use these medications with your little Johnny or Janie.

Lets start with cough medications, shall we? The most commonly used cough medications used include dextromethorphan, diphenhydramine, or codeine…all centrally (that means brain) acting medications that depress your child’s cough reflex, the reflex that is intended to clear your child’s lungs of mucous that, if trapped in the lung air spaces, can trigger the a serious infection we call pneumonia. Long time readers/listeners of the DocSmo blog may recall some recent information learned from children who had tonsillectomies and who had received codeine for pain relief.  ( Some of these children did not metabolize the codeine as intended and experienced life-threatening depressed breathing from correct doses of codeine, given to them for pain relief after surgery. Yes, all these depressant medications reduce cough some but is this safe to do… maybe not in every child.

Next comes the cold medications; you know, these mixtures of antihistamines that reduce the amount of mucous in your child’s nose, decongestants that open their nasal passages, often along with a pain reliever/ fever reducer such as acetaminophen. Well, there is trouble here as well. The mucous inhibiters actually may make your child’s mucous stickier and more likely to allow bacterial growth. When that happens, we call it an ear infection or a sinus infection. The decongestant part of these medications can be converted into substances that can be abused, and the fever reducer can often be a source of overdose since many parents are unaware that cold medicines contain acetaminophen 

Finally, lets talk about anti diarrheal medicines…what could be wrong there, you ask? Well, for one thing, slowing down your body’s defense of getting rid of microbes in the gut has been proven to PROLONG a child’s illness. You heard me right: these medicines make the diarrhea go on for a longer period of time. Less diarrhea in the short run but more in the long run and a slower recovery. That doesn’t sound like a good tradeoff. Additionally, the potent antidiarrheal medication marketed as Imodium is so potent, that toxic effects have frequently been seen in children less than 2 years of age. I think a parent (or doctor, for that matter) needs to have a VERY GOOD reason to consider ever using one of these medications.

And what about fever reducers you ask? Is nothing sacred?  Take two aspirin and call me in the morning is part of every doctor’s DNA, right? Wrong. Aspirin we all know shouldn’t be used in children because it can trigger a fatal liver disease called Reyes disease, ever-so-prevalent back in the 70’s. Now we are beginning to learn that aspirin’s cousin ibuprofen can cause kidney and blood vessel problems with chronic use, and acetaminophen, trusted acetaminophen, is toxic to our livers and may somehow bring out allergy in children.

So what is the take home message from all this? Medical science can do some amazing things: replace failing hearts and kidneys, eradicate leukemia cells from a child’s body, and stop convulsions in a seizing child. These are miraculous things, and we definitely need to give medical science its kudos. I think doctors and families start to get in trouble, though, when they stop doing miraculous things for extreme medical maladies and start trying to “trick” a child’s body into not protecting itself with reflexes that we find unpleasant like diarrhea, coughing, and fever. It probably took our bodies a long time to hone these reflexes and THEY ARE THERE FOR A REASON! Artificially stopping them always seems to  get us in trouble. So, before you reach for that acetaminophen to lower your child’s temperature, codeine cough syrup to stop a nagging cough, or an antidiarrheal medicine to stop diarrhea, think twice and decide if the medicine’s benefits outweigh any potential risks. That’s the prudent thing to do. “Do no harm” is still the guiding principle. Sometimes the best medicine to give is TLC.

That’s it for this installment of portable, practical, pediatrics. As always, your comments are welcome at my blog or iTunes. Take a moment to weigh in with stories or comments of your own. This is Dr. Paul Smolen, recording from studio 1E, that’s my first child’s bedroom on the east side of my house, hoping you use your head before reaching for that OTC med. Until next time.

Smo Notes:

1. J Randall, J Owen, A Decongestant-Antihistamine Mixture in the Prevention of Otitis Media in Children With Colds, PEDIATRICS Vol. 63 No. 3 March 1, 1979 pp. 483 -485     

2. Hutton, Nancy et al, Effectiveness of an antihistamine-decongestant combination for young children with the common cold: A randomized, controlled clinical trial,  Journal of Pediatrics, Volume 118, Issue 1, January 1991, Pages 125–130.


4. Marcia L. Buck, Pharm.D., FCCP, FPPAG Nov 27, 2012 Pediatr Pharm. 2012;18(10) © 2012  Children’s Medical Center,  University of Virginia