Interesting Conversations 2015 (Pedcast)

Welcome to another edition of, one of the most popular pediatric blogs out there. I feel really fortunate to have such a great job that allows me to have interesting conversations with so many intelligent fascinating people. As you can imagine, I get asked a lot of questions and many of these questions lead to interesting conversations so I thought once in a while, maybe I would share some of these questions and discussions with my blog audience. So here goes, my inaugural pedcast that I call “Interesting Conversations”.


Conversation 1: Recently, I was seeing a toddler with wheezing and I was asked by his mom, did giving cow’s milk to her infant cause him to wheeze?  An interesting question I thought. Certainly many infants are allergic to milk so why couldn’t this type of allergy cause wheezing? Part of the wheezing process involves excess mucous production and bronchial swelling so if allergy to cow’s milk can cause this, why couldn’t it contribute to wheezing? I know a many ENT doctors try babies who might need tubes in their ears on milk free diets before doing the procedure to see if this might remedy a child’s constant nasal congestion.  I have also heard that many singers and performers don’t ingest dairy products near the time of performances because they believe it changes their voices. I ended up telling this mom that I thought there is a belief and some evidence that milk allergy can contribute to chronic ear infections, chronic cough, and wheezing in infants. My research since seems to confirm this answer. Chalk up one for Doc Smo.

Conversation 2:

I was seeing a child other day who had had a bad injury that involved a laceration on his face. The injury was a few months old and I asked his mother if she was putting anything on the scar to minimize it’s appearance?  She said she was not and so we got into a discussion of what topical substances actually minimize and improve the appearance of a mature scar. She was surprised to learn that scars take about a year to reach their final strengthened state and that their appearance changes until they are totally healed, about a year after the initial injury. I told her that to my knowledge, daily sunscreen on top of the scar was the most effective way to promote healing and minimize the appearance of the scar. Why she asked? I explained to her that scar tissue itself has very little pigmentation and so it couldn’t protect itself from sun damage. Therefore, every time her child went out in the sun, the scar tended to get sunburned, therefore causing further injury, necessitating his body to lay down more scar. Sunscreen protected his scar from this from further sun injury, promoting a faster and better healing. According to my research, other products sold for this purpose are of questionable value. After our conversation, I did a little research and I think I told her the right thing. Yeah Doc Smo.

Conversation 3:  Finally, I had an interesting conversation with the mother of a six month old who had an ear infection. Her infant had a bad URI and had a unilateral ear infection without a fever but mom could tell that she was not right. As we talked through her infant’s illness, I told her about the “Wait and See” approach to ear infections that many experts advocate for treating ear infections in older children–those older than two years old.  This mom immediately jumped on that idea and said that is what she wanted to do. She had heard that antibiotics can have some untoward longterm effects and she said she described herself as “Granola”.  She wanted to try this. I told her that if she did do the “Wait and See” approach, we needed to check the child back immediately if she developed fever or got sicker. We talked about the fact that this was not the current standard of care but she had made up her mind.  She and I decided to just to look in a few days regardless and see how her ears were doing which we did. The child came in about 5 days after I originally had looked at her and to our delight, her ears were clear. Her eardrums looked normal and were in the normal position. This story had a very happy ending–no drug store run, no antibiotics, just natural healing. Fantastic. Maybe this is the wave of the future.  I hope so.

Thank you for joining me today and thank you for making one of the most most popular pediatric blogs out there. Creating portable practical pediatrics to help parents and children is our mission and focus here at the central. If you enjoy my pedcasts, take a moment and subscribe to my blog at and go to iTunes and write a short review; that would be great. This is Dr. Paul Smolen, hoping your parenting is full of smooth sailing.  Until next time.






Smo Notes:

Conversation 1:

1.Relationship between milk intake and mucus production in adult volunteers challenged with rhinovirus-2.

3. Current approach to the diagnosis and management of adverse reactions to foods: Journal of Allergy and immunology

Conversation 2:

  1. Web MD–