Interesting Conversations w/ Parents -January 2016 (Pedcast)

Topic Introduction

I must say, I have such a fascinating job! I get to talk to so many bright interesting parents and children–and they are full of questions, information, and observations. I have always found that people, and that includes me, love to learn new things and a medical visit provides a great opportunity for this to happen.  That’s why I started this series of pedcasts that I call “Interesting Conversations”.  The first such pedcast I did a few months ago turned out to be very popular so here I go again with interesting questions and topics my patients bring up in conversation. I hope you enjoy this edition of Portable Practical Pediatrics. Oh, I’m sorry. how rude of me. I didn’t introduce myself.  I am Dr. Paul Smolen, a board certified pediatrician practicing in Charlotte NC. I invented this blog as a experimental way to better communicate with my patients and their families. So here goes with the next installment of Portable Practical Pediatrics.

Musical Introduction


Conversation 1:

Length of time a child with strep remains contagious after treatment?

The other day a family asked me how long one is contagious with strep throat after treatment has begun? This is certainly a very relevant question for families ready to get back to life when their child contracts strep throat. Well the standard answer you will hear from pediatricians is 24 hours and I think this is a good rule of thumb, with a few caveats.  Consider the fact that bacteria can double their numbers every 15 minutes.  That’s 96 doublings every day, certainly enough time for a small number of strep bacteria to become many, many, many, in your child’s tonsils!. Well, that’s true in the opposite direction as well–the billions of strep germs that are in your child’s tonsils can become a very small number and disappear quite rapidly after treatment is begun.  A few doses of antibiotics and strep is history. There was even one study I came across that said if a child had a dose of antibiotic as late as 5pm in the day, they could attend school the next day without risk of infecting other children. But, and this is a very big but, strep can live in colonies called biofilms for at least a month on surfaces that an infected child has touched. So your child who has been treated may not be shedding strep germs anymore, but they likely left the strep germ on lots of surfaces at school and at home that might infect someone else. In fact, I used to moonlight for a pediatrician/microbiologist when I was a resident, who would collect his strep swabs all day long and not plate them for a many hours after the patient had gone home. He told me that strep lives on surfaces for a long long time, and he was right.  Strep is not a fragile germ, rather a touch street fighter type of microbe. The truth is that most children who get strep right after having been treated with antibiotics, are getting reinfected rather than the treatment being a failure.

Conversation 2:

Hearing impaired infant with amazing visual contact of examiner. Related?

I recently saw a child whose mother brought her to my office because she was worried about whether she had normal hearing. The child, like all children in the US, had her hearing tested at birth with a device called an OtoAcoustic Emissions device or OAE testing. This device essentially puts a click into the ear and listens for the echo. If the inner ear apparatus is intact and functioning, there will be a solid echo sent back. If the child does not have a functioning inner ear, there will be an abnormal echo. Now this child had passed the OAE in the state in which they were born, Connecticut. But this family had many hearing impaired members, including this child’s brother. This mom just thought something was wrong with her daughter’s hearing.  Interestingly, I noticed that while we were talking about her daughter’s hearing that this six month old child wouldn’t take her eyes off me. She kept intense eye contact with me. If I moved, she followed me with unbroken eye contact. “Could this be a sign of hearing impairment I wondered out loud with this mother?” She agreed, she had noticed the exact same thing and she felt that this was a sign of her hearing problem. Sure enough, with a little research I did find evidence that hearing impaired children have different eye movement patterns than children with normal hearing. I also discovered that up to 20 % of children who turn out to lose their hearing impaired,  had passed the newborn hearing screen. These poor children lost their hearing after the newborn period, possibly like this child. Speaking of eye movements in babies, you may have read  in the past few years that researchers interested in early diagnosis of autism have found that many autistic children avoid eye contact with caretakers very early in life. The child I am talking about today seems to demonstrate the opposite phenomena, possibly signaling something very important about their nervous system. I’m very sure we will be hearing more about eye movements in babies as a diagnostic test in the future.

Conversation 3: 

The Alexander Technique-What is that?

My final interesting conversation for this pedcast came during an ordinary checkup that I performed for a mother of four young children. While I was checking her six year old daughter’s spine for scoliosis, she reminded me that she, the mother, had very significant scoliosis as a teen and adult. Her curve was in the 30 degree range, a very large curve in scoliosis terms. Usually, if a child has a curve in the 40 degree range, a surgical rod is placed to stabilize the child’s back. Severe scoliosis not only causes the child pain, but can cause severe impairment in the child’s breathing. This mom was very anxious about her children developing scoliosis and rightfully so. I explained to her that idiopathic scoliosis usually doesn’t develop until a child goes through puberty and that we will need to watch her carefully for this in the future but so far, so good.  I reminded her that all of her children are only half her, the other half being Dad. She liked that but told me about how she had suffered with back pain as a child and she was very anxious about scoliosis. Then she told me about something called the Alexander technique that she said changed her life. The Alexander technique, she went onto telling me, is a method of holding one’s body to minimize stress on joints and muscles. It was invented by a British Actor in the 19th century who developed difficulty with speech during performances as he held his body in acting poses.  The Alexander Techniques are commonly used by musicians and actors today who need to hold themselves in exaggerated positions for long periods of time during performances. She told me that the Alexander method saved her. By using these techniques, she has been very functional and pain free for years, even with all the demands of caring for four young children. She attributes that success to her Alexander Technique Training. So even though her daughter doesn’t have a curved back, this conversation allowed me to learn about a non drug/non surgical therapy that could possibly help many other teens with big back curves. Fantastic.  If you want to learn more about Alexander training, check out the video I have linked to this podcast.


Well, that’s it for this pedcast. For more Portable, Practical Pediatrics, check out the hundreds of pedcasts stored at I am sure you will find my blog a place for interesting, stimulating conversations that can help you with your parenting. While you are there, subscribe to my weekly podcast to keep up with what is new in pediatrics. You can also get the same content on iTunes by following Portable Practical Pediatrics.  And if you are a real Doc Smo junky, you can also follow me on Facebook, twitter, or Google Plus. This is Dr. Paul Smolen, reminding you that interesting conversation can be your source of parenting edification. Until next time.

Smo Notes:

Conversation (1)

–Web MD-Strep throat

–How many hours after a dose of Penicillin can kids return to school?

–Biofilm Formation Enhances Fomite Survival of Streptococcus pneumoniae and Streptococcus pyogenes
Laura R. Marks,a Ryan M. Reddinger,a and Anders P. Hakanssoncorresponding authora,b,c
L. Pirofski, Editor
Author information ► Article notes ► Copyright and License information ►

— How long can Strep survive on a surface and be infectious?

Conversation (2)

–Effects of Mother and Infant Hearing Status on Interactions at
Twelve and Eighteen Months
Kathryn P. Meadow-Orlans
Gallaudet University

–Number of children who have normal newborn screeing by OAE who go onto being hearing impaired.

Conversation (3)