Auditory Processing, Night Shift, Baby Yoga – PediaCast 248

Posted by Dr. Mike on April 10, 2013

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This week Dr Mike tackles more of your questions! Join us in the PediaCast studio as we cover auditory processing disorder, hemangiopericytoma, working the night shift while pregnant, subgaleal hemorrhage, baby yoga, and listening skills.

Topics

Tornado Safety
Auditory Processing Disorder
Hemangiopericytoma
Sarcoma
Night Shift & Pregnancy
Subgaleal Hemorrhage
Cephalohematoma
Baby Yoga
Dynamic Gymnastics
Listening Skills

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus from Nationwide Children's, here is your host, Dr. Mike!

Dr. Mike Patrick: Hello, everyone and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We're in Columbus Ohio. It is April 10th, 2013. It's Episode 248, and we're calling this one "Auditory Processing, Night Shift and Baby Yoga."

Now, of course, we have more topics than just those three coming your way. It is a Listener edition of the program so we're going to be answering your questions. And I'll get to a complete line-up of the topics here in just a moment.

First, I want to say welcome to the program, all of you. And Spring has sprung here in Ohio. So we're pretty happy about that. The sun is shining, it's a bit warmer outside. You'll notice I have a little bit more jump in my step, a more positive outlook. The Ohio winter grey was really getting to me last week, as you probably surmised by my tone. So spring is here and I'm pretty happy about that.

Spring also means tornado season. And, those of you who are potentially in the paths of the large type tornadoes, so those in the Plains States and here in the Midwest as well. I remember, and I guess this is sort of probably where I don't know if I'd call it a fascination, but sort of my interest in tornado stems from the fact when I was a kid, there was a very large tornado, an F5. Back then, it was just F. Now, it's EF. But anyway, it was the largest type tornado you could have back in 1974. And it hit a town here in Ohio called Xenia. And we live about an hour, an hour and a half, right around there, away from Xenia, in a town called Urbana, Ohio.

0:02:19

And I remember we had debris from the surrounding countryside. We have like dried corn husks. I can vividly remember, they blew into our yard, which is really weird in April. That was dried stuff from a field. But a friend of mine — and this is true story, not kidding you here — had a large ceramic Easter egg land in his yard and it was unbroken and had a family name and said "Xenia, Ohio" on it.

So, it blew, like an hour, hour and a half away, up in the air and landed in my friend's yard. So that was pretty amazing and true. It really did happen. I didn't see it land. Now, I'm sitting here thinking, maybe he made this whole thing up. Maybe he had like an aunt who lived in Xenia and he's like, "Hey, look what fell in my yard." [Chuckle] I think I need to give this guy a call.

Anyway, that's sort of where my interest in tornadoes comes from. But anyway, my point here is since this is a pediatric podcast, we have to kind of wrap this around and make it relevant to pediatrics. We want your family will be safe. And you know, you got little ones at home and it's important that you have a tornado plan. They have one at school, you probably have one where you work, you need one at home, too. And particularly since we've seen pretty big deadly tornadoes in recent years. Back in May 2011, Joplin, Missouri, a 158 deaths.

So even with our improved knowledge of tornadoes and early warning systems, we still see big ones with large death tolls. So it's really important that you are prepared. And to help you do that, I have a couple of links for you in the Show Notes for this Episode 248. If you want to head over to pediacast.org, you'll find them, from the National Oceanic and Atmospheric Administration, otherwise known as NOAA. They have a very nice tornado FAQ and also a tornado safety tips sheet. Really everything that you need for your family to be prepared for tornado season.

0:04:17

What supplies do you need, like a battery-operated radio and flashlight, where do you go at home? If you have a basement, that's a good bet. But the southwest corner idea, as it turn out is a myth and their FAQ talks about that. If you don't have a basement, you know, you want an interior hallway or a bathroom and it really goes into where you need to be and what you need to do. You can take a mattress in with you and cover yourself up, that would be good if you have time. Also if you're out in your car, it's not a good idea, as it turns out, to hide under an overpass. And they explained why that is and what you should do in their FAQ and in their Safety Tips sheet.

So definitely check those out again, Episode 248 in the Show Notes over at pediacast.org.

All right, as I've mentioned, we do have a Listener show coming your way this week. And I recently put out a call for questions. And of course, in usual fashion, you guys responded. But we need more. So if you're sitting out there with a pediatric question in your head, maybe it concerns your child or a grandchild or a niece or nephew, or really any other kid or teenager that you know, or if you have a topic idea or you want to point me in the direction of a new story, if that's the case, head over to pediacast.org, click on the Contact Link and ask away. That's what the five listeners who are featured in this week's program did and you could be next.

So what are we talking about today? What questions did you have? Well, the first is on auditory processing disorder. What is it? What causes it? How do you diagnose and treat it? So that's coming your way.

Also, hemangeopericytoma– OK now, I lost some of you there. But never fear, our listener has a question about a tumor on her child's knee. We'll break down the word, hemangeopericytoma. We'll make it easy to understand and let you know the ins and outs of this sarcoma.

0:06:05

That may not have helped. What is this sarcoma? You've probably heard the word, but what exactly does it mean? We'll clue you in.

And then, working the night shift while pregnant, is it dangerous to the health and well-being of mother and child? We'll give that some thought.

Then, we're going to go on another technical topic. Well, you guys asked some good scientific questions this week. Subgaleal hemorrhage and cephalohematoma — you probably seen a baby born with a giant baggy lump on the back of their head. or you know someone who had a baby with a lump on their head, or maybe your child did. That's usually a cephalohematoma and we'll explain what it is and why some babies get them. And then, we'll also explore their much more dangerous but far less common cousin, a subgaleal hemorrhages.

So that's coming up. And then, we're going to take a look at baby yoga, also known as dynamic gymnastics. There had been some popular YouTube videos surfacing on this practice, but it's dangerous. And in my mind, it amounts to child abuse. Want to know why? Well, stick around and I'll explain.

And then, finally, we're going to wrap up with a final word on listening skills.

So lots of great questions this week from our wonderful audience. And again, if you have a question of your own, we're caught up on questions and I need more. So head over to pediacast.org, click on the Contact link and ask away.

Also, I want to remind you the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you do have a concern about your child's health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find over at pediacast.org.

All right, let's take a quick break and I'll be back with your questions, right after this.

[Music]

0:08:24

All right, our interlude music there, you'd probably heard that one many times before, especially if you're a regular listener of PediaCast. It has a name. As it turns out, the name of that one is Windy City, which I thought was appropriate given our little talk about tornadoes earlier. I kept this in the back of my mind. A ceramic Easter egg, a big one with a family name and then, it says "Xenia, Ohio". Did that really land in my friend's yard? I believed it all these years. In fact, the only time that doubt ever slipped in was as I'm presenting it to you. And I'm thinking, did that really happened or was he just kidding me? Seriously, I'm friends with him on Facebook. I need to ask and report back to you.

All right, first stop with our listener questions this week is Marcy in Bellmore, New York. Marcy says, "Hi, Dr. Mike. My daughter is five years old. When she started kindergarten, her teacher thought it would be a good idea for her to receive speech therapy, because she was mispronouncing different letters. As part of her assessment for speech therapy, she was required to see an ear, nose and throat doctor. We've already been seeing an ENT because my daughter has a history of frequent ear infections. The ENT doctor suggested that my daughter may have an auditory processing disorder. I was hoping you could explain this a bit more on your show. Thanks. Marcy."

Well, thanks for the question, Marcy.

Auditory processing disorder, also known as central auditory processing disorder. It's another one of those diseases that we don't fully understand. As the name suggest, the underlying problem is how a person processes sounds.

OK, so what does that mean? Well, if you think about the brain as a black box, which sometimes is not very far from the truth. Something goes in and in this case, information from the ears in the form of sounds. And then, something comes out which is our response to those sounds in the form of speech or actions. In this case, the problem is in the black box. So sounds make it in OK. And then, there's nothing wrong with the response to those sounds in and out of themselves. But the response isn't what we would expect, given the sounds that went into the box.

0:10:32

So the response is OK, there's nothing wrong with it, other than that it doesn't quite match up with what went in. So the issue is inside the black box or inside the brain at the location where we interprete sounds and initiate a response to them. So that's what is meant by a processing disorder.

Now, why do we think this is? How do we know it's not a hearing problem. Maybe the ear isn't sending in the correct signal. Well, kids who have an auditory processing disorder do have normal hearing. So, if you sit him down on a quiet sound booth with an audiologist and the audiologist does a sound test with pure tone, they pass the test, no problem. But when you add in background noise and dynamic speech, so when sounds need to be separated and analyzed on the fly, that's when it appears that the trouble starts. Unfortunately, we don't yet understand what the problem is or even where the problem lies inside the black box. And at the end of the day, there probably isn't a single problem. Auditory processing disorder is likely a group of diseases with a common expression and as more becomes known, we'll do a better job of teasing out the differences in the future.

OK, so now that we've defined auditory processing disorder, how common is it, what specific problems do these kids face and how can we help them? Well, it turns out about 5% of school-aged children are affected, so it's pretty common. Five percent of school-aged kids affected by it.

0:12:03

In terms of specific problems that these kids face, the biggest issue is following speech, and particularly, in noisy environments. So, how does this look at home or in the classroom? Well, these kids don't like to be in a noisy environment. So background noise typically aggravates the problem and leads to stress and frustration on the part of the kid. However, when you sit him down in a quiet and focused environment, they'll settle down, they're more comfortable and they perform better.

These kids often and initially present with speech problems. Why? Because they interpret sounds differently and repeat back what they think they heard rather than the actual sounds. So,they may have a problem differentiating similarly sounding phonics. For instance, ch 'cha' and sh 'sha'. So ch and sh, they may have difficulty telling those apart even when the difference is readily apparent to everyone else.

They may also have trouble differentiating words when the endings sound alike. For instance, they may confuse light and sight. And by the time they figured out which of those words make sense in the context of the sentence, you're already through your four sentences downstream and they've lost you.

So these kids have difficulty following speech and sometimes even in quiet environments, they may have trouble following instructions, they may have trouble understanding, they may have trouble learning, because they aren't following you. And because these kids have trouble following, what's the normal response? They give up and stop paying attention. So these kids seem to have an attention problem because they aren't paying attention and they may seem disorganized and forgetful.

And you'll see right away that these symptoms seem an awful lot like another problem we've recently covered, ADHD. And in fact, there are many kids out there diagnosed with attention deficit hyperactivity disorder, treated for ADHD who really have an auditory processing disorder and stimulant medication is not going to help them.

0:14:02

OK, so what does help? Well, the first step is getting the right diagnosis. And this is best accomplished by evaluations. First, from an audiologist to make sure there isn't a hearing problem, because a true hearing problem can cause similar symptoms. And then, an evaluation by a speech pathologist who has the tools and knowledge to make the right diagnosis.

Now, I do want to point this out — kids with auditory processing disorder may have other issues going on at the same time, like ADHD or autism or anxiety or depression. So comprehensive medical and behavioral examination is still important. And your child might benefit from medications for their other problems, if those exist.

OK, so let's say your child has all of these evaluations done and a speech pathologist diagnoses an auditory processing disorder. What then? What do you do about it? Well, working on a regular basis with a speech therapist is in order. And there are some practical things you can do to help your child. For instance, reducing background noise. Have your child look at you when you're speaking. Talk slowly. Use simple sentences. Write down instructions rather than relying on your child remembering what you say.

To help with school work, you want to make sure that the school is providing a quiet, distraction-free study space and that you are providing that at home, as well. And also, teach your child organizational strategies that rely on written words.

And of course, the school does need to be dialed in to the problem. They can provide a distraction for your learning devoid of background noise. These kids should be sitting in the front of the classroom. They benefit from written supplements to the lesson, rather than solely relying on spoken lectures. Also, having lectures recorded or in podcast form, so they can review and re-listen, that may be helpful as well.

Unfortunately, a lot of these kids get placed in a special education classrooms, which is good in terms of the learning environment, but these kids don't have a problem with intelligence. And you do run the risk of dumbing down the material they're working on in special classrooms, which can affect standardized test scores in the college admissions.

0:16:11

It's also important to point out that with the right diagnosis and support structure in place, these kids usually do not have a problem with academic success. But again, you need the right diagnosis and the right support strategy.

You know, this is one of those things, too. If you have a kid with ADHD, that's what their diagnosis is and they're on stimulant medication, and they're doing great, then great! You probably have the right diagnosis. But do keep in mind, if you have a kid who's been diagnosed with ADHD and they've tried this medicine and that medicine and this dose and that dose, and nothing seems to be working, then maybe it's time to explore some other things and auditory processing disorder would be one of those.

In terms of long-term outlook, many of these kids either outgrow the problem or dramatically improves by the time they reach adulthood. There are others who don't see as much improvement and auditory processing problems can persist into adulthood. But again, with proper recognition and appropriate strategies for learning and work environments, adults with auditory processing disorder can also lead successful and rewarding lives.

So hope that helps, Marcy. And, again, thanks for the question.

All right, let's move on to our next one. This one comes from Deb in Green Rapids, Michigan.

"Hi, Dr. Mike. I've been listening to your podcast for several years and have sent in a couple of questions before. Thank you for doing such a wonderful job of bringing answers, news and information to all of us, parents. I have another question I'm hoping you can help me with. Last Fall, we noticed a growth on our ten-year-old daughter's knee, which was biopsied and then removed in January. Three separate pathology reports all agreed that it was an infantile hemangeopericytoma. We've been to four different doctors. Our pediatrician initially referred us to a dermatologist, who referred us to a pediatric surgeon, who referred us to a pediatric oncologist. Each time, we've gotten a little more information about the problem and we're comfortable with the course of treatment that's being recommended after an MRI, a CT-scan and bone scan. A second surgery would do a wide re-section of the tumor area, which is now mostly scar tissue. But they don't feel chemotherapy or radiation is necessary at this time.

0:18:18

I know that hemangeopericytoma is a form of sarcoma and that it's a rare type of tumor so that not much research is available. And that's a lot of the reason why we've had multiple doctors and varying treatment options. I'm wondering if you might be able to explain more about sarcomas and how it's determined as to whether tumors are benign and malignant, and if there's anything specifically out there about hemangeopericytoma as well. The oncologist explained that when they occur in anyone under 18, they're classified as infantile but that's misleading since these tumors do behave differently in infants than in kids or adults. I try to find information online but there's not much out there and I don't understand most of what I do find.

Anything you can explain or describe in layman's terms would be incredibly helpful. I know this is a rare tumor and most likely other listeners will never need to know about it. But in talking to other parents since this whole thing begin, I've heard of other kids with various types of sarcomas, so even knowing more about them in general might help someone else. I've written about our experience with this on my blog at momstakeonthings.com. Most recent post starting with the one in January called 'That Funky Looking Thing on Hannah's Knee'. Thank you — Deb."

Well thanks for the question, Deb, and thanks for your long-time loyalty to the show. Really appreciate that as well.

So, let's begin with the benign versus malignant tumors and then we'll move on to a definition of sarcoma and we'll wrap with some detail of hemangeopericytoma.

Actually, before we begin, and I don't think we've really covered cancer on PediaCast much. So let's define what cancer and tumors are. Cancer is really just out-of-control cell division. Now, obviously cell division is importan for growing and for replacing damaged tissue. But when cells grow in an uncontrolled fashion, they can impede on surrounding tissues. They can spread to other areas of the body and then leash havoc. They can cause dysfunction and damage and ultimately lead to death.

0:20:14

So , what causes cells to start dividing out of control? What causes cancer? We know genes are involved, so DNA, genetics, genes. And we know environmental factors which alter those genes play a role, things like chemicals and radiation and viruses. A tumor by definition is a massive cell that have divided in abnormal fashion. A benign tumor is one which may get larger but it's not expected to spread aggressively. So there's potential for encroachment on surrounding tissue and for that reason, it may need to be removed, but there isn't fear of aggressive growth or distant spread. On the other hand, a malignant tumor grows and spreads to distant sites in an aggressive manner and without intervention can lead to organ system dysfunction failure and death.

So what determines if a tumor would be benign or malignant? Well, that depends on the source cell. So the cell that started the out-of-control process and certain characteristics of that source cell.

Now, admittedly, I'm simplifying this a bit because I have five to seven minutes to explain cancer, which is no easy task. So, depending on the source cell and characteristics of the source cell, we can make predictions on how the tumor will behave based on past observations and our knowledge of that specific type of cancer or tumor. As it turns out, the source cell and it's characteristics also determine what word we use to describe the type of cancer we are dealing with. So if the source cell is a malignant epithelial cell which are cells that line tissues and make up glands, then we call the cancer a carcinoma. If the source is a malignant mesenchymal or mesenchymal cell, which are cells that make up connective tissue, things like bone, cartilage, fat, muscles, blood vessels, then we call the cancer a sarcoma.

0:22:13

So, what then is a hemangeopericytoma? Let's break down the word and that will help us to understand. So hemangeo, that let us know a blood vessel is involved. Pericyte — that lets us know that a specific cell, a pericyte cell is involved. Now, it's not a parasite like the micro-organism, but a pericyte. But the micro-organism parasite, P-A-R-A-S-I-T-E, this is P-E-R-I-C-Y-T-E. So a pericyte is a type of blood vessel cell. So what are these cells? What are pericytes? Well, they are cells that make up the deep portion of the inside lining of various small blood vessels like capillaries. The oma at the end of the name, hemangeopericytoma, that lets us know that this is a sarcoma. So it's a malignant cell of mesenchymal cells. So putting it all together, mangeopericytoma is a malignant tumor that arises from cells which make up a portion of the deep lining inside the capillary wall.

OK, so what do you do about it and how do you treat it and why are there differing opinions among your doctors? Well, here's the deal, in the world of cancer treatment, things aren't always black and white. In fact, I think they're seldom black and white. Treatment protocols for specific cancers are fluid. They're changing to reflect new knowledge and success and failure in the treatment of similar tumors at different institutions.

So as long as your cancer team is being managed in that approach, as a team, and that includes oncologists and surgeons who discuss the case and make individualized treatment decisions based on your specific disease and taking into account up-to-date research, up-to-date experiences, up-to-date treatment protocols, and the team has experience and access to appropriate resources for that particular cancer, then you're in good shape.

0:24:17

Now, how do you know for sure that your team is up to date, has the right resources and is doing the right thing? Well, in my opinion — so this is my kid we're talking about — I make sure that I'm at a dedicated pediatric institution with a solid reputation for cancer treatment. And by the way, I do want to point out, at Nationwide Children's Hospital, we do have a world-class cancer team that is happy to see kids from outside the State of Ohio, whether that be for primary treatment or for a second opinion.

Now, I'm not suggesting you do this, Deb. You may be in very good hands in Grand Rapids. But I do want to make sure that everyone out there is aware of our outstanding cancer programs. It's recently ranked as one of the best in the nation by both US News and by Parents Magazine. And I'll put a link in the Show Notes, again, Episode 248 over at pediacast.org. And you'll also find a link to our exclusive contact form so you can easily reach out to one of our cancer specialists with any concerns affecting your child.

So, thanks again for your question Deb and thanks, too, for sticking with us through the years, really appreciate your trust and loyalty. The rest of you out there, if you'd like to read more about Deb's journey with, in her words, "the funky looking thing on Hannah's knee", I'll put a link to her blog, momstakeonthings.com, again on the Show Notes for Episode 248 over at pediacast.org.

All right, let's move on to question number three. This one comes from Sarah in Nebraska.

"This might not be a question you're interested in answering because it deals with pregnancy instead of pediatrics but I trust you to provide quality information, so I thought I'd ask. What kind of information is available about working in overnight shift, 10pm to 7am, for example, while pregnant. I've done some Google-ing but it's either anecdotal information or somewhat scary article about miscarriage or something. I love your show and I'm hoping you'll be interested in talking about this topic."

0:26:13

Well, thanks for the question, Sarah. I think it's interesting you mentioned the 10pm to 7am shift, because that just happens to be a shift that I am acquainted with, working in the Emergency Department. And I am happy to talk about staying healthy during pregnancy as well.

Now, we know a mother's health does affect baby development in pregnancy outcomes. But what about working in the night shift specifically? Well, I did a little research and there really has not been any extensive study of this issue. So we have to fall back on what we know. I'd personally take a practical approach to this. Some people tolerate the night shift just fine. They've been doing it for years. It's like they were made to work nights. They're happy and healthy and really wouldn't have it any other way. There are people like that.

For others, they tolerate the night shift, it's not their favorite, but they deal with it. They sleep fine when they go home. They feel well rested when they wake up. They eat healthy and exercise. They take care of their bodies. It's not their favorite thing in the world but it agrees with them OK.

Then, there are those of us that pretty much go kicking and screaming into the night shift. You know what I mean. Or even worse, those of us who work erratic schedules, switching back and forth between nights and days. And that's my life, when I work shifts in the ER. For us, it's not so easy. We don't sleep well after working all night. We feel tired, we use caffeine as an eye opener at all hours and some folks even resort to other drugs to manage sleep-wake cycles when they're living in that kind of situation.

Now, the first two groups I described are likely fine during pregnancy. Again, I don't have any research supporting my assessment but it makes sense given what we know. And without research in a given area, that's all we have to go on.

The third group however, for them, there are concerns — concerns for the effects of chronic stress and fatigue, concerns for drug use including caffeine, alcohol, nicotine and other sleep aids, and concerns for relationships and social problems that might stem from working the night shift. And sure, these things may contribute to problems with fetal development and pregnancy complications and outcomes.

0:28:19

So what about your case, Sarah? Well, I think you have to ask yourself how well do you handle nights. Are you getting rest and good nutrition and appropriate exercise? Are you exposing your baby to chemicals that help you sleep and wake up? What's your stress level? How about your relationships?

And of course, with the balances with your need to work and possibly support your family — if nights are a problem, what are your alternatives? Can you switch shifts? Can you switch jobs? Or, if the problem is child care when you get home for other kids in the house — and that's leading to lack of sleep and stress and fatigue and drug use — can you make other child care arrangements, so that you can get some rest when you do get home after the night shift?

So I guess, Sarah, you really have to reflect on the specifics of your unique situation. If life is good, great! There's no evidence out there to suggest that nigh shifts in and out of themselves are a problem. But, if night shifts are leading to other issues like fatigue and stress and nutritional problems and chemical use and relationship issues, then you'll be best served by making any adjustments that are within your control. Now, having said that, I realize some adjustments are not within your control but others are, and you have to identify and adjust those accordingly.

So hope that helps, Sarah. And again, thanks for the question.

All right, we're going to move now to Austin in Bountiful, Utah. Austin says, "Hello. I recently begin listening to your podcast and so far had found them useful. My 11-week-old daughter has a subgaleal fluid collection on her head. She acquired it at about five weeks of age and our pediatrician at the University of Utah Hospital knows little to nothing about it. Our pediatrician think it is from the difficult labor which included three hours of pushing in the posterior position followed by a C-section. The fluid collection recently increased in volume as to make the skin tight around it and then, receded back to about two-thirds capacity of the skin. Do you have any information about subgaleal fluid collections or a podcast that touches on it? Thanks – Austin."