PediaCast 165 * ADHD and Diet, Texting and Driving

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Topics

• ADHD and Diet

• Texting and Driving

• Safe Gas Cans

Links

• Effects of a restricted elimination diet on the behavior of children with attention-deficit hyperactivity disorder
• The choice to text and drive in younger drivers: behavior may shape attitude
• Texting and Driving Laws (Hands Free Info)

Transcript

Announcer 1: This is PediaCast.

[Music]

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

Dr. Mike Patrick: Hello, everyone, and welcome to this week's edition of PediaCast. It's a pediatric podcast for moms and dads. We are coming to you from the campus of Nationwide Children's Hospital in beautiful downtown Columbus, Ohio, especially beautiful on a June afternoon. It's June 21st, 2011 and we're talking about ADHD diets, can food or changing your child's diet actually help ADHD symptoms, is it possible, also texting and driving.

01:18

This is actually one of our research shows. What that basically means is that we're going to look at a couple research studies, kind of dissect them, and then apply them to your life as a mom and dad. So, welcome.

Before we get started with the show, I want to mention that last week, I had said that this week we were going to have Dr. Koranyi on PediaCast to talk about hand-foot-mouth disease, and I had also mentioned that sometimes these interviews have to be switched around at the last minute because of patient care responsibilities, a little something that doctors have. [Laughter] More than a little something. Dr. Koranyi had to switch things around, so she's actually going to be here next week, not this week. So next week, on Thursday, actually, Dr. Koranyi's going to stop by and talk about hand-foot-mouth disease.

02:12

Before that, also next week we have Dr. O'Brien who's going to stop by. She's a hematologist here at Nationwide Children's. We're going to talk about Von Willebrand disease. That's coming up next week.

But we do have a different interview for you coming up later this week. Dr., not Dr., I'm sorry, she's going to appreciate this, Kelly is our social media guru here at Nationwide Children's and she's actually going to stop by the PediaCast studio on Thursday of this week to talk about all the social media opportunities that you have as moms and dads, just to give you an overview of what Nationwide Children's has going on and how you as a parent can take advantage of the information and communities that we've been putting together.

03:00

All right. Don't forget, if there is, oh, I also want to mention, at the end of the show, stay tuned at the end, we're going to have a little chat about grocery stores and gas stations. So just look for that at the end.

If there is a topic that you would like us to talk about or you have a question for one of the specialists here at Nationwide Children's, it's easy to get a hold of us. Just go to pediacast.org and you can click on the Contact link. You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS, that's 347-404-5437.

I also want to remind you that the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, 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.

04:00

All right. Very quickly, before we get to our two research studies today, I do have a listener comment on a news item that we did a couple shows ago. This is Whizzy in Austin, Texas. Whizzy says, "I really enjoy your show, but I was disappointed when you covered the study from the CDC journal "Emerging Infectious Diseases" on bedbugs being a source of MRSA and VRE transmission."

"Being an entomologist, I had already read about the study and still stand by the idea that bedbugs have not been shown to transmit human disease. I was waiting for you to discuss the study further as you normally do and explain the sample size was very small, three patients and five bedbugs collected, also maybe including the fact that vector biologists have shown that there are numerous insects that may harbor pathogens but are not considered infectious to humans. I feel the study cited still falls into speculation. Just my two cents. Thanks, Whizzy."

So Whizzy, an entomologist in Austin, Texas, writes in. Thanks, Whizzy. Really, I appreciate it. And shame. Shame, shame, shame on me.

05:08

This is not an excuse, but I do want to say that we did cover that in the context of a news story. The news shows here on PediaCast are sort of what's circulating out there, and I have to admit to you, I did not go to the primary source. If I had, I would not have included that news story.

And Whizzy really brings up some excellent, excellent points. A study that has a sample size of three patients and five bedbugs examined is just a horrible study in terms of sample size, and it probably should not have been published by the CDC until a larger sample size study could be done, should not have been picked up by the mainstream media, and should not have been touted on PediaCast.

Whizzy makes another good point: just because bacteria live in bedbugs does not mean that the disease is transmitted by the bed bug. You really need a whole different type of study for that, and the best design is going to be where you allow a bedbug to bite someone with a known MRSA infection, and then they bite the test subject on their normal skin and then see if the person's normal skin, if they develop MRSA, and what the transmission rate is.

06:20

But even that's difficult because then you have to ask yourself, 'Where did the MRSA come from?' which is methicillin-resistant Staphylococcus aureus, a type of resistant staph infection. Did that MRSA come from the bedbugs' intestinal tract, their body, so to speak, inside, or did it just come from the bedbugs' legs? Did it come from the test subject's skin? Then you've got to figure out a way to sanitize the skin before they're bitten by the bedbug and/or sanitize the bedbug feet by making the bedbug crawl across a panel with an antiseptic in it.

So the bottom line here is we need more data before we all worry about bedbugs and whether they can transmit, whether we can all worry about them in terms of them being a nuisance and an itch and the cause of rash.

07:08

But in terms of bedbugs spreading MRSA, we don't know the answer to that yet, and the study that I had mentioned in the news segment was not a very good study. So I apologize for that.

Again, the focus of that really was, this is not an excuse, but the focus was on it as a news story and not necessarily as dissecting it as a research study, which is what we're going to do today with a couple of topics.

So let's get right to the first one, and that is the effect of a restrictive diet on ADHD. Now this comes from the ADHD Research Center in Eindhoven, Netherlands and it was published in the journal "Lancet" in February 2011. In the show notes over at pediacast.org, we'll put a link to that study on PubMed. So if you're interested in seeing the study itself, you can go to the show notes and click on that link.

08:00

The question before the researchers, really, they had two questions. The first, and this is their primary question, in children diagnosed with ADHD, does a restrictive diet improve symptoms? Secondary to that, if food is a factor, so if a restrictive diet does improve symptoms, is the mechanism allergic or non-allergic? Is it because the child has an allergy to that food and that's causing ADHD symptoms or is it by some other process?

So what did the researchers do? Well, they took 100 children. They recruited 100 kids. They were all between the ages of four and eight and all of them simply had ADHD diagnosed without comorbidity. So it was just plain ADHD. They didn't have any other disease processes going on to sort of muddy the waters.

And then, before they did anything, they did a pre-study assessment and they used four different tools. They had parents, teachers and physicians all use a variety of these tools and they included, not every person did each of these, so in other words the physicians used a structured psychiatric interview and parents and teachers used an 18-item ADHD rating scale, a 10-item abbreviated Conners' Scale, and strengths and difficulties questionnaires.

09:20

So they had this sort of system where each kid would be evaluated by their parent, by their teacher, and by a blinded physician, meaning it was a physician who did not know the child personally. It wasn't their regular doctor, so they were sort of blinded to how bad the kid's ADHD was to begin with. They used these tools to basically get a picture of how bad each child's ADHD symptoms were.

The other thing that they did at the beginning of the study is they drew blood samples for IgG and IgE food panels. They're basically looking to see what foods a child might be allergic to or have evidence of them being allergic to it by the presence of antibodies against those particular foods floating around in their bloodstream.

10:06

As it turned out, very few of the kids had elevated IgE antibodies as related to food, so they did not use that data. However, the IgG, which is a different type of antibody, that was elevated for many foods in many of the kids, so they were going to use this information. We'll get to how they used that in just a few minutes.

So the first phase of the study, they took these 100 kids, they analyzed their baseline ADHD symptoms, and then they randomized them to one of two groups, either a control group or the study group. The study group was going to have the diet restrictions and the control group would just go on with their regular normal diet.

Now, to sort of make things fair, the control group, they did advise everyone in the control group on the qualities of a healthy diet. What's a healthy diet for a kid? Just education. They didn't tell the parent they had to feed them this sort of a diet. They just did all the food groups, not the pyramid anymore but now are plate of the different foods and how much. So they basically just did education on what constitutes a healthy diet and then said, 'Go get them. Feed your kid what you want.'

11:17

The diet-restricted group, they had an elimination food plan for five weeks. What this basically did is it made it so the child's diet consisted of rice, meat, vegetables, pears and water, and complemented with potatoes, fruit and wheat. So they really tried to get out all of the simple sugars, food additives, dyes, colors, all of those sort of things. So really just a plain diet of rice, meat, vegetables, pears, water, complemented with potatoes, fruit and wheat.

So they did this, and then after five weeks, they repeated the ADHD evaluation and they repeated the blood work as well. They just wanted to see, did the diet-restricted group have improvement in their ADHD symptoms.

12:08

Now before we get to the answer to that, the second phase of the study, they did a crossover. First, they identified the clinical responders. Those in the experimental group who had at least a 40% improvement on their ADHD evaluation, they took those kids and they divided them into two different groups, and each one would have a customized diet for four weeks.

Group 1, they looked at their IgG panels of the foods that they might be allergic to. Now if these kids, of course, were known to be highly allergic to a particular food to the point that they broke out in hives and had an anaphylactic response, obviously they're not going to feed those kids those foods, so they're going to be safe about this, but they looked at what foods they had elevated IgG levels to and what ones they had low IgG levels to, so the foods they didn't make very many antibodies against and some foods that they did make a lot.

13:03

One of the two groups, they fed them three foods that they were likely to be allergic to for two weeks and then reevaluated them for their ADHD symptoms, and then fed them three foods that they were unlikely to be allergic to for another two weeks and then repeated their ADHD evaluation.

In the second group, they just did it in the opposite way. First, they fed them three foods that they were unlikely to be allergic to for two weeks, then repeated their ADHD evaluations, and then they fed them the three foods they were likely to be allergic to for two weeks and repeated their evaluation.

So they're just trying to give an idea if, we've got a baseline ADHD, it got better when we restricted your diet, now what happens when we introduce foods that your blood panel says you might be sensitive to, and then we feed you foods that you're not sensitive to and just see if those things are making a difference in ADHD evaluations.

Incidentally, when they did those ADHD evaluations, everyone was blinded the diet. The parents, the teachers, and the physician did not know what the children were eating during that time period, which if you're the parent of a four- to eight-year-old, that may be a difficult blinding scheme, but they did it.

14:18

So what did they find out? For the control group, there was no statistically significant change in their ADHD evaluation. Their ADHD symptoms over the course of the study stayed basically the same, which you would expect.

Now this is interesting. The study group, 64% of the children had an improvement of at least 40% on their ADHD evaluations, and this was statistically significant. This is really interesting. You restrict these kids from simple sugars, from dyes and additives and colorings, and 64% of the kids had an improvement of at least 40% on their ADHD evaluations. So I think that is significant.

Now, the parents and teachers were not blinded to what the children were eating and which group they were in. The physicians were, but the parents and teachers were not. So you could argue, the parents knew their child was on a restrictive diet, so did they sort of have a different opinion on what their children were doing and how they were behaving?

15:23

That's a possibility. So it would've been nice if not just during that crossover phase, too, of the study but if they had made the parents blind to the food they were eating during the first phase as well, that would've been, I think, a little bit more interesting and have made it a better study.

Now, 63% of the kids who did improve, so once we sort of took those clinical responders, as we called them, the 64% of them who did have an improvement of at least 40% in the study group, when they did the crossover where they reintroduced foods, 63% of them relapsed when those foods were reintroduced, and that also was statistically significant.

16:07

However, there was no correlation that was statistically significant between whether what food was being reintroduced was one of their low IgG foods or high IgG foods. So during that two weeks when you fed them things they might be allergic to versus things they might not be allergic to, there was no correlation between possible food allergies and the ADHD symptoms.

So the authors conclude that a strict elimination diet may be valuable to determine if ADHD is induced by food, but the use of IgG blood tests to prescribe diets for these children is not a value.

In other words, maybe some things in food does contribute to ADHD in some kids. Now, a restrictive diet obviously did not help everyone. It wasn't 100% of the kids that did better, and we do know that ADHD has complex causes, and probably not just one cause, and if there is a food mechanism involved here, we don't know what it is. According to this study, it doesn't seem like it's an allergic type of a response. But somehow, food does seem to be playing a role; we just don't really know what that role is.

17:18

So not all cases of ADHD are going to be responsive to food, but it is worthwhile, according to this study, if you have a child with ADHD to try that diet and see if it makes a difference. If it does, great. If it helps, great. If it doesn't help, it doesn't help. It may be not a worthwhile thing to restrict your child to eating those foods if it's not really going to help their ADHD. They didn't look to see if this was a healthier diet in respect to health in general.

We're not saying all kids should only eat these foods, but if they have ADHD, this diet may help. Something to try. If it doesn't help, go back to their regular diet, but if it does, then you have something that can help their symptoms.

18:01

Is it an alternative to drugs? Well, they didn't look at that with this study. That's another thing; how does this now compare if you restrict their diet in one group and take them off of their ADHD medicines, and in another group you also restrict their diet but keep them on their ADHD medicines. This is a different study that could be done in the future to see, is this something that's an alternative to stimulant medication or is this just a complementary sort of thing? And that's probably going to vary from one kid to another.

The bottom line here, it's something to discuss with your doctor, and summer may be a good time to give it a try with your own kids to see if it helps.

All right, let's move on to our second study. This one's a little quicker, but an interesting one. This was done by the Department of Psychology at the University of Kansas and it was reported in the January 2011 edition of "Accident Analysis and Prevention". Once again, in the show notes over at pediacast.org, we'll put a link to the PubMed site that has a version of this study.

19:03

The question before these researchers was, among college-age drivers, what are the rates and patterns of specific text-messaging behaviors while driving, and how do these drivers perceive the associated risks? So we're looking at driving and texting.

They surveyed 348 undergrads and all of these undergrads owned both an automobile and a cell phone. The questionnaires asked about specific texting behaviors while driving, including: Do you read text messages while you drive? Do you respond to text messages while you drive? Do you initiate text messages while you drive.

And then they also looked at the message content to see if that affected texting behavior. Does it make a difference what you text about when you decide if you're going to text or no while you're driving?

They also asked about texting safety in particular road or traffic conditions. Is city driving more or less dangerous to text in? How does highway driving compare? Is that more dangerous or less dangerous to text in? They asked those kind of questions.

20:09

What they found from their questionnaire is how many of the undergrads reported that they never text while driving, they never do it, if they get in the car and they're driving, cell phone's put away, they do not text ever while driving: 2%. That's it, 2%. So 98% report that they do text while driving. Ninety-eight percent. Wow. Of those, 92% say that they read messages, 81% said they responded to messages, and 70% said they initiate text messages while they're driving.

Again, remember these numbers were for activities while driving. The numbers were actually higher for those who said they only interacted with texting during traffic stops. This is actually while the car is in motion. Those were the specific questions. The numbers I just gave you related to, 'When the car is in motion, are you texting?'

21:08

Now, how often did the undergrads respond to or initiate texts while driving? The average number per driver during the week prior to the questionnaire, they said, 'Think back to the last week about how many text messages did you send while you were in a moving vehicle behind the wheel,' and the average answer was about 14 text messages.

Now, what about content of those messages? Well, texting was more likely while driving if the content was task-oriented. For example, if they were getting directions or they were giving directions or they were updating their current status, telling someone, 'Hey, I'm running late,' or they were contacting a significant other to say, 'Hey, I'm on my way,' or sharing information about school or work. In terms of just texting to chat or to relieve boredom, those kind of activities while driving and texting was less common.

22:02

What about the perceived risk? Well, responders universally perceive texting while driving to be a very risky behavior. So top-of-the-chart, one of the most risky behaviors you can do and more risky than simply talking on a cell phone.

So even though they perceive it as being something that is very risky, and by the way, that little chime there, I have to start remembering to turn off my Outlook notifications [Laughter] when I'm doing the show. You didn't use to hear those because we did PediaCast in a little bit of a different studio environment, and the software and setup that we're doing now in the new PediaCast studio, I forgot to do that. I need to remember to shut it down. OK, sorry about that distraction.

It's interesting that even though all of these undergrads perceive this as a very, very risky behavior, 98% of them still do it. So that's definitely interesting.

Now, in terms of what driving conditions, highway driving was considered by them to be sort of the safest, although they still said it was very risky, but definitely safer on the highway than driving in the city.

23:11

But, and this is also interesting, highway-driving was considered safer in the context of initiating a text compared to if they were reading or responding to a text. In other words, they asked the undergrads, 'If you're reading or responding to a text, what's the safety level of being on the highway?' and they gave that sort of a number. And then, when asked, 'What about you initialize a text, then how do you consider highway driving?' then they considered it to be even safer.

The authors suggest that choosing to initiate a text instead of just merely reading one or responding to one, but actually making the active choice to initiate a text message influences a driver's perception of the risk. In other words, 'OK, I'm choosing this behavior, not just responding to it, so now I perceive highway-driving as being even safer when I'm texting,' rather than the other way around. So rather than the type of driving you're doing affecting what kind of texting you do, it's more the type of texting you're doing influences your perception of risk.

24:23

This is consistent with something called the cognitive dissonance theory. It's basically fooling yourself, downplaying the risk to justify the game so you don't feel so bad about it. It's kind of interesting if you're a psych person. It's kind of an interesting thing that the authors found and use as their explanation.

In conclusion, the authors say that texting while driving has achieved the status of a social norm, I would say, with 98% doing it, definitely, and that sort of social norm status has got to change in order to decrease the incidents of this risky behavior.

25:04

So everyone realizes it's risky, but it's a social norm, so we're going to do it. It's like keeping up with traffic on the highway even if keeping up with traffic means going 10 miles an hour over the speed limit. That's the social norm. In that case, you could make an argument that perhaps it is safer to keep up with traffic than to be the one that everyone's cruising around. But in this case, this is probably not a similar situation. We have to sort of really eliminate the status of texting and driving being a social norm in order to reduce the incidence of the behavior.

So just how risky is texting and driving? Can we quantify it? The latest year with reported data is 2009, and in 2009 nearly 4,000 U.S. drivers under the age of 20 were involved in fatal crashes. Of those, 16% involved driver distraction, and of those, 22% involved a cell phone. Now if you calculate that all out, you have about 150 teenage deaths directly related to cell phones and driving, and that's in 2009.

26:11

Now, 150 may not seem like all that many in a country with a population of 300 million, until your kid is one of them, and you realize that every one of those 150 deaths was preventable.

The other thing to keep in mind was that was in 2009. How much more prevalent is cell phone usage and texting today in 2011? I think it's more prevalent, and it makes you worry that there's going to be more deaths this year than there were a couple of years ago.

So what can we do? Of course, education. Parents, teachers, doctors, all of us play a role in terms of telling our kids about these statistics and the dangers. We also have to be an example to our kids and, as adults, not text and drive and to show them, 'This is not safe. We're not going to do it, either.'

27:01

And then also through legislation. Actually, 32 states have passed laws banning texting for all drivers regardless of age, including Kansas, where this study was done, and they actually passed their law in response to this very study earlier this year.

What about your state? You can find out at handsfreeinfo.com, and we'll have a link to that in the show notes as well. They basically have a legislation by state. It even gives you localities as well so you can look up your individual cities and see if they have any ordinances regarding cell phone use and texting use while you're driving.

In Ohio, there's no state-wide texting law. However, some cities, including Columbus, which is the home of PediaCast, some localities do have laws banning texting while driving. But in terms of there being a state-wide texting law like there are in 34 states, Ohio does not have that yet. Although from what I understand, there are some things sort of making their way through the House and Senate that could possibly cause there to be a state-wide ban in the future.

28:12

All right, that concludes our Research Roundup for this episode of PediaCast number 165. We haven't actually done that in a while. Been really focusing on news and answering listener questions, so it was kind of refreshing to actually go through a couple of research studies with you. I really enjoyed that.

Speaking of cars, I like the transition there, I've noticed that here in the Midwest, we lived in Ohio before and then we moved to Florida, and we were down there for about two and a half years, and then we moved back up to Ohio, and I've noticed since we got back up here that it's a really big thing here for grocery stores to have gas stations. There were a couple of them here and there when we moved away from Ohio, but coming back, it's like every grocery store has a gas station associated with it.

29:02

In Florida, this was not the case. Most publics did not. Winn-Dixie, Albertsons, they didn't have gas stations associated with them. But here, Giant Eagle and Kroger, for example, they have gas stations.

Now, the cool thing is that when you buy groceries there, you get credits on your gas, and when you buy gas there, you get credits on your groceries. So every time you buy gas, which is a pretty cool marketing thing, really, you buy gas, you get discounts on your groceries and vice-versa, compared to if you went to a grocery store that didn't have the gas stations, they mark up their prices to begin with. That's neither here nor there. They probably do to some degree.

But you do get these discounts on the gas when you buy the groceries, and you can actually get enough discounts, especially if you're buying for a family, that you get free gas. This is kind of a tempting thing, especially with gas prices, what they're doing. So you get this free gas and you can get up to 30 gallons.

30:02

Now, my wife and I, we have two cars, each with a tank that holds about 15 gallons. It would be nice to get the free gas in both cars, right? OK, so we're cheap. [Laughter] But I'm sure many families out there know exactly what I'm talking about.

Well, you can't, and I do understand this, you can't pull one car up and then pause the pump and then start your car with an active pump there in your hand and move one car and pull the other car in and then start pumping. They don't like you doing that. They also don't want you pulling one car on one side of the pump and the other on the other, and then transferring the pump handle from one over to the other.

I understand, these are safety issues, but they don't just say, 'We only allow one car.' What they say is, 'Up to 30 gallons, you can fill your car, and then you can fill some gas cans.' OK, fine. Let's do that. Let's get this extra 15 gallons into cans, and then we'll put that in the other car. Because it's free gas. It's tempting.

31:06

Well, what we've discovered is, when we moved to Florida, we got rid of our gas cans that we had, because we had a couple of acres and we had a running lawnmower, so we had gas cans that you would fill up. Just a few years ago, gas cans, they were pretty easy. The funnel had a little clip on it so the gas didn't spill out and there was a vent one on the back. It was a pretty simple thing.

Well, I don't know if any of you have been out looking at gas cans recently, but it's not like that anymore. We've got these safe gas cans now. Which sounds like a great idea, don't get me wrong. I'm all for safety. I don't know how many unsupervised kids were drinking out of gas cans or how many explosions there were because of the old design of gas cans, but now they've made these things so that they're idiot-proof, except that we're idiots when it comes to trying to use them. They're very complicated.

32:08

Again, I don't know if any of you have been out to the market to try to find these things, but I think it's the government's attempt to protect us from ourselves, and they're just very difficult to use.

The nozzle itself has a self-ventilating feature, and again, I think the reason for this is so you don't have an extra little opening that kids can flip open and drink from one side. So it has this self-ventilating nozzle, and it's a tiny little ventilation hole, which means that the gas is going to trickle out.

And I'm telling you, a five-gallon gas can, it takes about 20 minutes to empty. I kid you not. You have to hold it there for about 20 minutes because it comes out so slowly, because the vent hole in the nozzle is so small.

So if you're doing two of these, because you've got an extra 15 gallons that you can buy, well, we're not lugging around three of these gas cans, we've got two of them, so we've got 10 gallons, so literally to put 10 gallons of gas in my car by doing it with these gas cans took 40 minutes. I kid you not.

33:17

And we're using them appropriately. It took us a little while to figure it out because it's not as intuitive as you would seem, but it took us about 40 minutes to dump the gas. So now I'm to calculate, money is time, time is money, and now I'm not so sure the free gas is worth it anymore.

The other issue is that the design makes it so that you can't get all the gas out. There's about a half a gallon residual in the can that absolutely you cannot just pour out with the safety-funneled system that they have in place. Really, if you wanted to get that out, you need to get tubing and a funnel and do it the unsafe and probably now-illegal way.

And then my wife is asking, 'How safe is it that I'm smelling this fume for 40 minutes while we're trying to dump gas into the car?' I guess they don't take that into account.

34:07

Anyway, I wanted to bring this up, because it has nothing with pediatrics, but hey, at least we're saving these discussions for the end for those of you who are interested.

If you've had a similar experience with these new, safer gas cans, let me know. Or maybe you have a trick that I don't know about. I think we need to try to find some old cans that don't have the safety features. It sounds horrible coming from a pediatrician. We have teenage kids who are a little older, so I don't have to worry about them trying to drink it or get into it. I just want something that's going to flow easily and not take 40 minutes to transfer gas. Anyway.

I don't really know what else to say about that. If you've had a similar experience, let me know. Or if I'm doing something terribly wrong, let me know that, too, because not only can you learn from me but maybe I can learn from you, if you're a gas can expert.

35:01

All right, well, I want to thank all of you for listening to PediaCast and putting up with my rant sometimes. Thanks to Nationwide Children's for hosting us and allowing us to exist on their campus. We appreciate them. And of course, thanks to listeners like you.

I want to remind you, if you have not shared PediaCast with your doctor, please do so. Just the next time you're in for a sick visit or a well-child check, just say, 'Hey, Doc, I found this really cool evidence-based medicine podcast coming out of Nationwide Children's. You'd be interested in it.' Just let them know, pediacast.org. We really appreciate that.

We're still in the process of redesigning our website with some cool new features that should be coming out in the next month or two, probably August is when we're going to see it, and we will have at that point some downloadable material that you'd be able to print out and actually take to your doctor that they could hang up in their exam rooms. But we are in the process of changing over some things, and without giving away too much, it's not worthwhile to design something that we have to change. So just be on the lookout for that. But you can still tell your doctor. Also tell your friends and family.

36:15

And then of course, iTunes reviews are extremely helpful, as are mentions or shout-outs on your blogs, Facebook, and your tweets.

And one final time, if there's a topic that you would like to hear on PediaCast, just something you'd like us to hear about, or you have a rant of your own or any kind of issue at all, it's easy to get a hold of me, and I do read everything you send, pediacast.org, you just click on the Contact link. You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS, 347-404-5437.

Until next time, which will be in just a couple days when we have Kelly, our social media guru, in the studio to talk about the opportunities for parents here at Nationwide Children's in terms of Facebook and Twitter and YouTube and those sort of things, until then, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everyone!

[Music]

37:24

Announcer 2: This program is a production of Nationwide Children's. Thanks for listening! We'll see you next time on PediaCast.