Ep 225: Wisdom from a Pediatrician with 40 Years of Experience, with Dr. Stan Block

In this episode of Your Child Is Normal, Dr. Jessica Hochman talks with Dr. Stan Block, a pediatrician who spent more than four decades caring for children and is the author of Pediatrics Around the Block.

Drawing on years of experience in clinical practice and pediatric research, Dr. Block shares practical wisdom about the questions parents ask every day. They discuss why vaccines remain one of the most important tools in pediatric medicine, what normal speech development looks like in young children, how to think about ADHD concerns in active kids, and why frequent colds and ear infections are often part of normal childhood.

They also talk about one of the most common worries parents have: fever and developmental delays. Dr. Block explains when parents should be concerned. This episode is full of reassuring, practical advice for parents!

Your Child is Normal is the trusted podcast for parents, pediatricians, and child health experts who want smart, nuanced conversations about raising healthy, resilient kids. Hosted by Dr. Jessica Hochman — a board-certified practicing pediatrician — the show combines evidence-based medicine, expert interviews, and real-world parenting advice to help listeners navigate everything from sleep struggles to mental health, nutrition, screen time, and more.

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Transcript

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So as you know, parents worry a lot about speech delays, fevers, ADHD, frequent colds, vaccines, the list goes on and on, but what actually matters and what's completely normal? So welcome back to your child is normal. I'm your host, Dr Jessica Hochman, today I'm joined by Dr Stan block. He's a pediatrician with more than 40 years of experience caring for children over the course of his career, he's taken care of 1000s of patients working in rural Kentucky, and he's published more than 150 scientific papers. He recently wrote a book called pediatrics around the block, where he shares lessons from decades in pediatrics, including memorable cases, practical advice for families and insights for pediatrician. In our conversation, we talk about common concerns that parents have, like vaccines, speech delays, ADHD, frequent illness in young children and fevers. What I love about Dr block's perspective is that it comes from decades of caring for kids, and he's really seen it all. He has advice about what to watch for, what's normal and when worry. Can help parents feel more confident raising healthy children. Thank you so much for listening, and if you enjoyed the episode today, please consider leaving a five star review for your child is normal. Reviews really help more families find the podcast, and I highly encourage you to read Dr block's book. I am leaving more information about how to find it in the show notes below, Dr block, you wrote a book. Yes, pediatrics around the block. It's a compilation over the last two and a half decades my work, and it's a compilation of interesting cases, a lot of humor. I go through my family as well. I have four daughters, and they're all adults and grown. It's a fun read, though. A lot of wit and humor there. Mostly make fun of myself, almost entirely. Occasionally, I make fun of my girls because they were such a fun group to raise. So a lot of wisdom in that regard, because I raised four kids and got nine grandkids, so I'm still doing child raising two of them. Spent the night two nights ago. That's fantastic. Well, I'm excited to talk to you. I I've been a pediatrician for 15 years, and I always love talking to experienced pediatricians. I feel like I learned so much. There's knowledge that doctors can get from books, but there's nothing that replaces real life experience and the wisdom that comes from real life experience. So I have to tell you, I actually practice pediatrics alongside my father. He has three kids, and he also has nine grandchildren, who he talks about all the time, and he really enjoys spending time with them. So did he write a book? You know? He's thought about it. He's taken writing classes before where he's wanted to share funny stories or interesting stories that he's come across. You collect a lot over time. The amazing thing is, I can remember so many details. It's incredible. Well. And tell me about your career as a pediatrician. Where did you practice? Did you work in the same community for your entire career? Okay, let's go back. So I went to UNC Chapel Hill for undergraduate. Then I went to Wake Forest Bowman Gray for my pediatric residency. And then from there, I started practice here in bars, Kentucky, we take care of everything we in pediatrics in rural areas have to know a ton more and know it well, pharmacology and diagnosis of psychiatric and orthopedic and other mental health conditions and school and educational systems. We have to know it all out here. But anyways, I'm in the same community for 43 years, same house, same practice, same office, 43 years and another niche for you. We're the only father daughter team of pediatricians in the state. My daughter went to pediatrics too. Oh, wow. Okay, so we have a lot in common, and I'll tell you the truth as I tell all my patients, she's much prettier and smarter than I am, but I have more experience. You have more experience, and you have wisdom. So that brings me to the first question I'd like to ask you. I'm curious. You've been practicing pediatrics for over four decades. When you think back to your career as a pediatrician. Are there any messages that you would like parents to know as they raise their kids? Well, the most important and the most critical, which is the heart and soul of Pediatrics, is immunizations. So vaccines, pure and simple, it's critical to the kids to have those vaccines in them, because I live the era of pneumococcal pneumonia, hip meningitis, hip epigotis. I have a story about hip epiglottitis. 2am rushing to the emergency room in the middle of cold winter night, kids sitting forward, drooling, couldn't breathe, and you didn't dare touch him, because if you did, it collapsed into full blown airway obstruction. So I had to my dad has the same story. I had to go down to the Dan gone and call him a surgeon as a backup in case I couldn't get it in. So he's fortunate I got it in and then therefore saved his life. Because if we had sent him down the road, he wouldn't have made it, he'd have died on me. And remember, hip germ, hip bacteria, haemophos, influenza, type B occurs in one in 200 kids. And you go to pneumococcal pneumonia, again, about one in 100 kids that are healthy and unvaccinated will get pneumococcal pneumonia. So interesting thing is, at the same time I'm doing this regular practice, we started getting involved with major research. So we became the largest pediatric research outpatient group in the USA in the last 15 years. And. This little Podunk rural community of 14,000 counties, 44,000 our main industry is agriculture. Second industry is bourbon whiskey. Where the bourbon whiskey capital of the world, we were considered the most beautiful small town in America, about USA Today, about 10 years ago, it's in their one of their articles. By the way, my dad shares a lot of stories with me, and he told me that the scariest time he ever can remember working as a pediatrician in the outpatient setting was a child who presented with Hib who had a modulus influenza type B came in drooling, sitting in the tripod position. So it's very, very scary, and he reminds me how lucky I am to practice in an era where there are vaccinations, Hib is about 100% effective, and there's nothing we're like except for maybe polio. It's interesting, because a lot of people will come to me and say, gosh, there are so many more vaccines than there used to be. And I say this is true. There are more vaccinations, but on the flip side, there are many fewer illnesses that we see. There are many fewer sick kids. So yes, there have been more vaccinations, but we also see kids that are healthier. In fact, the hospital that is close to where I work, they've had to close this last year because so few kids are sick enough to make it to the hospital, which is a great thing. But I have to say, I think a really big part of this is that we've had widespread vaccinations for our children, yes. And the other thing is, you have to remember rotavirus vaccine. Rate of hospitalization rotavirus is one in 75 children. One in 15 children wound up in the ER, and all the kids get infected with their vomit diarrhea for weeks, and you can do nothing except fluids or IV fluids, and every kid gets at least twice in their lifetime, because there are multiple serotypes for rotavirus, and now we have a vaccine that covers it. So again, vaccines are the godsend. We're the only profession that tries to put ourselves out of business. What do you say to families that have questions about vaccines? Do you think it's okay to delay the schedule? What would your advice be to families listening? Okay, so let me address the delay. First. I wrote a full article on delay of vaccines, where you can give it and still be within the schedule. It's a complete article in pediatric annals in 2013 I believe it's in my book as well. So I have an alternative schedule that you can use that keeps you within compliance for our safety and your child's safety. So it's doable. We just give them every month, and so it can be done now, going back to the other issue. So the big issues they worry about are, number one, Mercury. There is no mercury in any vaccine. In pediatrics gone. Only shot that had mercury in it was the multi dose valve flu, which had ethyl mercury, mercury, which is non toxic to begin with, but that's the only one. So no mercury period. Second thing to complain about is aluminum. It's been given for like 3540 years. It's a wonderful adjuvant makes the vaccines work two or three times better. Without it, your vaccine programs would fail because they're not going to last long. It gives longevity to the vaccine durability and also much better antibody levels. Because I've done multiple studies with and without aluminum vaccines, and most vaccines that have it, you have to use it. So what you're saying is the aluminum, it's a small amount, it's a trace amount, and it stimulates the immune system to make a robust response to the immunization and longer response longevity as well. So you get both effects. I actually really appreciate that you offer an alternative schedule that's within the recommendations, because I do think parents are looking for they just want to feel like they're doing the right thing for their kids, and they want to keep their kids safe. So there's been debate amongst pediatricians, should we offer an alternative schedule? But I actually think if we can do it in a safe way, even if it means spreading out the vaccines, I'm for that perspective. I'm all for it, but we do know the current vaccine schedule we've had for decades is perfectly safe and worthwhile and very effective. We really don't know it's splitting it up, but it should work because we've done isolated vaccine studies with particular components, and it should work fine, but the current vaccine schedule, as it is at 246, months, 12 and 15 months, is extremely safe and extremely effective and well tested. And I'm just curious, in your experience as a pediatrician, have you seen vaccine injuries? Have you seen harm caused to children, specifically, irreversible harm caused to children from vaccinations? No, I've never seen that in any we've the only time I've ever heard of vaccine injury was an adult who got the Tdap and he had some young beret and permanent disability from it. The covid is another one that we talked about, but I don't know if you want to get into it. That's a whole can of worms. So basically, we could talk about vaccines, I know, for days and days actually, I'm sure. But just to reassure parents, if you could give them some final reassurance based on your experience, what would it be okay? So the vaccines are extremely safe. They do not cause autism. The Wakefield study with 12 kids in it, his lab person even admits later that it was all fabricated. He made up the data, 11 out of 12 kids. So they retracted the study in The Lancet, they took it all back. Said it's not valid. It's gone. We don't want any part of that data. So if you want to read the story behind. The whole Wakefield fiasco. Get my book. It's in there too. I have everything you want to know about vaccines. I think, to be totally honest, I'm empathetic to families. I understand that there's a lot of noise and a lot of talk that they hear from the internet, that they hear from friends, and I understand that as a parent, all you want to do is keep your kid healthy and safe, and you don't want to harm them, of course, because frankly, I feel like a lot of us now, we are lucky. We live in an era where we're raising our kids, where there have been vaccines, so we don't see a lot of these illnesses. And so I think it's interesting to hear from a doctor like yourself who's seen the impact that vaccines have had over the decades, absolutely and again, just look at the Pertussis outbreaks every year and your babies die from pertussis. The kids are sick in the hospital for a month or two, then they ask you and talk about damage, get pertussis and then go to measles. Oh, my goodness. Once you get below that 95% threshold for herd immunity, or herd protection, you're going to see it spread like crazy. I was in 1988 in my office going, oh my god, what is this fever and rash? Yes, complex spots. Whoa. Tell people what complex spots are inside the buckle mucosa in there, and you're looking to go, Oh, lordy. It looks like it's a sign of measles. It is measles period. There's like two or three white spots on either side, so it's very distinct spots. And they have this full minute rash. They have hunt three fevers. They looked horrible sick kids, and rash all over the body, full blown. And the trouble is, one in 500 is going to get brain damage, encephalopathy. And also blindness occurs in the one in 500 and then hearing loss occurs in like one in 1000 you don't want to see this, and you haven't talked about mumps. So anyways, there's no treatment for it. You're going to get some severe illnesses and deaths, no doubt about it. So mises a bad sucker, okay, all right. So we have adults. We get we have teenage kids and college kids come with mumps. Two shots, it wanes. The mumps wanes. And about maybe, I don't know, 10 20% of adults really, 18 and over, and we saw a bunch of college kids with orchitis. You know what that means, don't you? I do tell everybody, because the testicles inflame. I don't wanna see that. It's highly contagious, too. And mumps, for people that don't know, mumps is the second m in the MMR, so it's measles, mumps and rubella, yeah, and then rubella. I'm a rubella baby. I didn't get the mental retardation and, you know, the cognitive impairment, but I had a PDA fixed when I was 16. Yeah, one of the major causes of PDA in babies is besides prematurity, rubella, rubella, congenital rubella. So I didn't get the full blown rubella syndrome, but I had to my PDA repair to 16 crack my chest. Open, open. Tell everybody what a PDA is for those patent ductus arteriosus, that's where the connection between the pulmonary artery and the aorta should close up within a few hours to a few days when you're born. It's a conduit that bypasses the lungs. In average kid, oxygen hits it. It sends a signal to the blood vessel to close up and tighten up and go away anyway. So yes, you don't want to see a PTA or congenital rubella syndrome either. So that's vaccinated with rubella. It's not for the kids so much. It's not for actually, the pregnant mother. It's for the fetus. And rubella is just a it's called germ of measles. It's a very mild illness otherwise, but you don't want to see it during pregnancy. And flu vaccine annual is worthwhile doing it, and most of us get around 30 to 40% flu vaccine uptake, which is sad, because it's such a good vaccine. They don't realize that there are three strains of flu every year, and a lot of kids get two cases of flu every year. So if you want to prevent the fevers, the missed school days, the missed work days, get a flu vaccine for your kid. It's so important to do that annually. It's prevents severe disease and pneumonias and prevents death. But as far as being effective, preventing 100% flu, flu shot, mediocre vaccine. It's not great. What I tell parents is it defangs The flu that the flu shot doesn't prevent somebody from getting the flu, but it makes the symptoms, hopefully less severe, less severe and shorter, but it prevents severe morbidity and mortality, which is critical as well. Well, this is a great reminder about the importance of getting your children their immunizations, and a reminder of what diseases were preventing them from getting by getting their immunization. So thank you. So now I would love to just go back a second every vaccine that we've had today, pretty much we have tested in this office, so I know, personally, the data inside out what's been tested and how it works and how safe and effective it is. Now I can't verify that it's safe and effective for a million kids, but over time, with phase four studies, which look at hundreds of 1000s of kids in these vaccine safety data links very rare to see any signals pop through, and most of signals. The CDC has been religious about checking out the bad cases. And also, a recent study just showed that in 2020 there were 100 of these signals. Shown in these studies, epidemiologic studies, to try to show that maybe there's some cause and effect. Remember, these are all temporal association. Associations in time doesn't mean it's causal Association. You look and see if it's valid or not, but usually it's not. So these cases, if you try to verify it, you can't find the data, you can't find the patient, you can't find any illness that's been corroborated by medical charts. Very here the story is, 100 epidemiological papers were reported in 2000 22,025 there were 600 of them. These are epidemiologists. I, like my epidemiologist, but they're trying to make a name for themselves. Oh, we were the first report that for Meningococcal vaccine caused Guillain Barre in Colorado. Remember that new Meningococcal vaccine that was FDA approved and given to all teenagers, whether Colorado or six cases of Guillain Barre? Well, they went back and looked no place in the world sought. It was just statistical flukes. And you have to allow for statistical flukes and background noise. And background noise is everywhere. When you look at these adverse event reports, I think this is critical to know for your parents, because they're getting all this information and it seems like it's valid, but it's not. You have to really dig into it. The devil's in the details, and that's the nature of random events, is that you're going to have clusters, yes, in certain areas, and less clusters in other areas, right? And then, as a pediatrician who's practiced for over 40 years, if there's one thing that you would want parents to remember when it comes to a child's normal health and development, what would you want it to be Now, if you're going to stick with normal health, that one's simple. The only way you can prevent 99% of the severe illnesses that we see is through a vaccine. So vaccine prevention is critical. They're safe. They're effective. We have tons of data. I did the testing, almost everything. I did the articles, I did the research. I can give you the raw data if you want. So in essence, vaccines are the heart and soul of keeping your child healthy. So now I love talking to pediatricians who have experienced seeing kids from the beginning and seeing how they end up as adults. And my question to you is, I have a lot of parents who worry about their children's behavior. Specifically, I want to say young boys that have a lot of trouble sitting still, they have a lot of trouble paying attention at school, they move around a lot. And there is also an increase in kids being diagnosed for conditions like ADHD, which, of course, is a real condition, but we're seeing that diagnosis really skyrocket, and a lot of parents are worried that there's something wrong with their children, when they when they can't sit still, when they move around a lot, when they don't always behave perfectly. So do you have any thoughts on this topic? What is your advice to families where the parents have some behavioral concerns? When should they worry? How can they think about it? A few articles on this as well. So basically, couple things you need to know. First of all, back at one point speech in boys. So I tell all parents who come in the office, boys are laggard with their speech. And we have a lot of boys that don't talk till two and a half, probably 20% very few words till two and a half. I have three grandsons point in case, just anecdotally, didn't say a word till two and a half, except water lights and ball. That's it, three words, so two and a half. However, the key is that's expressive language, spoken language. You need to know about their receptive language, or what they understand if they understand multiple things. You know, cat, dog, ball, refrigerator, all these simple things. I use objects because it's simple to verify objects. If they understand all these objects and lot of complex objects, they're okay. You just got to weigh them out two and a half there's a switch that turns on, boom, and they start talking. It applies to occasional girls, but it's really common in boys on boys, expressive language is not critical. It's receptive language. That's when you know you have a global intelligence problem. If they're understanding everything you're telling them, You don't have to worry about their expressive language. So that's a pearl for your folks. And so just to summarize, if you have a child, if they're late, talkers are just saying a few words, and they're two, two and a half, but they're otherwise normal. They interact with other children. They understand what you're saying to them. We can feel reassured that the speech is likely going to come absolutely so again, receptive language is the key. What do they understand? And I was like parents to know what the red flags would be when to worry. And it sounds like what you're saying is, if the receptive language is poor or they're not really understanding you, that would be a reason to be concerned. And as you said, mentioned or social interaction. Do they laugh? Do they interact with peers or interact with their family? Do they have a sense of humor that gets you if they have a sense of humor, you really don't have to worry about autism. It's not 100% but it's pretty close to it. The other thing you have to worry about is that they do puzzles. You can get their puzzles. They're two year old, three year old, four year old, and if they do those puzzles. Your kids on target, they're going to be fine because puzzles are very require a lot of intellectual facilities up there. So I use puzzles. And again, do they interact with their peers or their siblings? And how well do they interact? And a sense of humor is very important too. That gets you that diagnosis of true autism. So that's really helpful for speech and the younger age group, kids that are in the elementary school years, I find parents worried because they want them to be, understandably so, a good student in school. They want them to sit during the class. They want them to get good grades and good remarks from the teacher. They want them to finish their homework. And a lot of parents have trouble getting their kids to fit that mold. Can you speak to that at all from your experience? So yes. So boys at four, five and six are very active, very busy, very wiggly, and you can't use that parameter to diagnose it very well. It's more of how disruptive they are, how they can't modulate their behavior, even if they have it. I don't treat add unless it's interfering socially, intellectually, educationally, and in the family, if it's not interfering with it. And they have some elements of add it's not worth going through the treatment modules and say, Okay, we'll handle it if we start failing at any of those three areas. Then was considered treatment. You also have to remember, it's a case of fit, fit. Some teachers can tolerate anything, right? But the key is, how much is it interfering. And the other group is the opposite, the ones that get home and they're off the wall and they're acting up at school, they're fine. They're angels. Okay, that's a defiance problem. That's an opposite problem. That's a blowing off steam problem. They need to vent somewhere, and so they'll do it at home frequently. And again, they push their mothers to the limits so that you have to deal with on a different level. That's a good point, being disruptive, being defiant. Those are good points to think about. You know, whether or not a child could benefit from extra support and help. But I also just like to remind parents that kids being wiggly, getting out of their seats, talking, that is a normal thing for a child to do. Okay. Now, a question for you that I would love for parents to hear from an experienced doctor. So many parents worry that their children get sick too much. The term I hear all the time is, oh, my child's immune system must be weaker. Why do they get sick so much? When you have children that that get sick often, can you describe what is actually normal for young children in terms of colds, fevers and an illness we're applying to kids probably under two and a half. Okay? So number one is they're going to get about 10 viral illnesses a year. You can kind of count it once a month, almost until the summertime, and summertime usually is about late May till early September, so maybe a three months that you're going to be free of most illness. So the big thing you're worried about it is number one, recurrent ear infections. So if the ear infections are occurring every month, and they're going on to get four or five within a six month period, yes, you're going to have to resort to tubes. But number one is a diagnosis accurate. Pediatricians are the best among the group, but it's still appalling what goes on in the world of ear infections. So if these diagnoses are coming from urgent care, from non pediatricians, the diagnosis is very suspect, because anything that they can't see, they're going to diagnose as acute otitis. And I do agree, experience makes a difference. A lot of times, kids have fevers, and that makes a fever will make the eardrum look a little more inflamed. But it's not a true ear infection. So I often see that get misdiagnosed. I don't mean to knock on urgent care. They have a great role in our community, but sometimes I'll have a kid that gets diagnosed with an ear infection, and when I look in, the ear is filled with wax, and I think, how could they have called this an ear infection when you cannot see the eardrum? And so I'm sympathetic when a kid has a fever and the kid's crying and fussing, maybe it's hard to get a good look and it's just easier to write a prescription for antibiotic. But I completely agree with you that I think ear infections tend to be over diagnosed. Yes, and the pressure's on the practitioner. I came with urgent care, I'm spending $120 you better give me something. Yes, people want to leave with something. I understand that you want to feel like the visit was worth your time and your child's time, and that you're going to do something to make them feel better. So the fortunate point is, you and I have rapport with the parents, so we can reassure them enough say, No, this is okay. We can recheck it if it seems to get worse. But and the other thing is, fever is rarely associated with ear infections. 12% of bad ears, I'm not with bad bulls and ears have fever. So fever is really not a clue for ear infections. It's not relevant to it. But a cold is very relevant for ear infections. Yes, when kids are under the age of two and a half, I rarely find a true otitis media or ear infection in the absence of a recent cold. Yes, 90% of all kids that have a precedent, Uri, meaning upper respiratory infection. So, and I say that because some parents come in they have a nine month old, for example, the kid is touching their ears, and they said, Oh, maybe it's an ear infection. And if they didn't have a recent cold, it's very unlikely that there's truly an ear infection. Yes, absolutely. So that's one of the criteria. And again, ear tugging is not very helpful sign. And. So kids, it can be but most kids, and it's not that helpful, it's nonspecific. So if they start getting ear infections, really ear infections under six to nine months, that's what's called the otitis prone child. So that group's at higher risk, and your index of suspicions gonna go way up for that kid. But there's that child who has bad plumbing. And remember, the other big thing about the recurrent infections is the number one cause of recurrent infections is daycare and bad plumbing. Bad plumbing, mean bad ears. And then it gets cigarette smoking, which is not as bad as it used to be. So those are factors. At what point should a parent worry? Do you have any red flags or any are there any times when parents should actually truly be concerned? Okay, so you got the kid with recurrent ear infections four or five within a 612, month period. That's different. That's an ear plumbing issue. However, I've had several kids over the year. If I can convince the mom that she'll pull the kid out of daycare, they're going to go away for the most part. And it's very common that if they're out of that exposure and they're not around more than one sibling or one other child, their ear infections may drop like a rock and they won't need tubes. But this is not practical for a lot of parents. I understand that. So if you're stuck with daycare, that's okay. And I'm just curious, because a lot of doctors will say, Well, it's good for them to get exposed. It's good for their immune system. If they get sick more frequently in the daycare years, that'll be protective for them in the later years. But I hear what you're saying. If it's too much and the kids just constantly sick, I think that's an acceptable option. Just just take them out of daycare if you can. Yes, but it does make a difference. If you look at the kids that have not been exposed at all, you'll find that when they hit school, that kindergarten or preschool, four year old, five year old, they are sick a bunch that first year, then they get better. But you're going to pay the piper one time or another. The difference is when you pay the piper when they're little, it's bad illnesses. It's ear infections, occasionally pneumonias and others more severe, like rotavirus, viral infections too. So it's more so you're saying it's harder on the smaller bodies have smaller airways, smaller ear tubes, that when they get sick, it can be harder on younger children. Yes, if you look at the rotavirus, but they're little, 1521, days. If they get it when they're older, it's two or three day illness. So yes, the immune system and your airways and your GI tract handle it much better the older you are. But again, you'll pay the price eventually. It is true on little babies, some of those illnesses can really wreak havoc on their systems. Yes, and then go back to your recurrent infection. Now, if they're getting recurrent pneumonias or recurrent bacteremias, that's the red flag for you and the child with recurrent high fevers, the FAPA syndrome, you know, yes, periodic fever, Aptus ulcers, the pharyngitis and at night is so anyways, that's called FAPI syndrome, discovered just to translate for people listening who might not have Aptus ulcers. Means canker sore, yes, the little blisters you see inside the mouth Exactly. So anyways, so that that's different. So that child with recurrent three fevers every three to four weeks, that's a red flag that child needs to be evaluated. Different red flag, recurrent pneumonias, recurrent bacteremia. Bactere means high fever, high white count, looking sick, not acting very well. That group two is again at risk for having some kind of immune deficiency, but recurrent ear infections that are mild, no way, recurrent URIs, no way. It's just not worth the effort. And again, persistent coughs you got to watch out for too, because it's occasionally that little subtle sign that something else is going on that you need to look for carefully. A lot of them have these low grade pneumonias, and then you got to possibly get a chest X ray if your exam doesn't reveal the crackles and rolls that we hear with our stethoscope. And sometimes, I'll find with kids with chronic coughs, even if it's not recurrent pneumonias, sometimes kids that are coughing all the time, you find out maybe it's allergies, maybe there's asthma, and there's things that we can do for them to make them feel better. So I agree, persistent coughs are definitely something to bring up to your pediatrician. Now I'd love to ask you about fevers, because fevers are a really common concern that parents have just to reassure families. What are your thoughts on fever what? What good are fevers doing for our body? When should we be worried about fevers? And how do you tell parents to think about fevers in general? You can tell you're a practitioner. You would do a lot of this. Yes, I'll reassure what you're doing is totally correct. So anyways, yeah, fever is the body's way of fighting off whatever infection it is. In general, sometimes it's autoimmune stuff like lupus or rheumatoid arthritis, but most of the time, it's fighting off some virus. For me, I have to say, I've rarely had fevers associated with a rheumatologic condition, but we see fevers all the time in kids, where it makes parents so nervous, but they're just the body's normal way of fighting an infection. It gets the body hot internally. It's a natural, normal immune response most by far and away, most of the time, right? And those with rheumatoid logical diseases have other things as well. So there's always something else with those kids, the kid with just isolated fever and a runny nose, that's what you're asking about. So that kid, the thermostat is being reset to fight off whatever virus or bacteria is invading 98% of time it's some virus, 2% of time it's going to be some bacteria. So that's what we have to watch out for. Is that bad bacteria stuff? So in general, what I look for. Is the following, give them acetaminophen or Tylenol, or you can give ibuprofen or Advil or promotion, and once you give that, wait an hour and see how they look, then, if they still look bad, then, and if you're still worried, that's when you know you've got something you need to be dealing with. That's different. So the key is after an antipyretic which means a fever medicine, Tylenol, Motrin, is given, and they're still looking bad. They're still not responding, they're still not interactive. This goes off after you give them two hours after you give it the medicine, then your red flags go up, okay. This is not what we expect. But if they're starting to drink, start to eat a little bit, start to interact a bit more and more social, then you're probably okay. The exception will be the child with 104 or more fever. So that high fever stuff is a big red flag in the old days, 5% of them had bacteremia, and 1% had meningitis in my days, so it was a scary phenomenon back in the old days. Nowadays, and I can testify, several kids have been misdiagnosed at our tertiary care centers because they're too cavalier about it. We're going to they got a 30,000 white cat, 104 fever. You still think it's viral. You guys haven't seen the ugly stuff that we've seen, and UTIs as well. UTIs, especially in girls, are fairly common, and so the half fever and a child is still irritable and cranky. We need to check the urine as well. So there's other parameters, but the big one is that the acne will not complain with anything else. They call Stein hormones, the urine doesn't seem to be bothering. Those are all reassuring signs. But you know, you want to know the big things aren't there, meaning pneumonia, UTI and bacteremia. And even got asked this today, their child has had a fever for a few days, and the mom said to me, how can you tell by looking at the child, it's not bacterial I thought that was I thought that was a great question, because I'm looking at the child. The child had a classic flu season, symptoms, high fever, muscle aches, headaches, runny nose, cough, symptoms of the flu. And she said, But how can you be sure it's not bacterial? Yes, and I think that is a reasonable question. Oh, absolutely. The key is that demeanor after you give an anti priority so motor Tylenol, does the fever come down some? Do they look like they're feeling better? They look interactive? Do they start what to drink and eat more? Just that social response? You can see in their eyes. They're kind of perkier and starting to play more. That reassures you. And I'm curious, a lot of parents give Tylenol and ibuprofen at the same time. And I find that usually one is sufficient. You don't have to give both. But I feel like that's becoming more commonplace, where people are giving both antiparetics together. In your experience, what do you recommend? Okay, so you're right. The fever is really not gonna hurt unless it gets above one six. That's number one. So you're not going to see that, almost never in real practice. And I think this is a great point to remind parents that a fever is not going to hurt your child, and I like to remind parents that we're giving these medications not to make the fever go away, but we're giving them to make a child more comfortable. Would you agree with that precisely? One of the 3.5 you definitely want to really watch vigilantly and probably contact your doctor. That's the kind of cut off you go. This is getting a little out of hand. So anything 100 405, I suggest go ahead and be seen. And then the other thing is Tylenol motion. I'm taking two Tylenols probably two or three times a day, because I have this horrible bio situs all the time. I can't remember when I got it. And so to ask a parent, when did I give the motion when did I give the Tylenol every three hours? Every four hours? Impossible. You're too busy. You got other things going on your life, so it's you're going to mess up. You're going to overdose your kid. Okay, Tylenol overdose is not a problem. Motion overdose is a little more problematic, but nonetheless, you're going to screw that up, unless you write it down specifically what you've given. I'd love to know why you said that. Why you said that. Why do you say Tylenol overdose not a problem, because children metabolize it, and their metabolism in the liver is extremely good, and you almost never see Tylenol overdoses with standard doses. I love that point, because a lot of parents aren't aware of that. It's really hard to overdose Tylenol on a child. In fact, it's almost impossible to do. A kid under, I think, three or four, unless you gave the whole children's bottle, it would be extremely difficult to do so. I had a toxicologist come on as a guest a couple of years ago, and he told me he's never seen an overdose with Tylenol a kid under five years old, unlike adults and teens, their glutathione is too insufficient to handle it, so therefore they're at risk for major problems. So that's a different beaks again. Why bother, though? Okay, here's my theory on this. So I say give ibuprofen to kids under age three, generally okay, unless they're not drinking. Well, are there any signs of dehydration or not peeing? Well, Ibuprofen is nephrotoxic, so you have to be extremely careful if they're not drinking. I always warn parents, if you said ibuprofen exclusively, you've got to make certain they're drinking some don't give so a child coming off is vomiting, diarrhea, I don't give motive. Number one, it's irritating for the stomach. Vomiting. Number two, if they're not drinking, well, they're going to get kidney damage if they're not drinking, it. Have to keep the kidneys flushed. So Ibuprofen is kind of contraindicating my book. And again, the other group of kids for ibuprofen or Motrin is kids who have kidney disease as well. So you don't want to give ibuprofen to kids with any kidney disorder, any kids there's a risk for dehydration. So just to summarize, when it comes to Tylenol and ibuprofen to treat fevers, if you give two, it can be very complicated for parents, and that can be too much work. Simplify your life. Stick with one. Tylenol is preferred. In the case of diarrhea and vomiting, Tylenol is metabolized and broken down by the liver. So if your child has a liver problem, that is a situation where you would want to avoid Tylenol. And then, when we're talking about ibuprofen, Ibuprofen is metabolized by the kidney, so to keep the kidney healthy, if your child is taking ibuprofen, make sure that they're drinking enough fluids, and then try to avoid it if they are at risk of being dehydrated, because it may be harmful to the kidneys if your child is not drinking enough Yes, and we know this from adult studies as well. And in what situations do you recommend ibuprofen? I like it better for kids under age four for fever reduction, because it's a better pain reliever too, for headaches and the irritability. It works for that. Now, as you get older, Tylenol is a better fever reliever in kids that are teens and preteens. That's my experience. You may get refutation of that, but in general, I find if a child's one three fever and they're a 12 year old, I prefer two adult Tylenol, if they're big enough to use it over ibuprofen. Ibuprofen is not a great fever reliever in kids, probably at school age and above. Interesting point, isn't it? It is. But I do find ibuprofen can be really beneficial, specifically for situations like menstrual cramps, for mouth pain. I find that it works well for ear pain, I find it works well and it also lasts longer than Tylenol. So I do think that there is a plus with ibuprofen. If you have a child who's not great at taking medication, it will last a little bit longer. So there are definitely situations where I like ibuprofen better. The reason I use Tylenol is fever, nothing else, if you're interested, headache, sore throat, achiness, no motor is much better. Ibuprofen is much better. But fever alone, if your target is fever, Tylenol is, I think, preferred over ibuprofen for feed. I see in the odor, nothing else, pain reliever, Ibuprofen is much better. Absolutely, yes, you're okay. This is such great advice, hearing it from an experienced doctor. So thank you. Are you calling me old? No, that is not calling experienced. I've been called Old, not enough experienced experience. Well, also, there's a lot of doctors that don't see many patients, right? Yeah. In my lifetime, we average about 25 to 30 patients a day. So we're busy. And the old days, we'd sit 35 to 40 a day. And I'm curious, in your time as a pediatrician, do you find that there's things that now parents worry about more than they used to. And I think specifically what I'm thinking about is social media. Do you find that there's a lot of parents that now are extra worried because of what they're finding online? Oh gosh, they have a right to be worried. You know, in my household when they're growing up, I could turn that TV off and we were done, and if I wanted to ground them, take away their landline and take away the TV, and you were done easy. Now they can sneak on their cell phones. They can sneak up on the TV. It's all sorts of junk out there, and then social media is a disaster because there's no accountability. I also think what's so hard is what gets attention online, what gets clicks are things that make parents worry, so any case of something going wrong with a child a bad outcome, that's what gets eyes, that's what gets clicks. And so I have a lot of parents that come in here really worried that something bad is going to happen to their child, and they admit to me, it's something that they found on Tik Tok. And so I know that there is a lot of benefit that people find. They do get a lot of good advice, but there's also a lot of misinformation and unnecessary worry that I I personally find that there's more harm than good. Yeah, I agree. The thing with it, I always tell my families is, go to recognize medical sites, American Academy of Pediatrics, American Academy of Family Physicians, ACOG. And I also say, go to your pediatrician. Have a doctor that you trust. Yes. And I also think something that we don't do enough now is talk to your parents, or talk to parents in your life where you've seen them raise kids and you like how their kids have turned out. Get advice from them. Yeah, yes. So before we close, I think it's fun to end with a lightning round of questions. If you don't mind if I ask you some questions and give me the response that first comes to mind, oh, gosh, it could be bad, you'll do great. Okay, what childhood symptom Do you think parents worry about way too much? Probably fever is up there. And then second to that would be educational things, language and developmental things, a parenting instinct that's usually right, mother's instinct when they think something bad is wrong, and it's persistent, and her gut feeling is saying something's wrong. Always listen to the mother. Always, even if you think she's scattered, the blind squirrel finds a nut once in a while, you've got to listen to the mother's instincts. Must say, it's always accurate, but I'd rather be guessing wrong than it to listen to her. Come back two days later, say my child's in the hospital is 104 fever, he's got meningitis. Okay, so, yes, listen to the mother. Their their instinct is very good. It'll save you so much hassle. I'm going to start using the blind squirrel finding a nut analogy. I like that one, something parents Google that causes unnecessary panic, probably the biggest one like recurrent infections and fever, and it's scary. When you go to Dr Google too much, they think everything's pneumonia, meningitis and leukemia. It just scare tactics, a sign a child is doing just fine, even if it doesn't look that way. The key there is, let's take a child who's sick again, it's their demeanor. Are they interacting? Are they playful? Are they playing with their toys, interacting with the brothers, sister, interacting with you? Their eyes look like they're starting to respond to what you're doing. Are they laughing and giggling at all? Are they starting to want to drink and eat during phases when the fever is down? Are they feeling somewhat better? So it but it's important to know if they're not, it goes on even without fever, and they're looking kind of puny and they're not responding to look terrible. They still might have serious illness. So this is going on more than 1224, hours. Check in with the doc. Is there a phrase that you find that you say to parents over and over again? Probably the biggest one I say, Is this too shall pass and just be patient with whatever phase it's going through and a fever is not going to hurt your child. The other big one we use a ton of as well, and Dr block, will you tell us the title of your book? Show us what it looks like, and where can we find it? Pediatrics around the block. It's on amazon.com, right now, easy to find there. It's also on walmart.com, Barnes and Noble. And the book is fun to read. It's got great advice. All the things I told you today are pretty much in there as well. And like the title, the title is great, yeah. Well, actually, when I wrote for pediatric news 20 years ago, that was the title of my column I wrote every three months. Was fantastic around the block. So her block, I look forward to reading pediatrics around the block, and it was really a treat to talk to you. Thank you so much. Thank you, Jessica, it's pleasure, man. Thank you for listening, and I hope you enjoyed this week's episode of your child is normal. Also, if you could take a moment and leave a five star review, wherever it is you listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr. Jessica.