Pack healthy school lunches: beware of junk food disguised as healthy foods

Junk food in disguise.

Junk food in disguise.

Need ideas on what to pack in your child’s lunch bag? Beware of junk food masquerading as healthy food. Dr. Roxanne Sukol, an internist who writes the popular nutrition blog Your Health is on Your Plate , mom of three children, and friend of Dr. Kardos’s from medical school, shares her insights.

What should we pack in our children’s lunch bags?  The key to retraining our children to eat real food is to restore historical patterns of food consumption.  My great-grandparents didn’t eat potato chips, corn chips, sun chips, or moon chips.  They ate a slice of whole-grain rye bread with a generous smear of butter or cream cheese.  They didn’t eat fruit roll-ups.  They ate apricots, peaches, plums, and grapes.  Fresh or dried.  Depending on where your family originated, you might have eaten a thick slice of Mexican white cheese (queso blanco), or a generous wedge of cheddar cheese, or brie.  Sunflower seeds, dried apples, roasted almonds.  Peanut butter or almond butter.  Small containers of yogurt.  Slices of cucumbers, pickles, or peppers.  All of these make good snacks or meals.  My mom is proud to have given me slices of Swiss cheese when I was a hungry toddler out for a stroll with my baby brother.  Maybe that’s how I ended up where I am today.

When my own children were toddlers, I gave them tiny cubes of frozen tofu to grasp and eat.  I packed school lunches with variations on the following theme:  1) a sandwich made with whole grain bread, 2) a container of fruit (usually apple slices, orange slices, kiwi slices, berries, or slices of pear), and 3) a small bag of homemade trail mix (usually peanuts + raisins).  The sandwich was usually turkey, mayo and lettuce; or sliced Jarlsberg cheese, sliced tomato, and cream cheese; or tuna; or peanut butter, sometimes with thin slices of banana.  On Fridays I often included a treat, like a few small chocolates.

Homemade trail mix is one terrific snack.  It can be made with any combination of nuts, seeds, and/or dried fruit, plus bits of dark chocolate if desired.  Remember that dark chocolate is good for you (in small amounts).  Dried apple slices, apricots, kiwi or banana chips, raisins, and currants are nutritious and delicious, and so are pumpkin seeds and sunflower seeds, especially of course in homes with nut allergies.  Trail mix can be simple or involved.  Fill and secure baggies with ¼ cup servings, and refrigerate them in a closed container until it’s time to make more.  I would include grains, like rolled oats, only for children who are active and slender.

What do I consider junk food?  Chips of all kinds, as well as those “100 calorie packs,” which are invariably filled with 100 calories of refined carbohydrate (white flour and sugar) in the form of crackers (®Ritz), cereal (®Chex), or cookies (®Chips Ahoy).

You can even find junk food snacks for babies and toddlers now:  The main ingredients in popular ®Gerber Puffs are refined flour and sugar.  Reviewers tout: “You just peel off the top and pour when you need some pieces of food, then replace the cap and wait for the next feeding opportunity.” [Are we at the zoo?] “He would eat them all day long if I let him.” [This is not a benefit.  It means that the product is not nutritious enough to satisfy the child’s hunger.]

Beware not only of drinks that contain minimal amounts of juice, but also of juice itself.  Even 100% fruit juice is simply a concentrated sugar-delivery system.  A much better approach is to teach children to drink water when they are thirsty, (See my post entitled One Step at a Time) and to snack on fresh fruit when they are hungry.  Milk works, too, especially if they are both hungry and thirsty!

©2016, reprinted and updated from 2010 Roxanne B. Sukol, MD, MS

TeachMed, LLC

http://yourhealthisonyourplate.com

Reprinted with permission in edited form for Two Peds in a Pod

Roxanne B. Sukol, MD is a 1995 graduate of Case Western Reserve School of Medicine.  She is board-certified in Internal Medicine and practices Preventive Medicine in the Wellness Institute at Cleveland Clinic in Cleveland, Ohio.  With special interests in the prevention and management of diabetes and obesity, Dr. Sukol writes the blog Your Health is on Your Plate .  Because her patients (the grown-ups) are the ones packing the school lunches for our patients, we thank her for this post.

Julie Kardos, MD and Naline Lai, MD

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No more night owl! How to adjust your child’s sleep schedule for school

Great-horned owl, NPS Photo, Big Bend National Park

Great-horned owl, NPS Photo, Big Bend National Park

Okay, we admit it: our kids are definitely in summertime stay up late/sleep late sleep mode. With school starting soon, many of us now have to shift our children from summer to school year sleep schedules. Because school start times are constant (and early), the kids will have an easier time if you help them shift their bedtimes gradually over the period of a week or two toward the desired earlier bedtime. Remember, the average school-aged child needs 10-11 hours of sleep at night and even teenagers function optimally with  9-10 hours of slumber per night.

Here are some straight forward ways to help ensure good quality sleep for your child:

1)   Keep sleep onset and wake up times as consistent as possible 7 days a week. If you allow your child to “sleep in” during the weekends, she will have difficulty falling asleep earlier on Sunday night, have difficulty waking up Monday morning, and start off her week over-tired, more cranky, and less able to process new information—not good for learning. That said, you can allow your teens, who generally have a much earlier school start time than their biological clocks desire, to sleep in an hour or so on weekends to catch up on sleep.

2)     Limit or eliminate caffeine intake. Often teens who feel too sleepy from lack of sleep drink tea, coffee, “energy drinks” or other caffeine laden beverage in attempt to self-medicate in order to concentrate better. What many people don’t realize is that caffeine stays in your body for 24 hours so it is entirely possible that the caffeine ingested in the morning can be the reason your child can’t fall asleep later that night. Know also that kids who drink “pre-work out” drinks may not realize that caffeine is one of the ingredients. Better to pre-hydrate with water. Caffeine can have side effects of jitteriness, heart palpitations, increased blood pressure, and gastro-esophageal reflux (heartburn). If your child already has a daily ice-tea, coffee, or other caffeine containing drink, let her wean down gradually- abrupt caffeine withdrawal can cause headaches.

3)      Keep a good bedtime routine. Just as a soothing, predictable bedtime ritual can help babies and toddlers settle down for the night, so too can a bedtime routine help prepare older kids for sleep. Prevent your child from doing homework on his bed- better to associate work with a desk or the kitchen table and his bed with sleep.

4)     Avoid TV/computer/ screen time/smart phones just before bed. Although your child may claim the contrary, watching TV is known to delay sleep onset. We highly recommend no TV in a child’s bedroom, and suggest that parents confiscate all cell phones and electronic toys, which kids may otherwise hide and use without parent knowledge, by one hour prior to bedtime. Quiet activities such as taking a bath, reading for pleasure, and listening to music are all known to promote falling asleep. Just be sure your kids put down the book, turn off the music, and turn off the light to allow time to relax in their beds and fall asleep. Many use this time for prayer or meditation.

5)      Encourage regular exercise. Kids who exercise daily have an easier time falling asleep at night than kids who don’t exercise. Gym class counts. So does playing outside, dancing, walking, and taking a bike ride. Participating in a team sport with daily practices not only helps insure better sleep but also has the added benefit of promoting social interactions.

Getting enough sleep is important for your child’s academic success as well as for their mental health. We pediatricians have had parents ask about evaluating their children for attention-deficit hyperactivity disorder because of an inability to pay attention, only to find  that their youngster’s focusing issues stem from tiredness. Teens are often so over-involved in activities that they average 6 hours of sleep or less per night. Increasing the amount of sleep in these kids will alleviate their attention problems and resolve any hyperactivity.

Additionally, sleep deprivation can cause symptoms of depression. Just recall the first few weeks of having a newborn:  maybe you didn’t think you were depressed but didn’t you cry from sheer exhaustion at least once? A cranky kid or sullen teen may become much more upbeat and pleasant if they get an extra hour of sleep each night.

Unfortunately for children, the older they get, their natural circadian rhythm shifts them toward the “night owl” mode of staying up later and sleeping later, and yet the higher-up years in school start earlier so that teens in high school start school earliest at a time their bodies crave sleeping late. A few school districts in the country have experimented with starting high school later and grade school earlier and have met with good success. Unless you live in one of these districts, however, your teens need to conform until they either go to college and when they can  choose classes that start later in the day or choose a job that allows them to stay up later and sleep later in the day.

For kids of all ages, a night time ritual of “tell me about your day” can help kids decompress, help them fall asleep, and keep you connected with your child.

Julie Kardos, MD and Naline Lai, MD

©2016 Two Peds in a Pod®, updated from 2009

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Text me… for my daughter going off to college

 

texting collegeToday , Dr. Lai shares with us the texting guidelines she will be giving to her daughter as she goes away for college (wasn’t kindergarten just yesterday?). We can all learn from this list.

–Dr. Kardos

Text me to share a funny meme.

Text me to wish me a happy birthday and then follow it with a call.

Text me if you are about to go over our shared data plan.

Text me if you are deciding whether to study abroad.

Text me sooner than the day before spring break about your spring break plans.

Text me if you are unhappy about a break-up…even if you forgot to tell me you were going out in the first place.

Text me if you have a cold. I know you know what to do, but it will make us both feel better if I tell you to get good rest and hydrate well.

Text me if you are changing majors…but not before you have a plan for a new major

Text me if you find the essentials of life: “eat, sleep, drink, pee, poop,” difficult. Especially the poop—no one will ever obsess about your bowels like a mother (except maybe a grandmother).

Text me when you are not in class (because I know you will be paying rapt attention to your professors and sucking every last bit of paid knowledge out of their craniums).

Text me sometimes at 1am with the understanding that I will be texting you sometimes at 7 am.

Text me to ask for the phone number of your dentist, but do not ask me to schedule the appointment for you.

Text me if you are feeling 😬 or 😞 or like 💩.

Do not text and ask me to email your professors.

Do not text me to ask about your clothing choices for the day…unless you just want me to say you look beautiful.

Do not text me asking for college housing deadline information; you have the same access to the internet as I do. Plus, you are actually on campus!

Do text me to complain about the 4 loads of laundry you did all Saturday afternoon -it makes me happy to see you can survive on your own- and I promise not to lecture you on how you allowed the laundry to pile up.

And of course, text me out of the blue just to say ❤️

mom

aka Naline Lai, MD

©2016 Two Peds in a Pod®

 

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Finger Foods for Your Famished Toddler

Ready to eat! -Photo by Lexi Logan

Ready to eat! -Photo by Lexi Logan

Got a baby starting on table foods? Good news:  You don’t have to go broke over buying toddler Puffs®.

Babies and young toddlers don’t have a lot of teeth. In fact, a full set of teeth does not come in until around two years of age. In the meantime, to help your new eater avoid choking, cut up food into tiny pieces. Now, sawing at food with a knife is not easy. Meet your new friend: the kitchen shears! Use shears to snip food into perfect toddler bite-sized pieces.

Cut table food into bite-sized pieces smaller than a grape, or approximately Cheerio® sized, and place on a clean surface, such as the high chair tray. Plates are not necessary and often end up on the floor. Go ahead and give your toddler a fork but don’t expect him to use it- most toddlers are eighteen months before they can master a fork or spoon. Always be present when he is eating in case he starts to choke. Toddlers tend to put a handful of food in their mouth at one time, so teach your child to eat pieces of food “one at a time.”

Forget the toddler-food aisle, just grab your shears and cut away. Below are finger-food ideas to help you get started. These foods are appropriate for babies who are able to finger-feed, starting anywhere between 7 to 9 months of age, even without teeth:

canned mandarin oranges

fruit cocktail (in juice, not syrup)

bananas

diced peaches

diced pears
diced mellon
diced berries, cut blueberries in half at first

diced cooked apples

raw tomato pieces

avocado

beef stew

liverwurst cut into small pieces

diced cooked meat

Cooked, diced chicken

Diced cooked fish (careful to discard any bones) click here for U.S. Food and Drug Administration recommendations 

tofu (extra-firm is easiest to cut)

black beans, cooked or canned (rinse off the salty sauce they come in)

egg salad or hard-boiled egg pieces

bits of scrambled egg

soft cheese- such as American or Munster

vegetable soup (just scoop out the veggies and give them to your child. You can put the broth into a cup for him to drink)

diced cooked veggies such as peas, carrots, corn, broccoli, zucchini, etc.

diced cucumbers

cooked diced squash

cooked diced potatoes, sweet potatoes, or yams

rice (rinse the rice grains in cold water prior to cooking to wash away trace amounts of arsenic that can be found in rice, couscous, quinoa

noodles

pierogies

mini ravioli

macaroni and cheese

waffles

pancakes

french toast

crackers with cream cheese

toast with jelly

toast with nut-butter (soy, peanut, almond, sunflower, etc.)

stuffing

Cheerios®

If your baby still likes his cereal, you can continue to offer it (We both still like oatmeal- it’s not just for babies!). Just be sure to vary the types of grain that you offer your baby and, specifically, avoid feeding rice cereal every day. Rice, even in rice baby cereal has been found to contain arsenic absorbed in the rice from the soil that rice grows in. Please see the latest American Academy of Pediatrics and U.S. Food and Drug Administration advice on this topic.

Bon appetite!

Naline Lai, MD and Julie Kardos, MD

©2016 Two Peds in a Pod®, revised from 2013

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Yellow? All about newborn jaundice and bilirubin

bilirubin jaundice

Can you pick out the jaundiced one?

Pediatricians often cringe when they find newborns swathed in a yellow blanket. The color always seems to accentuate a baby’s jaundice and we’re not fond of jaundice.

Jaundice, an orange-yellow coloration of the eyes and skin, is caused by a blood breakdown by-product called bilirubin. We all break down blood, but it’s more difficult for the newborn’s liver to process it into a form that his or her body can get rid of.  Eventually, we get rid of bilirubin  by peeing and pooping it out. Bilirubin is what gives the yellowish color to urine  and stool.

Why do we care about jaundice? In the 1950s and ’60s, infants who had died from a neurological issue called kernicterus were found to have extremely high levels of bilirubin (jaundice) – up into the 100s of mg/dl. High levels of bilirubin can cause hearing and vision issues. Even at lower levels, jaundiced babies tend to be more sleepy and eat sluggishly.

Nowadays, for a full term baby,  we generally let the bilirubin level rise to 20 mg/dl at most before starting treatment, and often we treat even earlier. More than 60% of newborns appear jaundiced in the first few days of life,  but most never need any special treatment because the jaundice self-resolves. Conveniently, the first line of treatment is simply feeding more: the more milk that goes in, the more pee and poop that comes out, bringing the bilirubin with it. If improving intake does not lower the bilirubin enough, the next step is shining special lights  (phototherapy) on a baby’s skin.

Jaundice first starts noticeably in the eyes and face. As bilirubin levels rise, the yellow (jaundice) appears more and more down the body. Yellow in the face of a newborn is expected. If you see yellow in the belly, call your pediatrician. Levels naturally rise and peak in the first few days and we have graphs and apps to predict if the bilirubin may reach treatable levels.

Some babies are more likely to have higher bilirubin numbers and thus appear more yellow:

  • Premature babies, because they have immature livers.
  • Babies who have different blood types than their moms. Certain blood type differences can cause some breakdown of blood even before a baby is born, therefore increasin chances of an elevated bilirubin after  birth.
  • Babies who acquire bruising during delivery; they have more blood to break down.
  • Be aware, there are a few other less common risk factors,  and if needed,  your pediatrician may address them with you.

Hydrating your baby will help jaundice. You should watch the number of wet diapers your newborn has in a day. Wet diapers are a sign of good hydration. In the first week, she should have about one wet diaper for every day of life (so on day of life one= one wet diaper, day of life two=two wet diapers, etc). Also  watch for bilirubin to start coming through the stool. At first, your baby will poop out the black stool called meconium, but as milk starts going through her system, expect the stool to turn yellowish. (click here for more information about the colors of newborn poop) . As with the urine, look for one bowel movement for every day of life (so day of life one=one bowel movement diaper, day of life two= two etc). Eventually some newborns poop every time they are fed, although some max out at 3 or 4 bowel movements per day.

So, if you hold up your newborn baby in a yellow blanket to show your pediatrician and call the baby “our little pumpkin” you’ll know why she raises an eyebrow.

Click here for other fun medical color facts.

Naline Lai, MD and Julie Kardos, MD

© 2016 Two Peds in a Pod®

Revised from July 24, 2016 at 10:58pm

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Happy Birthday-Two Peds in a Pod Turns Seven! About seven-year-olds

seven year old development

We are so proud that Two Peds in a Pod® turned SEVEN this week!

It’s the golden age of seven— too old to take a nap and too young to drive. Some parental worry will now subside. Finally, you will  be able to clean your garage out on the weekend without wondering if your kid has stuck her head in a bag of mulch.

Seven Wonders of your Seven-year-old’s World

Entering first or second grade, a seven-year-old will often sport a toothless grin (and still believes in the tooth fairy) as she continues her march to independence and self care. Wondering what she is capable of? Now she is able to set an alarm, wake up for school, get dressed and brush teeth on her own. However, self care will not be as meticulous as the care you give, so be prepared to dot sunscreen on the large patch of skin that she missed.

Wondering if your child is too old for you to read to him at bedtime? We recommend you not only continue to read aloud to your child, but have your child read out loud to you. Read higher level, more interesting books to him (chapter books), which will inspire him to become a better reader. He is now transitioning from learning to read to reading to learn. In other words, he will start to gain information from reading. Bedtimes become busy, with electronics and extra curricular activities crowding up the family schedule, but persevere.

Wonder if your child can do his own homework? Improve your child’s self-esteem by allowing him do his own homework. Encourage success by setting up a quiet, clean place away from his younger siblings. At this age, homework is not supposed to take more than 10-20 minutes- if it does, alert the teacher. Let your child see natural consequences of not doing homework (teacher will have a repercussion, refrain from double punishing). Set up good expectations.

Wonder if you or your child is ready for sleepovers? Remember: kids do not sleep at sleepovers. If you will not sleep at night because a) your child is at a family’s home that you are not familiar with, b) your child is at your own home and you will be constantly interrupted by the thumping of feet running about, or c) you dread how crabby and whiny your child will be in the morning, don’t do it. Despite any accusations you may hear, you will not be the only parent in history to say “no” to a sleepover. Many times in the office when we see an ill child, the parent starts out the office visit with, “Well, she was at a sleepover and the next day she came down with a fever/sore throat/cough/etc.”

Wonder how your child conducts himself when he is away from you? A seven-year-old is fully capable of entertaining his own friend at your home and remembering “yes, please” and “no, thank you” in a friend’s home. Make sure your seven-year-old has memorized your phone number as well as his address.

When you get into a car with a seven-year-old, he not only can buckle himself up in the car (another wonder of the seven year old world and a huge improvement from having to kneel in the back seat straining your back as you buckled him up as a toddler) but also he will likely remind you to do the same. Seven-year-olds are rule followers. A strategy you can use at home to encourage desired behavior is to say “The rule in our house is that everyone cleans up his own mess,” rather than saying “Clean up your toys because I said so.” (Although he may ask, he still needs to be in a booster seat.)

Our 7th wonder of the seven year old world: when your seven-year-old recovers from a nasty stomach virus, it is possible that NO ONE ELSE in the family will catch it. A seven-year-old can use a basin, run to the toilet, wash his own hands, and change his own pajamas. You just have to supply the watered down gatorade (and comfort, as older sick kids still appreciate a parent’s cool hand and reassuring words) and remind him to keep drinking.

We are excited to have reached our 7th year writing practical pediatrics for parents on the go. That’s hundreds of posts on topics that you have suggested to us both in the office and online. Please continue to share our content- we wonder if we can reach 7 million families this year!

Thank you for your suggestions and comments over the years.

Sincerely, Julie Kardos, MD and Naline Lai, MD

©2016 Two Peds in a Pod®

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Summertime ear pain? It might be swimmer’s ear

These lucky fish don't have to worry about swimmer's ear... they don't have any ears!

These lucky fish don’t have to worry about swimmer’s ear… they don’t have any ears! –Photo by Dirk Peterson, MD

Its the type of ear pain that usually creeps up on a school aged summer camper. One night he may notice discomfort when his ear is against his  pillow. The next night, the pain gets worse. Eventually, even touching the ear is painful. The ear is probably infected, but infected with “the other kind” of ear infection—swimmer’s ear.

Ear infections are divided into two main types: swimmer’s ear (otitis externa) and middle ear infections (otitis media). An understanding of the anatomy of the ear is important to understanding the differences between the two types of infection.  Imagine you are walking into someone’s ear. When you first enter, you will be in a long tunnel. Keep walking and you will be faced with a closed door. The tunnel is called the external ear canal and the door is called the ear drum.

Swimmer’s ear occurs in the ear canal. Dampness from water, and it can be water from any source- not just the pool, sits in the ear canal and promotes bacterial infection.  

Next, open the door. You will find yourself in a room with a set of three bones. Another closed door lies at the far end.  Look down.  In the floor of the room there is an opening to a drainage pipe. This room is called the middle ear. This is where middle ear infections occur.

During a middle ear infection, fluid, such as during a cold, can collect in the room and promote bacterial infection.  Think of the sensation of clogged ears when you have a cold. Usually the drainage pipe called the eustachian tube,  drains the fluid.  But, if the drain is not working well, or is overwhelmed, fluid gets stuck in the middle ear and become infected. 

Because a swimmer’s ear infection occurs in the external canal, the hallmark symptom of swimmer’s ear is pain produced by pulling the outside of the ear.  Since middle ear infections occur farther down in the ear, pain is not reproduced by pulling on the outer ear.

Swimmer’s ear is treated topically by your doctor with antibiotic drops.  To avoid dizziness and discomfort when putting drops in, first bring the ear drop medicine up to body temp by holding the bottle in your hand.

Home remedies to prevent swimmer’s ear:

  • After immersion in the water, tilt your child’s head to the side and towel dry what leaks out.
  • Mix rubbing alcohol and vinegar in equal parts. After swimming, place a couple drops in the ear.  Do not put these drops in if there is a hole in your child’s eardrum. 
  • Prior to swimming put a drop of mineral oil or olive oil in each ear. This serves as a barrier protection against the water as well an ear wax softener. Do not put in if there is a hole in your child’s eardrum

Although it’s tough to remind children to dry their ears well, take heart.  Dr. Lai once spent two hours trying to get a cockroach out of a child’s ear canal.   We  suspect those parents would have been happier if instead, water had gotten into their child’s ear.

Naline Lai, MD and Julie Kardos, MD

2016 Two Peds in a Pod® 
originally posted August 9, 2009, 2011

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Poison Ivy: Soothe the itch

Teach your child to recognize poison ivy: "leaves of three, let'em be!"

Teach your child to recognize poison ivy: “leaves of three, let’em be!”

Recently we’ve had a parade of itchy children troop through our office.  The culprit: poison ivy.

Myth buster: Fortunately, poison ivy is NOT contagious. You can catch poison ivy ONLY from the plant, not from another person.

Also, contrary to popular belief, you can not spread poison ivy on yourself through scratching.  However, where  the poison (oil) has touched  your skin, your skin can show a delayed reaction- sometimes up to two weeks later.  Different  areas of skin can react at different times, thus giving the illusion of a spreading rash.

Some home remedies for the itch :

  • Hopping into the shower and rinsing off within fifteen minutes of exposure can curtail the reaction.  Warning, a bath immediately after exposure may cause the oils to simply swirl around the bathtub and touch new places on your child.
  • Hydrocortisone 1%.  This is a mild topical steroid which decreases inflammation.  We suggest the ointment- more staying power and unlike the cream will not sting on open areas, use up to four times a day
  • Calamine lotion – a.k.a. the pink stuff. This is an active ingredient in many of the combination creams.  Apply as many times as you like.
  • Diphenhydramine (brand name Benadryl)- take orally up to every six hours. If this makes your child too sleepy, once a day Cetirizine (brand name Zyrtec) also has very good anti itch properties.
  • Oatmeal baths – Crush oatmeal, place in old hosiery, tie it off and float in the bathtub- this will prevent oat meal from clogging up your bath tub. Alternatively buy the commercial ones (e.g. Aveeno)
  • Do not use alcohol or bleach– these items will irritate the rash more than help

The biggest worry with poison ivy rashes is not the itch, but the chance of infection.  With each scratch, your child is possibly introducing  infection into an open wound.  Unfortunately, it is sometimes difficult to tell the difference between an allergic reaction to poison ivy and an infection.  Both are red, both can be warm, both can be swollen.  However, infections cause pain – if there is pain associated with a poison ivy rash, think infection.  Allergic reactions cause itchiness– if there is itchiness associated with a rash, think allergic reaction.  Because it usually takes time for an infection to “settle in,” an infection will not occur immediately after an exposure.  Infection usually occurs on the 2nd or 3rd day of scratching.  If you have any concerns take your child to her doctor.

Generally, any poison ivy rash which is in the area of the eye or genitals (difficult to apply topical remedies), appears infected, or is just plain making your child miserable needs medical attention.

When all else fails, comfort yourself with this statistic: up to 85% of people are allergic to poison ivy.  If misery loves company, your child certainly has company.

Naline Lai, MD and Julie Kardos, MD

©2016, 2015 Two Peds in a Pod®, updated from 2012

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Time out from summer for an important flu update

Time out from summer for a flu update

Time out from summer for a flu update

We interrupt your summer to bring you a Flu vaccine reminder and update.

Although flu (influenza) may be far from your minds, as we enter hot July, pediatricians are already ordering flu vaccines in preparation for Back to School. When the time comes, parents should add “schedule flu vaccine” to their back-to-school list as flu vaccines will arrive in offices as early as late August. Even immunizations given in August will last the entire winter season.

For fans of the nasal spray version of the flu vaccine—bad news. Turns out, data from the past 3 years shows the nasal spray is not nearly as effective as the injectable version. The American Academy of Pediatrics  and the American Center for Immunization Practices both recommend giving only the injectable version of flu prevention for protection against influenza.

Nonetheless, for the inconvenience of a pinch, the vaccine is still worthwhile. A total of 77 children died from flu in the US during the 2015-2016 flu season and many more children were hospitalized with flu related complications such as pneumonia and dehydration. Flu is highly contagious and spreads rapidly within households and schools, including daycare centers. People are contagious from flu one day prior to showing any symptoms of flu.

While most people who become sick with the flu survive, they will tell you it is a tough week. In addition to having a high fever that can last 5-7 days, a hacking cough, and runny nose, those stricken will tell you that every part of their bodies hurt. Even the movement of their eyes can hurt. In addition to the physical effects, our high school and college level patients are particularly distraught about the amount of schoolwork they miss while recovering from the flu.

An ounce of prevention is worth a pound of cure, which is why the flu vaccine is so terrific. There is no “cure” for the flu- you have to let your body fight it out. Unfortunately antiviral medications such as oseltamivir at best shorten the duration of flu symptoms by about one day. Flu vaccines work by jump starting your body’s natural immune system to produce disease fighting cells called antibodies. Vaccines are given yearly because flu virus strains  often morph between flu seasons.

For more Two Peds In a Pod posts about flu and about vaccines in general: How to tell the difference between the common cold and the flu, Fact or Fiction: a flu vaccine quiz, Getting back to basics: how vaccines work.

OK, now back to your summer fun!

Julie Kardos, MD and Naline Lai, MD

©2016 Two Peds in a Pod®

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Bring on the heat: Hot Tub Folliculitis

Note that the hot tub folliculitis rash is worse under the area of the swimming suit at the top of the thigh.

Note that the hot tub folliculitis rash is worse under the area of the swimming suit at the top of the thigh.

 

From the start, a family I know was suspicious of the hot tub sanitation at the resort where they recently stayed. As time went by, even though the water looked clear, the hot tub seemed less chlorinated, and the water more tepid. They dubbed the tub “the scuz tub.” After their return, one of the kids broke out in the rash of hot tub folliculitis pictured above. You could say, they figured out just what the “scuz wuz”. 

 Hot tub folliculitis is a skin rash caused by a bacteria called pseudomonas aeruginosa. The rash appears a day or two after soaking in a hot tub. A light pink bump appears around hair follicles (hence the name). As you can see in this photo, the rash is typically worse on areas of skin where bacteria was trapped under a swimming suit. The rash can cover all body surfaces, including the face, if your child dunked his head under water.
 
The rash can be slightly itchy but is not usually painful. No other symptoms develop such as fever or sore throat. The rash is not contagious, but often other people who swam in the same hot tub also break out.
 
Treatment is to wait it out. Typically by one to two weeks, provided your child does not go back into the hot tub, the rash resolves on its own. If your child feels very itchy, you can treat her with oral diphenhydramine (brand name Benedryl). Rarely, just like mosquito bites, the rash can become infected with other bacteria if your child scratches too much.
 
Pseudomonas thrives in warm wet places. In fact, it’s the same bacteria that causes “swimmer’s ear.” Tight control of chlorine and acid content of the hot tub water limit the growth of the bacteria. Unfortunately, you cannot tell the pseudomonas content of water just by eyeing it.
 
May you bring back a better souvenir than this family did on your next vacation.
Julie Kardos, MD and Naline Lai, MD

©2012, 2016 Two Peds in a Pod®

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