What’s that red mark on my child’s face? Picture puzzle of the day

 

spider angioma

A red mark on your child’s cheek appears just like the one above. Can you wait to ask the pediatrician about it at their next check up? Yes, you can wait. The spider-like pinkish mark is aptly named a spider angioma. Also called by other names such as spider nevus or spider telangiectasia, the marks are composed of fine blood vessels in a radiating pattern close to the skin’s surface. When pressed, they momentarily disappear (blanching). Although in adults they can be associated with pregnancy or liver disease, having one or two is common in healthy children. Since they are harmless and often resolve in their own, we usually leave them alone.

There’s also a type of red mark called a cherry angioma. You can probably guess what shape those marks take.

Julie Kardos, MD and Naline Lai, MD
© 2018 Two Peds in a Pod®




Hooray! United States flu vaccine is here!

should my child get the flu vaccine?

Fight the flu! Vaccinate!

It’s time for your child’s yearly flu vaccine!

Why get the flu shot? Vaccinate against influenza (the flu) not only to avoid missed school days, but also to avoid hospitalizations and death. Last year in the USA, 172 children died from flu. You may not have heard about these fatalities because more sensational news tends to overshadow news about illness. We wish the news would inform that the vast majority of kids who died from flu had not received the flu vaccine. In addition, about half of the children who died from the flu were previously healthy and without underlying medical problems. Excluding the 2009 flu pandemic (H1N1), last year’s flu deaths represents “the highest reported since influenza-associated pediatric mortality became a nationally notifiable condition in 2004.” Kids younger than 5 years old have the highest flu complication rate of all children, so even if they do not yet attend daycare or school, bring your little ones in for a flu vaccine. Vaccinate your school-aged kids as well, for they spread the flu to more folks than any other age group.

Does it help to wait to give the vaccine? What if the vaccine wears off before flu season ends?
We wish we could predict just when the flu will hit, but sadly we cannot. Therefore, we urge you to give your children the flu vaccine as soon as your pediatrician has it available. Like all vaccines, it will take about two weeks for the protection against flu to kick in, and you never know when flu will strike your community. Did anyone catch the story about Vanilla Ice quarantined on a plane in New York with sick passengers last week? Turns out flu was on board. Don’t worry about immunity decreasing over time, infectious disease experts would not allow us to give it in early fall if they thought protection wouldn’t last for at least a few months.

If I give my children the flu vaccine every year, why do I have to give it again this year? Even we constantly-exposed-to-germs pediatricians get our flu vaccine yearly. The flu germs morph from year to year so the vaccine also changes.

Why does my younger child need a second dose this year?
As in previous years, children under nine years of age need a booster dose the first year they receive the vaccine. If your young child should have received a booster dose last year, but missed it, they will receive two doses of this year’s vaccine spaced one month apart (the primary dose plus a booster dose).

Is the nasal spray form back? Or is it only in injectable form?
The nasal spray form of the flu vaccine is back for healthy kids ages 2 years and up. However, this year, it received only a lukewarm reception from the American Academy of Pediatrics. The AAP recommends giving all children aged 6 months and older the flu SHOT, because in past years the intranasal form did not protect against the flu nearly as well as the shot did.

Not only is the nasal spray vaccine not getting a high endorsement, but some kids with asthma and kids with certain immune system problems are not allowed to get the nasal spray form. All kids can get the shot. So, pediatricians will continue to recommend injectable form of flu vaccine this year. However, with the rationale that something is better than nothing, for the severely injection-phobic family, some doctors may elect to give the nasal spray.

In the past, my child did not get the flu vaccine because he is allergic to eggs- did that change?
Even kids with severe egg allergies can get the flu shot safely in their pediatrician’s office. Now we know that allergic reactions to flu vaccine, as with any vaccine, are exceedingly rare.

We visit other people’s homes only if they are not sick. If my child’s friend doesn’t have flu symptoms, doesn’t that mean we can’t catch it from him?
Nope. You are infectious the day before symptoms show up.

Why is it worth it? The coverage is never 100 percent.
Children who get the flu vaccine but then get the flu anyway do not get sick as severely as kids who are unvaccinated. If all kids and adults got flu vaccine, then the chances of YOUR vaccinated child getting flu would be MUCH less. That’s how vaccines work.

Here we have tips on how to help your children if they get the flu.

You can read a comprehensive summary of this year’s flu vaccine recommendations from the Centers for Disease Control here.

Julie Kardos, MD and Naline Lai, MD
© 2018 Two Peds in a Pod®




Updated car seat safety guidelines!

car seat safety 2018 update

Car seat safety isn’t just child’s play.

Just in time for families who plan to drive to Labor Day Weekend destinations, the American Academy of Pediatrics updated their car seat safety recommendations.

Families are now encouraged to keep their children rear facing for as long as possible, until they exceed the height or weight limit allowed by their car seat’s manufacturer. This means that some kids who are older than two years will continue to ride backwards. Dr. Lai’s own pip squeaks easily would have ridden backwards until they were three or four years old.

Regardless of age, kids facing backward in a car crash fare better than kids facing forward. A rear facing car seat prevents whip lash by fully supporting a child’s head and neck. A forward facing car seat does not restrain kids’ heads. In a crash, kids’ heads continue to move at the speed of the car until the shoulder harnesses and lap belts restrain their bodies. It makes us wish that grownups could also somehow ride backwards.

Other recommendations remain the same. For example, children can graduate from booster seats when they are 4 ft 9 inches tall and the car’s seat belt fits them properly. You can read about other car safety tips and view a link to children’s airline safety restraints in our 2017 post about car seat safety. In the post you will see a fabulous photo of a child who was saved by her car seat.

Again, no matter the age, as long as they fit, keep your children riding backwards in their car seats.

We’re thrilled that car safety has progressed over the years. Pictured here is Dr. Lai ready to go out in her 1960’s car seat : 1960 car seat

Drive Safe!

Julie Kardos, MD and Naline Lai, MD
©2018 Two Peds in a Pod®




Ready for school: backpacks, packing lunches, when to keep your kid home for illness, and more

 

get your kids ready for schoolNow that you just read how to drop your kid off at school on the first day, you may be backpack shopping, pondering what to send your child for lunch, and knowing that your child will have difficulty waking up early for school. Never fear! Your Two Peds can help you and your kids get ready for school.

First, make sure your child’s backpack fits correctly and is not too heavy. Our guest blogger, a pediatric physical therapist, provides tips to help lighten the load.

Help your child get back on a school-friendly sleep schedule. If your child is still in summer vacation sleep mode, we provide ways to help get your child’s sleep back on track.

If your child brings lunch to school, you may need some hints on what to pack and how to beware of junk food disguised as healthy food. And this post provides suggestions for healthy snacks.

Need suggestions on how to motivate your child to want to learn? Two former school principals share their wisdom in this post.

Finally, you should know when to keep your child home for illness. This post also contains some surprising truths about when you can send your child back to school during as well as after certain maladies.

Julie Kardos, MD and Naline Lai, MD
©2018 Two Peds in a Pod®




The truth about the first day of school for parents- from kindergarten to college

first day of school for parents

The first of many first days of school.

Parents, let’s admit it. Many of the tears shed on the first day of school are our own. The first day of school for parents is not easy. There is genuine sadness and ache that goes beyond the bittersweet as our kids approach momentous milestones such as kindergarten entry and college send off. As our pediatrician friend Dorothy Novick posted on Facebook, “Because here’s a thing no one ever says out loud on Facebook: as all the balloons and congrats explode on our feeds, many of us parents of graduates are experiencing some pretty serious grief. There’s true pride in the photos, yes, but there’s also honest to goodness grief.”

For your kid-remember the rules of drop off:

  • For kids of all ages, convey to them that the transition is a positive experience. You give your child cues on how to act in any situation. Better to convey optimism than anxiety. Kids, no matter the age, mirror the emotions their parents convey.
  • For daycare and preschool, take your child and place her into the arms of a loving adult- do not leave her alone in the middle of a room.
  • Say good bye. Let your child know that you are leaving. Don’t try to sneak off. At any age, it’s unsettling for you to suddenly disappear.
  • Do not linger. Prolonging any tears, only prolongs tears. The faster you leave, the faster happiness will start.
  • For the younger ones- it’s ok to go back and spy on them to reassure yourself that they have stopped crying- just don’t let them see you. For the older ones-let them have their independence- this is what you’ve trained them for. In fact, encourage their independence. When your young adult asks you a question, ask it back. Chances are, they already know the answer. Just remind them that you are always available. Send the care packages and answer their midnight texts.

For yourself:

Congratulate yourself on reaching a family milestone. The first day of school for parents and children is momentous. Yes, the configuration of your family has changed and it will not be the first or last time. Acknowledge the ache of the passage of time, and reach out to others in similar situations.

Just as your child delights you with all of their unique interests and attributes, go show them all the amazing unique things you do. Take up ball room dancing, start a business painting colorful furniture or join an adult soccer league …these are all real life examples of things we know people embarked on when their kids went off to school.

Cry those “happy tears.” But be aware, sentimental “happy tears” can tip over into depression.

If negative thoughts or worries constantly impinge on your thoughts and weigh you down, then seek help. Talk to your doctor for advice. Also, the National Alliance on Mental Illness maintains a lists of resources.  Depression looks like sadness much of the time but it can also manifest as anger or anxiety.

Warning signs of depression include:

  • Acting out of control
  • Losing interest in activities which normally bring pleasure
  • Changes in sleep patterns-difficulty falling asleep, numerous awakenings, or excess sleeping
  • Having feelings of worthlessness about yourself or other
  • Poor work performance
  • Low energy or fatigue or conversely restless or “hyper” (excessive shopping binges)
  • An increase in alcohol or drug use (attempts at “self-medicating”)
  • Thoughts of being better off dead or a desire to hurt yourself or others

To end on an upbeat (and ok, bittersweet) note, we invite you to read the letter Dr. Lai wrote the day before her first child left for kindergarten.

A letter to my child

My Child,

As we sit, the night before kindergarten, your toes peeking out from under the comforter, I notice that your toes are not so little anymore.

Tomorrow those toes will step up onto to the bus and carry you away from me. Another step towards independence. Another step to a place where I can protect you less. But I do notice that those toes have feet and legs which are getting stronger. You’re not as wobbly as you used to be. Each time you take a step you seem to go farther and farther.

I trust that you will remember what I’ve taught you. Look both ways before you cross the street, chose friends who are nice to you, and whatever happens don’t eat yellow snow. I also trust that there are other eyes and hearts who will watch and guide you.

But that won’t stop me from worrying about each step you take.

Won’t stop me from holding my breath­.

Just like when you first started to walk, I’ll always worry when you falter.

I smile because I know you’ll hop up onto the bus tomorrow, proud as punch, laughing and disappearing in a sea of waving hands. I just hope that at some point, those independent feet will proudly walk back and stand beside me. Maybe it will be when you first gaze into your newborn’s eyes, or maybe it will be when your child climbs onto the bus for the first time.

Until then, I hold my breath each time you take a step.

Love,
Mommy

Naline Lai, MD and Julie Kardos, MD
©2018 Two Peds in a Pod®




How to stop nail biting-thoughts to chew on

Stop Nail biting

A preschooler nibbles on her nails.

Stop nail biting! One of our readers wrote to us: “My 3.5-year-old daughter has started biting her nails to the quick. She does have a new little sister so perhaps it is stress/anxiety about that, but I don’t know what to do. Do I ignore it? Offer rewards for not biting? Please help – the habit drives me nuts and her poor little fingers are looking worse for the wear (and painful).”

As many of you have likely already discovered, telling your kid, or pleading with them, or bribing, ignoring, or yelling at them, will not help your kids stop nail biting.

Nail biting is a common childhood habit. Really common. In fact, according to this review article from 2015, it is THE most common habit seen in school-aged and college-aged kids. As many as 60% of kids, at some point, bite their nails. Nail biting usually starts between the ages of three to six years, so our reader’s child is right on target for this habit.

I am amused that many of the parents who ask me how to help their kids stop biting their nails are, themselves, nail biters. I will point out that even if we can’t stop nail biting, the concerned parent is a living example of a nail biter who still grows into a successful adult.

Assuming that your child is otherwise acting well, eating and sleeping normally, and mostly cheerful, it is not always important to identify the trigger of nail biting. More importantly, make sure your child washes their hands after playing outside and before eating (and nail biting) to limit germ spread. Check their fingers for signs of infections that can result from nail biting.

What to do

A quick internet search reveals dozens of products that you can dab onto your child’s fingers to discourage nail biting. Products with nasty tasting ingredients such as “bitter apple” tote promises such as “stop nail biting instantly.” Unfortunately, most nail biters are not deterred by paint-on products.

Usually kids have a hard time breaking a habit unless they REALLY want to break it themselves. Here are some suggestions to help:

  • Offer painting nails or small rewards for not biting nails.
  • Don’t be a nag.
  • Establish a code word for stop biting your nails that only your child knows. The word can be a nonsense word (e.g. oogleschmertz) or a word entirely out of context (e.g. elephant). For younger kids especially, this creates an environment of humor, rather than annoyance when you are reminding them to stop biting.
  • Substitute a less annoying habit for nail biting. Hand them something to keep their hands busy. Give them a squishy toy to squish or a hair scrunchy to wear on their wrist to flick.
  • Offer older kids sugarless chewing gum to keep their teeth busy.

If all else fails, take heart in one study that came out in favor of nail biting (and thumb sucking). Perhaps it’s not imperative to stop nail biting after all. The study showed that nail biters and thumb suckers had a lower rate of atopic sensitization (medical term for allergic eczema) than their non-nail biting or thumb sucking peers. The researchers conclude “Although we do not suggest that children should be encouraged to take up these oral habits, the findings suggest that thumb sucking and nail biting reduce the risk for developing sensitization to common aeroallergens.” In other words, the nail biters show fewer allergy symptoms in their skin than the non-nail biters.

Let’s face it: We all are creatures of habit. The key is to make sure the habit is not self-detrimental. Every childhood habit does not need to be broken immediately, even if it drives us parents crazy.

Julie Kardos, MD and Naline Lai, MD
© 2018 Two Peds in a Pod®




About nine-year-olds and Happy Birthday to Two Peds

Nine year old

Nine-year-olds love collecting little treasures.

It’s a funny thing about nine-year-olds. You may look at your own nine-year-old and think: where did my baby go? Gone is the nine-MONTH-old who worried about approaching strangers and howled when you walked away. Now you have a nine-YEAR-old who may shoo you away when you drop her off at a friend’s house.

Yes, some nine-year-olds may seem embarrassed by their parents, yet they absolutely want you around on the sidelines. They want you to attend their sporting events or school concerts and to organize their birthday parties. Just try not to take it personally when they want to spend more time with friends.

Nine-year-olds can get a little stinky, even if puberty is years away for many of them. Be sure to let them know that their bodies will change gradually over time. Get them deodorant and remind them to use it. Talk to girls about periods because some start around 10 years of age.

Because of increased attention span and intellectual growth, nine-year-olds will reliably carry out chores and perform many self care tasks. Encourage them to be more self sufficient. You will be happy for the help and you will build your nine-year-old’s self-esteem. On the academic side, they read chapter books and often enjoy non-fiction books. At this age, they enjoy a variety of clubs, team activities, and hobbies.

Remember the basics:

-Eat: Teach basic nutrition

-Sleep: Most nine-year-olds need around 11 hours of sleep per night.

-Pee/poop: While nine-year-olds use the bathroom independently, occasionally ask your child if they are constipated, and ask if they try to “hold it” all day in school. If the answer to either one of these questions is yes, see our post on these topics.

-Love/guidance: Just like you did when they were toddlers, remember to praise your nine-year-old for positive behaviors such as saying “please” and “thank you” or for helping you clear the dinner table. Once they know that you approve, they will repeat those behaviors. Nine-year-olds are known for whining for long periods of time. Dr. Lai remembers her son whining about losing screen time. He would suddenly appear out of nowhere and whine two inches from her face wailing,”Why? Why? Why?” Watch out, if you give into a whining kid, even sometimes, you’ll end up encouraging their whining. Think slot machines— even though gamblers usually lose at slot machines, they continue to play them because SOMETIMES gamblers do win.

If you have not done so already, teach your nine-year-old to use a phone and teach them whom to call in an emergency. Some kids this age come home to an empty house for a little while until parents return from work. Review what you expect them to do while they are alone.

Reminder about car safety: Many should still be in booster seats because they are not yet 4 ft 9 inches tall. They should NOT sit in the front seat of a car; the back seat is still safer for them.

Nine-year-old kids are still part of the golden age of parenting— too old to take a nap, but too young to drive. Enjoy spending time with your nine-year-old doing things that interest both of you. Enjoy their enthusiasm and increased ability to understand higher concepts. Time spent with parents or other caregivers who enjoy them contributes to building their resilience.

Speaking of nine-year-olds, please celebrate with us NINE YEARS of Two Peds in a Pod®! We are enjoying the journey and hope that our advice can help build resilience and self-confidence in the parents we write for! Our best present from you is your continued presence.

Happy Ninth Birthday to your nine-year-old and to Two Peds in a Pod®!

Julie Kardos, MD and Naline Lai, MD
©2018 Two Peds in a Pod®




In a scrape? Preventing infection in cuts and scrapes

cuts and scrapes

How can you tell if your child’s scrape is infected if his skin is already bright red?

I heaved a sigh of relief. My children greeted my husband and me at the door. The children had just baby-sat themselves. I thought everyone was unscathed until I saw one of my children covered in bandages. Cuts and scrapes? Apparently, although I had admonished them not to ride anything with wheels and not to climb on anything above the ground, the child with the bandages had tripped over her own feet during a benign game of four square.

“Did you wash the scrapes?” I asked.

“Yes,” the kids said, proudly nodding. They knew the first line of defense against a wound infection is to wash out cuts and scrapes. But as it turns out, they had only dabbed the cuts with wet paper towels. Aghast, I propelled the injured child off to the bathroom and hosed down the cuts. Too many times I have seen a minor scrape turn into a major skin infection.

When a wound is not thoroughly cleansed, the bacteria which normally live on intact skin (Staphylococcus or Streptococcus) find an opportunity to enter the body through the wound and cause infections. Even a mosquito bite can turn into a raging, puss-filled mess if scratched often and not cleansed enough. These days, some children carry on their skin a type of Staphylococcus called MRSA (Methicillin Resistant Staphylococcus Aureus). Since this germ can be tough to treat when it causes an infection, a thorough cleansing is more important than ever.

While infection is rarely introduced from the actual object that cuts the child, exceptions include cuts caused by animal or human bites (the human mouth is particularly filthy) and cuts caused by old, dirty or rusty metal. Tetanus lives in non-oxygenated places such as soil. So for deep or very dirty wounds, make sure your child’s tetanus vaccine is up to date.

Despite what many believe, wiping the surface of a cut with a wipe is not adequate to cleanse a wound. “Irrigate, irrigate, irrigate,” a wise Emergency Department physician explained to me when I was a resident in training. “I have never had someone return with a wound infection,” she said proudly. In the emergency room, saline is usually used. At home, soap and running water are effective. Stay away from hydrogen peroxide and rubbing alcohol because they can irritate rather than help the skin.

After washing your child’s cuts and scrapes, you can use bandages to help prevent further exposure to germs and to avoid irritation from clothes or from your child’s scratching, probing fingers. Infections, if they occur, can set in 2-3 days after your child gets her wound. Remove the bandage daily and check the wound for signs of infection such as pus, increased redness, warmth and pain. Wash the wound again, and then replace the bandage. You could also apply topical antibiotic such as Bacitracin to further help prevent wound infection.

So, even if your child just took a shower, wash him again if he scrapes himself. The sooner you irrigate even the tiniest of wounds, the better.

An ounce of prevention is worth a pound of antibiotics.

Naline Lai, MD and Julie Kardos, MD
© 2018 Two Peds in a Pod®




Hurray! Updating to keep you updated

two peds in a pod new look

hurray! launching a new look (photo credit: pixabay)

It’s no longer a secret. Many of you have noticed our new Two Peds in a Pod® logo. And indeed, we’re launching a whole new look. It’s a new vibe with the same dependable and relevant pediatric advice in a mobile friendly format!

The average blog’s lifespan is counted in months, not years, and as we complete our ninth year, we’re proud to have exceeded that expectation many times over. But it’s now harder to hang in.

Please don’t let us disappear off the internet!

As more and more advertisers jockey for spots at the top of search engines and more content crowds the web, it has grown tougher to reach parents. In fact, if you are reading this on Facebook, it’s because we’ve just paid Facebook to have this post reach all of our followers. We’re proud to avoid distracting pop-out ads on our blog, and we’re depending on your grassroot efforts to inform other parents and caregivers about our site. Invite your friends to follow us!

It’s been nine years, and like a cat with nine lives, we are determined to land on our feet. We believe, more than ever, that the internet is the best medium to reach you at all hours of the day. Help grow our worldwide presence.

Wishing you all Peds on earth!

Naline Lai, MD and Julie Kardos, MD
©2018 Two Peds in a Pod

Read our very first blog post from 2009 here.




When a pet dies

Photo by Lexi Logan

We welcome Bereavement Counselor Amy Keiper-Shaw who shares with us how to discuss the death of a pet with your child.
–Drs. Lai and Kardos

When I first graduated from college I worked as a nanny. One day the mom shared with me that their family goldfish recently died. As this was her daughter’s first experience with death, we schemed for nearly 20 minutes to find the best way to talk to her child. The mom and I thought it could be an excellent teaching moment.

 

We pulled the girl away from her playing to explain that the fish had died. We told the girl we’d help her have a funeral if she wanted, and we would find a box (casket) to bury the fish so she could say her goodbyes. We explained what a casket was and what a funeral was in minute detail. After our monologue we stopped, we asked if she had any questions.

After a slight pause she asked, “Can’t we just flush it?”

The lesson I learned from that experience, and still use to this day, is to keep things simple, and know my audience. Sometimes as parents we overcompensate for our own fears and make situations more challenging than they need to be.

Here are some tips on how to talk to your children about pet loss:

Tell your child about the death, and then pause. Ask her what she thinks death means before moving on with further explanations. This will help you know if she has questions or if she has enough information for the moment. Children often need a small amount of information initially and will later come back to you several times later to ask more questions after they process the information.

Remember to express your own grief, and reassure your child that many different feelings are ok. Be sure to allow children to express their feelings. If your child is too young to express herself verbally, give her crayons and paper or modeling clay too help express grief.

Avoid using clichés such as: Fluffy “went to sleep.” Children may develop fears of going to bed and waking up. The phrase “God has taken” the pet could create conflicts in a child and she may become angry at a higher power for making the pet sick, die, or for “taking” the pet from them.

Be honest. Hiding a death from a child can cause increased anxiety. Children are intuitive and can sense is something is wrong. When the death isn’t explained they make up their own explanation of the truth, and this is often much worse than the reality of what occurred.
Children are capable of understanding that life must end for all living things. Support their grief by acknowledging their pain. The death of a pet can be an opportunity for a child to learn that adult caretakers can be relied upon to extend comfort and reassurance through honest communication.

Developmental Understanding of Death

Two and three-year-olds
Often consider death as sleeping, therefore tell them the pet has died and will not return.

Reassure children that the pet’s failure to return is unrelated to anything the child may have said or done (magical thinking).

A child at this age will readily accept another pet in the place of a loved one that died.

Four, five, and six-year-olds
These children have some understanding of death but also a hope for continued living (a pet may continue to eat, play & breathe although deceased).

They can feel that any anger that they had towards the pet may make them responsible for the pet’s death (“I hated feeding him everyday”).

Some children may fear that death is contagious and could begin to fear their own death or worry about the safety of their parents.

Parents may see temporary changes in their child’s bladder/bowels, eating, and sleeping.

Several brief discussions about the death are more productive than one or two prolonged discussions.

Seven, eight, and nine-year-olds
These children have an understanding that death is real and irreversible.

Although, to a lesser degree than a four, five, or six-year-old, these children may still possibly fear their own death or the death of their parents.

May ask about death and its implications (Will we be able to get another pet?).

Expressions of grief may include: somatic concerns, learning challenges, aggression, and antisocial behavior. Expression may take place weeks or months after the loss.

Adolescents
Reactions are similar to an adult’s reaction.

May experience denial which can take the form of lack of emotional display so they could be experiencing the grief without outwards manifestations.

Resources:
Petloss.com– a gentle and compassionate website for pet lovers who are grieving the death or an illness of a pet- they have a Pet Loss Candle Ceremony every week

Your local veterinarian- often your veterinarian has or knows of a local pet loss group

Handsholdinghearts.org– our group of counselors offer grief support to children, teens, and their families centered in Bucks County Pennsylvania.

Books on pet loss for children:

Badger’s Parting Gifts (children) by Susan Varley
Lifetimes by Brian Mellonie & Robert Ingpen
The Tenth Good Thing About Barney (children) by Judith Viorst

Amy Keiper-Shaw, LCSW, QCSW, GC-C
©2013, 2018 Two Peds in a Pod®
Amy Keiper-Shaw is a licensed grief counselor who holds a Masters Degree in clinical social work from the University of Pennsylvania. For over a decade she has served as a bereavement counselor to a hospice program and facilitates a bereavement camp for children. She directs Handsholdinghearts, a resource for children who have experienced a significant death in their lives.