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Naline Lai, MD and Julie Kardos, MD

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Drs. Kardos and Lai advise parents on what they can do for their tired teen. Although we all enjoyed an hour’s extra sleep this past weekend with the resetting of the clocks, many teens are back to their “usual” sleep deprived state. Listen here to find out how to help reset your teen’s internal clock, and what  to consider when you have a tired teen.


 




Julie Kardos, MD  and Naline Lai, MD


© 2009 Two Peds In a Pod



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Boo (boo-hoo)

A lot of Halloween festivities in our area have been dampened by H1N1 flu.  For all the parents of the boys and ghouls in a similar situation, this picture will make you smile.  It was sent to me by Ben’s mom.  It is flu from the perspective of a kindergarten boy.  The arrow points to Ben’s nose.  Note the huge boogie to nose ratio.  The red represents “boss germs” and the purple ones are the “just plain mean” ones. 

Don’t let the “Boogie” man get your family this Halloween

Naline Lai, MD

© 2009 Two Peds In a Pod

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If your child’s health care provider prescribes the liquid form of Oseltamivir, brand name Tamiflu, to treat your child’s flu, pay particular attention to how you dose the medication.

The dosing syringe that comes with the manufacturer’s liquid formulation is marked in milligrams (mg), not in the customary milliliters (ml) or teaspoons (tsp).

Also, be aware that if your pharmacist makes up a liquid version from the tablets (because the liquid formulation is in short supply), the concentration (amount of medicine per amount of liquid volume) is different than what the manufacturer makes. The manufacturer makes 12mg/ml and the commonly used receipe your pharmacist will use for making a liquid formulation makes a 15mg/ml formulation.

Confused? Before you leave the pharmacy with Tamiflu, just make sure you clarify the proper amount to give with your pharmacist.

Naline Lai, MD and Julie Kardos, MD

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We just returned from this year’s American Academy of Pediatrics National Conference and Exhibition in Washington D.C. It  was heartening and motivating to meet with thousands of pediatricians from across the country all dedicated to improving the health and welfare of children locally and globally.  We attended numerous seminars, workshops, and lectures and even ran a 7 a.m. 5K race to benefit the American Academy of Pediatrics Friends of Children Fund.  We plan to incorporate what we’ve learned these past few days both in our offices and in future blog posts.

We were fortunate to find other pediatricians who promote pediatric education outside of the office setting.  We enjoyed exchanging ideas with fellow pediatric blogger Dr. Roy Benaroch (www.pediatricinsider.com). In addition to writing his blog, Dr. Benaroch has authored two books for parents: A Guide to Getting the Best Health care for Your Child and Solving Health  Behavioral Problems from Birth Through Preschool: A Parent’s Guide.  Also, we spent time with Dr Kardos’s medical school friend Dr. Laura Jana (Drlaurajana.com), author of Heading Home with your Newborn, from Birth to Reality and Food Fights. She is also a pediatric media spokesperson. It was also nice to meet Dr David Hill from North Carolina whose work can be found as well on the internet.  

With pediatricians like these, the health of our nation’s children is in good hands.

Julie Kardos, MD and Naline Lai, MD

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Even after over a decade in pediatrics, teens always surprise me.

Last week a junior high student came into a checkup with the scabbed hand pictured in the photo above.  Apparently there is a game new to me called “Erasing”. My patient told me the game can be played with any type of eraser, but the pink one at the end of a number two pencil works best.  The object of the game is rub with an eraser hard enough to “erase” as much of your skin on the back your hand as possible.  The players each choose a ligament (one of the cords which run from your knuckles to your wrist) to “erase.” The first person to stop erasing loses the game.

If you find your teen erasing, tell them about the dangers of infection and scarring. Since a teen often does not understand long term ramifications, it is often a more a more effective deterrent to tell him/her to stop because it “looks ugly”. Even if your teen is not erasing, use a discussion about erasing as a starting point to talk about other self injurious behaviors (i.e. “choking games” where the object is to cut off someone’s breathing).

Since I thought erasing was a brand new trend, I took the photograph to show the other doctors in my office. When I flashed the photo in front of one of my colleagues,  he glanced briefly at it and said,” Oh, that’s erasing- I did that when I was a kid.”

Amazing we all got through.

Pass this info on to other parents.

Naline Lai, MD

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Stumbled onto a novel use for a diaper, courtesy of the nursery nurses at Doylestown Hospital. 

Diapersmake a perfect ice pack.  At the end of the diaper which has adhesivetabs, make a hole in  the inner lining.  Push your hand into the diaperto separate the the lining from the back of the diaper.  This will makea pouch.  Put crushed ice into the pouch and roll the end of the diaperwith the hole a couple times.  Secure with adhesive tabs. Now you havea soft, waterproof icepack which will remain cool as the ice melts andis absorbed by the gellatinous diaper innards.

Perfect for all sorts of boo-boos.

WhenI told one of my patients’ mom about this hint today, she told me thatshe used a number 5 diaper when her water broke.  I suppose Plato wasright , necessity is the mother of invention.

Naline Lai, MD

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As the first batches of the H1N1 vaccine are distributed, is my pleasure to introduce our first  guest blogger Kimberly Lafferty.  A mom and well respected scientist, she brings us information on the H1N1 vaccine.  Dr. Lafferty holds a doctorate in pharmacology from University of North Carolina at Chapel Hill and a masters of business administration from Pennsylvania State University.  She completed a fellowship in clinical research and drug development  and  is a mom to a young child and an infant.

Naline Lai, MD

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As a mother of two young children, I am always concerned about their health and well-being.  So, naturally, I am especially concerned about the novel influenza A/H1N1 strain that has led to the current global pandemic.  But, as a pharmacist with over ten years experience in the pharmaceutical industry (mostly in research & development), I also know the importance of good research and making decisions based on the best available scientific evidence. Therefore, I have spent quite a bit of time researching the novel H1N1 virus and the soon-to-be available vaccine.  Below is a summary of my findings:
 
1.  While most people infected with H1N1 have had only mild to moderate symptoms, there have been deaths associated with this virus.  Many of these have been in people with underlying chronic health conditions, but some deaths have occurred in otherwise healthy, young people.
 
2.  According to the CDC (US Center for Disease Control and Prevention) on 10/1/2009, 100 pregnant women in the U.S. have required treatment for H1N1 influenza in intensive care units; 28 of these have died.  Pregnant women are especially vulnerable to infections (due to a weakened immune system) and are at especially high risk of complications from the H1N1 strain.
 
3.  The H1N1 vaccine is made by the same companies and by the same processes as the seasonal flu vaccine.  It is also undergoing the same lot testing and release procedures as the seasonal flu vaccine.  The only difference between the seasonal vaccine and the H1N1 vaccine is that the H1N1 vaccine contains only one strain of influenza while the seasonal vaccine contains three. While the strain in the H1N1 vaccine is different from the strains in the seasonal vaccine, the seasonal flu vaccine has been safely admininstered to millions of people over many years, including children.
 
4.  Because the H1N1 vaccine is made the same way as the seasonal flu vaccine, clinical trials were officially not necessary for this vaccine. However, the NIH (National Institute of Health) and the manufacturers are separately conducting clinical trials, not only to verify the safety of the vaccine, but also to determine the optimal dose and dosing schedule needed to ensure that people who are vaccinated become immune to the H1N1 strain of flu.
 
5.  The H1N1 vaccines currently approved in the U.S. do NOT contain adjuvant (or “immune boosters”).  Adjuvants are used in European seasonal flu vaccines and the European H1N1 vaccine.
 
6.  As with the seasonal influenza vaccine, the H1N1 vaccine will be available in preservative-free formulations.  These will most likely be targeted to young children and pregnant women.
 
Since there are a lot of myths and misinformation out there regarding the H1N1 vaccine, focus your own research on independent, credible sources such as the World Health Organization (WHO), the US Centers for Disease Control and Prevention(CDC), the Food and Drug Administration (FDA), and your state/local health departments.  One important resource is www.flu.gov

Kimberly Lafferty, Pharm D, MBA
 

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I’ve heard some interesting things about milk over the years. I am going to share with you three myths about milk that  I heard when I was a kid and I still hear from my patients’ parents.


Myth #1: Don’t give milk to a child with a fever, the milk will curdle (or some other variation).


Truth: As long as your child is not vomiting, milk is a perfectly acceptable fluid to give your febrile child. In fact it is superior to plain water if your child is refusing to eat, which is very typical of a child with a fever. Fevers take away appetites. So if your child is not eating while he is sick, at least he can drink some nutrition. Milk has energy and nutrition, which help fight infection (germs). Take milk, add a banana and a little honey (if your child is older than one year), and maybe some peanut butter for protein, pour it into a blender, and make a nourishing milk shake for your febrile child. Children with fevers need extra hydration. Even febrile infants need formula or breast milk, NOT plain water. The milk will not curdle or upset them in any way. If, on the other hand, your child is vomiting, I advise sticking to clear fluids until his stomach settles.


Myth #2: Don’t give children milk when they have a cold because the milk will give them more mucus.


Truth: There is NOTHING mucus-inducing about milk. Milk will not make your child’s nose run thicker or make his chest more congested. Let your runny-nosed child have his milk! Yet my own mother cringes when I give any of my children milk when they have colds. Never mind my medical degree; my mom is simply passing on the wisdom (?) of her mother which is that you should not give your child milk with a cold. Then again, my grandmother also believed that your body only digests vitamin C in the morning which is why you have to drink your orange juice at breakfast time. But that’s a myth I’ll tackle in the future.


Myth #3: You can’t over-dose a child on milk.


Truth: Actually, while milk is healthy and provides necessary calcium and vitamin D, too much milk can be a bad thing. To get enough calcium from milk, your child’s body needs somewhere between 16 to 24 ounces of milk per day. Of course, if your child eats cheese, yogurt, and other calcium-containing foods, she does not need this much milk. The recommended daily intake of  Vitamin D was increased recently to 400 IU (International Units).  This amount translates into 32 ounces of milk daily.  But, we pediatricians know that over 24 ounces of milk daily leads to iron deficiency anemia because calcium competes with iron absorption from foods. You’re better off giving an over-the-counter vitamin such as Tri-Vi-Sol or letting older children chew a multivitamin that contains 400 IU of vitamin D. In addition to iron deficiency anemia, drinking excessive amounts of milk is bad for teeth (all milk contains sugar).  Extra milk can also lead to obesity from increased calories. Ironically, too much can also lead to poor weight gain in children who are picky eaters.  The milk will fill them up, leaving them without an appetite for food.


In summary, you can safely continue serving your children milk in sickness and in health, in moderation, every day. Now, all this talk about milk really puts me in the mood to bake cookies…


Julie Kardos, MD

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Well it finally happened.  The day all mothers with daughters regard with mixed feelings.  No, I’m not talking about my daughter’s first period.  Today I discovered that my oldest daughter’s foot size is the same as mine.

I took it as a sign.  Time to blog a little about shoes and feet.

First shoes:  Shoes are to prevent injury to feet. While indoors, let your infant stand and walk without shoes.  Bare feet are best.  Your baby will learn to balance better when he or she can feel the floor directly under her feet.  However, for protection, shoes are needed.  Start with a sturdy sneaker.  No need for the clunky white leather shoes of the past.  Also, avoid sandals, toddlers are more liable to trip and there is not much protection against stinging insects.

For school: The average length of recess per day is about 30 minutes(
www.centerforpubliceducation.org)  Therefore, pick comfy shoes which allow your children to utilize this time for physical activity.

Athlete’s foot: Caused by a fungus, athlete’s foot appears as wet, moist, itchy areas usually between the toes.  The fungus loves moist areas and can be treated with over the counter antifungal creams or powders such as clotrimazole (Lotrimin AF), and tolnaftate (Tinactin). While common in teens, athlete’s foot is much less common in general than foot eczema. Vinegar soaks are helpful- put half a cup of vinegar into a small basin of warm water and have your child soak for 10 minutes daily. 

If your child has eczema on other areas of his or her body, be more suspicious of eczema than athlete’s foot. Both can look alike, but be careful, the steroid creams used for eczema may worsen athlete’s foot.

Flat feet: Most children with flat feet have flexible flat feet which do not require any intervention. Nearly all toddlers have flexible flat feet. A child with flexible flat feet will not have an arch upon standing.  However, the arch should reappear when the child’s feet are relaxed in a sitting position off the floor. Any pain in the arch or suspicion of an inflexible flat foot should be brought to a physician’s attention.

Ingrown toe nails: Ingrown toe nails occur when the sides of the nails grown into the skin.  After enough irritation, bacteria can settle in and pus pockets form.  To prevent ingrown toe nails from becoming infected, at the first sign of redness, soak feet in warm water with Epsom salts.  Gently pull the skin back from the area of the nail which is in grown.  Attempt to cut off any area of the nail which is pushing into the skin.

Clipping newborn toe (and finger) nails: A newborn’s nails have not separated enough from the nail bed to easily get a nail clipper under a nail. For the first few weeks, stick to filing the nails down.  Parental guilt warning: at some point almost every parent mistakenly cuts their child’s skin instead of their nail.

Naline Lai, MD

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