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The American Academy of Pediatrics has increased the recommended daily requirement for Vitamin D in children and adolescents to 400 IU (international units), based on studies of decreasing bone density in kids. This is equivalent to 32 ounces of milk per day. This is TOO MUCH milk for anyone other than an older formula-fed baby who has not yet started solids foods. All breastfed babies, babies on formula AND solid foods, and all other children and teens should be given a vitamin D supplement such as Tri-Vi-Sol or a chewable children’s vitamin. Read the labels: look for “Vitamin D—400 IU.” The goal is to prevent rickets (a bone disease that results in brittle bones) and to make sure growing bones reach their maximum potential for strength. Vitamin D is also important for other body systems such as the immune system.

Interestingly, 15 to 30 minutes of direct sunlight per week is all kids need to absorb enough vitamin D through skin. However, concern for increased risk of skin cancer from cumulative sun exposure means that kids are absorbing less vitamin D from sunlight because we parents are so good at applying sunscreen. Also, especially in winter months, children spend more time playing inside than playing outside.

Calcium requirements vary somewhat by age but generally can be met with 16 to 24 ounces (2-3 cups) of milk, or less if kids consume other calcium containing foods such as cheese, yogurt, broccoli, sweet potatoes, fortified cereals, or a supplement. The milligram (mg) requirements are around 500mg for toddlers, 800mg for children and 1200-1500mg for kids 11-18 years. To give you an idea of how to visualize this amount, one cup of milk contains 300mg of calcium. When you read food labels that report calcium as a percent of daily requirement, know that the “standard” for food labels is set as 1000mg. So if a yogurt container reports “25% of daily calcium requirement” you assume that the yogurt contains 250mg of calcium (25% of 1000mg).

So continue to have your kids Drink Milk! But remember to give them a Vitamin D supplement as well.

For more interesting tidbits about milk, please refer to our blog post: “Got Milk? Dispelling Myths About Milk

Julie Kardos, MD
©2009 Two Peds in a Pod

 

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For families with young children, holiday time can be magical yet stressful. Often families travel great distances to be together and parties tend to run late. Fancy food and fancy dress are common.  And winter holidays, well, they occur in the winter, usually during flu season, stomach virus season, and in general multi-illness season. Here are some suggestions about how to keep your kids healthy and happy during this time.


We preface by referring you to suggestions # 1, 2, and 3 of Part 1of A Happy, Healthy Holiday. HANDWASHING, HANDWASHING, AND HANDWASHING will prevent spread of germs. In addition:


1.      Traveling 400 miles away from home to spend the week with close family and/or friends is not the time to solve your child’s chronic problems. Let’s say you have a child who is a poor sleeper and tries to climb into your bed every night at home and you have chronic fatigue from arguing with her/walking her back to bed. Knowing that even the best of sleepers will often have difficulty with sleeping in a new environment, just take your “bad sleeper” into your bed at bedtime and avoid your usual exhausing home routine of waking up every hour to walk her back into her room. That way everyone gets better sleep. Similarly, if you have a very picky eater, pack up her favorite portable meals and have them available during the fancy dinners. (But when you return home, please refer to our podcast and blog posts on helping your child to establish good sleep habits and on feeding picky eaters.) Good sleep and good nutrition keep children and their parents healthy and happy.


 


2.      Think of giving your children a wholesome, healthy meal at home before a holiday party which you know will be filled with junk food and food that may seem “foreign” to your children. Hunger fuels tantrums, so eliminate that meltdown source by taking them to the party with full bellies. Also you won’t feel guilty letting them have some of the sweets because they already ate a healthy meal.


 


3.      Speaking of sweets, ginger-bread house vomit is DISGUSTING.   Dr. Kardos found this out first-hand with one of her children after a holiday party where the hostess served the kids a beautiful (and generous sized) ginger bread house for dessert. While Dr. Kardos was engrossed in conversation with a long lost friend, one of her boys over-ate. Make sure you supervise what your child is eating at parties. 


 


4.      If you have a young baby, be careful not to put yourself in a situation where you lose control of your ability to protect the baby from germs.  Well-meaning family members love passing infants from person to person, smothering them with kisses along the way. Unfortunately, kisses can spread cold and flu germs, as well as stomach virus germs.


 


5.      On the flip side, there are some family events, such as having your 95-year-old grandfather meet your baby for the first time, that are once in a lifetime. While you should be cautious on behalf of your child, you can balance caution while looking at the whole context of a situation before deciding whether or not to attend a gathering.


6.      Once you have children, their needs come before yours. (Of course there is a healthy balance-but that is a talk for another day.) Although you have anticipated a holiday reunion, your child may be too young to remember it.  An ill, overtired child makes everyone miserable.  If your child has a cold, is tired, won’t use the unfamiliar bathroom, has eaten too many cookies and has a belly ache, and is in general crying, clingy, and miserable, just leave the party. You can console yourself that when your child is older his actions at that gathering may be the stuff of legends, or at least will make for a funny story. 


 


7.      For the allergic families- think twice before you drag in a live Christmas tree into your house.  The trees are often covered in dust and mud.  Washing the tree off with a hose in the driveway will keep the sneezing down to a minimum.  Every year Dr. Lai tells families about rinsing off the tree in the driveway. Most parents dismiss the idea as too time consuming.  However, she is pleased to report that a family recently told her they did rinse the tree and it did help keep the allergens at bay.


 


8.      No one else baby proofs.  Remember this when you are on the road. We worry less in our own homes.  But with their medication pills lying on the end tables and their menorah candles within a toddler’s reach, other people’s homes should make us more cautious.  One year at holiday time Dr. Lai’s family was in a hotel room and her six year old came running up saying “look what I found”…It was a pill of Viagra. 


 


We wish you all the best this holiday season.


Julie Kardos, MD and Naline Lai, MD
©2009 Two Peds in a Pod

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The other day when Dr. Lai asked a dad in her office how his college freshman son was doing, the dad replied that he was in a state of shock. The  reason? His son recently confessed that he drank alcohol and smoked pot at college.




What would you do if your child told you he or she was drinking or using other drugs? Standing with one’s mouth gaping open is probably not the best response. When your child returns home after her first semester away, take the opportunity to discuss alcohol and drugs. Today, licensed psychologist John Gannon who has over 25 years experience as a marriage and family therapist in the Philadelphia area, blogs about what a parent can say.  A father of a young adult and a teen, John Gannon has spoken both locally, and nationally on family matters. He has addressed numerous teacher and parent groups, given advice on a radio call in program and has appeared on The Montel Williams Show.


 


* * * * * *


 


Okay, it happened. Your child went off to college and now he tells you his college experience is just as bad as yours was. Yes, he is doing well academically. But he is smoking pot and drinking alcohol- it is just about enough to push you over the edge. OMG!

I won’t tell you to relax about this, but remember for the most part, this is a transitional time and not necessarily a life changing scenario. After all, people have gone off to college for 100’s of years and survived. The likelihood that your child will be the exception is not overly high. If this scenario occurs and you comment about drug and alcohol use, you will act responsibly for your child and not necessarily condone the behavior. Most likely, the actions are unlikely to be life changing and isolated to college.

So what is fair to talk about and what is probably too much to talk about? First, if there is any family history for either drug or alcohol abuse this should be discussed. The family secret needs to be revealed so that your child has a chance to minimize the impact of biology/genetics. Painful as it may be, your child deserves the chance to understand why his situation is somewhat unique and that he is at greater risk for drug and alcohol abuse issues than other students.

Secondly, if there is any family history of depression, anxiety, mood disorder, or other significant mental health issues this also needs to be revealed. These disorders run in families.  The presence of these disorders increases the likelihood a person self medicates with drugs or alcohol in order to combat mental illness.

Next, isolated events do occur. We always hear about them from our friends. We are grateful that the events do not happen to us. Although these events do appear random, your child has the potential to experience one of them. For instance, episodic binge drinking can be epidemic at some colleges. Chances are your child will participate at some point or another.

Did you ever have that talk about alcohol and drugs that you promised yourself you would have with your child before he went to school? Did you explain about mixing substances? Did you explain about how the body metabolizes alcohol? Did you talk about how alcohol and marijuana lower impulsivity and reduce judgment? Did you tell him how proud of him you are and yet you also feel scared? Did you set the stage to have a dialogue versus a lecture from parent to child?

So go on! Have the talk even if your child already started college.  Sure you might be met with some eye rolling. Don’t forget, you rolled your eyes at your parents. What goes around comes around. Listen, if your child hears one thing from you that he remembers, that’s a win! With luck, your child’s events are not the ones others are talking about.

John Gannon
Psychologist, Marriage and Family Therapist


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For more information Partnership for a Drug-Free America www.drugfreeamerica.org


 


National YouthAnti-Drug Media Campaign www.TheAntiDrug.com


 


If you are concerned your child is addicted : to find treatment- U.S .Department of Health and Human Services- Substance Abuse and Mental Health Services Administration – Substance Abuse Treatment Facility Locator www.findtreatment.samhsa.gov 1-800-788-2800


 


Naline Lai, MD and Julie Kardos, MD


©2009 Two Peds in a Pod


 

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Acetaminophen, brand name Tylenol, has been in the news recently, and parents are asking me if it is safe.


This medication, used as a pain reliever and as a fever reducer, is safe to give to babies older than two months, but you must be very careful about the dose that you give. Medicine doses are based on the weight, not the age, of a child. So when checking the label on the bottle that tells how much acetaminophen to give, look at the weight recommendations if there is a discrepancy between your child’s weight and age. If you are not sure, then ask your child’s health care provider. I cannot stress proper dosing enough because of how dangerous an overdose can be.


 Here are some facts you need to know in order to avoid over-dosing your child with Tylenol:


1)      Always measure the medicine in the dropper or cup provided by the manufacturer of that particular medicine bottle.


 


2)      Be aware that Tylenol infant drops are more concentrated than the children’s suspension liquid. This means that if you were to pour out equal amounts of infant drops and children’s suspension, the amount of drug is actually HIGHER in the measurement of infant drops than in the same measurement of children’s suspension. For example, one full infant dropper of Infant Tylenol Drops, measured to the 0.8ml line of the dropper, is 80mg of Tylenol. The same 0.8ml of Children’s Tylenol Suspension Liquid is only 25mg.


Another way to look at this medicine math: if you intended to give 80mg = 2.5ml = 1/2 teaspoon of Children’s Tylenol Suspension Liquid   but you actually gave your child 2.5ml = ½ teaspoon of Infant Tylenol instead of Children’s Tylenol, you would be giving them over 240 mg of Tylenol, which is THREE TIMES the amount that you wanted to give. Again, use the dropper provided to give Infant Tylenol drops and use the cup provided when dosing the Children’s Tylenol Suspension Liquid.


 


3)      Note that other medications have acetaminophen (Tylenol) in them. I advise my patients’ parents to avoid combination cold and flu medicines for two reasons. First, there is little evidence that shows that they actually provide symptom relief. Second, from a safety perspective, parents can accidentally overdose their child with acetaminophen because many contain acetaminophen in them. For example, as of this writing, the following medications all contain acetaminophen as stated in the ingredient list:


Benadryl  Allergy and Cold Tablets, Sudafed PE nighttime Cold Maximum Strength Tablets, Theraflu Nighttime Severe Cold and Cough Powder, Tylenol Plus Children’s Cold and Allergy Suspension, Tylenol Sore throat Nighttime liquid, Tylenol Chest Congestion Liquid, and Nyquil.


4)      Be aware that “APAP” in the ingredient list means acetaminophen.


Tylenol overdoses can be fatal by causing liver failure. If your child has a chronic liver disease, it is likely that she should avoid Tylenol altogether.


Because of the risk of overdose, I also avoid advising my patients to “alternate Tylenol (acetaminophen) with Motrin (ibuprofen).” I discourage this practice because I am afraid of parents forgetting which medicine they gave last and possibly over-dosing by mistake. Tylenol is meant to be dosed every 4 to 6 hours unless otherwise specified on the label or by your child’s health care provider. 


If you ever have questions about possible overdose, call the national US Poison Control Center at 1-800-222-1222.


Julie Kardos, MD
©2009 Two Peds in a Pod

Addendum 10/11/2011: The manufacturers of Tylenol (acetaminophen) responded to the hazard of parents and caregivers accidentally giving the wrong dose of infant drops ( see point #2 above) and stopped making the “concentrated infant drops.” Instead, they now manufacture the “infant drops” and “children’s liquid” using the same concentration as each other. Continue to use the measuring dropper or cup provided with the medication for proper measuring.

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A thrilling moment in the office is when a mom of a patient shares with me that she is pregnant again. I say, “Wonderful!” What better gift to give your firstborn than a sibling! And I love being a part of good news! As an older sister myself, as a mother of three children, and as a pediatrician, I know the net result of adding another child to the family is positively fabulous.


Although the news is good, sometimes parents are anxious about how to prepare their firstborns for the birth of their younger sibling. Here is what I usually suggest:

For most kids under the age of three to four years, time literally has no meaning.  At best, everything in the past occurred yesterday, and everything in the future will occur tomorrow. So in general, there is no magic moment to announce a forthcoming new baby. A few weeks ahead of time, simply start talking about “when a baby comes to live with us.”  Don’t expect your child to really believe you until you walk into the house with the baby. And don’t be surprised if your firstborn asks, “When is it leaving?” Kids this age do not understand the idea of “forever” or “permanent.”

Parents often feel guilty about bringing a second baby into the home. They worry they will not have as much time for their firstborn.  Well, here’s one secret. Newborns aren’t all that demanding. Unlike with your first born, you will never  have the time or urge to stare endlessly at your second born while she sleeps.  But, the second time around you will realize that feeding, changing, and washing a newborn take up relatively little time. Your firstborn will likely continue to be the center of attention. She is, after all, much more interesting now that she can pretend and play simple games. Believe me when I tell you that you CAN play Candyland and breastfeed an infant at the same time. You CAN burp an infant while reading aloud to a toddler. You CAN change a diaper WHILE pretending you and your toddler are wild jungle animals. You CAN make a bottle while telling a terrifically exciting story to your toddler.

A word about visitors and gifts: the best part of a gift, to a toddler, is opening it, NOT what’s in it. So don’t worry about trying to make sure your older child gets a gift for every gift the new baby gets.  Just allow your toddler to open all the baby’s gifts (if she wants to) because “babies don’t know how to open presents, but big kids do!” Also, newborns don’t care who holds them so visitors are a perfect chance to hand off the baby and get on the floor and play with your toddler. To a toddler, parents are the most important and interesting people in the world.  Even if ten people walk in to visit the baby, your toddler will not be jealous if YOU are the one playing with her.

By three years old, kids understand taking turns. In addition to the above tips, if your eldest asks why you need to hold/feed/care for the baby “so much,” just explain that it’s the baby’s turn. Then reinforce how glad you are that your eldest is able to talk, feed herself, play with toys, and maybe use the potty.  Remind her that her ability to be independent make her more similar to Mommy and Daddy than to a baby.

Finally, realize whether your firstborn embraces her younger sibling with open arms or pretends that the new baby does not exist, you will have plenty of love to go around . Your  heart is big enough for everyone.  Dr. Lai tucks each of her three children in at night with the words, “I love you more than anyone in the universe.”

Truth be told, no one will make your younger child laugh as loud and long as her older sibling. Also, older babies are much more interesting than newborns. Even “luke warm” older siblings will warm up as time progresses and the baby becomes more interactive.

In the meantime, tell lots of “when you were a baby” stories to your older child. Toddlers are egocentric (they all think the world revolves around them) and they will LOVE being the main character in your stories. Bring out baby pictures and videos of your firstborn to share. Be sure to point out how far she has come and all the great things she can do now as a big kid.

I end with a personal story:

When I was pregnant with twins, many of our friends commented to us about our firstborn son, “Boy, you are really going to rock his world.”

HIS world, I would think to myself. How about OUR world?

In order to prepare him for his transition from “only child”to “big brother” we emphasized to our son (who was three at the time) that most older brothers get only ONE baby. Our son would be getting TWO babies! He was excited about having two instead of one. For years afterwards, whenever he heard about a pregnant aunt, friend, or neighbor, his first question was always, “Oh, how many babies is she having?”

Out of the mouths of babes….

Julie Kardos, MD
©2009 Two Peds in a Pod

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The moment is here, your web cam is on and you beam your toddler’s first steps to hundreds of relatives.  But what comes after this highly anticipated moment?  Your toddler’s walking gait looks more like Frankenstein’s than that of an Olympic athlete.  Deborah Stack, who holds Masters and Doctoral Degrees in Physical Therapy from Thomas Jefferson University, joins us today to tell us what to expect next from your little Frankenstein.

Naline Lai, MD and Julie Kardos, MD

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I remember looking at my 16-month-old son and telling him, “You need to learn to walk before your new brother or sister is born.” I did not relish the idea of simultaneously carrying two children.   But even after my second was born, I still did a lot of carrying.  We all focus on our children’s first steps, but mature walking does not occur immediately.  

Toddlerhood officially begins when a child takes his first steps, around 12-15 months, and ends with a mature walking pattern around age three years.  But what happens in between?  Look for your child to begin taking steps with his feet closer together. His hands progress from being held out to the side near the shoulders to a relaxed position lowered at his sides as he moves.  Children will also begin to be able to walk on a wider variety of surfaces such carpet, grass, sand and inclines.  They will learn to walk sideways and backwards as well as maneuver around and over toys in their path.  Initially your child will probably walk on his toes or with his whole foot hitting the ground at the same time and his feet as wide apart as his shoulders or even more.  By age three, most children will walk with their feet just a few inches apart and a “heel-toe” gait, meaning their heel will hit first and then they will shift their weight forward to the big toe before lifting it for the next step.  Skills such as running and jumping occur at varying times during toddlerhood.  

Taking a walk is a great way to help your child develop his gait. But don’t restrict him to staying on the path!  Try walking on grass, playground surfaces, sand boxes, and snow.  Once your child can walk on level surfaces, try walking up and down hills and then across them.  Decrease your support as he gains confidence.  At the playground, climbing is a great way for toddlers to strengthen their muscles, as well as to develop balance and spatial awareness.

This holiday season, save the shipping boxes.  Stepping in and out of low boxes is a great way to practice balance and will provide hours of fun during the upcoming holiday festivities.

These tips will help you enjoy your child’s “next steps” as much as his first ones.

Deborah Stack, PT, DPT, PCS

www.buckscountypeds.com
© 2009 Two Peds in a Pod

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A friend of mine who has no children commented to me that many people tell him, “You just can’t know happiness until you have children of your own.” However, I know several adults who are very happy people and who have made a conscious decision to not have children. So I would actually amend the above adage to: “You just can’t know WORRY until you have children of your own.”


Especially in winter, many illnesses circulate. All these sick kids make for many worried parents. Some questions that I answer many times a day in the office are: “Okay, Doc, you just told me that my child is handling her illness right now, but how will I know if she is getting worse? When do I need to worry?”


Here is what I tell my patients’ parents:


First and foremost, trust your parent instincts that something is wrong.


Think about these THREE MAIN SYSTEMS: breathing, thinking, and drinking/peeing.


Breathing:


Normally, breathing is easy to do. It is so easy, in fact, that if you take off your child’s shirt and watch her breathe, it can be hard to see that she is breathing. You should try this while your child is healthy. Normal breathing does not involve effort. It does not involve the chest muscles.


If your child has pneumonia, bad asthma, bronchitis, or any other condition that causes respiratory distress, breathing becomes hard. It becomes faster than baseline. It involves chest muscles moving so it looks like ribs are sticking out with every breath. The chest itself moves a lot. Kids’ bellies may also move in and out. Nostrils flare in attempt to get more oxygen. Sometimes kids make a grunting sound at the end of each breath because they are having difficulty pushing the air out of their lungs before taking another breath in. Also, instead of a normal pink color, your child’s lips can have a blue or pale color. Pink is good, blue or pale is bad. Children old enough to talk may actually have difficulty talking because they are short of breath. Any of the above signs tell you that your child needs medical attention.


Thinking:


This refers to mental or emotional state. Normally, children recognize their parents and are comforted by their presence. They are easy to console by being held, rocked, massaged, etc. They know where they are, and they make sense when they talk.


Change in mental state, whether it comes from lack of oxygen/shortness of breath, pain, or severe infection, results in a child who is inconsolable. She may not recognize her parents or know where she is. Instead of calming, she may scream louder when rocked. She may seem disoriented or just too lethargic/difficult to arouse. Being very combative can also be a sign of not getting enough oxygen. In a baby, extreme pain can cause all these signs as well.


Drinking/peeing:


While this varies somewhat depending on the age of the child, most kids urinate every 3-6 hours or so. Young babies may urinate more frequently than this and some older kids urinate perhaps 2-3 times daily. You should know your child’s baseline. Normal urine reflects a normal state of hydration. If you don’t drink enough, you will urinate less.


If your child has fever, coughing, vomiting, or diarrhea, she will use up fluid in her body faster than her baseline. In order to compensate, she needs to drink more than her baseline amount of liquid to urinate normally. A child will refuse to drink because of severe pain, shortness of breath, or change in mental state, and may go for hours without urinating. This is a problem that needs medical attention. Occasionally a child will urinate much more than usual and this can also be a problem (this can be a sign of new diabetes as well as other problems). Basically any change from baseline urine output is a problem.


A note about fever: any infant 8 weeks of age or younger with fever of 100.4 F or higher, measured rectally, requires immediate medical attention, even if all other systems are good. Babies this young can have fever before any other signs of serious illness such as meningitis, pneumonia, blood infections, etc. and they can fool us by initially appearing well.


In older babies and children, fever is defined as 101 F or higher. Some kids can look quite well even at 104 and others can look quite ill at 101. Fever is a sign that your body’s immune system is working to fight off illness. In addition to fever, it is important to look at breathing, thinking, and hydration state because this will help you determine how quickly your child needs medical attention. A child with a mild runny nose and fever of 103 who can play still play a game with you while drinking her apple juice is less ill than a child with a 101 fever who doesn’t recognize her parents.


To summarize, any deviation from normal breathing, thinking, or drinking/urinating (peeing) is a problem that needs medical attention, even if no fever is present. In addition, any change in the wrong direction (getting worse instead of getting better) is a problem that needs medical attention.


Finally, all parents have PARENT INSTINCT. Trust yourself. Ultimately, if you are wondering if you should seek medical advice, just do it. If parents could just worry every problem away, no one would ever be sick.


Julie Kardos, MD with Naline Lai, MD
© 2009 Two Peds in a Pod

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I wash my hands about sixty times a day, maybe more.  This in combination with cold Pennsylvania fall air leads to chapped hands.  It’s a sure sign winter is approaching when patients start to show me their raw hands.  Here are the hands of a girl I saw a couple days ago.


To prevent dry hands:
•    Don’t stop washing your hands, but do use a moisturizer afterwards.  

•    Whenever possible, use water and soap rather than hand sanitizers.  Hand sanitizers are at minimum 60% alcohol- very drying.  

•    Wear gloves as much as possible even if the temperature is above freezing.  Remember chemistry class, cold air holds less moisture than warm air and therefore is unkind to skin.  Gloves will prevent some moisture loss.   

•    Before  exposure to any possible irritants such as the chlorine in a swimming  pool,  protect the hands by layering heavy lotion (Eucerin cream) or petroleum based product (i.e. Vaseline or Aquaphor) over the skin.  

To rescue dry hands:
•    Prior to bed smother hands in 1% hydrocortisone ointment.  Avoid the cream formulation.  Creams tend to sting if there are any open cracks.  Take old socks, cut out thumb holes  and have your child sleep at night with the sock on his hands.  Repeat nightly for a week or so.  Alternatively, for mildly chapped hands, use a petroleum oil based product such as Vaseline or Aquaphor in place of the hydrocortisone.    

•    If your child has underlying eczema, prevent your child from scratching his hands.  An antihistamine such as diphenhydramine (Benadryl) or cetirizine (Zyrtec) will take the edge off the itch.  

•    For extremely raw hands, your child’s doctor may prescribe a stronger cream and if there are signs of a bacterial skin infection, your child’s doctor may prescribe an antibiotic.

Happy  moisturizing. Remember how much fun it was to smear glue on your hands and then peel off the dried glue? It’s not so fun when your skin really is peeling.  

Naline Lai, MD

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Sudden Infant Death Syndrome, or SIDS, refers to the sudden unexplained death of an infant between the ages of 1-12 months and seems to occur during sleep. We (meaning pediatricians and the rest of the scientific community) still don’t know exactly what causes SIDS, although we do know that some babies seem to be more at risk, such as premature infants and infants of multiple births (twins, triplets, etc).While parents cannot control prematurity and multiple births, parents CAN control other risk factors. 

Here is a summary of ways to reduce the risk of Sudden Infant Death Syndrome (SIDS) as recommended by the American Academy of Pediatrics:

·    Place babies on their backs (supine) to sleep. Do not waste money buying positioners or wedges for the crib because they are not proven to prevent SIDS and are not endorsed by the American Academy of Pediatrics. A newborn cannot roll from back to stomach. If you start out always placing your infant down on his back to sleep, he will stay this way and learn to like to sleep this way. Side sleeping is not as safe as back sleeping.

·    Do not sleep with your baby in a chair, couch, or adult bed. You can take your infant into your bed to nurse/feed but then put him back in his own sleep space.

·    Do not let your infant sleep in a bed with older siblings. Put your baby in his own crib.

·    Put nothing in the crib other than your baby. No stuffed animals, blankets, pillows, etc. Even bumpers are not recommended.

·    Do not smoke in the room where your baby sleeps.

·    Offer a pacifier. This has a protective effect.

·    Breastfeeding has a protective effect.

Some parents admit to us that they place their babies stomach down (prone) to sleep because “the baby sleeps better that way.” Unfortunately, what seems to be easier in the short run isn’t always the best for children in the long run. For the same reason that you should insist your children wear bike helmets and seatbelts, even if they protest at times, you should put your children down on their backs (supine) to sleep as infants. The rate of SIDS in the USA has dropped by over 50% since 1994 after the start of a “Back to Sleep” campaign. This sleep position change has been the single most effective way, to date, of reducing the rate of SIDS. Of course if your child has any rare medical condition that may prevent supine sleep, your child’s doctor should advise you on the safest sleep position for your child.

The best way to form good habits is to use them from the beginning. It is perfectly safe to position your newborn on his belly during awake time/ playtime while you are with him. However, if you are putting your baby down to sleep, or if you are putting your baby down and walking away and during this time he might fall asleep, just put your baby down on his back. And remember to tell anyone else who cares for your baby the same instructions, including daycare workers, nannies, and even well-meaning grandparents, because safe sleep advice has changed over the generations.

 

Julie Kardos, MD  and Naline Lai, MD
©2009 Two Peds in a Pod

 

 

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We noticed Atom 1.0 readers did not pick up the podcast. Try the RSS 2 feed instead.

Let us know about any technical glitches.  We are still very new to cyberspace and appreciate your feedback.  We say in our podcasts, “Right now our recording studio is our kitchen table”…. you should see our computer help desk

Naline Lai, MD and Julie Kardos, MD

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