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A few days ago, I spoke with the faculty of a local early childhood education center about flu vaccine myths. See how you do on the true and false quiz I gave them:


 


I can tell when I am getting the flu and will leave work before I infect anyone.


False. According to the CDC (US Center for Disease Control), you are infectious the day before symptoms show up.




I never get the flu so it’s not necessary to get the vaccine. 


False. Saying I’ve never had the flu is like saying, “I’ve never a car accident so I won’t wear my seat belt.”


 


I hate shots. I hear I can get a flu vaccine in a different form.


True.  One flu vaccine, brand name Flu Mist, provides immunity when squirted in the nose. Non-pregnant, healthy people aged 2-49 years of age qualify for this type of vaccine.


 


I got the flu shot so I was healthy all year.


False. Perhaps it was the half-hour a day you added to your workout, or the surgical mask you wore to birthday parties, but your entirely healthy winter was not secondary just to the flu vaccine.  The United States flu vaccine protects against several strains of flu predicted to cause illness this winter. This year’s vaccine contain both seasonal and the 2009 H1N1 strains. Your body builds up a defense (immunity) only against the strains covered in the vaccine. Immunity will not be conferred to the thousands of other viruses which exist. On the other hand, the vaccine probably did protect you from some forms of the flu, and two fewer weeks of illness feels great.




My friend got the flu shot last year, therefore, she was sick all winter.


My condolences. True, your friend was sick. But the answer is False, because the illnesses were not caused by the flu vaccine.  Vaccines are not real germs, so you can’t “get” a disease from the vaccine. But to your body, vaccine proteins appear very similar to real germs and your immune system will respond by making protection against the fake vaccine germ. When the real germ comes along, pow, your body already has the protection to fend off the real disease. Please know, however, there is a chance that for a couple days after a vaccine, you will ache and have a mild fever. The reason? Your immune system is simply revving up. But no, the flu vaccine does not give you an illness.


 


I got the flu vaccine every year for the past decade. I will still need to get one this year.


True. Unfortunately, the flu strains change from year to year. Previous vaccines may not protect you against current germs.


 


I am a healthy adult and not at high risk for complications from the flu, so I will forgo the flu vaccine this year.


False. The flu vaccine is now recommended for everyone greater than 6 months of age. When supply is limited, targeted groups at risk for flu complications include all children aged 6 months–18 years, all persons aged ≥50 years, and persons with medical conditions that put them at risk for medical complications.   These persons, people living in their home, their close contacts, and their CARETAKERS are the focus of vaccination. 


Even if I get the flu, I’ll just wash my hands a lot to keep the germ from spreading. I have to come back to work because I don’t have much time off.


False, According to the American Academy of Pediatrics Report of the Committee on Infectious Diseases, the influenza virus can spread from an infected person for about a week after infection.


 


Yes, kids get sick from others kids, but as a parent who comes in contact with two children, an early childhood educator who comes in contact with ten children, an elementary school teacher who comes in contact with twenty children or a high school teacher who comes into contact with one-hundred children daily, you may end up the one who seeds your community with a potentially deadly illness.  Right now, flu vaccine clinics are as plentiful as Starbucks. Hit that CVS or Walgreens on the way home, wander into your doctor’s or grab a shot while you get groceries.  By protecting yourself from the flu, you protect the children you care for.


 


Naline Lai, MD with Julie Kardos, MD


© 2010 Two Peds in a Pod℠

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pumping at workPicture this: you are going back to work after a too-short maternity leave. Briefcase? Check. Lunch? Check. Breast pump? Check. Photo of your baby to put on your pump for inspiration? Check.

 

Many moms ask how to continue breastfeeding when they return to work. Because babies should receive breast milk or formula for at least their first year, here is how you can incorporate breastfeeding into your work routine:

 

Offer bottles by four weeks of age. Bottles can contain breast milk or formula, but you need to give your baby practice taking milk from a bottle by four weeks old. If you wait much longer, your baby will likely refuse the bottle. Have someone other than yourself give at least one bottle per day or every other day. In this way, your baby learns to accept nutrition from someone else.

 

Store breast milk using the simple and conservative “rule of twos.”  Leave breast milk in a bottle at room temperature for no more than two hours, store breast milk in the refrigerator for no more than two days, and store in the freezer for no more than two months. If your baby has already sucked out of a breast milk bottle, that milk is only good for up to two hours. Remember to write the date on your milk storage bags and use the oldest ones first.

 

Now select from the following breast feeding menu, understanding that you might start with option 2 or 3 and then change to option 4. The best option is the one that works best for you and your baby.

 

Option 1: Continue to breast feed at work. This option works for moms who work from home, moms who have child care in their work setting, and moms close enough to dash home to breast feed during the day or who have caregivers willing to drive babies over to work for feedings.

 

Advantage: no pumping, no buying formula, no bottle washing. Disadvantage: may require some creative scheduling.

 

Option 2: Breast feed when home and pump and store breast milk at work. Have child care givers offer stored breast milk in bottles. This method allows moms to provide exclusively breast milk to their babies. Start pumping after the first morning feeding (or any other feeding that you feel you produce a bit more than your baby needs for that particular feeding) beginning when your baby is around four weeks old. Also pump if your baby happens to sleep through a feeding. Store this milk in two or three ounce amounts in your freezer. You can obtain breast milk freezer bags from lactation consultants and baby stores, or you can store milk in zip lock bags.  As you continue to pump after the same feeding each day, your body will produce more milk at that feeding.

 

Once you have some breast milk stored and you are a few days out from returning to work, try pumping during the feedings you will miss while at work. Have someone else feed your baby breast milk bottles for these feedings. Finally, when you return to work, continue to pump at the same schedule and leave the stored breast milk for your child’s caregivers. Consider leaving some formula in case caregivers run out of breast milk. Remind them never to microwave the milk (this kills the antibodies in breast milk as well as creates a potential burn hazard) but rather to thaw the milk by placing in a hot water bath.

 

This method becomes easier as babies get older. Once babies start solid foods, they breast feed fewer times per day. Somewhere between six to nine months, your baby eats three solid food meals per day and breastfeeds four or five times per 24 hours. Thus, the number of times you need to pump decreases dramatically.

 

Advantage to this option: breast milk with its germ-fighting antibodies given through the first year and no expense of formula. Disadvantage: having to pump at work.

 

Option 3: Breast feed before and after work and give your baby formula while you are at work.  If you do not pump while at work, your body will not produce milk at these times. If you work full time, then on weekends you might find it easiest on your body to continue your “work time” feeding schedule. If you choose this method, wean your baby from daytime breast feeding over that last week or so before returning to work. Suddenly going a long time without draining your breasts can lead to engorgement, subsequent plugged ducts, and mastitis.

 

Advantage: baby continues to receive breast milk. No need to pump at work. Disadvantage: you still have to wash bottles and have the added cost of formula.

 

Option 4:  Breast feed until you return to work, then formula feed. Wean over the last week you are home with your baby to avoid engorgement and leaking while at work. Your baby still benefits from even a few weeks of breast milk.

 

Advantage: No need to incorporate pumping into your work schedule.  Baby still gets adequate nutrition. Disadvantage: babies who are in childcare and exposed to many germs miss out on receiving extra antibodies in breast milk. However, weaning your baby off breast milk will not cause illness. Do what works for your family. Also, more expensive to buy formula and time-consuming to wash bottles.

 

Pumping should not take longer than 15 minutes if you’re pumping both breasts at the same time and can take as short as 7-10 minutes. Remember to wash your hands before pumping.

 

What kind of breast pump should you buy/rent? If you are in it for the long haul, we recommend the higher-end electric double pumps with adjustable suction. Ask the hospital nurses, your midwife, or your obstetrician for names of people who rent or sell pumps in your area.

 

Finally, remember that the calorie count and nutritional content of breast milk and formula are the same. So do NOT feel guilty if pumping does not pan out and you and end up giving some formula. Your baby is almost always going to be more efficient than a breast pump and some breasts just don’t produce milk well during pumping sessions. In contrast, some of my patients never got the hang of breast feeding and their moms pumped breast milk and bottle fed them for the entire first year. Dr. Lai and I have each had patients who refused to take a bottle at childcare but just waited patiently for their moms to arrive. These babies got what they needed by nursing throughout the night. The babies didn’t mind what time of day they ate. Just like many aspects of parenting, sometimes with breast feeding, you just have to “go with the flow.”

 

Julie Kardos, MD with Naline Lai, MD
2010 Two Peds in a Pod®

 

 

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A concerned parent wrote to us:

Can you please read this and comment?www.thinktwice. com.
I’m terrified to vaccinate due to sites like these. There seems to be many horrifying stories out there to what happens to kids after getting vaccines. If the chance of them getting these diseases is small, is it worth taking the risk of them suffering these near death or death experiences?

Here is our response:

 

Dear Concerned,

We looked at the web site you sent to us. When evaluating the merit of information that you read on the internet, it is important to know the source of the information. The thinktwice site has an easy to read disclaimer. To highlight: the founders of the site explain that they are NOT medical professionals and that they do NOT give medical advice. They refer their readers to “licensed medical professionals” for medical advice. In addition, they acknowledge that their site is NOT endorsed by the American Academy of Pediatrics (AAP), the Food and Drug Administration (FDA), or the US Center for Disease Control (CDC). In fact, they refer their readers to these organizations for vaccine information and advice. They post “information” that will certainly cause a stir on the internet but actually defer to well established medical experts at the AAP, the CDC, and the FDA for definitive advice about vaccines. If you investigate those sites,  you would find that all  of the organizations actually endorse the use of vaccines.  

It makes sense to consult experts in the field for any problem that you have. When researching a health care issue, actresses, political figures, and web site sponsors, while experts in knowing their own children, are not medical professionals. If, for example, we had a car problem, we would consult a mechanic. We would not read testimonials of car owners on the internet to figure out how to fix a car. If we did not trust our mechanic’s recommendation, we would get a second opinion from another car expert.

Doctors are trained to evaluate evidence. We are medical professionals who read all the medical textbooks for you. Pediatricians go to school and train for nearly a quarter of a century before they even begin practicing on their own. We base our medical advice on the pediatric standards set forth by the American Academy of Pediatrics. These standards represent consensus of thousands of pediatricians who dedicate their lives to improving the well being of children. We would never support a practice that causes more harm than good.

If you are moved by testimonials, then you should also read testimonials of parents whose children were not vaccinated and then died or suffered disability from vaccine preventable diseases:  http://vaccinateyourbaby.org/why/victims.cfm, http://vaccine.chop.edu. In addition, we encourage you to read our own vaccine posts: How Vaccines Work and Do Vaccines Cause Autism? Please visit the websites we provide in these articles for more information about vaccines.

Experts in pediatrics have evaluated data based on millions of vaccine doses given to millions of children. The evidence shows that the benefits of vaccines outweigh risk of harm.  Think of seat belts. You may imagine that your child’s neck may get caught in a seat belt, but you would never let your child go without a seatbelt.  The reason is that rather than trust a “feeling” that theoretically the seat belt could cause harm, we know from evidence, data, and experience that seatbelts save lives.

Vaccines are a gift of protection against childhood disease. As moms, both of us vaccinated our own children on time according to the standard schedule. Tragically, the more parents don’t vaccinate, the easier it will be for all of our children to contract these preventable and often deadly disease. Proof of this is California’s current whooping cough epidemic which has killed six infants so far. Most of the illness is breaking out in areas where parents stopped vaccinating their children.

If you are wondering about the merits of a web site, try to cross reference the information with organizations which set medical standards such as The American Academy of Pediatrics, the Centers for Disease Control, and your local Children’s Hospital.  And of course, you can always ask your pediatrician.

By asking questions you are being a responsible parent. 

Keep on asking.

Julie Kardos, MD with Naline Lai, MD
© 2010 Two Peds in a Pod℠

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crybabyonesieWhy do babies cry? This may seem like a silly question, but sometimes you really want to know why your infant is crying.

Remember, newborns cannot talk. They can’t even smile back at you until around six weeks of age.  Why do babies cry? In short, newborns cry to communicate.

Ah, but what is it, exactly, that they try to communicate? Babies cry when they…

      – Are tired.

      – Are hungry.

      – Feel too cold.

      – Feel too hot.

– Need to be changed –I never really believed this reason before I had my twins. My firstborn couldn’t have cared less if he was wet and could nap right through a really poopy diaper. Then I had my twins.  I was amazed that their crying stopped if I changed the tiniest bit of poop or a wet diaper. Go figure.

– Are bored. Perhaps she is tired of the Mozart you play and prefers some good hard rock music instead. Maybe she wants a car ride or a change of scenery. Try moving her to another room in the house.

– Feel pain. Search for a piece of hair wrapped around a finger or toe and make sure he isn’t out-growing the elastic wrist or ankle band on his clothing.

– Need to be swaddled. Remember a fetus spends the last trimester squished inside of her mom. Discovering her own randomly flailing arms and legs can be disconcerting to a newborn.

– Need to be UN-swaddled. Hey, some like the freedom to flail.

– Need to be rocked/moved. Dr. Lai’s firstborn spent hours tightly wrapped and held by her dad in a nearly upside down position nicknamed “upside-down-hotdog” while he paced all around the living room.

– Check to see if there is a burp stuck inside her belly. Lay her down for a minute and bring her up again to see if you can elicit a burp. 

– Does your baby seem gassy? Bicycle his legs while he is on his back. Position him over your shoulder so that his belly presses against you. You’d be gassy too if you couldn’t move very well. The gassy baby is a topic for an entire post- talk to your doctor for other ideas.

– Are sick. Watch for fever, inability to feed normally, labored breathing, diarrhea or vomiting. Check and see if anything is swollen or not moving. Listen to his cry. Is it thin, whimper-like (sick) or is it loud and strong (not sick)? Do not hesitate to check with your pediatrician. Fever in a baby younger than eight weeks old is considered 100.4 degrees F or higher measured rectally. A feverish newborn needs immediate medical attention.

What if you’re certain that the temperature in the room is moderate, you recently changed his diaper, and he ate less than an hour ago?

– Walk outside with your baby- this can be a magic “crying be gone” trick. Fresh air seems to improve a newborn’s mood.

– Offer a pacifier. Try many different shapes of pacifiers. Marinade a pacifier in breast milk or formula to increase the chance your baby will accept it.

– Pick her up, dance with her, or walk around the house with her. You can’t spoil a newborn.

– Try vacuuming. Weird, but it can work like a charm. Place her in a baby frontal backpack or in a sling while cleaning.

– Try another feeding, maybe she’s having a growth spurt.

-When all else fails, try putting her down in her crib in a darkened room. Crying can result from overstimulation. Wait a minute or two. She may self-settle and go to sleep. If not, go get her. The act of rescuing her may stop the wailing.

-If mommy or daddy is crying at this point, call your own mom or dad or call a close friend. Your baby knows your voice and maybe hearing you speak calmly to another adult will lull her into contentment.

– Call your child’s health care provider and review signs of illness.

– If you feel anger and resentment toward your crying baby, just put her down, walk outside and count to ten. It is impossible to think rationally when you are angry and you may hurt your child in order to stop your frustration. Seek counseling if these feelings continue.

Now for the light at the end of the newborn parenting tunnel: the peak age when babies cry is six weeks old. At that point, infants can cry for up to three hours per day. Babies with colic cry MORE than three hours per day. (Can you believe people actually studied this? I am amused that Dr. Lai won a prize in medical school for a paper on the history of colic). By three months of age crying time drops dramatically.

While most crying babies are healthy babies and just need to find the perfect upside-down-hot-dog position, an inability to soothe your baby can be a sign that she is sick. Never hesitate to call your baby’s health care provider if your baby is inconsolable, and don’t listen to the people who say, “Why do babies cry?…They just do.”

———

Thanks to our Facebook friends for other ideas for what the cartoon baby is saying:

“Stop looking at me like that and please loosen this blanket and don’t hold me up here like this and where is my hat my diaper is giving me a wedgie! JUST MAKE IT ALL STOP!”

“WHY CAN”T YOU LET ME GO BACK TO SLEEP, PEOPLE!”

———

 

Julie Kardos, MD with Naline Lai, MD

©2010 Two Peds in a Pod℠

 

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Ok, so now you are in charge of caring for a newly circumcised penis. As a mom who’s never had a penis or as a dad who has no memory of his pre-circumcised days, you may have questions after you leave the hospital about how to care for this “wound.”

Unlike most infants in the world, in the United States, most boys are circumcised. Parents choose to circumcise their sons for various reasons including medical and cultural beliefs.  In this blog post I will not address any debates about circumcision. I will only address care of the recently circumcised penis.

It takes about one week for a circumcised penis to fully heal. This is not long in the scheme of things. While there are no absolute standards of circumcision care, most providers recommend putting a walnut size amount of either petroleum ointment or antibiotic ointment directly onto the head of the penis at every diaper change for the first 3 or 4 days.  Some find it easier to dollop the ointment onto a gauze pad and then tuck the ointment covered pad into the diaper.

Be sure to clean any stool on the penis using mild soap and water. Some white, gray, or yellow material will accumulate on the head of the penis around the third or fourth day. This material, called granulation tissue, is a normal part of the healing process. (You may remember a similar healing process occured when you skinned your knee as a child). Go ahead and wash the goo with warm water, the secretions will disappear over the next few days.  

Infection is rare, but does occur. Watch for an increase in swelling, an increase in redness, redness extending down the shaft of the penis, an increase in pain, pus discharge from the wound site, and fever of 100.4 F or higher. With any of these symptoms, take your child to be evaluated by your child’s health care provider.

Sometimes extra, or redundant, foreskin remains around the head of the penis. Over time, this extra tissue does retract back. Scar tissue rarely forms permanently because with each erection (yes, infants have erections) the head of the penis pulls away from the shaft. As the baby gets older, parents can gently pull back redundant skin with their hands when they give the baby a bath. If you are concerned about the appearance of your child’s penis, ask his health care provider to take a look.

One last tip:  remember to point the penis DOWN when putting a new diaper on your son; otherwise he will urinate “up” through the diaper and all over his shirt. Trust me on this one.

Julie Kardos, MD with Naline Lai, MD
©2010 Two Peds in a Pod℠

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Earlier in the month I attended a developmental pediatrics conference in Philadelphia. The keynote speaker, Barry Zuckerman MD, professor and chairman of pediatrics at Boston University, raised a set of thoughtful questions. Parents can use the answers as a starting point for understanding how they were raised. Here are some of the questions with modifications:

 

        -What was it like growing up? Who was in your family? Who raised you?

 

        -Do you plan to raise your child like your parents raised you?

 

        -How did your relationship with your family evolve throughout your youth?

 
How did your relationship with your caregivers (mother/father/aunt/grandparent/etc) differ from each other? What did you like or not like about each relationship?

 
Did you ever feel rejected or threatened by your parents? What sort of influence do they now have on your life?

 
Did anyone significant die during your youth? What was your earliest separation from your parents like? Were there any prolonged separations?

 
If there were difficult times during your childhood, were there positive role models in or outside your home that you could depend on?

 

Some of these questions may be tougher than others to answer. Ultimately you are not your parents (although you may feel otherwise when you hear a familiar phrase escape your own lips), and likewise your children are not you. Parenting techniques that worked, or did not work, for your parents will not necessarily work, or not work, for you. However, stopping to reflect on your own youth will help you understand why you parent the way that you do.

 

Naline Lai, MD with Julie Kardos, MD

© 2010 Two Peds in a Pod℠

 

 

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One parental job you probably did not anticipate is the upkeep of rapidly growing finger and toe nails.  Questions first time parents often ask me include:  Should I use clippers or scissors? How do I avoid accidently nicking the skin? How often should I trim?  The only question I haven’t heard so far is: Should the tips be rounded or squared?

When your newborn fingers her face, even her soft finger nails can cause scratches. Yes, newborns need their first “manicure” within days of birth. Although the nails are long enough to scratch, most of the nail is adherent to the underlying skin. I recommend using an emery board or nail file for the first weeks of nail trimming. This method is unlikely to go awry and is effective. File from the bottom up, not just across the nail, in order to shorten and dull the nail.

Babies gain weight rapidly in the first 3 months at a rate of about one ounce per day and they grow in length at a rate of about an inch per month. Their finger nails grow as rapidly as the rest of the body and therefore need trims as often as twice a week. Toe nails grow quickly as well but because they do not cause self-injury, infants tend to be okay with less frequent trimming.

Once the nails are easy to “grab,” advance to using scissors or clippers. I honestly don’t believe either method is superior to the other. The method I used was to hold my baby on my lap facing out and then gently press the skin down from his nails and clip or cut carefully.

Unfortunately, no matter how careful you are, it is possible to hurt your child while cutting his nails. I remember injuring one of my twins when he was a few months old. Picture a benign tiny paper cut that seems to cause a disproportionate amount of bleeding. He wasn’t even all that upset, but…oh, the guilt I felt!  If you accidentally nick your child, wash the cut with soap and running water and apply pressure for a few minutes with a clean washcloth to stop the bleeding. Once the bleeding stops, band aids are not necessary and can actually be a choking hazard in babies who spend most of their waking moments with their fingers in their mouths. Thankfully, rapidly growing kids heal wounds rapidly.

I think it is a good idea to trim nails while babies are awake so that they get used to the feeling of a “home manicure.” This practice can prevent the later toddler meltdowns over nail trimming. However, some kids are just adverse to nail trimming, or have sensitive, ticklish feet and balk at trims. Yet trim we must! Try clipping an uncooperative toddler’s nails while she is sleeping. If your toddler sleeps lightly, then you may have to time your manicure/pedicure for when another adult caregiver is home with you. One adult holds the hand/foot or distracts the toddler with singing, book reading, or watching a soothing video together (Elmo to the rescue once again!). The other trims the nails.

So, now with the birth of your child you have added a new title – “Master Manicurist” of your home.  This job does become more glamorous when your child is old enough to ask for nail polish. Until then, happy nail trimming!

Julie Kardos, MD
©2010 Two Peds in a Pod

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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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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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