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Remember Elmer Fudd from the Bug Bunny cartoons? He was the hunter who would say “Where’s the wascally wabbit?” instead of “Where’s the rascally rabbit?” Think how frustrated Elmer was as a kid when his parents and teachers didn’t understand him.   

Unclear speech or lack of speech development can be a sign of hearing loss or an inability to communicate (autism, retardation or developmental delay).  Amy King, MA, CCC-SLP with over 12 years as a speech therapist outlines important speech and language milestones to watch for: 
 

Receptive Language Milestones- what your child understands (children should be doing these things by the time they reach the year marker)

By the time they are

1 year:  shakes head to respond to simple questions such as “Want milk?” and identifies some body parts

2 years:  Follows 1 step directions- “Go get the ball.”

3 years:  Follows 2 step directions- “Go get the ball and give it to daddy.” 

4 years:  Understands if/then- “If you pick up your toys, then you can help Mommy make a cake.”

5 years:  Follows 3 step directions- “After you wash your hands, get the napkins and put them on the table.” 

Expressive Language Milestones- what your child is able to say

1 year: 1 word

2 years: 2 word sentences- two words with one meaning such as “thank you” does not count. Expect phrases such as “mommy up” for “mommy, pick me up.”

3 years: 3 to 5 words—Dr. Kardos tells parents think Cookie Monster from Sesame Street: “me want cookie”

4 years: 4 to 7 word sentences with consistent correct use of parts of speech (nouns, verbs, adjectives, pronouns, prepositions, etc.): “I want to go to the park.” 

Speech Milestones- phonetics (sounds should be produced accurately and consistently in words and phrases)

By the time they are:   

3 Years:  sounds of the letters:  m, b, p, h, w, n, f,

 4 Years:  t, k, g, ng, s, r, sh

5 Years:  z, l, v, y, th, wh, ch

6 Years:  j, st, br, cl, r (by now if not before) 

Speech Intelligibility -how well strangers understand your child

         2 Years:     at least 25%-50% of what your two year old is saying

         2 ½ Years:  at least 60%-75% of what your two and a half year old is saying

         3 Years:      at least 75%-90% of what your three year old is saying

         4 Years:      at least 95% of what your four year old is saying 

Fluency- stuttering

         Stuttering is normal in the preschool years.  Be sure to give the child time to say what she is trying to say. Dr. Lai likes to think of a preschool stutterer as a child whose mind is thinking faster than he can move his mouth. If stuttering lasts more than 6 months and is accompanied by facial contortions, grimaces, or repetitive body movements, speak to a medical professional. 
 

Red flags that always need further workup:

o  Does not coo by 4 months of age

o  Does not babble by 9 months of age

o  Child does not respond to his/her name by 9 months of age

o  Child does not look at you, others or objects upon request by 9 months of age

o  Does not gesture (point, wave, grasp, etc.) by 12 months of age

o  Child does not respond to your simple verbal requests (e.g., “Look!”, “Wave bye-bye”, “Come here”, “Give a kiss,” etc.) by 12 months of age

o  Does not say single words by 16 months of age

o  Does not say two-word phrases on his or her own (rather than just repeating what someone says to him or her) by 24 months of age

o  Loss of any language or social skill at any age

 
 Amy King, MA, CCC-SLP

©2010 Two Peds In a Pod

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Here is how to tell if your child is VERY ill with fever vs not very ill:

 

Any temperature in an infant younger than 8 week old that is 100.4 (rectal temp) degrees or higher is a fever that needs immediate attention by a health care provider, even if the infant appears relatively well.

 

Any fever that is accompanied by moderate or severe pain, change in mental state (thinking), dehydration (not drinking enough, not urinating because of not drinking enough),  increased work of breathing/shortness of breath, or new rash is a fever that NEEDS TO BE EVALUATED by your child’s health care provider. In addition, a fever that lasts more than three to five days in a row, even if your child appears well, should prompt you to call your child’s health care provider, who most likely will want to examine your child. Recurring fevers should also be evaluated.

 

Should you treat fever? Given the information from above and from Part 1 of this fever blog post, you can see that fever is an important part of fighting germs. Therefore, we do NOT advocate treating fever UNLESS the side effects of the fever are causing harm. Reduce fever if it prevents your child from drinking or sleeping, or if body aches or headaches from fever are causing discomfort. If your child is drinking well, resting comfortably or playing, or sleeping soundly, then he is handling his fever just fine and does not need a fever reducing agent just for the sake of lowering the fever.

 

A note about febrile seizures (seizures with fever): Some unlucky children are prone to seizures with sudden temperature fluctuations. These are called febrile seizures. This tendency often runs in families and usually occurs between the ages of 6 months to 6 years.  Febrile seizures last fewer than two minutes. They usually occur with the first temperature spike of an illness (before parents even realize a fever is present) and while scary to witness, do not cause brain damage. No study has shown that giving preventative fever reducer medicine decreases the risk of having a febrile seizure. As with any first time seizure, your child should be examined by a health care provider, even if you think your child had a simple febrile seizure.

 

Please see our “How sick is sick?” blog post for further information about how to tell when to call your child’s health care provider.

 

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

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So now that your children have been back in school, there has been plenty of opportunity for germs to circulate. In addition to washing hands, your child’s body has many ways to fight germs. I receive many worried questions about fever, so here is what every parent needs to know:


Fever is a sign of illness. Your body makes a fever in effort to heat up and kill germs without harming your body.


Here is what fever is NOT:


·         Fever is NOT an illness.


·         Fever does NOT cause brain damage.


·         Fever does NOT cause your blood to boil.


·         Unlike in the movies and popular media, fever is NOT a cause for hysteria or ice baths.


·         Fever over 100 degrees F is NOT a sign of teething.


Here is what fever IS:


·         Fever is a body temperature that is equal to or higher than 100.4 degrees F rectally in a newborn until the age of 8 weeks old.


·         Fever is a body temperature of 101 degrees F or higher in anyone older than 8 weeks old.


·         Fever is a very effective defense against disease.


 To understand fever, you need to understand how the immune system works.


Your body encounters a virus or bacteria (germ) that it perceives to be harmful. Your brain sends messages to your body to HEAT UP and kill the germs. Your body will never let the fever get high enough to harm itself or to cause brain damage. Only if your child is experiencing Heat Stroke (locked in a hot car in July, for example) can your child get hot enough to cause death. This is because the heat source is EXTERNAL (a hot car) and not generated by your child’s body.


When your body has succeeded in fighting the germ, the fever goes away.  If you “treat” the fever with a fever reducing agent (Tylenol, Motrin, etc) the fever goes away temporarily but WILL COME BACK if your body still needs to kill off more germs.


Symptoms of fever include: feeling very cold, feeling very hot, muscle aches, headache, and/or shaking/shivering.


Fever may be a sign of any illness. Your child may develop fever with cold viruses, the flu, stomach viruses, pneumonia, sinusitis, meningitis, appendicitis, measles, and countless other illnesses. The trick is knowing how to tell if your child is VERY ill or just having a simple illness with fever.


Our Fever: Part 2 post reveals how to tell.

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

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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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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 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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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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And speaking of vaccines…

Do you ever wonder how a vaccine works?

To understand how vaccines work, I will give you a brief lesson on the immune system. Trust me, it is interesting. Let me give you an example of me. When I was eight, I had chicken pox. It was a miserable week. I started out with fever and headache, then suffered days of intense body itching from blister-like spots, and ultimately, because I “scratched off” some scabs, ended up with scars. During this time, my immune system cells worked to battle off the chicken pox virus. Immune cells called memory cells also formed. These cells have the unique job of remembering (hence the name “memory cells”) what the chicken pox virus looks like. Then, if ever in my life I was to contact chicken pox again, my memory cells could multiply and fight off the virus WITHOUT MY HAVING TO GET SICK AGAIN WITH CHICKEN POX. So after I was well again, I was able to play with my neighbor even while he suffered with chicken pox.  I even returned to school where other children in my class had chicken pox, but I did not catch chicken pox again. Even now, as a pediatrician, I don’t fear for my own safety when I diagnose a child with chicken pox, because I know I am immune to the disease.

This is an amazing feat, when you think about it.

So enter vaccines. A vaccine contains some material that really closely resembles the actual disease you will protect yourself against. Today’s chicken pox vaccine contains an altered form of chicken pox that is close to but not actually the real thing. However, it is so similar to the real thing that your body’s immune system believes it is, in fact, real chicken pox. Just as in the real disease, your body mounts an immune response, and makes  memory cells that will remember what the disease looks like.  So, if you are exposed to another person with chicken pox, your body will kill off the virus but YOU DON’T GET SICK WITH THE CHICKEN POX. What a beautiful system!

Before chicken pox vaccine, about 100 children per year in the US died from complications of chicken pox disease. Many thousands were hospitalized with secondary pneumonia, skin infections, and even brain damage (encephalitis) from chicken pox disease. Now a shot in the arm can prevent a disease by creating the same kind of immunity that you would have generated from having the disease, only now you have one second of pain from the injection instead of a week of misery and possible permanent disability or death. I call that a Great Deal!

All vaccines operate by this principle: create a safe environment for your immune system to make memory cells against a potentially deadly disease. Then when you are exposed to someone who actually has the disease, you will not “catch” it. Your body will fight the germs, but you do not become sick. If everyone in the world were vaccinated, then the disease itself would eventually be completely eradicated. This happened with small pox, a disease that killed 50 percent of infected people. There is no longer small pox because nearly everyone on earth received the small pox vaccine. Now we do not need to give small pox vaccine because the disease no longer exists. This is a huge vaccine success story.

Friedrich Nietzsche said “What doesn’t kill us makes us stronger.” We pediatricians feel this is unacceptable risk for children. We would rather see your child vaccinated against a disease in order to become immune rather than risking the actual disease in order to become immune.

Hopefully this blog post answers your questions about how vaccines work. For more details or more in depth explanations, I refer you to the AAP (American Academy of Pediatrics) website www.aap.org, the Children’s Hospital of Philadelphia’s Vaccine Education Center at www.chop.edu,  and the book Vaccines: What You Should Know, by pediatricians Dr. Paul Offit and Dr. Louis Bell.

Julie Kardos, MD and Naline Lai, MD

© 2009 Two Peds In a Pod®

updated 1/18/2015

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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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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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