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As the school year comes barreling to an end, I always find an assortment of students parading through my office with stress related ailments. Whether the child is college aged or elementary school aged, concerned parents want to know how to prevent their child from internalizing stress. Today, psychologist Dr. Sandy Barbo provides us with relaxation techniques to deflect tension. The mom of two college-aged daughters, Dr. Barbo has worked with children and their families for over twenty years. – Dr. Lai

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Hurry, hurry, hurry!!!  Off to soccer practice, or the orthodontist’s office, or swim class, or a scout meeting, or a violin lesson.  Don’t forget homework, that spelling test… oh no! Wasn’t there a special poster project due soon? Quick, run into Staples to get that poster board.  Oh, and yes, we can’t forget to grab some take-out because with all the rush, who had time to make dinner?

Sound familiar?  We tend to live very busy lives these days and our children’s schedules reflect that in all the many activities they engage in.  Even our youngest and smallest have schedules!

Busy-ness can lead to stress, but so can a host of other experiences our children live through day to day.  Our kids have to juggle performance in school (getting assignments done, managing academic and extracurricular challenges), survival in social groups (peer pressure,bullying, overcoming shyness), and even the occasional external stress that filters down from the adult world (news of a disaster, parental job stress, illness in an extended family member).

How do we as parents help inoculate our kids so they can better manage the various stresses and anxieties that come their way?  There are many possibilities.  Here are a few:

One of the easiest and most effective stress busting strategies you can teach your child (and yourself!) has to do with the deep, diaphragmatic breath.  Lie down on the floor with your child or sit upright in a comfortable chair.  The trick is to align the chest above the pelvis.  Make a diamond shape with your thumbs and index fingers.Show your child how to position the belly button in the middle of the diamond. Now instruct her to slowly take in a deep, filling breath so that the belly starts to raise her hands up as far as they can go.  Slowly, exhale and allow the belly to sink back down.  When empty, fill up again slowly, but comfortably.  For some kids, it helps them to imagine they are filling a balloon with their breath and then letting it all out.  When you’ve completed 3 belly breaths you’ve created a “mini”.   And “minis” are wonderful as they can be done almost anywhere, anytime, incognito!  Remind your child on the way to school, “Let’s do a mini”; or before going into an anxiety provoking situation; or even at the end of the day, in bed to help settle everyone down.  The deep breath counters our body’s response to stress and is incompatible with anxiety which provokes shallow chest breathing.  Try modeling “minis” for your child and encourage him to practice them at least 3 times each day.  When you teach your child how to do “minis”, he’s learned a powerful stress buster that he can put to use whenever or wherever the need arises.

Don’t forget the good old fashioned belly laugh.  We know that humor helps us reframe and relieve stress, but the deep belly laugh is also diaphragmatic and forges a healthy mind/body connection.  Don’t be bashful.  Suggest a tickle fest.  Have a book of age-appropriate jokes around that you can share with your kids. Belly laughs are infectious.  It almost doesn’t matter what silly idea starts them.  Show your kids that the sillies can get the better of you too and laugh all of yourselves to the point of exhaustion.

We tend to hold our tension in our “stress triangle”the area between the shoulders and up towards the neck.  Show your kid show to gently press their shoulders up towards their ears, then roll them back and relax along with those wonderful deep breaths they’ve already learned.  Also, indulge in massage.  Rub between your child’s shoulders.  At bedtime, offer a foot massage.

Another helpful de-stressor at bedtime can be a guided imagery exercise.  You become your child’s guide.  Help her create her imaginary safe, relaxed place by engaging all of the senses. Pick, or have your child pick, her favorite vacation setting. Beach?  Be ready to customize your guided tour to her most wonderful fantasies.  Have her close her eyes, start deep breaths and use her imagination to picture herself  stepping down a series of 10 steps into the setting as you slowly and in your most soothing voice count.  For example:

1. You’re at the top of a set of stairs that go down the dunes to the beach.  You see the beautiful beach below you.Imagine what you see.  Imagine the colors all around you.  (Deep breath)

2. You can see the wonderful beach scene before you,the boats on the water, the few wispy clouds in the beautiful blue sky, the gulls that fly over the water.  (Deep breath)

3. You can feel the sun on your skin.  It’s deliciously warm.  (Deep breath)

4. A cool breeze, just the right temperature is gently blowing through your hair.  (Deep breath)

5. You can hear the sound of the waves lapping at the shore.  The sun is sparkling off the water.  Imagine the other sounds you hear on the beach.  (Deep breath)

6. You can smell all those wonderful beach smells, the sunscreen, the wet sand.  You can almost taste the salty ocean water droplets as they reach your lips.  (Deep breath)

7. You feel your toes in the sand.  It is just the right warm temperature, soft and comfortable under your feet.  (Deep breath)

8. You are at the water now.  Just let your toes wiggle and feel the wonderful temperature of the water.  As you wriggle your toes you can see the sea foam and the sand make wonderful patterns between your toes.  (Deep breath)

9. All around you are the people you love.  (Deep breath)

10. You lie down on the beach feeling so relaxed and comfortable, just resting and enjoying the wonderful sounds, smells, feelings,tastes, views of the beach.  You are restful and relaxed.  You are breathing deep steady breaths.  Enjoy this feeling of relaxation in this safe, warm, wonderful place.  In a minute, when you are ready, you can gently open your eyes or allow yourself to drift off to sleep.

The above mentioned guided imagery exercise can become a beloved ritual.  My daughter’s favorite involved a meadow with a family of unicorns.  Each night, I learned to tap all my creative resources to keep the characters on interesting adventures in the meadow all the while engaging my daughter’s sensory system within her fantastic imagination, as she continued to deep breathe and leave the stressors of her day behind.

Invite your kids to share when they’ve used their stress busters during the day.  Model for them how to take a “mini” to manage some aggravation that comes your way.  With just a little bit of practice, your child can start to use these stress-busting strategies, when challenged, to reestablish a sense of calm.  It’s truly a gift that keeps on giving over and over again.   

Sandy Barbo, Ph.D.
© 2010 Two Peds in a Pod

Dr. Barbo is a licensed psychologist and the mom of two college-aged daughters.  She has been working with children, parents and families for over 20 years.  In addition to providing psychotherapy for anxiety, depression, trauma, Dr. Barbo has developed sub-specialties in infertility, pre and post-adoption, and ADHD. Contact her at: drsandybarbo@comcast.net   or P.O. Box 196, New Hope, PA 18938  telephone (215)297-5092
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Standing in line at a fast food restaurant off an East coast highway during spring break, I overheard the cashier greet the family in front of me by name. I cringed. Was the family a regular customer at the chain? Hopefully, they were just friends with the cashier.


Most of us, including me, are not always health food angels. However, a family who is a regular customer at a fast food restaurant may simply not know how to break the habit. For those who still need to get those healthy eating New Year’s resolutions rolling, our Feburary podcast, “Helping the Overweight Child,” gave the 5-4-3-2-1-0 rules for healthy eating.  This post gives more hints:


BMI, or Body Mass Index (weight in kg divided by height in meters squared) is a number which indicates whether your child’s weight is normal for his or her height and age. Normal weight school aged kids DO look a bit scrawny.Children’s bellies should NOT hang over their pants. On the other hand, normal weight toddlers do look a bit pudgy. The Centers for Disease Control and Prevention has a nice BMI calculator


Snacks aren’t needed at sports games which last only an hour. Supply water bottles and forget the snack.


Don’t feed your younger child snacks to keep him occupied during an older sibling’s event. Bring books, paper and crayons, a doll, or a matchbox car instead.


 Make a stack of peanut butter and jelly or cheese sandwiches and keep them wrapped, ready to go, in the fridge. Keep some washed apple slices or carrot sticks along side the sandwiches and  this stash can be your “fast food” at those times you need to feed your family “on the run”. 


 Don’t give your children a junky snack in order to carry them over until dinner. If your kids come home from school STARVING!!, give them a REAL dinner, and then give them a fruit or vegetable when the entire family later sits down.


holiday is one day, Halloween is October 31st. . Why eat the candy for days and weeks afterwards?


Don’t keep junk food in your home. This will avoid arguments about what to eat.


Have your children ask you if they can have something to eat, rather than allowing “free access” to your pantry/refrigerator. That allows you decide if it is too close to mealtime to have a snack (remember from the Picky Eaters blog post,“hunger is the best sauce”) and will allow you to choose an appropriate snack and portion size. If kids inherently knew healthy choices and portion sizes, they wouldn’t need parents! Also this allows you to determine if the child is truly hungry, bored, or attention seeking. 


Now back to the the fast food establishment I find myself in with my family. “Maybe this restaurant chain should offer a Two Peds in a Pod kid’s lunch box,” I mused as my family finished up their greasy, salty meal. Everyone’s curiosity was piqued. My husband and I began to hypothesize what kind of food would be inside a Two Peds box.


“What do you think?” I asked the kids.


“We’re actually more interested in what kind of prize would you would offer,” they said.


Gotta love my regular customers.


 


Naline Lai, MD with Julie Kardos, MD


©2010 Two Peds in a Pod

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Today, our esteemed guest pediatric physical therapist Deborah Stack helps us with therapy for twisted ankles. Dr. Stack has been a physical therapist for over 15 years and heads The Pediatric Therapy Center of Bucks County in Pennsylvania. She holds both masters and doctoral degrees in physical therapy from Thomas Jefferson University.

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As I watched my ten-year-old play basketball today, my first question was “Will my child might finally get the ball into the basket?” My second question was, “Will all the kids make it through the game without spraining an ankle?

Kids are playing competitive sports at younger and younger ages and children are suffering sports injuries earlier as well. Acute ankle trauma is responsible for 10 to 30 percent of sports-related injuries in young athletes.1With all the rapid starts, stops, and turns on the basketball court some injury is inevitable.  But what is an ankle sprain?  What can you do to help your child from joining the crutches crew?  What do kids need to do to get back to full play after an injury?

A sprain is stretching and or tearing of ligaments that connect bones to one another.  Sprains are graded from one to three with one being the mildest and three being the most severe.  In a grade one sprain the ligament simply is overstretched.  Grade two sprains involve partial tearing of the ligaments and grade three feature a complete tear.

The most common ankle sprain is an inversion sprain where the ankle turns over so the sole of the foot faces inward and damages the ligaments on the outside of the ankle. In younger children, the ligaments tend to be stronger than their bones,so growth plate fractures occur instead of sprains.  Therefore, if a child refuses to walk on his leg or seems to be in excessive pain, you should have your pediatrician rule out a fracture.

To help avoid injury, make sure those sneakers are in good condition. Pull laces snug and tie them securely. High top sneakers are recommended for basketball for added protection.  Physically three things are needed for a healthy ankle: range of motion, muscular control, and proprioception.  Proprioception is the information that comes from your joints and muscles to your brain and lets your brain know what position the ankle is in.

My child turned his ankle.  Now what do I do? Remember the acronym RICE: rest, ice, compression, elevation.  Rest means to stay off the ankle.  For more severe sprains this may mean using crutches for a few days.  Ice should be applied (over a thin towel to protect skin) immediately and then for up to 20 minutes every few hours until swelling is minimal.  Compression refers to wrapping an elastic bandage over the area. When you use a bandage, it is important to make sure the bandage is not too tight and that any bandage is wrapped at an angle, not straight around the leg, to prevent circulatory problems. The ankle should also be elevated above the level of the heart several times a day while swelling is still present.  Recline on the couch while putting ice on for 20 minutes.

How does your future Olympian get back into the game?  Range of motion exercises can begin as soon as they can be done without pain, preferably in 48-72 hours.  Ankle circles and alphabet letters (below) are two good exercises. These should then be followed by isometric (muscle contraction without movement) and isotonic strengthening exercises (toe and heel raises, see below) such as the ankle heals.  Finally, rehab is not complete until the child works to regain proprioception on balance boards, compliant foam etc.  One low-tech option is to stand on a firm pillow while watching television.  For a bit more excitement, try some Wii balance board games.  Remember, full ligaments strength does not return until months after an ankle sprain.Without full rehabilitation, the ankle is prone to reinjury.

So tell your child to play, but play smart.  An ankle sprain is a real injury and needs proper attention before your child returns to the court.

Exercises

Ankle circles3

Sit on the floor with your legs stretched out in front of you. Move your ankle from side to side, up and down and around in circles. Do five to ten circles in each direction at least three times per day.



Alphabet Letters3

Using your big toe as a “pencil,” try to write the letters of the alphabet in the air. Do the entire alphabet two or three times per day.



Toe Raises4

Pull your toes back toward you while keeping your knee as straight as you can. Hold for 15 seconds. Do this ten times at least three times per day.



Heel Raises4

Point your toes away from you while keeping your knee as straight as you can.Hold for 15 seconds. Do this ten times at least three times per day. 


1. Perelman M, Leveille  D, DeLeonibus  J, Hartman  R, Klein  J,Handelman  R, et al.  Inversion lateral ankle trauma: differential diagnosis, review of the literature, and prospective study.  J Foot Surg. 1987;26:95–135.

2. Wolfe MW, Uhi T, McCluskey, L.Management of Ankle Sprains. Am Fam Physician 2001;63:93–104.

3. http://www.med.umich.edu/1libr/sma/sma_anksprai_rex.htm

4. http://familydoctor.org/online/famdocen/home/healthy/physical/injuries/010.html

 

     Deborah Stack, PT, DPT, PCS

www.buckscountypeds.com

© 2010 Two Peds in a Pod

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The newest trend in kidville- trading rubber bands in various shapes. The kids wear the bands like bracelets and strut around with the colorful bands jutting out in all directions from their arms and wrists. The elementary school crowd is fascinated by them.  Teachers, who find them a distraction, are not as enamored. Somewhere there is one teacher today who is particularly appalled. During a check up, a nine year old told me today that a classmate was sent to the nurse’s office- the reason? The bands were on so tight that they were cutting off circulation to the classmate’s arm. 


Always something. 



Naline Lai, MD
© 2010 Two Peds in a Pod

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You have a hole in your head.

Actually, you have several.

You, your children, and everyone else.  These holes are called sinuses.

 

These dratted air pockets in your skull can fill with puss and cause sinus infections.  Scientists hypothesize they once helped us equilibrate water pressure during swimming. Now, sinuses seem only to cause headaches.

 

Sinuses are wedged in your cheek bones (maxillary sinuses), behind your nose (ethmoid sinuses) and in the bones over your forehead (frontal sinuses).  When your child has a cold or allergies, fluid can build up in the sinuses. Normally, the sinuses drain into the back of your nose.  If your child’s sinuses don’t drain because of unlucky anatomy, the sludge from her cold may become superinfected with bacteria and becomes too thick to move. Subsequently, pressure builds up in her sinuses and causes pain.  A sinus infection of the frontal sinuses manifests itself as pressure over the forehead.  The pain is exacerbated when she bends her head forward because the fluid sloshes around in the sinuses.  Since frontal sinuses do not fully develop until around ten years old, young children escape frontal sinus infections. 
 
Another sign of infection is the increased urge to brush the top row of teeth because the roots of the teeth protrude near the  maxillary sinuses. Bad breath caused by bacterial infested post nasal drip can also be a sign.

 

The nasal discharge associated with bacterial sinus infections can be green/yellow and gooey.  However, nasal drainage from a cold virus is often green/yellow on the third to fourth day.  If your child has green boogies on the third or fourth day of a cold, does not have a fever, and is comfortable, have patience. The color should revert to clear. However, if the cold continues past ten days, studies have shown that a large percentage of the nasal secretions have developed into a bacterial sinus infection.  
 
Because toddlers in group childcare often have back-to-back colds, it may seem as if he constantly has a bacterial sinus infection. However, if there is a break in symptoms, even for one day, it is a sign that a cold has ended.

 

Hydrate your child well when she has a sinus infection. Your child’s body will use the liquid to dilute some of the goo and the thinner goo will be easier for her body to drain.  Since sinus infections are caused by bacteria, your pediatrician may recommend an antibiotic.  The usual duration of the medicine is ten days, but for chronic sinus infections, two to four weeks  may be necessary. Misnamed, “sinus washes” do not penetrate deep into the sinuses; however, they can give relief by mobilizing nasal secretions. When using a wash, ask the pharmacist for one with a low flow. Although the over the counter cold and sinus medicines claim to offer relief, they may have more side effects than good effects. Avoid using them in young children and infants.

 

Who knows. Someday we’ll discover a purpose to having gooey pockets in our skulls. In the meantime, you can tease your children about the holes in their heads.

 

Naline Lai, MD
© 2010 Two Peds in a Pod

 

 

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“Help, Mommy, Daddy, I wet the bed!”

As you wash yet another set of bed sheets and wet pajama bottoms, you may be wondering WHEN your child will stay dry at night and WHY your child still wets the bed when his friends, or worse yet, his younger siblings, are dry. This article will address primary bedwetting (doctors call this “primary nocturnal enuresis”), or kids who have NEVER been dry at night. Children who have had months or years of dry nights and then start bedwetting consistently need to be evaluated by their health care providers to rule out medical causes of new bedwetting.

Here are a few things parents of bed-wetters should know.

Most children master staying dry during the day BEFORE staying dry during the night. Only a small number of children actually wake up dry in the morning before they start potty training.  Daytime dryness is under your child’s cognitive control. Night time dryness is not learned or controlled by your child’s rational brain, but rather is a function of your child’s bladder being mature enough to send a WAKE UP!!  signal to your child. Quick hint here:  nightmares can result from a full bladder. As you comfort your child from a bad dream, don’t forget to take him to the bathroom.

About 80 percent of children are dry overnight by age four. They sleep through the night and wake up dry or they wake up once to urinate in the bathroom and go back to bed. What about the other 20%? Each year after age four years, about 10% of kids who are wet at night become dry without any intervention. Genetics play a big role in this. If one parent was a bedwetter until age 7, for example, then the child has a 35% chance of bedwetting until this age. If both parents wet the bed until school age, then their child has at least an 80% chance of being just like Mom and Dad.

However, some kids just wet the bed even though their parents were dry at an early age. Regardless, parents can help.

·         Do NOT punish your child for wetting the bed. It truly isn’t his fault.

·         It is reasonable to limit fluid intake in the few hours before bed but do allow your child to drink water if thirsty or with teeth brushing.

·         By all means let your child wear training pants at night or at least put some form of water repellant mattress protector on your child’s bed. These are not “crutches” or “enablers” but rather save you from having to wash sheets and mattresses.

·         Not all kids are actually upset about bedwetting, but they can become very upset if parents let them feel that way. Reassure your child that someday “the pee pee will wake you up to go potty in the night” just like it tells your child to go to the bathroom during the day.

If your child is old enough to become self-conscious or to have his self-esteem impacted by his bedwetting (somewhere between the ages of 8 to 10 years, usually, because sleep-overs and camp gain popularity at these ages), there are a few ways to help your child approach potentially awkward situations.

1)      Have the sleep-over at your house and have your child’s absorbent training pants already in the bed hidden under the covers. Your child can put them on after “lights out.”

2)       Tell your child he does not have to share the reason for not wanting to sleep away from home.

3)       Alternatively, he can tell his friends that YOU, the meanie parent, will not allow him to attend sleepovers yet.

 If your child is motivated to try to become dry overnight, you can try a bed-wetting alarm system. These systems work well over a period of several months.  With alarms, both parents and child have to be active participants. Alternatively, you can talk to your child’s health care provider about medicine called DDAVP that can give a “quick fix.” The medication can keep your child dry on the night he takes the medicine. The medicine comes in pill form and can either be used for sleepovers only or can be taken for a few months at a time to help your child feel better if self-esteem is becoming compromised by bed-wetting. Note that even after months of dry nights on medicine, your child will likely bed wet if the medicine is stopped. However, there is also a chance that nature will have taken over and by the time the medication is stopped, your child will have reached the age that his body was programmed to stay dry at night.

Of course, your child’s health care provider can help ensure that your child merely has an immature bladder-to-brain messaging system and not any other cause of his bed-wetting. Your doctor can also help evaluate if your child’s self esteem is affected by his bedwetting.

While not the most glamorous part of the parenting game, washing up after a bedwetting child and keeping a positive attitude for him are very important. The next time you will play this supportive role is when you become grandparents and your former bedwetter calls you for advice about his own bedwetting child.

Julie Kardos, MD
©2010 Two Peds in a Pod

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It’s that itchy, scratchy time of year. Today our guest blogger, dermatologist Mary Toporcer MD, gives us hints on how to combat dry skin. For the past 21 years, Dr. Toporcer has practiced general medical dermatology in Doylestown, PA.  She did her dermatology training at Hahnemann University and at St Christopher’s Hospital, both in Philadelphia, PA.

Many patients suffer from severe dry skin (xerosis) in the winter when the air is cold and the humidity low.  Those who are atopic (have a personal or family history of eczema, allergies, asthma, hayfever or sinus problems) are much more affected by their environment.  A few MUST DO’s include:
1.  Moisture every day especially after bathing with Cerave Cream or Lotion. It contains ceramides which “waterproofs”the skin and keeps moisture in, but without that greasy feel.
 
2.  Use gentle soaps such as Dove in the shower and keep the shower water luke warm, not hot. Hot water just irritates and ultimately dries the skin even more. It also increases itch.
 
3.  Avoid irritants such as anti-static sheets in the dryer. Even if they say “free”, they still put a coating on your clothing in an effort to prevent it from sticking together. This substance is very irritating to dry, sensitive skin. Liquid, fragrance-free fabric softener is much gentler on skin.
 
4.  Lastly, for those terribly dry, scaly, fissured hands and feet, try vaseline or Aquaphor under the soft stretchy gloves and socks that you can buy at Bath and Body Works…they’re often impregnated with aloe for extra moisture.

Mary Toporcer, MD
© Two Peds in a Pod
 
 

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A common question that many parents ask us in the office is “Howcan I help my overweight child?”


Our newest podcast provides six simple rules for healthyeating. Listen in to find out the “5-4-3-2-1-0” rules of what to feed yourchildren, how to portion their foods, and how to change their behavior to helpthem lose excess pounds and maintain a healthy weight.


(If the podcast is not embedded in your RSS reader page,visit the www.TwoPedsInAPod.com home page directly.)




Julie Kardos, MD and Naline Lai, MD


©2010 Two Peds in a Pod

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Your nine-year-old sweetie pie still has baby fat on her cheeks and the changes of puberty have barely started, yet you find yourself in the aisles of a pharmacy scratching your head over the best starter deodorant. Yes, the dreaded body odor has started. Much to the consternation of parents in my office, adult-like body odor appears before periods and voice changes.


What to do about stinky armpits in tweens? Antiperspirants can be very irritating to skin. For a first deodorant, chose something like Tom’s of Maine- natural care, which does not contain antiperspirants. For some kids, a cornstarch powder works well. 


For stinky feet, make sure the kids wash with soap daily-this can be tough for a kid who is just learning how to balance in the shower.


The bacteria which causes athlete’s feet can lead to an unpleasant odor. Add a half-cup of vinegar to a basin of water and soak the feet once a day to kill the bacteria.


Keep their feet well moisturized with lotion. Contrary to popular belief, the more dry and flaky the feet, the more pungent they are.


Yes, those UGGs are fashionable, and the UGG care kit comes with an anti-stink spray; however, sheepskin and warm feet in an enclosed boot leads to stinky feet.  I know it’s counter UGG culture, but remind your kids to wear socks with their shoes.  In general change socks often. Kids tend to go from school to a sporting event and into bed with the same socks.


Even with these hints, if your child’s body odor remains strong, reassure your child that nobody, especially the kid he has a crush on, really notices. Besides, if you have a stinky kid, at least you’ll never lose him in the dark.




Naline Lai, MD
© 2010 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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