Subduing stress: relaxation techniques

As the school year comes barreling to an end, I always find an assortment of students parading through my office with stress related ailments. Struggling to keep up in class can be extremely stressful for a child. 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.

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

Managing Munchies: More healthy weight ideas

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 February 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 31^st. ^.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 and Julie Kardos, MD

Making Sense of Ear Pain

“Help, help, my EAR HURTS!!!”

I admit to having no statistics on this observation, but as a pediatrician and a mom, I have observed that ear infections strike disproportionately on Friday nights. Have you observed this as well?

I wish children had some kind of external ear indicator that would flash “infection” or “not an ear infection” when they have middle of the night attacks of pain. Unfortunately, most people can not diagnose their child in the middle of the night. Even I can’t diagnose my own children at home because my portable otoscope, the instrument used to examine ears, died from overuse a year ago. However, there are ways to treat ear pain no matter what the cause.

Of course we all want to know the cause of our children’s pain. However, there is no danger in treating pain while we investigate the cause, or until daytime comes and pediatricians open their offices. Good pain relievers such as acetaminophen (brand name Tylenol) or ibuprofen (brand names Advil and Motrin), given at correct doses, will treat pain from any source. Treating pain does not “mask” any physical exam findings so go ahead and ease your child’s misery before going to your child’s health care provider. I feel bad for my young patients whose parents tell me, “We didn’t give him any pain medicine because we wanted you to see how much his ear is hurting him.”

Heat in the form of warm wet compresses or a heating pad will also help. Prop your child upright. If the pain is from an ear infection, the position will relieve pressure. Distraction such as a 2:00 am Elmo episode will also blunt pain.

blog post) is treated differently than a middle ear “inside” infection. Nearby body parts can also produce pain. Throat infections (pharyngitis), from strep throat (see strep throat posts) or viruses, often cause pain in the ears. Even pain from jaw joint strain and dental issues can show up as ear pain. Over the years I have sent several children straight from my office to the dentist’s office for treatment of tooth ailments masquerading as ear pain.

No article on ear pain would be complete without addressing“ear tugging.” Many babies by nine months of age discover their ears and then play with them simply because they stick out (I will leave to your imagination what boy babies tug on). Babies often tug on ears when they are tired. Therefore, tugging on ears alone may not indicate an ear infection, especially if not coupled with other symptoms.

Although ear infections are one of the most common ailments of childhood and most children have at least one ear infection by age three, remember that not all ear pain is caused by ear infections. In the middle of the night, and even in the middle of the day, it IS okay to give some pain relief before seeing your child’s health care provider.

Why ear pain always seems to awaken a child in the middle of the night, I’ll never know. All I know is that I have to remember to buy a new otoscope for home.

Julie Kardos, MD
©2010 Two Peds in a Pod

Child (or anyone) abduction prevention tips

In order to distinguish between a real police officer and an impostor, tell your child that if he is confronted by someone who claims to be a police officer, have him tell the officer to call for another one. Real officers rarely work without a partner.

Here is state by state information about Megan’s Law. http://www.state.nj.us/njsp/info/reg_sexoffend.html

Naline Lai, MD
© 2010 Two Peds in a Pod

Traveling With Children

As I pack for an upcoming family vacation, I am reminded of the numerous questions over the years that parents have asked me about traveling with children. Often they ask, what is the best way to travel that will allow everyone to enjoy the vacation?

Ha,ha, I think to myself. The real answer is to hire a sitter or enlist grandparents to babysit and leave the kids at home. My husband and I always refer to family vacations as “family displacements.”

No, really, family vacations are wonderful experiences as long as you hold realistic expectations. First you have to get there.

Easier said than done.

When traveling by air, parents wonder if they should bring a car seat for the plane. Young children who sit in a car seat in the car should sit in a car seat in an airplane. Unfortunately, not all car seats fit into the airplane seat properly. The best advice I can give is to bring your car seat and make an attempt to fit it properly. If it doesn’t fit properly, you will still need it for the car ride from the airport after you arrive at your destination. Not all car rental facilities provide car seats.

Another question I am frequently asked about long plane rides is “Should I give my child Benadryl (diphenhydramine) so he/she will sleep through the flight?” Unfortunately, Benadryl’s reliability as a sleep aid is spotty at best. Most kids get sleepy, but the excitement of an airplane ride mixed in with a “drugged” feeling can result in an ornery, irritable child who is difficult to console. I advise against this practice. On the other hand, Benadryl can help motion sickness and is shorter acting than other motion sickness medications.

Ear pain during an airplane’s descent is also a common worry. Yes, it is true that ears tend to “pop” during the landing as the air pressure changes with altitude. Some young children (and their parents) find this sensation very unpleasant. However, most babies are lulled to sleep by the noise and vibration of an airplane and are unaffected. If your child is safely in a car seat, I do not advise taking him out of it to breastfeed during landing. Offer a pacifier if you feel he needs to suck/swallow during the landing, and offer an older child a snack so she can swallow and equalize ear pressure if she seems uncomfortable during the landing.

Speaking of food, try to carry healthy snacks rather than junk food when traveling. Staying away from excessively salty or sweet food will cut down on thirst. Also, keep feeding times similar to home schedules in order to prevent toddler meltdowns.

Remember that young children hate to wait for ANYTHING and that includes getting to your destination. Bring along distractions that are simple and can be used in multiple ways. For example, paper and crayons or pencils can be used for: coloring, drawing, word games, origami, tic-tac-toe, math games, etc.

When traveling internationally, check the Center for Disease Control website www.cdc.gov for the latest health advisories for your travel destination. Do your research several weeks in advance because some recommended vaccines are available only through travel clinics. Also, some forms of malaria prevention medicine need to be started a week prior to travel.

Please refer to our “Happy, Healthy Holiday” blog post from 12/10/2009 for further information about keeping kids on more even keel during vacations. In general, attempt to keep eating and sleeping routines as similar to home as possible. Also remember to wash hands often to prevent illness during travel. Finally, locate a pediatrician or child friendly hospital ahead of time in case illness does strike. Unfortunately, most illnesses cannot be diagnosed by your child’s health care provider over the phone.

While traveling with young children can seem daunting, the memories you create for them are well worth the effort. And it DOES get easier as the kids get older. Now I can laugh at the image of my husband with two car seats slung over his back lugging a large diaper bag and a carry-on, leading my preschooler struggling with his own backpack filled with snacks and air plane distractions, while I am balancing two non-walking twin babies, one in each arm, as we all take our shoes off for the airplane security checkpoint.

We’ve come a long way, and so can you. Happy Travels!

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

Ankle Strengthening Exercises- what to do after an ankle sprain

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. This could happen for a multitude of reasons, from play or even an accident that might not have been their fault, this type of sprain may need attention from a doctor, especially if it is after an accident.

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.²Without 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

Always something-those rubber bands

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

Holes In Your Head: Sinus Infections

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.

How to Help Your Bedwetting Child

bedwetting “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 post addresses primary bedwetting (doctors call this “primary nocturnal enuresis”), kids who have NEVER been dry at night. Children who have had months or years of dry nights and then start bedwetting consistently should go see their pediatrician 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 repellent 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.

Older kids might become self-conscious, and their self-esteem gets impacted by their bedwetting. Typically this happens between the ages of 8 to 10 years, when sleep-overs and camp gain popularity.

Ways to help your child approach potentially awkward situations include:

Have the sleep-over at your house and have our child’s absorbent training pants already in the bed hidden under the covers. Your child can put them on after “lights out.”
Tell your child that he does not have to share the reason for not wanting to sleep away from home.
Alternatively, he can tell his friends that YOU, the mean 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 children have to be active participants.

Additionally, there is one medical option.

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. Your child could either take it only for sleepovers or can take it for a few months at a time if bedwetting compromises his self-esteem. Note that even after months of dry nights on medicine, your child will likely bed wet if he stops taking the medicine. 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.

Dry winter skin – guidance from a guru

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