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

Our newest podcast provides six simple rules for healthy eating. Listen in to find out the “5-4-3-2-1-0” rules of what to feed your children, how to portion their foods, and how to change their behavior to help them 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

Dr. Dave, a friend of Dr. Kardos, is a physician in a Student Health Center at a respectable college in a large city. Here is an alarming, yet typical, scenario involving binge drinking that Dr. Dave encounters on a too-frequent basis.

 

A 19 year old young man comes in to the Student Health Center very concerned because he had woken up that morning in an apartment in bed with a woman he did not know. He had been out with friends drinking at a bar (a frequent occurrence), vaguely recalls meeting a woman, but had so much to drink that he cannot even recall leaving the bar, let alone what happened afterward. His greatest concern is that he has no idea if he used a condom (he left before she woke up), and thus could have been exposed to HIV and other sexually transmitted infections.

Ironically, this student is worried about exposure to sexually transmitted diseases but not about the root of his problem: binge drinking. In other words, he is worried about sexually transmitted diseases but not about his drinking which caused his potential exposure to dangerous diseases. 

Here is what Dr. Dave, a career student health doctor, wants parents of college students to know about binge drinking in college students:

Although alcohol use is often considered a rite of passage for college students, it is also one of the major health risks for this age group.  Alcohol-related health problems can present in a variety of ways and do not have to involve any signs of dependency.  Among college-aged students, the most common manifestation of alcohol abuse comes from the consequences of binge drinking.  

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1,400 student deaths from alcohol-related unintentional injuries (including motor vehicle accidents)

500,000 unintentional student injuries 

More than 600,000 cases of student-on-student assault 

More than 70,000 cases of sexual assault or date rape

400,000 students having unprotected sex and more than 100,000 students too intoxicated to remember if sex was consensual.

The first 6 weeks of the first semester of college is an important predictor of first year academic performance and is an important window period to monitor for any significant changes in a new student’s behavior and lifestyle habits.  Parents can help by being aware of these issues and by being open to speaking with their children about the potential risks of alcohol use both before and during the college experience.  A simple rule of thumb for parents is to stay involved, while still allowing their children the space necessary for learning, exploring, and maturing into adulthood. 

If your child begins to exhibit unusual behavior, such as lower grades, mood changes, or a new unwillingness to talk to you, this behavior should prompt you to find out more. 

Additional information is available at http://www.collegedrinkingprevention.gov/.

Dr. Dave, MD is a physician who has been working in college health since 2000.

© 2010 Two Peds in a Pod

 

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

 

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

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

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

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

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

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

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

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

John Gannon
Psychologist, Marriage and Family Therapist

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

 

National YouthAnti-Drug Media Campaign www.TheAntiDrug.com

 

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

 

Naline Lai, MD and Julie Kardos, MD

©2009 Two Peds in a Pod

 

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

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

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

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

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

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

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

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

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

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

Naline Lai, MD and Julie Kardos, MD

©2009 Two Peds in a Pod®

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Drs. Kardos and Lai advise parents on what they can do for their tired teen. Although we all enjoyed an hour’s extra sleep this past weekend with the resetting of the clocks, many teens are back to their “usual” sleep deprived state. Listen here to find out how to help reset your teen’s internal clock, and what  to consider when you have a tired teen.

 

Julie Kardos, MD  and Naline Lai, MD

© 2009 Two Peds In a Pod

Even after over a decade in pediatrics, teens always surprise me.

Last week a junior high student came into a checkup with the scabbed hand pictured in the photo above.  Apparently there is a game new to me called “Erasing”. My patient told me the game can be played with any type of eraser, but the pink one at the end of a number two pencil works best.  The object of the game is rub with an eraser hard enough to “erase” as much of your skin on the back your hand as possible.  The players each choose a ligament (one of the cords which run from your knuckles to your wrist) to “erase.” The first person to stop erasing loses the game.

If you find your teen erasing, tell them about the dangers of infection and scarring. Since a teen often does not understand long term ramifications, it is often a more a more effective deterrent to tell him/her to stop because it “looks ugly”. Even if your teen is not erasing, use a discussion about erasing as a starting point to talk about other self injurious behaviors (i.e. “choking games” where the object is to cut off someone’s breathing and the “find your true laugh” game).

Since I thought erasing was a brand new trend, I took the photograph to show the other doctors in my office. When I flashed the photo in front of one of my colleagues,  he glanced briefly at it and said, “Oh, that’s erasing- I did that when I was a kid.”

Amazing we all got through.

Pass this info on to other parents.

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

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

Well it finally happened.  The day all mothers with daughters regard with mixed feelings.  No, I’m not talking about my daughter’s first period. Today I discovered that my oldest daughter’s foot size is the same as mine.

I took it as a sign.  Time to blog a little about shoes and feet.

First shoes:  Shoes are to prevent injury to feet. While indoors, let your infant stand and walk without shoes.  Bare feet are best.  Your baby will learn to balance better when he or she can feel the floor directly under her feet.  However, for protection, shoes are needed.  Start with a sturdy sneaker.  No need for the clunky white leather shoes of the past.  Also, avoid sandals, toddlers are more liable to trip and there is not much protection against stinging insects.

For school: The average length of recess per day is about 30 minutes. Therefore, pick comfy shoes which allow your children to utilize this time for physical activity.

Athlete’s foot: Caused by a fungus, athlete’s foot appears as wet, moist, itchy areas usually between the toes.  The fungus loves moist areas and can be treated with over the counter antifungal creams or powders such as clotrimazole (Lotrimin AF), and tolnaftate (Tinactin). While common in teens, athlete’s foot is much less common in general than foot eczema. Vinegar soaks are helpful- put half a cup of vinegar into a small basin of warm water and have your child soak for 10 minutes daily.

If your child has eczema on other areas of his or her body, be more suspicious of eczema than athlete’s foot. Both can look alike, but be careful, the steroid creams used for eczema may worsen athlete’s foot.

Flat feet: Most children with flat feet have flexible flat feet which do not require any intervention. Nearly all toddlers have flexible flat feet. A child with flexible flat feet will not have an arch upon standing.  However, the arch should reappear when the child’s feet are relaxed in a sitting position off the floor. Any pain in the arch or suspicion of an inflexible flat foot should be brought to a physician’s attention.

Ingrown toe nails: Ingrown toe nails occur when the sides of the nails grown into the skin.  After enough irritation, bacteria can settle in and pus pockets form.  To prevent ingrown toe nails from becoming infected, at the first sign of redness, soak feet in warm water with Epsom salts.  Gently pull the skin back from the area of the nail which is in grown.  Attempt to cut off any area of the nail which is pushing into the skin.

Clipping newborn toe (and finger) nails: A newborn’s nails have not separated enough from the nail bed to easily get a nail clipper under a nail. For the first few weeks, stick to filing the nails down.  Parental guilt warning: at some point almost every parent mistakenly cuts their child’s skin instead of their nail.

Naline Lai, MD and Julie Kardos, MD

©2009 Two Peds in a Pod®

Parents often ask how they can tell if their child has The Flu or just a common cold. Here’s how:

A cold, usually caused by one of many viruses such as rhinovirus, starts out gradually. Think back to your last cold: first your throat is scratchy, then the next day your nose gets stuffy or then starts running profusely, then you develop a cough. Sometimes during a cold you get a fever for a day or two. Sometimes you get hoarse, losing your voice. Usually kids still feel well enough to play and attend school with colds, as long as their fevers stay below 101 and they are well hydrated and breathing without difficulty. The average length of a cold is 7-10 days although sometimes you feel lingering effects of a cold for 2 weeks or more.

The flu, caused by influenza virus, comes on suddenly and basically makes you feel as if you’ve been hit by a truck. Flu always causes fever of 101 or higher and some respiratory symptom such as runny nose, cough, or sore throat (many times, all three at once actually). Children, more often than adults, sometimes have vomiting and/or diarrhea with the flu along with their respiratory symptoms. Usually the flu causes total body aches, headaches, and the sensation of your eyes burning. The fever usually lasts 5-7 days. All symptoms come on at once; there is nothing gradual about coming down with the flu.

Fortunately, vaccines against the flu can prevent the misery of coming down with the flu. In addition, vaccines against influenza save lives by preventing flu related complications that can be fatal such as flu pneumonia, flu encephalitis (brain infection), and severe dehydration. Hand washing also helps prevents spread of flu as well as almost every other disease of childhood. Please see our blog post on flu posted on September 6, 2009 for more information on prevention and care of children with flu.

The much touted “Tamiflu” is a prescription medication that can ameliorate the effects of the flu. In an otherwise healthy person, this medicine can shorten duration of symptoms by ½ to 1 day. Are you underwhelmed by this fact? So is the medical profession, which is why we reserve this medicine for people ill enough to need hospitalization or who we know have underlying medical conditions, because this medicine has been shown to decrease hospital stays and complication of flu in people who have asthma, diabetes, immune system defects, and heart disease.

Because of all the hype over the novel H1N1 flu (again, please see our blog post on this subject) I am already getting many anxious phone calls and office visits from parents who are worried that their child might have “the flu” when their children are having runny noses and some cough but no fever. Hopefully this blog post will help you sort out your child’s symptoms.

Julie Kardos, MD