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Take a look at the February 2011 issue of Real Simple magazine. We are two of the experts cited on page 124. The good news is that some of our thoughts on the essentials of a medicine cabinet were integrated into a photo-essay piece. The bad news is that children’s cough medicine is listed as a component of the medical cabinet.  While the other contributors to the piece may encourage use of over-the-counter cold and cough medications, we discourage use.

Of concern, safety and effectiveness of cough and cold medicine has never been fully demonstrated in children.  In fact, in 2007 an advisory panel including American Academy of Pediatrics physicians, Poison Control representatives, and Baltimore Department of Public Health representatives recommended to the U.S. Food and Drug Administration (FDA) to stop use of cold and cough medications under six years of age.

Thousands of  children under twelve years of age go to emergency rooms each year after over dosing on cough and cold medicines according to a 2008 study in Pediatrics . Having these medicines around the house increases the chances of accidental overdosing. Cold medications do not kill germs and will not help your child get better faster. Between 1985 and 2007, six studies showed cold medications didn’t have significant effect over placebo.  

So why are children’s cough and cold medicines still around? A year after the advisory panel published their recommendations, FDA advised  against using these medications in children younger than two years but data about these medications in older children is still rolling in.   FDA continues to advise caution with these medications. The producers of cold medicines said at that point they would launch new studies on the safety of medication for those two to twelve years of age. In the meantime pharmaceutical companies stopped manufacturing cold medicine products for those under two years of age and changed the labels to read “for four years old and above.”

Yes, watching your child suffer from a cold is tough. But why give something that doesn’t help her get better and has potential side effects?  There is plenty to do besides reach for cold medicine.  Give honey for her cough  if she is over one year of age. Run a cool mist humidifier in her bedroom, use saline nose spray or washes, have her take a shower with you, and teach her how to blow her nose. Break up that mucous by hydrating her well- give her a bit more than she normally drinks.

If you have young children and want to make your medicine cabinet truly “real simple” then take out the over the counter cough and cold medication. 

 

Naline Lai, MD and Julie Kardos, MD
©2011 Two Peds in a Pod®

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We know the first time your child rides a two wheel bike or loses a tooth is a momentous occasion. In honor of January first, we’ve compiled a list of some of our favorite, lesser known, firsts. Have we missed any of your favorites? Please add to this list.


First time he tries peas


First time she walks on sand or grass in bare feet


First time he sees snow


First time she explains to you how to work your computer


First time she sleeps through the night (if ever)


First he calls grandpa on the telephone


First poop in potty- remember saving it to show your spouse?


First time she buckles herself into the car, with no help from you


First time she sleeps over someone else’s house


First time he gives you a handmade gift


First time finding the restroom by himself in a restaurant, and you allow him to “got it alone”


First time you leave her home alone to babysit herself


First time he is too old to qualify for the restaurant’s kids menu


First time she shaves her legs or first time he shaves his face


First time your teen drives herself to a sports practice


First day your youngest starts kindergarten



We wish you a year filled with many successful “firsts.”


Naline Lai, MD and Julie Kardos, MD with mommy of three Steffie MacDonald 
©2010 Two Peds in a Pod℠

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Panic.

Off to the mall today with my children. Everyone was strapped in the minivan ready to go.  But where were the gift certificates the kids just got for Christmas from the relatives? I was perplexed and scuttled back into the house. Inside, I recreated in my head the scene at grandma and grandpa’s where I had last seen the gift certificates. At their house, after the children had properly said their thank yous, I remembered carefully folding the certificates in tissue paper and tucking them into the sparkly blue gift bag which was to go to my parents on behalf of my in-laws.  As an added guarantee that they would not be forgotten, I deliberately placed the blue bag with the other presents we had received. Where could they be? After all, they were safely in the big black trash bag with all of the other presents.

The trash bag? Oh dear.

Suddenly I remembered arriving home from my in-laws to a family room cluttered with gifts from Santa. I told the kids to clear everything out. When the dust settled I saw a big black trash bag in the center of the room. I grabbed it and threw it in the garage. Then a Christmas miracle happened.  In the midst of holiday hub-bub, my husband remembered that it was trash pickup day and took out the trash.

Gone were the gift certificates. Gone were my in-law’s presents to my parents. Gone was the plug in Star Wars game module. Gone was the “last copy” of a book of Chinese folk tales lovingly picked out for my daughter. And gone was the silly Bop- it game, a crazy game of Simon Says where one of the commands is to “bop” the toy against your tummy.

For a brief moment I contemplated running down to the dump and trolling through the garbage. After all, there were probably only a couple thousand black garbage bags. If I started now, I could be done by next Christmas.

Laughing (what else could I do?), I made my way back to the car where I broke the news to my kids. I too was disappointed, but I couldn’t go back and undo the event.  I had no choice but to laugh.

Together, between the tears, we stepped through lessons learned.

Lesson #1 Be more careful with our things

Lesson #2  Forgiveness is hard but essential for moving forward

Lesson #3 We were happy two days ago and that was before the presents arrived

Lesson #4  Let your kids play with their new toys the moment they get them- you never know when they will disappear

And the most important lesson #5 Use clear trash bags

My oldest smiled slowly and pointed out that I had declared to the kids, “Any presents not cleared out of the family room and put away in your own rooms will be thrown out.” I had unknowingly carried out my threat. Gradually, murmurs of disappointment gave way to laughter as we all imagined a scruffy bearded hobo going through the garbage picking up gift certificates from the girly stores Justice and Abercrombie.  Somewhere there is a stylin’ hobo with a scruffy beard in a fur trimmed hooded puffy coat and tank top, hopping up and down, playing Bop-it.

The minivan shook with laughter.”Oh, mommy, I’m laughing so hard my stomach hurts,” my daughter said. “Mine too,” my other two moaned between giggles.

The cost of “the stuff”:

A lot.


Making kids laugh so hard that their stomachs hurt:

Priceless.

Naline Lai, MD
©Two Peds in a Pod℠

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Kids are noisy. A noisy child is usually a healthy child, so we pediatricians welcome noise. Today we give you Top Ten Sounds we are grateful for this Thanksgiving:

10. The sound of a six-month-old baby’s belly laugh.

 9. The sound of a two year old trying to say “gobble, gobble, gobble.”

 8. The sound of a three year old saying “why?” about 100 times a day.

 7. The sound of a chatty first grader who tells you about her favorite part of her day in one gigantic run-on sentence.

 6. The sound of a grade school orchestra concert (as heard through ear plugs).

 5. The sound of a high school orchestra concert played by the same students you remember playing in their grade school concert.

 4. The sound of a teenager confiding something very important during a check up and then answering “yes” to the question “Do your parents know about this?”

 3. The sound of a high school senior saying he got into his first choice college.

 2. The sound of children (and their pets) breathing as they sleep.

 1. The sound of a child’s small voice at Thanksgiving dinner leading her family in thanks.  


Wishing you all a noisy Thanksgiving.


Julie Kardos, MD and Naline Lai, MD

©2010 Two Peds in a Pod℠

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We are thrilled to introduce photographer Lexi Logan to the blogosphere. Look for her work in our upcoming posts. Busy mother of three,  Lexi holds a Bachelor of Science degree in Fine Art and Art Education from New York University. After graduating with honors, she worked in Manhattan creating original window displays on Broadway, teaching elementary art, and exhibiting her contemporary paintings.

In 2000 Lexi moved to Bucks County Pennsylvania with her Australian husband Andrew Logan, an internationally recognized sculptor. Together they launched Canal Street Studios, LLC., a company that embodies architectural design, sculpture, and a full service bronze foundry. Lexi also serves as Associate Producer for Lunch Productions, a video and New Media production company. Her most recent project, aside from keeping up with our erratic requests, includes providing illustrations for an upcoming children’s book.

Sure beats our blurry iphone photography.  Welcome Lexi!

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

 


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We were thrilled to record today with National Public Radio’s Robin Young on Here and Now about Two Peds in a Pod. Watch for the upcoming piece where we wax and wane philosophical about topics ranging from our thoughts on poop to our story of how we started. 

 

The recording studio sure beat our kitchen table!


Naline Lai, MD with Julie Kardos, MD

© 2010 Two Peds in a Pod℠
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At this time of the Jewish High Holy Days, Dr. Kardos offers us a glimpse into lessons learned as a doctor in training. This is a true story she wrote years after meeting Beth and until now, had only shared with a few close friends.


Tonight starts Yom Kippur and my two youngest children are asleep in their beds. As my oldest sits in the rocker next to my desk reading the last book in the Lord of the Rings series, my husband relaxes playing a computer adventure game. The Jewish High Holy Days are a time for reflection about the past year. But my mind goes back to a Yom Kippur Eve when I was working as a resident in the Pediatric Intensive Care Unit (PICU) as part of my pediatric training. 


Residents work through most holidays, even ones they consider important. This night, I wished I had off, but I consoled myself with knowing that I would be off on Thanksgiving. Luckily I was partnered with Amy, the lead physician in the PICU.


The sickest patient that night was twelve-year-old Beth. She had leukemia and had just started chemotherapy. Because her immune system was weak, Beth was very ill with a bacterial infection in her blood.  Despite powerful antibiotics, the infection raised havoc in her body. She developed such difficulty breathing that a tube from a mechanical ventilator was placed down her throat to force air into her lungs. Even the comfort of sleep escaped her. Beth was afraid of what was happening to her body. She refused to accept medicine that could help her sleep because she was so afraid that she would never wake up.


That night, despite her incredibly ill state, she got her period. Usually when a girl’s body is stressed, the body preserves all blood and the periods stop. But hers came, and because her blood cells were so abnormal from a toxic combination of infection, chemotherapy, and leukemia, she began bleeding to death.  We transfused her with bag after bag of blood to keep her alive.


In the middle of the night, Beth’s blood pressure suddenly plummeted so we added even more medication. Because my mentor Amy was not certain that Beth would survive the night, we called her family at the hotel near the hospital where they were staying and told them come to Beth’s side. And through it all, Beth refused to sleep. Her eyes always opened in terror whenever we approached her bed. Her face was gray. Her chest rose and fell to the rhythm of the mechanical ventilator, and you could smell the fear all around her.


I stood with Amy just outside Beth’s room as Amy reviewed a checklist for Beth’s care. It went something like: “Ok, we just called blood bank for more blood; we called her family; we called the lab; we called the pharmacy. We are currently attending to all of her problems, we now just have to wait for her body to respond.” She paused,” But you know what?”


“What?” I asked her.


“We need to address her spiritual needs as well. Do we know what religion her family is? They may want a clergy member with them.”


I was startled. In the midst of all the tubes and wires of technology, Amy remembered to summon the human factor in medicine. We looked in her medical chart under “religious preference” and there it was:  Jewish.


“Amy,” I said, “of all nights. Tonight is Yom Kippur…the holiest night of the Jewish year.”


I knew that the hospital had a Rabbi “on call” just like they had priests, nuns, ministers, and other spiritual leaders. But that night I was sure that every rabbi in Philadelphia would be at synagogue for Kol Nidre, the declaration chanted at the beginning of the Yom Kippur evening service. We were unlikely to track down a Rabbi.


Despite this, we asked her mother if they wanted us to call a Rabbi for them. She shook her head no.  I remember feeling relieved, then guilty that I felt relieved.  Amy left to check on another patient. Beth’s mom, dad, and older sister stood together watching Beth. Her sister’s hand lay on her mother’s arm. Her mother’s eyes darted from me to Beth to the mechanical ventilator next to the bed. Beth’s eyes were closed and it was difficult to know if she even knew we were there.


Her family walked out into the hall to talk. Beth at that moment opened her eyes and started tapping on the bed with her foot to get my attention. She couldn’t talk because of the tube down her throat and her hands were taped down with IVs. Yet she reached out with one hand as best she could.


I walked close to her bed so she could touch me and I asked, what is it, Beth?


Her lips formed the words around the breathing tube very deliberately, her body tensing. “Am I going to die?”


All in a split second I am thinking to myself:  How do I know/it could very well happen/how can I lie to her/how can I tell her the truth of what I fear could very well happen/how am I going to answer this child?


What I answered was, “Not tonight, Beth.”


She relaxed into her pillow but kept her eyes on mine. I waited to see if she would say anything else, but the effort to ask that one question had exhausted her. I stood, holding her hand, until her family came back into the room. Her eyes followed them to her bed and I left so they could be together.


Beth did survive the night and in fact survived a month in the PICU. She became well enough to be transferred to a regular hospital floor. By this time I was working in a different part of the hospital, but one of the oncologists pointed her out to me.


I don’t know what happened to her in the long term.


So now I tell my oldest child it’s time for him to stop reading and go to sleep, and I walk him to his room to say goodnight. My husband and I decide what time we’ll attend Yom Kippur services tomorrow. Part of me feels joined with Jews everywhere who will also be spending the next day reflecting, praying and celebrating a new year. But mostly, like every year at this time, I remember the sounds and the smells and the fear in the PICU where sickness doesn’t care who your God is or what your intentions are. I remember Amy caring enough to think about a dying child’s family religion, and always, I remember Beth.


Julie Kardos, MD
© 2010 Two Peds in a Pod

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One year ago today we posted our first blog post Maiden Voyage and what an adventure it has been! In honor of Two Peds in a Pod’s first birthday we reprint Dr. Kardos’s post “Let ‘Em Eat Cake”:

After completing my pediatric training, I worked for a couple of years in a large pediatric office before I had any children of my own. I was always struck by the Life Event of a child’s first birthday. This milestone carries so much meaning and emotion for families. My patients’ parents described huge birthday parties with characters such as Elmo walking around or Moon Bounces, large catered affairs with numerous friends, family members, and entire neighborhoods. Often I would see a child sick in my office a few days before such an event with parents who were panicked that their child might be sick on his Big Day, or I would see a child for his one year well check and hear many details about the enormous party. Of course I also saw plenty of children a few days after their first birthday party who became ill, most likely, from a well-intentioned friend or relative who was already sick and passed the illness on to the birthday child at the party. I heard about the kids who clapped for the Happy Birthday song and kids who cried and one who vomited from excitement… all over the birthday cake. Many of my patients had their first full blown temper tantrum during their own over-stimulating first birthday party.

I remember not quite understanding why parents go through such effort and expense to throw a party that their child will never remember at a developmental stage where 99 percent of children are having stranger anxiety and separation anxiety. Well meaning famillies would often forgo daily routine to skip naps, eat at erratic times, and then expect their birthday child to perform in front of a large crowd singing loudly at them. “My husband and I will do it differently,” I would tell myself.

Now, three of my own children later, I must apologize for not quite understanding about that first birthday. I remember waking up on the day my oldest turned one year. My pediatrician brain first exclaimed “Hurray! No more SIDS risk!” Then my mommy brain took over, “Ohmygosh, I survived the first year of parenthood!” This day is about Celebration of the Parent. I finally understood completely why my patients’ parents needed all the hoopla.

Because I am actually a little uncomfortable in large crowds, my son’s first birthday party included all close relatives who lived nearby, people he was well familiarized with. Some pediatric tips I had picked up which I will pass on:

1)      Sing the Happy Birthday song, complete with clapping at the finale, for about one month straight leading up to the birthday. Children love music and hearing a very familiar song sung by a large group is not as overwhelming as hearing an unfamiliar song.

2)      Plan mealtime around your child, not the guests. If you are inviting people close to your heart, they will accommodate. Dinner can be at 5:00pm if that’s when your child usually eats, or have a lunch party that starts midmorning and then end the party in time to allow your child to have his regularly scheduled afternoon nap. Most one-year-olds are usually at their best in the morning anyway.

3)      If your child becomes sick, cancel the party. Your child will not be disappointed because he won’t understand what he is missing. You as parent would have a lousy time anyway because all of your attention will be on your ill child and you will be anxious. Your guests who are parents will appreciate your refraining from making them and their own children sick.

Recently while performing a one-year-old well check I asked about my patient’s birthday party and her parents told me “Oh, we didn’t have a party. It was like any other day, although we did give her a cupcake for dessert.”

Now THIS is a pragmatic approach to parenting because, again, no child will ever have memories of her own first birthday. However, I hope the parents did take time, at least with each other, to congratulate themselves and to feel really good about making it to that huge milestone in their parenting career. I hope they savored their accomplishment as much as their child savored the cupcake.

_____________________________

How far we’ve come, and it is all thanks to you. We’ve watched with excitement as our readership climbed from two hits (from our husbands) to almost 20,000 hits. Two Peds in a Pod now has email and Facebook subscribers. You can find us through directories such as Technorati and iTunes and recently, Two Peds expanded to the West Coast of the United States with a bimonthly column in Family Magazine Group. Some of our Face book friends hail from Canada and we consistently receive hits from the United Kingdom. Looks like our goal to impact one million kids around the world may not be a far-fetched dream.

Our greatest reward is when people say to us, “That blog post was so helpful.” We are thrilled to reach out to many families.

While our main podcast recording studio continues to be our kitchen table, we also recorded with one mom’s group in their living room and another parenting group in a child care center.  From focus group back out to cyperspace!

We still depend on you to tell other families about our site. Our sources of inspiration continue to be our patients, your children and our own clans. Please keep those topic suggestions coming! As working pediatricians and parents like you, we want to continue to be your reliable (and sometimes amusing) source of sound pediatric information.

Thank you for reading, listening, commenting and letting your friends know about Two Peds in a Pod. Let the adventure continue!

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

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Two Peds in a Pod has made its way from Pennsylvania to California. Check out The Family Magazine GroupThis informative print and online group of family magazines now features a bimonthly article from Two Peds in a Pod.  The Family Magazine Group reaches a print audience of 350,000 and an online audience of about 100,000 each month.

(We’re on page 16)

Julie Kardos, MD and Naline Lai, MD

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