potty training dogs

Children master potty training typically between the ages of two and four years. Be patient, not everyone is “typical.” More important than your child’s age is whether she shows she is developmentally ready to train. These signs include:
– is generally agreeable/ can follow directions
– gets a funny expression on her face before passing urine or poop, or runs and hides, then produces a wet or soiled diaper
-asks to be changed/ pulls on her diaper when it becomes wet or soiled

– remains dry during the day time for at least two hours
-NOT because grandparents are pressuring you to start training their grandchild
– NOT if the child is constipated—the last thing you want to do is to teach withholding to a kid who already withholds
-NOT if a newborn sibling has just joined the family. A new baby in the house is often a time of REGRESSION, not progression. However, if your toddler begs to use the potty at this time, then by all means, allow her to try.

Hit play to listen to our potty training podcast:

Naline Lai, MD and Julie Kardos, MD

©2014 Two Peds in a Pod®



To all of the dads who read our blog: we invite you to help us with our Father’s Day post. Are there things you find yourself doing now that you are a dad that you never imagined you would be doing before you had a child? Try to finish this thought: “Before I became a dad, I never thought I’d…”

Please comment to this post or send us an email at:

We will post your responses on Father’s Day.

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®


baby child sleepWhen I was a child, a special treat was to have a sleepover at my grandparents’ house. My grandfather was an early riser and to this day I can still hear him roaring “When Pop-Pop’s up, EVERYBODY’S UP!” as I awoke to the aroma of my grandmother’s hot breakfast.


As all parents know, when BABY’s up, EVERYBODY’s up. What‘s the secret to good sleep? It’s all in the bedtime routine.


Parents should establish a good bedtime routine when their children are babies and should continue to enforce the routine until their children grow up and leave home. Just as prevention of heart disease begins with establishing healthy eating and exercise habits when your children are young, prevention of adult insomnia starts with establishing a healthy bedtime routine.


Here are ways to help your kids sleep from infancy through young adulthood: Start with our most commented upon podcast: how to help your baby to sleep through the night. Parents of preschool-aged kids will appreciate”sleep invaders”: nightmares, night terrors, and other monsters under the bed .  Even if you don’t have a teen, plug in our podcast on the Tired Teen .


Now that winter break is a memory, it’s time to buckle down and rid your child of the jet lag that persists from the “vacation sleep schedule.” For more ways to do this, refer to Wakeup sleepyhead its time for school.


May you have a good night this and every night!


Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®


We know that winter break often finds kids spending more time in front of screens: watching TV, playing video games, or surfing the internet. Today we repost our suggestions to help limit screen time in your home.
Drs. Kardos and Lai

“Mom, can we do screen?”

My kids ask me this question when they are bored. Never mind the basement full of toys and games, the outdoor sports equipment, or the numerous books on our shelves. They’d watch any screen whether television, hand-held video game, or computer for hours if I let them. But I notice that on days I give in, my children bicker more and engage in less creative play than on days that I don’t allow some screen time.

Babies who watch television develop language slower than their screen-free counterparts (despite what the makers of “educational videos” claim) and children who log in more screen time are prone to obesity, insomnia, and behavior difficulties. The American Academy of Pediatrics recommends no more than two hours of television watching a day for kids over the age of two years, and NO television for those younger than two.

Over the years, parents have given me tips on how they limit screen time in their homes. Here are some ideas for cutting back:

  • Have children who play a musical instrument earn screen time by practicing music. Have children who play a sport earn screen time by practicing their sport.
  • Turn off the screen during the week. Limit screen to weekends or one day per week.
  • Set a predetermined time limit on screen time, such as 30 minutes or one hour per day. If your child chooses, she can skip a day to accumulate and “save” for a longer movie or longer video game.
  • Take the TV, personal computer, and video games out of your children’s bedrooms. Be a good role model by taking them out of your own bedroom as well.
  • Turn off the TV during meals.
  • Turn off the TV as background noise. Turn on music instead.
  • Have books available to read in relaxing places in the house (near couches, beds, etc.). When kids flop on the couch they will pick up a book to relax instead of reaching for the remote control.
  • Give kids a weekly “TV/screen allowance” with parameters such as no screen before homework is done, no screen right before bed, etc. Let the kids decide how to “spend” their allowance.

Not that I am averse to “family movie night,” and I understand the value of plunking an ill child in front of a video in order to take his mind off his ailment. In fact, Dr. Lai lives in a house with three iPod Touches, two iPhones, a Nintendo DS and three computers. But I do find it frightening to watch my otherwise very animated children lose all facial expression as they tune in to a television show.

For more information about how screen time affects children, see the American Academy of Pediatrics web site ( and put in “television” in the search box.

Let us know how you dissuade your children from the allure of the screen.

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



how to cut down on sugarWe welcome back health coach Mary McDonald (the mom who overhauled her kids’ sports snack stand), to provide advice on how to survive what Dr. Shifrin referred to last week as Candy Season.
—Drs. Lai and Kardos

If your home is like mine, you have an extraordinary amount of Halloween candy lurking in the most unusual locations:  inside an old roasting pan, under a pile of shoes in your daughter’s closet, or tucked in an end table drawer in your living room.  It’s an incredibly hard time of the year to eat healthy and to help your children make good food choices when sweets are so abundant from October to January.  I
t is disturbing to think about the bad eating habits that start at the holidays and can lead to an addiction to sugar throughout the rest of the year.  In order to combat the inevitable onslaught of sugary treats, here are a few strategies to consider:

  1. Invite the “Switch Fairy” or “Switch Witch” to your home. If you’re tired of telling your children, “Step away from the candy!” then make sure it isn’t easy to access. Your kids will love you if you tell them the Switch Fairy will visit your home tonight to replace the candy with a toy, clothing, or their favorite item.  Keeping sweets out of sight will make it easier to replace the candy with a healthier option, such as fruit salad or a yogurt parfait. 
  2. So, what can the Switch Fairy do with the extra sweets? Contact your local dentist or do an online search for candy donation sites.  Many local organizations will buy back Halloween candy. This becomes a perfect way to subsidize the present that the Switch Fairy purchases. 
  3. Drink Water.  Staying hydrated is a great way to curb cravings.  When you crave sweets, there’s a good chance that you’re actually dehydrated and your brain is craving water.  When your kids are tired, instead of  reaching for a-little-something-sweet as a pick-me-up, try giving them a drink of water. You may be surprised that their cravings are reduced. Are you looking to make water more enticing?  Try purchasing a swirly straw and designate the straw for water only.
  4. Don’t drink soda.  Soda is nothing but liquid sugar and void of any nutrition.  Each 12-oz. can of Coke contains approximately 10 teaspoons of sugar.  An easy way to reduce your sweets during the holiday season is to select water as your drink of choice.  If your child must have a soda, suggest splitting the can with your child or with a friend.  Pour a few ounces into each cup and throw away the rest.  It’s okay. 
  5. Increase your carbs!  Yes, you heard me correctly.  For years, carbs were given a bad rap.  Low carb diets promoted the idea that all carbs are created the same.  In fact, they are not.  Natural carbohydrates (the ones found in fruits and vegetables such as sweet potatoes, carrots, bananas, and oranges) can help reduce your cravings for sweets.  Try reaching for one of these options before you go for a cookie.  For an added bonus, wash this snack down with a big glass of water.  You will be really surprised at how quickly you cure your sugar craving. Make fruit or veggies more exciting by using toothpicks to pick up the food.  See how many green peas you can fit on a toothpick.  Make it fun – who doesn’t like a pea eating competition?
  6. Chew Gum.  According to research from the University of Rhode Island, people who chewed gum consumed 68 fewer calories at lunch and did not compensate by eating more later in the day. Chewing gum also helped the study participants satisfy their cravings and resist fattening treats. And there’s more: Gum chewers actually burned about 5% more calories than non-gum chewers.
  7. Just say no.  Social pressure to join in and eat what others are eating can be overwhelming.  Most people are very receptive when you say, “No thanks, I’m full.”  Tell your children that it’s okay to “Just Say No”, whether you’re talking about food or other temptations.
  8. Cook from scratch.  Cooking, especially with your children, is a wonderful way to control the ingredients that are in the food that you eat.  There are many wonderful natural substitutions to cane sugar (stevia, agave syrup, maple syrup, dates, raisins, etc.) that provide an equal amount of sweetness to your food.  Become a scientist and experiment with alternative sweeteners.  Click here for recipe ideas. 
  9. Understand your labels.  Did you know that every 4 grams of sugar = 1 teaspoon of sugar?  Understanding the basics of a nutrition label is critical to understanding what you are eating. 

So, as you and your family weave your way through the sweetest months of the year, think of inviting the Switch Fairy to your house for a home cooked meal full of natural carbs and a big cup of water.

Mary McDonald
©2013 Two Peds in a Pod®

Mary McDonald holds a Masters of Education from Arcadia University and completed her health coach certification from Institute of Integrative Nutrition.  She is a high school teacher, a mom of four daughters, and an advocate for healthy food choices.  For more information on her health coaching services, please contact her at or visit her website at




Wake up!


Remember that sleeping, along with eating, peeing and pooping, is an essential of life that helps your child (and you) function well. Inadequate sleep is associated with obesity, learning difficulties, behavior problems, and emotional lability (gotta love the whining of an overtired kid.)

In honor of the National Sleep Foundation’s National Sleep Awareness Week, which ends on March 11when Americans “spring ahead” the clocks and we ironically lose one hour of sleep, please refer to our earlier podcasts and blog posts on sleep. We invite you to learn about how to teach healthy sleep habits to your kids and yourselves (the parents). 

The podcasts:
Sleep Patterns of the Newborn
Helping your baby to sleep through the night
-“There’s a monster under my bed”: all about nightmares, night terrors, night wandering, and bedwetting
The tired teen

The blog posts:
-Sleep Safety: How to decrease your baby’s risk of Sudden Infant Death Syndrome (SIDS)

-Parents of newborns: get your Zzzzzs back
I Need a Nap!
Wake up, sleepy-head, it’s time for school!

When your child’s bedtime seems too late, or, will I ever get a late night alone with my spouse again?

Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®


Vaccine protection against flu (influenza) is coming soon. Thankfully, last year’s confusion caused by two separate vaccines is eliminated. This year’s flu vaccine, both the injectable and the nasal forms, protects against both novel H1N1 and the season strains of flu. Not only from a confusion standpoint, but also from a health benefit standpoint, this is good news. Unlike seasonal flu, which causes severe disease in both the elderly and youngsters, 90 percent of deaths from H1N1 were in people younger than age 65 years.

The current recommendation of the US Center for Disease Control  ( ) is to immunize ALL children against flu starting at six months of age (if local supplies are limited, the highest risk groups will be targeted).  All household members and caregivers of babies too young to receive the immunization should also be vaccinated, as well as all caregivers of children of any age.

As always, children nine years old and older need only ONE dose of flu vaccine this year. Children below nine (eight years old and younger) will receive one dose of flu vaccine this year as long as they received at least two doses of seasonal flu and one dose of H1N1 vaccine in the past.

The children who need two doses of flu vaccine this year are the ones younger than nine years old who received zero or one seasonalflu vaccine in the past or who have never received H1N1 vaccine.

With school start comes illness season, so remember to schedule your children for their flu vaccines early this fall. Speak with your child’s health care provider about which form of flu vaccine is appropriate for him or her. Then schedule your own flu vaccine.

Remember the artwork from last year? The picture is a rendition of H1N1 from the perspective of a kindergartener. Note the large boogie to nose ratio. The red represents “boss germs” and the purple shows the “just plain mean ones.”

Ah-CHOO! Banish FLU!

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

Sept 16, 2010  a quick add- if your child actually had H1N1 last year (confirmed by a test) you can consider it the same as getting the H1N1 vaccine in the 2009 season (just building up immunity the hard way)


For all the kids who received separate seasonal and 2009 H1N1 (Swine flu) vaccines last year, there is good news from Kimberly Parnell, PhD, our favorite flu vaccine vigilant-scientist-mom (see the last H1N1 vaccine blog post). The World Health Organization, who meets on a yearly basis in February to decide on the strains for the upcoming fall’s “flu shot” has decided to roll the new/novel H1N1 into this year’s Northern Hemisphere vaccine. 

Winter flu season … it’s only nine months away !

For more detailed information: 

Naline Lai, MD

© 2010 Two Peds in a Pod



Art therapy allows children a means to express themselves when they are unable to articulate their feelings. Art not only serves as a mode of communication, but the process of creating art is healing.  Today’s guest blogger is Sarah Kutchta.  She hold a masters in art therapy from Albertus Magnus and a bachelors in fine arts from the University of Connecticutt and will soon be a LPC (Licensed Professional Counselor) as well. Sarah specializes in working with students with learning, mood, and autistic disorders. Ms. Kutchta gives us ways parents can communicate with their children through art:

Give children the space and permission to get messy. Put down painting plastic if cleanliness is an issue. Having the freedom to create whatever is needed can be very helpful for kids.

When discussing artwork with kids and adolescents, it is better to say “Tell me about your artwork,” than to ask “What is that?” Asking what something may imply that the child’s drawing is unclear or not good.

If a child or adolescent is having difficulty expressing emotions or has difficulty regulating emotions, it is better to have the child work with an art therapist than trying to work out the issue with the parents and art. The process of art creation can be very powerful emotionally and it is best to work with a professional who can provide a safe and supportive therapeutic environment.

Art therapists can be found by contacting the American Art Therapy Association,, or Pennsylvania’s Art Therapy Association, (Delaware’s is now based in Penn). Many are both LPCs and Art Therapists and accept insurance.

Sarah Kuchta, BFA, MAAT
Art Therapist
© 2010 Two Peds in a Pod

For families with young children, holiday time can be magical yet stressful. Often families travel great distances to be together and parties tend to run late. Fancy food and fancy dress are common.  And winter holidays, well, they occur in the winter, usually during flu season, stomach virus season, and in general multi-illness season. Here are some suggestions about how to keep your kids healthy and happy during this time.

We preface by referring you to suggestions # 1, 2, and 3 of Part 1of A Happy, Healthy Holiday. HANDWASHING, HANDWASHING, AND HANDWASHING will prevent spread of germs. In addition:

1.      Traveling 400 miles away from home to spend the week with close family and/or friends is not the time to solve your child’s chronic problems. Let’s say you have a child who is a poor sleeper and tries to climb into your bed every night at home and you have chronic fatigue from arguing with her/walking her back to bed. Knowing that even the best of sleepers will often have difficulty with sleeping in a new environment, just take your “bad sleeper” into your bed at bedtime and avoid your usual exhausing home routine of waking up every hour to walk her back into her room. That way everyone gets better sleep. Similarly, if you have a very picky eater, pack up her favorite portable meals and have them available during the fancy dinners. (But when you return home, please refer to our podcast and blog posts on helping your child to establish good sleep habits and on feeding picky eaters.) Good sleep and good nutrition keep children and their parents healthy and happy.


2.      Think of giving your children a wholesome, healthy meal at home before a holiday party which you know will be filled with junk food and food that may seem “foreign” to your children. Hunger fuels tantrums, so eliminate that meltdown source by taking them to the party with full bellies. Also you won’t feel guilty letting them have some of the sweets because they already ate a healthy meal.


3.      Speaking of sweets, ginger-bread house vomit is DISGUSTING.   Dr. Kardos found this out first-hand with one of her children after a holiday party where the hostess served the kids a beautiful (and generous sized) ginger bread house for dessert. While Dr. Kardos was engrossed in conversation with a long lost friend, one of her boys over-ate. Make sure you supervise what your child is eating at parties. 


4.      If you have a young baby, be careful not to put yourself in a situation where you lose control of your ability to protect the baby from germs.  Well-meaning family members love passing infants from person to person, smothering them with kisses along the way. Unfortunately, kisses can spread cold and flu germs, as well as stomach virus germs.


5.      On the flip side, there are some family events, such as having your 95-year-old grandfather meet your baby for the first time, that are once in a lifetime. While you should be cautious on behalf of your child, you can balance caution while looking at the whole context of a situation before deciding whether or not to attend a gathering.

6.      Once you have children, their needs come before yours. (Of course there is a healthy balance-but that is a talk for another day.) Although you have anticipated a holiday reunion, your child may be too young to remember it.  An ill, overtired child makes everyone miserable.  If your child has a cold, is tired, won’t use the unfamiliar bathroom, has eaten too many cookies and has a belly ache, and is in general crying, clingy, and miserable, just leave the party. You can console yourself that when your child is older his actions at that gathering may be the stuff of legends, or at least will make for a funny story. 


7.      For the allergic families- think twice before you drag in a live Christmas tree into your house.  The trees are often covered in dust and mud.  Washing the tree off with a hose in the driveway will keep the sneezing down to a minimum.  Every year Dr. Lai tells families about rinsing off the tree in the driveway. Most parents dismiss the idea as too time consuming.  However, she is pleased to report that a family recently told her they did rinse the tree and it did help keep the allergens at bay.


8.      No one else baby proofs.  Remember this when you are on the road. We worry less in our own homes.  But with their medication pills lying on the end tables and their menorah candles within a toddler’s reach, other people’s homes should make us more cautious.  One year at holiday time Dr. Lai’s family was in a hotel room and her six year old came running up saying “look what I found”…It was a pill of Viagra. 


We wish you all the best this holiday season.

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