Okay, admit it.


Before you became a parent, you never really gave much thought to poop.


Now you are captivated and can even discuss it over meal time: your child’s poop with its changing colors and consistency. Your vocabulary for poop has likely also changed as you are now parents. Before your baby’s birth, you probably used some grown-up word like “bowel movement” or “stool” or perhaps some “R” rated term not appropriate to this pediatric site. But now, all that has changed.


As a pediatrician I have many conversations with new parents, and some not-so-new parents, about poop. Mostly this topic is of real interest to parents with newborns, but poop issues come out at other milestones in a child’s life, namely starting solid foods and potty training. So I present to you the scoop on poop.


Poop comes in three basic colors that are all equal signs of normal health: brown, yellow, and green. Newborn poop, while typically yellow and mustard like, can occasionally come out in the two other colors, even if what goes in, namely breast milk or formula, stays the same. The color change is more a reflection of how long the milk takes to pass through the intestines and how much bile acid gets mixed in with the developing poop.


Bad colors of poop are: red (blood), white (complete absence of color), and tarry black. Only the first poop that babies pass on the first day of life, called meconium, is always tarry black and is normal. At any other time of life, black tarry stools are abnormal and are a sign of potential internal bleeding and should always be discussed with your child’s health care provider, as should blood in poop (also not normal) and white poop (which could indicate a liver problem).


Normal pooping behavior for a newborn can be grunting, turning red, crying, and generally appearing as if an explosion is about to occur. As long as what comes out after all this effort is a soft poop (and normal poop should always be soft), then this behavior is normal. Other babies poop effortlessly and this, too, is normal.


Besides its color, another topic of intense fascination to many parents is the frequency and consistency of poop. This aspect is often tied in with questions about diarrhea and constipation. Here is the scoop:


It is normal for newborns to poop during or after every feeding, although not all babies poop this often. This means that if your baby feeds 8-12 times a day, then she can have 8-12 poops a day. One reason that newborns are seen every few weeks in the pediatric office is to check that they are gaining weight normally: that calories taken in are enough for growth and are not just being pooped out. While normal poop can be very soft and mushy, diarrhea is watery and prevents normal weight gain.


After the first few weeks of life, a change in pooping frequency can occur. Some formula fed babies will continue their frequent pooping while others decrease to once a day or even once every 2-3 days. Some breastfed babies actually decrease their poop frequency to once a week! It turns out that breast milk can be very efficiently digested with little waste product. Again, as long as these babies are feeding well, not vomiting, acting well, have soft bellies rather than hard, distended bellies, and are growing normally, then you as parents can enjoy the less frequent diaper changes. Urine frequency should remain the same (at least 6 wet diapers every 24 hours, on average) and is a sign that your baby is adequately hydrated. Again, as long as what comes out in the end is soft, then your baby is not “constipated” but rather has “decreased poop frequency.”


True constipation is poop that is hard and comes out as either small hard pellets or a large hard poop mass. These poops are often painful to pass and can even cause small tears in the anus. You should discuss true constipation with your child’s health care provider. A typical remedy, assuming that everything else about your baby is normal, is adding a bit of prune or apple juice, generally ½ to 1 ounce, to the formula bottle once or twice daily. True constipation in general is more common in formula fed babies than breastfed babies.


Adding solid foods generally causes poop to become more firm or formed, but not always. It DOES always cause more odor and can also add color to poop. I still remember my husband’s and my surprise over our eldest’s first “sweet potato poop” as we asked each other, “Will you look at that? Isn’t this exactly how it looked when it went IN?” If constipation, again meaning hard poop that is painful to pass, occurs during solid food introductions, you can usually help by giving more prunes and oatmeal and less rice and bananas to help poop become softer and easier to pass.


Potty training can trigger constipation resulting from poop withholding. This poop withholding can result in backup of poop in the intestines which leads to pain and poor eating. Children withhold poop for one of three main reasons:


1.       They are afraid of the toilet or potty seat.


2.       They had one painful poop and they resolve never to repeat the experience by trying to never poop again.


3.       They are locked into a control issue with their parents. Recall the truism “You can lead a horse to water but you can’t make him drink.” This applies to potty training as well.


Treatment for this stool withholding is to QUIT potty training for at least a few weeks and to ADD as much stool softening foods and drinks as possible. Good-for-poop drinks and foods include prune juice, apple juice, pear juice, water, fiber-rich breads and cereals, beans, fresh fruits and vegetables. Sometimes, under the guidance of your child’s health care provider, medical stool softeners are needed until your child overcomes his fear of pooping and resolves his control issue. For more information about potty training I refer you to our podcast on this subject.


My goal with this blog post was to highlight some frequently asked-about poop topics and to reassure that most things come out okay in the end. And that’s the real scoop.


Julie Kardos, MD with Naline Lai, MD


©2009 Two Peds in a Pod®

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It is one week before the start of school and I watch as my daughter’s sixth grade teacher stabs an onion with a needle.  It’s a back to school ritual for my family.  Usually a piece of fruit is a proxy for my daughter’s thigh, and the needle contains epinephrine, a potentially life saving medication that my daughter would need if she were to eat a cashew. 



Two of my children are part of a growing number of people with food allergies.   According to the Food Allergy & Anaphylaxis Network, an estimated 11 million Americans have a food allergy.  Despite the numbers, the etiology of food allergies remains a mystery.  One of the most popular theories is that a child develops a sensitivity when the gut is exposed to a bit of the offending food during an unknown critical time in development–perhaps even in utero.  My son had an allergic reaction to peanuts at eight months of age without ever ingesting a peanut. He had been touched by an unwashed hand that had just handled peanuts.  To add to the confusion, experts wonder if there is a relationship between allergies and how food is processed.  In China, despite an abundance of peanut containing entrees, relatively few people are allergic to peanuts.  It is postulated that the smaller number is somehow connected to the fact that most peanuts are boiled not roasted.  Strangely, only eight categories of food:
milk, egg, soy, peanut, tree nut (i.e. cashews and pecans), fish, wheat and shellfish cause ninety percent of allergic reactions.



Reactions can range widely from a single, pesky, itchy welt to a choking off of all airway passages.  The type of suffocation that occurs can be impossible to ventilate, even with a respirator.  The medication  which can thwart allergic reactions, epinephrine, is available in a portable form.  Yet one study showed that even after medical evaluation, epinephrine was prescribed to only half of children and less than one quarter of adults with nut allergies.   More distressing, as a pediatrician, I find families fail to recognize the symptoms of respiratory distress and do not realize the urgency of the situation.  Even when respiratory symptoms are obvious, families are sometimes too panicked to think clearly.  I know of cases of parents who injected the medicine into their own fingers rather than into their child.

Unfortunately, even epinephrine can not always stop catastrophic consequences.  The only real treatment is avoidance.  This can be tough in a world where many confuse food allergies with a personal choice—like a person who chooses to be a vegetarian.  Adding to the confusion is the mistaken belief that food intolerance is synonymous with food allergy.  For instance, in milk intolerance, people have difficulty digesting the sugar in cow’s milk, whereas people with a milk allergy are reacting to the protein in cow’s milk. 



Watching an allergic person eat at a restaurant is like watching a person eat Japanese puffer fish- every bite could be lethal.  It took only one cashew to cause my daughter to break out in hives, vomit and experience a tightening of her throat.  During my first two weeks of college, I remember a  freshman at my college dying  because of peanut butter hidden as “the special thickening ingredient” in a restaurant’s chili.  Perils are everywhere.  A milk allergic person worries if a meat slicer has been previously used for cheese, the fish allergic individual needs to worry about Worcestershire sauce because it often contains anchovies and the egg allergic person needs to be suspicious of  foamy toppings on specialty drinks.   In my pediatric practice, one of my patients, a peanut-allergic girl, started wheezing simply because the child next to her in the car opened up a bag of peanut butter filled snacks.



Despite the sometimes small amount of an allergen required to set off an allergic reaction, one study showed that at least the major allergen in peanuts is relatively easy to clean from hands with simple soap and water.  Common household cleaning products remove the allergen from counter and table tops.  But kids, especially toddlers, are not known for their meticulous sanitation practices.  Schools and daycares often find keeping an entire classroom free of an offensive food easier than keeping kids from touching each other.



So when that letter comes home this fall identifying someone in your child’s class with a food allergy, don’t moan and groan.  Abstain from sending in potentially allergenic foods with your child.  Imagine sending your children to school knowing that a well meaning friend might try to share a deadly snack.  Like the millions of allergic Americans, your picky eater could learn to modify his or her diet.  Our family went from eating daily peanut butter and jelly sandwiches to becoming a nut free home.  What is an inconvenience to you may save a kid’s life.


 


 


Naline Lai, MD


 



For more info:
Food Allergy, Asthma and Anaphylaxis Network
www.foodallergy.org



 an online  resource and discussion group 



References:

Distribution of Peanut Allergen in the Environment


Perry TT et al.  J Allergy and Clinical Immunology.  2004;113:973-976


 


Prevalence of Peanut and Tree Nut allergy In the United States Determined By Means of A Random Digit Dial Telephone Survey: A 5 Year Follow-Up Study


Sicherer S. et al. Journal of Clinical Immunology 2003;112:203-1207

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With school starting in the next few weeks, many families will have to shift their children from “summer time sleep mode” to “school year sleep mode.” Your children will have an easier time if their bedtimes are shifted gradually over the period of a week or two toward the desired time period. Remember, the average school aged child needs 10-11 hours of sleep at night and even teenagers function optimally with at least 9-10 hours of slumber per night.


Here are some straight forward rules to follow to help ensure good quality sleep for your child:


1)      Keep sleep onset and wake up times as consistent as possible 7 days a week. If you allow your child to “sleep in” during the weekends, she will have difficulty falling asleep earlier on Sunday night, have difficulty waking up Monday morning, and start off her week over-tired, more cranky and less able to process new information—not good for learning.


2)      Limit or eliminate caffeine intake. Often teens who feel too sleepy from failing to follow rule number 1 from above may drink tea, coffee, “energy drinks” or other caffeine laden beverage in attempt to self-medicate in order to concentrate better. What many people don’t realize is that caffeine stays in your body for 24 hours so it is entirely possible that the caffeine ingested in the morning can be the reason your child can’t fall asleep later that night. Caffeine also has side effects of jitteriness, heart palpitations, increased blood pressure, and gastro-esophageal reflux (heartburn).


3)      Keep a good bedtime routine. Just as a soothing, predictable bedtime ritual can help babies and toddlers settle down for the night, so too can a bedtime routine help prepare the school aged child/teen for sleep.


4)      Avoid TV/computer/ screen time just before bed. Although your child may claim the contrary, watching TV is known to delay sleep onset. We highly recommend no TV in a child’s bedroom, and suggest that parents confiscate all cell phones and electronic toys, which kids may otherwise hide and use without parent knowledge, by one hour prior to bedtime. Quiet activities such as reading for pleasure, listening to music, and taking a bath, are all known to promote falling asleep.


5)      Encourage regular exercise. Kids who exercise daily have an easier time falling asleep at night than kids who don’t exercise. Gym class counts. So does playing outside, dancing, walking, and taking a bike ride. Of course, participating in a team sport with daily practices not only helps insure better sleep but also promotes social well being.


Getting enough sleep is important for your child’s academic success as well as for their mental health. I have had parents ask me about evaluating their child for ADD or ADHD because of his inability to pay attention and then come to find out that their youngster fights bedtime and averages 7-8 hours of sleep per night when he really need 1-2 hours more, or their teen is so over-involved in activities that she averages 6 hours of sleep per night. Increasing the amount of sleep these kids get can alleviate their attention problems and resolve their hyperactivity. Additionally, sleep deprivation can cause symptoms of depression. Just recall the first few weeks of having a newborn:  maybe you didn’t think you were depressed but didn’t you cry from sheer exhaustion at least once?


Unfortunately for children, the older they get, their natural circadian rhythm shifts them toward the “night owl” mode of staying up later and sleeping later, and yet the higher up years in school start earlier so that teens in high school start school earliest at a time their bodies crave “sleeping in.” A few school districts in the country have experimented with starting high school later and Grade School earlier and have met with good success with less tired, more productive teens. Unless you live in one of these districts, however, your teens need to conform until they either go to college and can choose classes that start later in the day or choose a job that allows them to stay up later and sleep later in the day in order to be better in sync with their age specific body rhythms.


Some children seem to get plenty of sleep at night and are still tired during the day. Some medical conditions that interfere with sleep quality include but are not limited to:



  • Asthma: kids cough themselves awake multiple times during the night
  • Obstructive sleep apnea: children often are obese or have enlarged tonsils and adenoids or have anatomically “floppy” airways. These kids snore and pause their breathing, then rouse themselves in order to start breathing again, multiple times per night.
  • Medication side effects
  • Psychological conditions such as depression or anxiety
  • Illicit drug use

If your child seems to be sleeping enough but still seems excessively tired during and after school, you should consult with your child’s health care professional to look for medical and psychological causes of fatigue. It is always ok to ask your child/teen directly if they feel depressed or anxious. Even if they deny this, they will appreciate your concern and may come back to you later with a more truthful answer.  A night time ritual of “tell me about your day” can help kids decompress, help them fall asleep, and keep you connected with your child.


Julie Kardos, MD

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It’s that time of year again, supply #3 on my back-to-school shopping list, glue sticks, are sold out at the Target down the street.  At this time of year, I see many of my patients embarking on their next stage of schooling.  Kids I remember starting kindergarten are off to high school.  Babies are starting daycare and the teens are starting college.  With all of these transitions to independence, the basic rules of daycare drop off still hold:



  • Always convey to your child that the transition is a positive experience.  You give your child cues on how to act in any situation.  Better to convey optimism than anxiety. 
  • Take your child and place her into the arms of a loving adult- do not leave her alone in the middle of a room.
  • Do not linger.  Prolonging any tears, only prolongs tears. The faster you leave, the faster happiness will start.
  • It’s ok to go back and spy on them to reassure yourself that they have stopped crying- just don’t let them see you.

Now with that all being said, kick back late at night, after all the school forms have been put away.  Whether your child is off to college, off to daycare or off to kindergarten, take out a glass of wine and listen to the letter I wrote for one of my own children years ago…


My Child,


As we sit, the night before kindergarten, your toes peeking out from under the comforter, I notice that your toes are not so little anymore. 


Tomorrow those toes will step up onto to the bus and carry you away from me.   Another step towards independence.   Another step to a place where I can protect you less.  But I do notice that those toes have feet and legs which are getting stronger.   You’re not as wobbly as you used to be.  Each time you take a step you seem to go farther and farther. 


I  trust that you will remember what I’ve taught you.  Look both ways before you cross the street, chose friends who are nice to you, and whatever happens don’t eat yellow snow.   I also trust that there are other eyes and hearts who will watch and guide you. 


But that won’t stop me from worrying about each step you take. 


Won’t stop me from holding my breath­. 


Just like when you first started to walk, I’ll always worry when you falter. 


I smile because I know you’ll hop up onto the bus tomorrow, proud as punch, laughing and disappearing in a sea of waving hands.  I just hope that at some point, those independent feet will proudly walk back and stand beside me.   


Maybe it will be when you first gaze into your newborn’s eyes, or maybe it will be when your child climbs onto the bus. 


Until then,


I hold my breath each time you take a step.


Love,
Mommy


Naline Lai, MD

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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 and 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, often forgoing 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 child check I asked about my patient’s birthday party and her parent 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.


Julie Kardos, MD

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Ouch! Stung on the scalp.


Ouch! Stung on the hand.


Ouch! Stung on the leg.


Ouch! Ouch! Stung TWICE on the lips.


Those nasty, nasty hornets.  During the hot days of August, they become more and more territorial and attack anything near their nests.  Today, in my yard, hornets mercilessly chased and attacked a fourth grader named Dan.  As everyone knows, you’d rather have something happen to yourself than have something negative happen to a child who is under “your watch.” As I rolled out the Slip and Slide, I was relieved not to see any wasps hovering above nests buried in the lawn.  I was also falsely reassured by the fact that our lawn had been recently mowed.  I reasoned that anything lurking would have already attacked a lawn mower.  Unfortunately, I failed to see the basketball sized grey wasp nest dangling insidiously above our heads in a tree.  So, when a wayward ball shook the tree, the hornets found Dan.


What will you do in the same  situation?


Assess the airway- signs of impending airway compromise include hoarseness, wheezing (whistle like sounds on inhalation or expiration), difficulty swallowing, and inability to talk.  Ask if the child feels swelling, itchiness or burning (like hot peppers) in his or her mouth/throat.  Watch for labored breathing.  If you see the child’s ribs jut out with each breath, the child is struggling to pull air into his/her body.    If you have Epinephrine (Epi-Pen or Twin Jet)  inject  immediately- if you have to, you can inject  through clothing.  Call 911 immediately. 


Calm the panic- being chased by a hornet is frightening and the child is more agitated  over the disruption to his/her sense of security than over the pain of the sting.  Use pain control /self calming techniques such as having the child breath slowly in through the nose and out through the mouth.  Distract the child by having them “squeeze out” the pain out by squeezing your hand.


If the child was stung by a honey bee, if seen, scrape the stinger out with your fingernail or a credit card.  Do not squeeze or pull with tweezers to avoid injecting any remaining venom into the site.   Hornets, and other kinds of wasps, do not leave their stingers behind.  Hence the reason they can sting multiple times.


Relieve pain by administering Ibuprofen (Motrin,Advil) or Acetaminophen (Tylenol).


As  you would with any break in the skin, to prevent infection, wash the affected areas with mild soap and water.


Decrease the swelling.  Histamine produces redness, swelling and itch.  Counter any histamine release with an antihistamine such as Diphenhydramine (Benadryl).  Any antihistamine will be helpful, but generally the older ones like Diphenhydramine, tend to work the best in these instances.  Unfortunately, sleepiness is common side effect.


To decrease overall swelling elevate the affected area.


A topical steroid like hydrocortisone 1% will also help the itch and counter some of the swelling. 


And don’t forget, ice, ice and more ice.  Fifteen minutes of indirect ice on and fifteen minutes off.


Even if the child’s airway is okay, if the child is particularly swollen, or has numerous bites, a pediatrician may elect to add oral steroids to the child’s treatment


It is almost midnight as I write this blog post.  Now that I know all of my kids are safely tucked in their beds, and I know that Dan is fine, I turn my mind to one final matter:  Hornets beware – I know that at night you return to your nest.  My husband is going outside now with a can of insecticide.   Never, never mess with the mother bear…at least on my watch.


Naline Lai, MD

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Recently I received a phone call from a mom whose six-year-old son was afraid to go to sleep at night. For the past two months the child insisted on falling asleep in the parents’ room while holding one parent’s hand, and if the parent carried him to his room after he finally fell asleep, he would wake up every few hours to return to their room. No one was getting good sleep. In addition, his mom was concerned that he often seemed angry during the day.


Turns out that two months ago the boy’s grandfather died. The boy and his toddler-aged sister had attended the grandfather’s funeral and at the viewing his younger sister, upon seeing her dead grandfather in the coffin, kept saying, “Grandpa, wake up, you are missing your party! Why can’t Grandpa wake up?”


When children are confronted with the death of a family member, friend, or pet, it is very important to never refer to death as “sleeping. Children are very literal and so it is better to say something like, “When people are dead, their bodies do not work, they do not breathe or move,” but do NOT use any sleep analogy. This can cause them to be afraid to fall asleep and not be able to wake up.


This child’s mom was concerned that her son “seemed angry a lot of the time” and was difficult to get along with. This behavior change is very normal and was occurring for two reasons:


1)   When children feel sad, they often appear angry. The child is still mourning the loss of his grandfather. In addition, his parents also are grieving and children perceive their parents’ moods. The child misses his grandfather and it is normal for him to feel sad about this. Children often express sadness with anger, so the parents need to be sensitive to this.


2)   When children are sleep deprived, they become short tempered. This child was staying up until midnight or later before falling asleep in the parents’ room, waking up in the middle of the night, and waking up at 7:00 am for school. School aged children need on average about 9-10 hours of sleep or more to function optimally.


I advised the mom to have a casual conversation during the daytime about death. She could start by saying something like, “You know, I was thinking about Grandpa’s funeral. Remember how your sister kept saying “wake up, grandpa?” I wanted to make sure that you knew that Grandpa was not asleep. He was dead and his body wasn’t working anymore.” Then wait and see if he asked any more questions. If he asked why he died, the parent should give a simple but truthful answer. In this case, Grandpa had cancer, so parents could say, “he had an illness that his body was too old and weak to fight off.” It is also fine for the parent to say, “I am sad because I miss Grandpa.” Again, answer questions if they come up but be very concrete and simple in your answer. If the child says, “What if I get sick? Will I die?” the parent could answer, “No, you are young and strong.”


The other important part of helping this child is getting back to good sleep habits. (I refer you to our forthcoming podcasts on sleep for baseline good bedtime habits.) This child may have been afraid of dying in his sleep or just may have developed a bad association with sleep. He clearly associated his parents with safety. I recommended that a parent sit on his bed in his room until he fell asleep. The bedtime would be moved about 15 minutes earlier each night until they arrived at a more appropriate bedtime. They were to tell the child that they would not leave until he fell asleep. If he awoke during the night and came into their room or called out for his parents, one of them was to sit on his bed again until he fell asleep. The parent was not to talk or interact during this time of falling asleep. The goal was to create a positive, safe association with falling asleep.


After a few days of the child falling asleep within about 15 minutes of sitting on his bed, tell him that the new rule is that one parent would sit NEXT to his bed until he falls asleep. Keep repeating this and wean farther away every few days (ie sit in the middle of his room, sit in the doorway, etc) until he is able to fall asleep on his own. Remember to give lots of praise the next day, small tangible rewards are okay for each accomplishment. 


By acknowledging his grief and also by using behavior changes to help restore good sleep at night, this child’s daytime anger gradually resolved.


Julie Kardos, MD

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When it comes to our children, we want the best that money can buy. However, in these difficult economic times, I want to offer some suggestions from the medical perspective that can save you money without compromising your child’s health or safety.


Don’t buy “Sippy cups.” Just teach your child to drink out of regular open cups. Sippy cups are for parents who don’t like mess-they are not a required developmental stage.  They are actually bad for teeth when they contain juice or milk and they do not aid in child development.


 


Buy generic acetaminophen (brand name = Tylenol), ibuprofen (brand name = Motrin, Advil), diphenhydramine (brand name = Benadryl), allergy medication (brand names Claritin, Zyrtec). If your child’s health care provider prescribes antibiotic such as amoxicillin (for ear infection, Strep throat, sinusitis), ask the pharmacist how much it costs because usually the cost of paying for this commonly prescribed antibiotic out-of-pocket is less than your insurance copay.


 


Accept hand-me-down clothes, shoes, etc. The purpose of shoes is to protect feet. Contrary to what the shoe sales-people tell you, cheap shoes or already-worn shoes will protect feet just as well as expensive, new ones. Just make sure they fit correctly.


 


Don’t buy “sleep positioners” for the crib. Place your newborn to sleep on his back and he will not/cannot roll over. If you need to elevate your baby’s upper body to prevent spit up or to provide comfort from gas, don’t buy a “wedge” but instead put a book under each of the 2 crib legs so the entire crib is elevated. Wedges and positioners are NOT shown to prevent SIDS (Sudden Infant Death Syndrome) and are NOT endorsed by the American Academy of Pediatrics.


 


Make your own baby food and do NOT buy “baby junk food” such as “Puffs” for finger food practice. Instead buy “toasted oats” (brand name = Cheerios) which are low in sugar, contain iron, and are much less expensive. “Stage 3” foods in jars are finger foods so just give your kids what you are serving the rest of the family cut into small bite-sized pieces instead of buying the expensive jars. One exception: do buy the baby cereals (rice, oatmeal, or barley) because they contain more iron than regular oatmeal and babies need the extra iron for their growth.


 


The best toys are ones that can be reconfigured and used again and again. Legos, blocks, crayons/markers/chalk, small cars, dolls, balls come to mind. Avoid one-time only assembly type items, breakables, etc. Have a “toy recycle” party or a pre-Halloween costume recycle party: everyone brings an old costume/toy they would like to trade and everyone leaves with a “new” item (kids don’t care if things are brand new or not, only if you teach them to care will they care). Along these same lines, inexpensive paint can turn a pink “girl’s bike” into her younger brother’s blue “boy bike.”


 


Borrow books from libraries instead of buying them in stores or look for previously owned ones at yard sales, thrift shops, etc.


 


Do not buy endless videos for your child. First of all, despite claims made on the packages, NO video has been shown to advance baby/toddler/child intelligence. In fact, almost all studies show that the more screen time a child logs in, the worse they fare in their language and intellectual development. Also there is some evidence that TV/video viewing in babies can be detrimental to their brain development. Now, as a pediatrician mom, I am not saying that I never sat down and watched Sesame Street with my children (I am a product of the “Sesame Street Generation,” after all). I’m just saying that I recommend using moderation and taking advantage of free offerings on public television instead of spending money on videos. Many libraries also offer free lending of videos if you and your child want occasional “down time” in front of the screen.

Julie Kardos, MD

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poisonivyRecently we’ve had a parade of itchy children troop through our office.  The culprit: poison ivy.

Myth buster: Fortunately, poison ivy is NOT contagious. You can catch poison ivy ONLY from the plant, not from another person.

Also, contrary to popular belief, you can not spread poison ivy on yourself through scratching.  However, where  the poison (oil) has touched  your skin, your skin can show a delayed reaction- sometimes up to two weeks later.  Different  areas of skin can react at different times, thus giving the illusion of a spreading rash.

Some home remedies for the itch :

  • Hopping into the shower and rinsing off within fifteen minutes of exposure can curtail the reaction.  Warning, a bath immediately after exposure may cause the oils to simply swirl around the bathtub and touch new places on your child.
  • Hydrocortisone 1%.  This is a mild topical steroid which decreases inflammation.  I suggest the ointment- more staying power and unlike the cream will not sting on open areas, use up to four times a day
  • Calamine lotion – a.k.a. the pink stuff. this is an active ingredient in many of the combination creams.  Apply as many times as you like.
  • Diphenhydramine (brand name Benadryl)- take orally up to every six hours. If this makes your child too sleepy, once a day Cetirizine (brand name Zyrtec) also has very good anti itch properties.
  • Oatmeal baths – Crush oatmeal, place in old hosiery, tie it off and float in the bathtub- this will prevent oat meal from clogging up your bath tub.
  • Do not use alcohol or bleach- these items will irritate the rash more than help

The biggest worry with poison ivy rashes is not the itch, but the chance of super-infection.  With each scratch, your child is possibly introducing  infection into an open wound.  Unfortunately, it is sometimes difficult to tell the difference between an allergic reaction to poison ivy and an infection.  Both are red, both can be warm, both can be swollen.  However, a hallmark of infection is tenderness- if there is pain associated with a poison ivy rash, think infection.  A hallmark of an allergic reaction is itchiness- if there is itchiness associated with a rash, think allergic reaction.  Because it usually takes time for an infection to “settle in,” an infection will not occur immediately after an exposure.  Infection usually occurs on the 2nd or 3rd days.  If you have any concerns take your child to her doctor.

Generally, any poison ivy rash which is in the area of the eye or genitals (difficult to apply topical remedies), appears infected, or is just plain making your child miserable needs medical attention.

When all else fails, comfort yourself with this statistic: up to 85% of people are allergic to poison ivy.  If misery loves company, your child certainly has company.

Naline Lai, MD and Julie Kardos, MD

2012 Two Peds in a Pod®

photo updated 6/03/12

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