My husband and I finally saw the Star Trek movie the other night, and as I write our first blog entry for Two Peds in a Pod I feel like I am aboard the USS Enterprise taking off from the space station for the first time, to “explore all aspects of child care, to boldly go where this pediatrician has never gone before,” namely, cyberspace. 

After all, I spend my work days in my pediatric office seeing patients and interacting with parents directly. The internet was born while I was in medical school and because I was so busy studying, then working and raising a family, cyberspace remains mostly foreign territory to me. However, I realize that the huge majority of my patients’ families turn to the internet for all sorts of information, including medical advice.  Unfortunately, medical advice in cyberspace is often shady, inaccurate, or incomplete.

Dr. Lai and I hope to give you easily accessible, accurate pediatric information in the form of podcasts for those who are auditory learners and blogs for those who prefer written material.

We will address the everyday questions that we hear from parents in our practices and we welcome your suggestions. Please email us at to suggest future blog and podcast content. We promise to keep our podcasts and blog entries brief so we can give you maximum information with your time constraints in mind.

Thank you for being a part of our maiden voyage.

Julie Kardos, MD


eight year old development

Photo by Lexi Logan

Happy 8th Birthday Two Peds in a Pod!

If our blog had a “face” we would put a party hat on a smiling head with disproportionately large emerging adult teeth and a body with gangly legs and arms.  In honor of our blog’s eighth birthday  (read our very first post here) today’s post celebrates your eight-year-old.

Typical eight-year-olds are no longer squishy-faced babies and no longer adoring young elementary school students who still think of their parents as heroes. Now you have an emerging friend-seeking, active child.

Eight-year-olds understand logic and are less apt to believe in “real” magic but are interested in spotting the “trick.” Parents may find that eight is the year that their child stops believing in Santa or the tooth fairy. If they do believe in Santa, expect them to question how Santa reaches all the children in one night, or how he can fit down a chimney.

This is an academic leap year. There is less hand holding in school. The switch-over from “learning how to read” to “reading in order to learn”  begins. Instead of rote memorization of individual words, reading comprehension increases and children now gain knowledge from books. Some eight-year-olds may prefer to read to themselves before bedtime because they can read to themselves faster than you can read to them. Even if they are reading on their own, continue to share books together at bedtime.  For many kids, this is the age when they begin to struggle academically if they have a previously unrecognized learning disability.

Eight-year-olds begin to notice kids who stand out, especially kids who act or look different from the other kids, and can be cruel with their observations and exclusions. Teach your child about differences and the importance of tolerance. As Dr. Lai tells her kids, “You don’t have to be friends with everyone, you just have to be nice.”

The long march through adolescence starts now. Some girls start to show the initial  sign of puberty called breast-budding (chest development). Teach your daughters about periods at this age because some girls begin to menstruate in the next couple of years, and girls who are caught unawares can become quite frightened by unexpected blood coming out of them. You can refresh your memories and check your facts about periods from our prior post on this subject.

Many eight-year-olds, even those who seem years away from puberty, become stinky. Trust us, you will notice, and so will others, so encourage them to wash their entire body, INCLUDING ARMPITS, every day WITH SOAP and to use deodorant daily. We do not have a favorite brand but you could look initially for a deodorant alone rather a deodorant/antiperspirant combination product as they may irritate young skin. Note that even though they may smell like adults, their brains are only eight years old, so you will have to remind your eight-year-olds to use the deodorant. One trick is to keep the deodorant next to the toothbrush so when they brush their teeth every morning, they will remember to incorporate deodorant into their morning routine.

Other self-care tasks also will need reminders. After years of tracking your child’s pee and poop pattern, you now probably don’t know when the last time your child moved her bowels. No need to follow your child into the bathroom, but every once in a while ask about their bowel and bladder habits. During the school year, be aware that eight-year-olds may avoid school bathrooms and don’t urinate all day, which can lead to problems with leaking urine (accidents) and urinary tract infections.

Eight-year-olds continue to  improve their concentration spans and have a greater interest in learning new skills. For many, this is the age of active sport participation (playing “real” sports games), the start of learning a musical instrument or foreign language, and club participation such as 4H or scouts. Some eight-year-olds begin to spend many hours a week in a chosen activity such as gymnastics (however, please note that the American Academy of Pediatrics recommends against home trampolines for all kids). Eight years is when they can handle the toys and art equipment that are labeled “for eight and above.” You will be impressed at the attention to detail that an eight-year-old can display in art projects.

Children this age often prefer to spend time with a friend rather than a younger sibling or parents. It is fun and also good for self-esteem for your child to host a friend at your home and to spend time with friends at their homes. While eight-year-olds are fully capable of entertaining themselves, they still require adult supervision, even if that supervision is from another room or floor of the house. Eight-year-olds do not yet need their own phones: an adult should always be present in case trouble arises. However, it is appropriate to teach your eight-year-old to use a phone and to arrange a get-together or a car pool after first checking with parents. Screen-addiction (to television, computers, and hand-held devices) starts early; set screen time rules now so that you won’t be frustrated later.

Speaking of self-reliance, by all means teach your eight-year-old to cook a simple meal, use the microwave and toaster oven, set and clear the table, do dishes, load and unload a dishwasher and washing machine, and take out the trash. Again, parents should supervise, but the goal is to create an independent adult. Eight-year-old egos enjoy a good boost when you acknowledge their increased sense of responsibility and contributions to running the household.

Last tip: if you are driving your child and an eight-year-old friend, be sure to have enough booster seats in the car for everyone (US law requires booster seats through age 8 years-see our post on car safety).

Yes, eight is great, and Two Peds is thrilled to celebrate this birthday.  Your eight-year-old celebrates this birthday smack dab in the middle of the “golden years” of parenting. During these years, they are too young to drive and too old to take a nap. The typical blog lasts less than 6 months, so keep us going by reading, sharing, sending us your post ideas, and inviting us to speak ( Our information is only good if others read it and share it! Please “follow” us on Facebook, tweet about us, email subscribe, and continue to get the word out. Pediatric colleagues: we welcome guest bloggers, so if you have something to share that we haven’t already said, please contribute.

Julie Kardos, MD and Naline Lai, MD
Ⓒ2017 Two Peds in a PodⓇ



Caroll Spinney a.k.a. Bird BIrd and Oscar the Grouch addresses the American Academy of Pediatrics National Conference in 2011 (Dr. Lai’s iPhone 3 or 4 captured this “high” quality photo)

Today, as Two Peds in a Pod turns six years old, we think about our favorite six-year-old, Big Bird.

A friend sent me this link to an interview with Caroll Spinney on NPR. Now 81 years old, Caroll Spinney has played Big Bird on Sesame Street since the show first aired in 1969. According to the puppeteer, Big Bird has always been six years old.

Spinney wanted Big Bird to forever bubble over with the curiousity and enthusiasm for  learning which characterize a six year old’s development. In kindergarten or first grade, a six-year-old rapidly gains new skills. They learn how to read at this age if not earlier.

They like to belong to a group and feel included. Sit in the back of a first grade classroom and listen to the class have a conversation. The teacher may ask the kids, “Who has ever been to the ocean?” and watch all the hands go up. As she calls on each child to tell his story about going to the beach, some kids tell about their beach vacations, some talk about which relative or friend they visited at the beach, and at least one six-year-old will say “I never saw the ocean, but I have a dog!” because they want so desperately to belong to the conversation.

As part of their interest in others, they will join sports teams, scouts, begin religious school or specialized language schools. Although they may seem interested in everything, be careful not to over schedule. This might be the first year of “all day” school, and even a child who attended an all day childcare or kindergarten can tire out after a full day of learning. Also, as part of their interest in group participation, children may start to form “clubs” as they play. To ward off future bullying, teach your child ,” You can’t be friends with everyone. You just have to be nice.”

Six-year-olds still have a great sense of wonder and imagination. They believe in Santa Claus and the Tooth Fairy. They also are interested in science and nature, planets and dinosaurs, and how things work. They can simultaneously believe in the very real and concrete and believe in magic.

Six-year-olds ask “Why?” and they are not shy about it: Why do I have to go to bed? Why does that man have only one leg? Why do helium balloons float? Why do people die?

Sometimes the “Why’s” can lead into  whining, but luckily, six-year-olds can be easily distracted out of their perceived injustices.

Kids at this age tend to concern themselves with body integrity and may cry over a relatively minor injury such as a paper cut or skinned knee. If you want attention from a room full of six-year-olds, put a Band-Aid on your arm and they will all ask, ” Why do you have a Band-Aid?”

We are excited that Two Peds in a Pod® turns six today. Like Big Bird, we hope to forever ask “Why,” as well as “How?” and “When?”  May your children continue to inspire a sense of wonder and curiosity in your lives, whether they are six months, six years, sixteen, or sixty!

Julie Kardos, MD and Naline Lai, MD

©2015 Two Peds in a Pod®

Click here to read our very first post from six years ago.



Naline Lai Julie Kardos

Drs. Lai and Kardos celebrate Two Peds in a Pod’s sixth birthday


We are two board certified primary care pediatricians and parents like you.

Naline Lai, MD FAAP earned her undergraduate degree at Brown University. She graduated from University of Pittsburgh School of Medicine in 1994 where she received the John R. Reinhart MD award for excellence in pediatrics and child psychiatry and the Sheehan/Laird Memorial Prize awarded in recognition of compassion and respect in patient interactions.

Julie Kardos, MD FAAP  earned her undergraduate degree at Duke University. She graduated from Case Western Reserve University School of Medicine in 1994 where she received the Pediatric Award for her “excellence and compassion in caring for children and their families.” She was named one of Philadelphia Magazine’s Top Doctors for 2018.

Drs. Kardos and Lai met each other during their pediatric residency training at The Children’s Hospital of Philadelphia. Both are married and each has three children. In practice for over 20 years, they are board certified pediatricians at The Children’s Hospital of Philadelphia Care Network-Newtown in Bucks County, PA. The doctors are also on staff at St Mary Medical Center in Bucks County, Pennsylvania. In addition Dr. Lai is a community affiliate at Doylestown Hospital. Pediatric advocates, Dr. Kardos is a co-leader for the Newtown practice and Dr. Lai serves on the board of directors for CB Cares Educational Foundation, the founding board of the Bucks County Children’s Museum, and the advisory board of Child Home and Community. You can find the pediatric visual diagnosis book for which she served as an associate editor here

As both practicing primary care pediatricians and as moms, we understand that a lot goes on between yearly check-ups with your child’s doctor. Parents often have questions about their children outside of office visits and turn to the internet for answers. This blog was born out of a desire to provide answers that are accurate, easy to understand, concise, and reassuring.

Credits include speaking on National Public Radio’s Here and Now with Robin Young (we’re about 2/3’s of the way through the show)

on local cable television, and at venues ranging from living rooms to libraries to children’s museums to convention centers, addressing concerns of parents and teachers as well as fellow physicians. Two Peds in a Pod® is listed as one of the “5 Pediatric Healthcare Blogs You Should Read” by Aha Media Group and their blog posts have appeared on numerous sites including and Recently we joined the advisory board of Happy Healthy Kids.

Please comment and send ideas for future topics to

We launched the blog in July, 2009, and it’s been a joy to have your family along on this internet journey around the world. Help our outreach to continue by letting other parents know about our site.

Thanks for finding us.

Drs. Lai and Kardos

“Practical Pediatrics for Parents on the Go”

Two Peds in a Pod is a Parents best of the web! May 2016

web award


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!

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