Today, our esteemed guest pediatric physical therapist Deborah Stack helps us with therapy for twisted ankles. Dr. Stack has been a physical therapist for over 15 years and heads The Pediatric Therapy Center of Bucks County in Pennsylvania. She holds both masters and doctoral degrees in physical therapy from Thomas Jefferson University.


As I watched my ten-year-old play basketball today, my first question was “Will my child might finally get the ball into the basket?” My second question was, “Will all the kids make it through the game without spraining an ankle?

Kids are playing competitive sports at younger and younger ages and children are suffering sports injuries earlier as well. Acute ankle trauma is responsible for 10 to 30 percent of sports-related injuries in young athletes.1With all the rapid starts, stops, and turns on the basketball court some injury is inevitable.  But what is an ankle sprain?  What can you do to help your child from joining the crutches crew?  What do kids need to do to get back to full play after an injury?

A sprain is stretching and or tearing of ligaments that connect bones to one another.  Sprains are graded from one to three with one being the mildest and three being the most severe.  In a grade one sprain the ligament simply is overstretched.  Grade two sprains involve partial tearing of the ligaments and grade three feature a complete tear.

The most common ankle sprain is an inversion sprain where the ankle turns over so the sole of the foot faces inward and damages the ligaments on the outside of the ankle. In younger children, the ligaments tend to be stronger than their bones,so growth plate fractures occur instead of sprains.  Therefore, if a child refuses to walk on his leg or seems to be in excessive pain, you should have your pediatrician rule out a fracture.

To help avoid injury, make sure those sneakers are in good condition. Pull laces snug and tie them securely. High top sneakers are recommended for basketball for added protection.  Physically three things are needed for a healthy ankle: range of motion, muscular control, and proprioception.  Proprioception is the information that comes from your joints and muscles to your brain and lets your brain know what position the ankle is in.

My child turned his ankle.  Now what do I do? Remember the acronym RICE: rest, ice, compression, elevation.  Rest means to stay off the ankle.  For more severe sprains this may mean using crutches for a few days.  Ice should be applied (over a thin towel to protect skin) immediately and then for up to 20 minutes every few hours until swelling is minimal.  Compression refers to wrapping an elastic bandage over the area. When you use a bandage, it is important to make sure the bandage is not too tight and that any bandage is wrapped at an angle, not straight around the leg, to prevent circulatory problems. The ankle should also be elevated above the level of the heart several times a day while swelling is still present.  Recline on the couch while putting ice on for 20 minutes.

How does your future Olympian get back into the game?  Range of motion exercises can begin as soon as they can be done without pain, preferably in 48-72 hours.  Ankle circles and alphabet letters (below) are two good exercises. These should then be followed by isometric (muscle contraction without movement) and isotonic strengthening exercises (toe and heel raises, see below) such as the ankle heals.  Finally, rehab is not complete until the child works to regain proprioception on balance boards, compliant foam etc.  One low-tech option is to stand on a firm pillow while watching television.  For a bit more excitement, try some Wii balance board games.  Remember, full ligaments strength does not return until months after an ankle sprain.Without full rehabilitation, the ankle is prone to reinjury.

So tell your child to play, but play smart.  An ankle sprain is a real injury and needs proper attention before your child returns to the court.


Ankle circles3

Sit on the floor with your legs stretched out in front of you. Move your ankle from side to side, up and down and around in circles. Do five to ten circles in each direction at least three times per day.

Alphabet Letters3

Using your big toe as a “pencil,” try to write the letters of the alphabet in the air. Do the entire alphabet two or three times per day.

Toe Raises4

Pull your toes back toward you while keeping your knee as straight as you can. Hold for 15 seconds. Do this ten times at least three times per day.

Heel Raises4

Point your toes away from you while keeping your knee as straight as you can.Hold for 15 seconds. Do this ten times at least three times per day. 

1. Perelman M, Leveille  D, DeLeonibus  J, Hartman  R, Klein  J,Handelman  R, et al.  Inversion lateral ankle trauma: differential diagnosis, review of the literature, and prospective study.  J Foot Surg. 1987;26:95–135.

2. Wolfe MW, Uhi T, McCluskey, L.Management of Ankle Sprains. Am Fam Physician 2001;63:93–104.




     Deborah Stack, PT, DPT, PCS

© 2010 Two Peds in a Pod


The newest trend in kidville- trading rubber bands in various shapes. The kids wear the bands like bracelets and strut around with the colorful bands jutting out in all directions from their arms and wrists. The elementary school crowd is fascinated by them.  Teachers, who find them a distraction, are not as enamored. Somewhere there is one teacher today who is particularly appalled. During a check up, a nine year old told me today that a classmate was sent to the nurse’s office- the reason? The bands were on so tight that they were cutting off circulation to the classmate’s arm. 

Always something. 

Naline Lai, MD
© 2010 Two Peds in a Pod



You have a hole in your head.

Actually, you have several.

You, your children, and everyone else.  These holes are called sinuses.


These dratted air pockets in your skull can fill with puss and cause sinus infections.  Scientists hypothesize they once helped us equilibrate water pressure during swimming. Now, sinuses seem only to cause headaches.


Sinuses are wedged in your cheek bones (maxillary sinuses), behind your nose (ethmoid sinuses) and in the bones over your forehead (frontal sinuses).  When your child has a cold or allergies, fluid can build up in the sinuses. Normally, the sinuses drain into the back of your nose.  If your child’s sinuses don’t drain because of unlucky anatomy, the sludge from her cold may become superinfected with bacteria and becomes too thick to move. Subsequently, pressure builds up in her sinuses and causes pain.  A sinus infection of the frontal sinuses manifests itself as pressure over the forehead.  The pain is exacerbated when she bends her head forward because the fluid sloshes around in the sinuses.  Since frontal sinuses do not fully develop until around ten years old, young children escape frontal sinus infections. 
Another sign of infection is the increased urge to brush the top row of teeth because the roots of the teeth protrude near the  maxillary sinuses. Bad breath caused by bacterial infested post nasal drip can also be a sign.


The nasal discharge associated with bacterial sinus infections can be green/yellow and gooey.  However, nasal drainage from a cold virus is often green/yellow on the third to fourth day.  If your child has green boogies on the third or fourth day of a cold, does not have a fever, and is comfortable, have patience. The color should revert to clear. However, if the cold continues past ten days, studies have shown that a large percentage of the nasal secretions have developed into a bacterial sinus infection.  
Because toddlers in group childcare often have back-to-back colds, it may seem as if he constantly has a bacterial sinus infection. However, if there is a break in symptoms, even for one day, it is a sign that a cold has ended.


Hydrate your child well when she has a sinus infection. Your child’s body will use the liquid to dilute some of the goo and the thinner goo will be easier for her body to drain.  Since sinus infections are caused by bacteria, your pediatrician may recommend an antibiotic.  The usual duration of the medicine is ten days, but for chronic sinus infections, two to four weeks  may be necessary. Misnamed, “sinus washes” do not penetrate deep into the sinuses; however, they can give relief by mobilizing nasal secretions. When using a wash, ask the pharmacist for one with a low flow. Although the over the counter cold and sinus medicines claim to offer relief, they may have more side effects than good effects. Avoid using them in young children and infants.


Who knows. Someday we’ll discover a purpose to having gooey pockets in our skulls. In the meantime, you can tease your children about the holes in their heads.


Naline Lai, MD
© 2010 Two Peds in a Pod




“Help, Mommy, Daddy, I wet the bed!”

As you wash yet another set of bed sheets and wet pajama bottoms, you may be wondering WHEN your child will stay dry at night and WHY your child still wets the bed when his friends, or worse yet, his younger siblings, are dry. This article will address primary bedwetting (doctors call this “primary nocturnal enuresis”), or kids who have NEVER been dry at night. Children who have had months or years of dry nights and then start bedwetting consistently need to be evaluated by their health care providers to rule out medical causes of new bedwetting.

Here are a few things parents of bed-wetters should know.

Most children master staying dry during the day BEFORE staying dry during the night. Only a small number of children actually wake up dry in the morning before they start potty training.  Daytime dryness is under your child’s cognitive control. Night time dryness is not learned or controlled by your child’s rational brain, but rather is a function of your child’s bladder being mature enough to send a WAKE UP!!  signal to your child. Quick hint here:  nightmares can result from a full bladder. As you comfort your child from a bad dream, don’t forget to take him to the bathroom.

About 80 percent of children are dry overnight by age four. They sleep through the night and wake up dry or they wake up once to urinate in the bathroom and go back to bed. What about the other 20%? Each year after age four years, about 10% of kids who are wet at night become dry without any intervention. Genetics play a big role in this. If one parent was a bedwetter until age 7, for example, then the child has a 35% chance of bedwetting until this age. If both parents wet the bed until school age, then their child has at least an 80% chance of being just like Mom and Dad.

However, some kids just wet the bed even though their parents were dry at an early age. Regardless, parents can help.

·         Do NOT punish your child for wetting the bed. It truly isn’t his fault.

·         It is reasonable to limit fluid intake in the few hours before bed but do allow your child to drink water if thirsty or with teeth brushing.

·         By all means let your child wear training pants at night or at least put some form of water repellant mattress protector on your child’s bed. These are not “crutches” or “enablers” but rather save you from having to wash sheets and mattresses.

·         Not all kids are actually upset about bedwetting, but they can become very upset if parents let them feel that way. Reassure your child that someday “the pee pee will wake you up to go potty in the night” just like it tells your child to go to the bathroom during the day.

If your child is old enough to become self-conscious or to have his self-esteem impacted by his bedwetting (somewhere between the ages of 8 to 10 years, usually, because sleep-overs and camp gain popularity at these ages), there are a few ways to help your child approach potentially awkward situations.

1)      Have the sleep-over at your house and have your child’s absorbent training pants already in the bed hidden under the covers. Your child can put them on after “lights out.”

2)       Tell your child he does not have to share the reason for not wanting to sleep away from home.

3)       Alternatively, he can tell his friends that YOU, the meanie parent, will not allow him to attend sleepovers yet.

 If your child is motivated to try to become dry overnight, you can try a bed-wetting alarm system. These systems work well over a period of several months.  With alarms, both parents and child have to be active participants. Alternatively, you can talk to your child’s health care provider about medicine called DDAVP that can give a “quick fix.” The medication can keep your child dry on the night he takes the medicine. The medicine comes in pill form and can either be used for sleepovers only or can be taken for a few months at a time to help your child feel better if self-esteem is becoming compromised by bed-wetting. Note that even after months of dry nights on medicine, your child will likely bed wet if the medicine is stopped. However, there is also a chance that nature will have taken over and by the time the medication is stopped, your child will have reached the age that his body was programmed to stay dry at night.

Of course, your child’s health care provider can help ensure that your child merely has an immature bladder-to-brain messaging system and not any other cause of his bed-wetting. Your doctor can also help evaluate if your child’s self esteem is affected by his bedwetting.

While not the most glamorous part of the parenting game, washing up after a bedwetting child and keeping a positive attitude for him are very important. The next time you will play this supportive role is when you become grandparents and your former bedwetter calls you for advice about his own bedwetting child.

Julie Kardos, MD
©2010 Two Peds in a Pod


It’s that itchy, scratchy time of year. Today our guest blogger, dermatologist Mary Toporcer MD, gives us hints on how to combat dry skin. For the past 21 years, Dr. Toporcer has practiced general medical dermatology in Doylestown, PA.  She did her dermatology training at Hahnemann University and at St Christopher’s Hospital, both in Philadelphia, PA.

Many patients suffer from severe dry skin (xerosis) in the winter when the air is cold and the humidity low.  Those who are atopic (have a personal or family history of eczema, allergies, asthma, hayfever or sinus problems) are much more affected by their environment.  A few MUST DO’s include:
1.  Moisture every day especially after bathing with Cerave Cream or Lotion. It contains ceramides which “waterproofs”the skin and keeps moisture in, but without that greasy feel.
2.  Use gentle soaps such as Dove in the shower and keep the shower water luke warm, not hot. Hot water just irritates and ultimately dries the skin even more. It also increases itch.
3.  Avoid irritants such as anti-static sheets in the dryer. Even if they say “free”, they still put a coating on your clothing in an effort to prevent it from sticking together. This substance is very irritating to dry, sensitive skin. Liquid, fragrance-free fabric softener is much gentler on skin.
4.  Lastly, for those terribly dry, scaly, fissured hands and feet, try vaseline or Aquaphor under the soft stretchy gloves and socks that you can buy at Bath and Body Works…they’re often impregnated with aloe for extra moisture.

Mary Toporcer, MD
© 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

Autism is a disorder of communication. Autistic children have difficulty relating to other people. Many parents are concerned about autism and ask me questions about how to know that their child does NOT have autism.

Tools for autism screens exist for older toddlers. For example, the M-CHAT is a standard autism screening tool used as young as 16 months and can be downloaded for free: hallmark of autism is delayed speech. This sign makes autism difficult to diagnose before the age of one year because language development really takes off after a child’s first birthday.

Here are some communication milestones that occur during the first year of life. Problems attaining these milestones can be indicative of autism or other communication disorders such as hearing loss, vision loss, isolated language delay, or other developmental delays:

By six weeks of age, your baby should smile IN RESPONSE TO YOUR SMILE. This is not the phantom smile that you see as your baby is falling asleep or that gets attributed to gas. I mean, your baby should see you smile and smile back at your smile.  Be aware that babies at this age will also smile at inanimate objects such as ceiling fans, and this is normal for young babies to do.

By 2 months of age, babies not only smile but also coo, meaning they produce vowel sounds such as “oooh” or “aaah” or “OH.” If your baby does not smile at you by their two month well baby check up visit or does not coo, discuss this delay with your child’s health care provider.

By four months of age, your baby should not only smile in response to you but also should be laughing or giggling OUT LOUD. Cooing also sounds more expressive (voice rises and falls or changes in pitch) as if your child is asking a question or exclaiming something.

Six-month-old babies make more noise, adding consonant sounds to say things like “Da” and “ma” or “ba.” They are even more expressive and seek out interactions with their parents. Parents should feel as if they are having “conversations” with their babies at this age: baby makes noise, parents mimic back the sound that their child just made, then baby mimics back the sound, like a back and forth conversation.

All nine month olds should know their name. Meaning, parents should be convinced that their baby looks over at them in response to their name being called. Baby-babble at this age, while it may not include actual words yet, should sound very much like the language that they are exposed to primarily, with intonation (varying voice pitch) as well. Babies at this age should also do things to see “what happens.” For example, they drop food off their high chairs and watch it fall, they bang toys together, shake toys, taste them, etc.

Babies at this age look toward their parents in new situations to see if things are ok. When I examine a nine month old in my office, I watch as the baby seeks out his parent as if to say, “Is it okay that this woman I don’t remember is touching me?” They follow as parents walk away from them, and they are delighted to be reunited. Peek-a-boo elicits loud laughter at this age. Be aware that at this age babies do flap their arms when excited or bang their heads with their hands or against the side of the crib when tired or upset; these “autistic-like” behaviors are in fact normal at this age.

By one year of age, children should be pointing at things that interest them. This very important social milestone shows that a child understands an abstract concept (I look beyond my finger to the object farther away) and also that the child is seeking social interaction (“Look at what I see/want, Mom!”).  Many children will have at least one word that they use reliably at this age or will be able to answer questions such as “what does the dog say?” (child makes a dog sound). Even if they have no clear words, by their first birthday children should be vocalizing that they want something. Picture a child pointing to his cup that is on the kitchen counter and saying “AAH AAH!” and the parent correctly interpreting that her child wants his cup. Kids at this age also will find something, hold it up to show a parent or even give it to the parent, then take it back. Again, this demonstrates that a child is seeking out social interactions, a desire that autistic children do not demonstrate. It is also normal that at this age children have temper tantrums in response to seemingly small triggers such as being told “no.” Unlike in school-age children, difficulties with “anger management” are normal at age one year.

As an informal screen for autism, children below one year of age should be monitored for signs of delayed or abnormal development of social and communication skills. Home videos of children diagnosed with autism reveal that even before their first birthdays, many autistic children demonstrate abnormal social development that went unrecognized.

Following the above guides and discussing your child’s development at all well child care check-ups will help you to pick out “red flags” that can prompt closer attention and further work up if indicated.

 Julie Kardos, MD
©2010 Two Peds in a Pod




Remember Elmer Fudd from the Bug Bunny cartoons? He was the hunter who would say “Where’s the wascally wabbit?” instead of “Where’s the rascally rabbit?” Think how frustrated Elmer was as a kid when his parents and teachers didn’t understand him.   

Unclear speech or lack of speech development can be a sign of hearing loss or an inability to communicate (autism, retardation or developmental delay).  Amy King, MA, CCC-SLP with over 12 years as a speech therapist outlines important speech and language milestones to watch for: 

Receptive Language Milestones- what your child understands (children should be doing these things by the time they reach the year marker)

By the time they are

1 year:  shakes head to respond to simple questions such as “Want milk?” and identifies some body parts

2 years:  Follows 1 step directions- “Go get the ball.”

3 years:  Follows 2 step directions- “Go get the ball and give it to daddy.” 

4 years:  Understands if/then- “If you pick up your toys, then you can help Mommy make a cake.”

5 years:  Follows 3 step directions- “After you wash your hands, get the napkins and put them on the table.” 

Expressive Language Milestones- what your child is able to say

1 year: 1 word

2 years: 2 word sentences- two words with one meaning such as “thank you” does not count. Expect phrases such as “mommy up” for “mommy, pick me up.”

3 years: 3 to 5 words—Dr. Kardos tells parents think Cookie Monster from Sesame Street: “me want cookie”

4 years: 4 to 7 word sentences with consistent correct use of parts of speech (nouns, verbs, adjectives, pronouns, prepositions, etc.): “I want to go to the park.” 

Speech Milestones- phonetics (sounds should be produced accurately and consistently in words and phrases)

By the time they are:   

3 Years:  sounds of the letters:  m, b, p, h, w, n, f,

 4 Years:  t, k, g, ng, s, r, sh

5 Years:  z, l, v, y, th, wh, ch

6 Years:  j, st, br, cl, r (by now if not before) 

Speech Intelligibility -how well strangers understand your child

         2 Years:     at least 25%-50% of what your two year old is saying

         2 ½ Years:  at least 60%-75% of what your two and a half year old is saying

         3 Years:      at least 75%-90% of what your three year old is saying

         4 Years:      at least 95% of what your four year old is saying 

Fluency- stuttering

         Stuttering is normal in the preschool years.  Be sure to give the child time to say what she is trying to say. Dr. Lai likes to think of a preschool stutterer as a child whose mind is thinking faster than he can move his mouth. If stuttering lasts more than 6 months and is accompanied by facial contortions, grimaces, or repetitive body movements, speak to a medical professional. 

Red flags that always need further workup:

o  Does not coo by 4 months of age

o  Does not babble by 9 months of age

o  Child does not respond to his/her name by 9 months of age

o  Child does not look at you, others or objects upon request by 9 months of age

o  Does not gesture (point, wave, grasp, etc.) by 12 months of age

o  Child does not respond to your simple verbal requests (e.g., “Look!”, “Wave bye-bye”, “Come here”, “Give a kiss,” etc.) by 12 months of age

o  Does not say single words by 16 months of age

o  Does not say two-word phrases on his or her own (rather than just repeating what someone says to him or her) by 24 months of age

o  Loss of any language or social skill at any age

 Amy King, MA, CCC-SLP

©2010 Two Peds In a Pod


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


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

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

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

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

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports the following sobering statistics regarding annual health risks directly attributed to alcohol use among college students between the ages of 18 and 24.  These statistics also serve as an important reminder that a person does not have to be drinking to be adversely affected by alcohol abuse.

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

·         500,000 unintentional student injuries 

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

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

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

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

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

Additional information is available at

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

© 2010 Two Peds in a Pod



Three little kittensthey lost their mittens, and they began to cry. 

Oh, mother dear,  we sadly fear That we have lost our mittens. 

What! Lost your mittens, you naughty kittens! 

Then you shall have no Nintendo   DS 

    -the modern version of a traditional poem



It’s only January and pictured here is a photo of my three kittens’ mittens (gloves) which are already missing mates.


Prolonged exposure to cold can lead to injury in body parts with relatively less blood flow such as the ears, fingers and toes. In frostbite, injury occurs secondary to ice crystals which form within or between the cells in your body. Injury can be so severe that the tissue dies and infection sets in.


Early signs of frostbite include tingling or achiness. Without treatment, the area will become pale and lose all sensation.


If you suspect your child’s hands are starting to become frostbitten, first remove all wet clothing. Rewarm the area by placing immediately in warm water.  Think opposite of a burn- where you use cold water. Do not massage the hand as this may cause further injury, but do encourage your child to move his hands. As very cold hands warm up, they will become blotchy and painful or itchy. Ibuprofen (brand names Motrin and Advil)or acetaminophen (Tylenol) will be helpful.  Warm for at least half an hour even if it is painful.


Signs of actual frostbite are blistering, numbness, or color changes. As my sister, an emergency room doctor says, red is good. Black and white are not.


Head over to the emergency room if you think your child has frostbite. To avoid the risk of over-heating and to manage the pain of treating frost bite, thawing for frost bite should be medically supervised. Just as you would seek care for a burn, seek medical care for a cold induced injury. To rewarm properly, the frostbitten part of the body should be submerged in warm 37-to-40 C (98 -to-104 F) water.  No higher because then it’s like trying to defrost a chicken. You will end up cooking rather than thawing the tissue, says my sister. Also a big no-no: starting to thaw but then not completing the thaw. Thaw-refreeze-thaw will injure tissue, same as it ruins a defrosting chicken. So again, seek medical attention for your child if you suspect frost bite has set in.

For a recent interesting, but somewhat technical article with photographs on a case of frostbite, check out the New England Journal of Medicine, N Engl J Med 2009;361:2654-62


Naline Lai, MD

Two Peds in a Pod © 2010.