How superheroes wear masks

Superheroes don’t wear masks just over their eyes when they fight germs.

Every child, long before COVID, was taught to prevent germs from entering their bodies by washing their hands and making sure their nose did not get too close to other kids’ noses. As we’ve always said, “You don’t want someone’s boogers to jump into your nose.” Besides distancing, wearing a mask is just another way to prevent those boogers from jumping in or out of noses. But most people are unfamiliar with wearing masks and are not sure how to teach their kids to wear them.

Enter superheroes. As we know, superheroes wear masks. Above is a photo of one of Dr. Lai’s favorite superheroes, along side other mask-wearing superheroes. Her superhero sister is an ER doctor. She wears layers to keep herself from bringing home COVID to her own kids. She works in this garb for hours and hours. We borrow from her hints for helping your kids do the same with their masks:

Cover both your child’s nose and mouth with the mask. The path for a germ to enter and exit the lungs is through BOTH the mouth and nose…it’s all connected. If the mask has a wire at the top part of the mask, pinch it over your child’s nose and press gently over the tops of their cheeks. This helps prevent glasses from fogging and also limits germs from coming and going through leaky areas of the mask.
Have your child talk, sing, and jump up and down in their mask before leaving the house. We have seen many a mask wiggle down a kid’s (or parent’s) face as they start to talk. It’s like watching a game of chutes and ladder…the mask goes up a little, and down and little, and sometimes it slides right off.
If the mask seems too big, try tying the loop with a small knot. The secret is to fold the mask in half (lengthwise) with the outsides facing each other and tie a knot close to where the strings meet the paper/fabric. Then pop it back open and tuck the corners in. This works best with a paper mask. Note, masks are not recommended by the American Academy of Pediatrics for those under two years old. Check out other kids who should not wear masks here.
Some kids will complain about the mask. It can be a comfort issue, a fashion issue, or a habit issue. They are just not accustomed to wearing a mask and over time they will get used to it. If comfort were the only goal of kid fashion, gel light-up princess shoes would not exist! Practice having all of your family members wear a mask around the house before venturing out. Also, try your child’s mask on yourself. Maybe the material really is “stinky” or “pinchy” and it’s time for a different mask.
Once a mask is on, teach kids to pull up a mask from the sides or near their cheeks, not near their nose. Again, you want them to avoid touching their boogers.
Taking off a mask correctly is as important as putting one on. When taking off a mask have them wash their hands with soap and water and then gently take their mask off at the ears. If their hands are not washed and they touch their mask around their nose, there is the potential for germy droplets on their hands to jump into their nose.
If you find that ear loops are chafing your child behind the ears or over the cheeks, moisturize an hour before wearing. If you moisturize right before putting on the mask, there is the risk that the mask will slide around. There are all sorts of methods to hook the loops to places other than behind the ears. You can sew buttons on a headband and secure the loops to the buttons or secure the loops to glasses. There are also mask extenders available. Use non-comedogenic (non-acne-producing) lotions such as Cervave®, Cetaphil®, or moisturizers meant for faces only.
If cloth, wash the mask in soap and water when they get home. There is no need to torch the mask with high heat or douse in a special chemical. A good wash with soap and air drying for a day will kill off germs- COVID and other germs as well.
Paper masks need to breathe. Most are technically one time use, but let’s get real, we know that you will use them more than once. Store them in paper lunch bags-fold the masks so the outside (germy side) is touching together.
One final tip: COMPLIMENT your child’s proper mask wearing! Dr. Kardos is often overheard exclaiming to her patients: “I LOVE your mask! It is so COOL! Do you like MINE? See how I wear it LIKE A SUPERHERO?” It is fun to watch the kids immediately put on their masks if they were initially off, and to pull it up over their noses correctly to mirror Dr. Kardos if they had been wearing the mask improperly.

What better barrier against nose spew than wearing a mask? Have your kids wear them in superhero style. Until this pandemic is under control, mask wearing will play a huge role in keeping your children safer from disease spread.

Naline Lai, MD and Julie Kardos, MD
©2020 Two Peds in a Pod®

Tick removal and prevention

The classic bullseye rash of Lyme

Kids are running about and so are the ticks. We’re talking about tick removal and prevention of tick bites in the Children’s Hospital of Philadelphia Tip of the Week!

Julie Kardos, MD and Naline Lai, MD
©2020 Two Peds in a Pod®

Conversations: Talking with kids about race

Does the adult looking through the camera at these children see what a child sees? — photo courtesy of Pixabay

No matter your skin coloration, you will have the first opportunity to teach your kids about racism in the United States. To help you approach the topic, therapist Dina Ricciardi culled through the internet to pick out resources to start a dialogue. — Drs. Lai and Kardos

Lately, conversations and news coverage about racism surround us. Images of unrest and violence have covered our news screens, affecting our country, our communities, and sometimes our own homes. On top of the global pandemic of COVID-19, navigating the topic of race and race relations with your family can feel downright overwhelming. Adults may be experiencing a whole range of feelings. Emotions may range from anger to sadness to fear and beyond. While us parents want to teach our kids, we also want to protect them. We wonder, do we talk with them about what they see on television and social media? Or do we shield them from serious problems?

Our understanding and beliefs about race, whether our own race or others’, is deeply personal and rooted in our own unique experiences. As parents, we may feel unprepared and not know how to address our children’s questions and concerns. Therefore, we may avoid conversations about race.

Fortunately, there are many available resources. Many educators, mental health experts, and medical professionals are sharing information to equip us with knowledge and confidence. Below is a handful of the offerings.

Links to issues of racism, police violence and discrimination (says COVID, but not about COVID):

https://www.pa-fsa.org/Admin/Dealing-With-Covid-19-Copy

These are just a few of the resources available to help you wade into challenging conversations about race. As stated by Dr. Howard Stevenson from the Penn Graduate School of Education, “The more you listen for what your child already knows, what they are concerned about, what they are afraid of, the more you’ll be able to help them speak and feel confident…and keep listening, because your child will need you to keep that conversation going.”

Dina Ricciardi, LCSW, ACSW

Ricciardi is a licensed clinical social worker and psychotherapist in private practice treating children, adolescents, and adults in Doylestown, PA. She can be reached at dina@nourishcounseling.com.

What to do if you are exposed to someone with covid-19

Who needs to isolate after a COVID exposure?

Who "counts" as an exposure to COVID, and what should exposed individuals do? Dr. Roy breaks it down and makes it simple, with a little help from some friends!

Posted by Pediatric Physicians, PC on Tuesday, June 23, 2020

Confused about what do to if you are exposed to someone with covid-19? What if you are exposed to someone who was exposed to covid-19 illness? Do you self-isolate? How long?

We welcome back our pediatrician friend Dr Roy Benaroch as he explains, briefly and clearly in his two minute video, just what to do. We promise you will gain knowledge and confidence.

Julie Kardos, MD and Naline Lai, MD

Roy Benaroch, MD, of Pediatric Physicians, PC , has been practicing pediatrics in Atlanta, Georgia since 1997. He is an adjunct professor of Pediatrics at Emory University, writes an excellent blog The Pediatric Insider, and has authored several helpful pediatric related books, articles, and videos. This video is shared with his permission on Two Peds in a Pod®

How to sit at the computer: Ergonomics for kids doing schoolwork at home

#homeschooling #computer ergonomics #COVID #admireteachers

Oh my aching back…

Right now, with schools closed, kids of all ages are doing schoolwork at home. Technology has allowed continuation of learning and even face-to-face check in with teachers. But it also poses some challenges. School classrooms are designed for children; our kitchen tables are not. How to sit at the computer? Just as we require ergonomic workstations for our jobs; we need to consider proper fit and alignment for our children as they learn virtually. The following are basic ergonomics for kids doing schoolwork from home that can prevent muscle aches and fatigue.

Where to place the computer screen:

Place the computer screen directly in front of your child with the eyes level with a spot about 2-3” below the top of the screen. In addition, place the keyboard so that the upper arms and shoulders are relaxed. The forearms should be parallel to the floor and the elbow bent less than 90 degrees. The chair should have back support and allow the thighs to be supported parallel with the floor. Knees should also be bent to 90 degrees or a bit less with feet supported. This can be a challenge for our elementary school kids who are trying to work at home. The Canadian Safety Council suggests: “choose a chair that places the child at the proper height in relation to the equipment. If that means a higher chair, provide a footrest to support the feet and a pillow to support the back.”

How can you adjust the chair?

Chairs with adjustable seat and footrest heights are great for this. If you don’t have an adjustable chair, you may need to create a footrest out of a box, block or storage crate. Also, since many children are using laptops, it is difficult to position both the screen and keyboard appropriately; it may be best to attach a separate monitor at the right height once the keyboard is set for proper arm and body position.

Avoid back and neck pain:

If children are using an iPad or reading a textbook, an angled book holder may help with proper positioning to avoid back and neck pain. We have cookbook holders for a reason!

If your child is doing lots of writing or drawing:

An angled writing surface will help with fatigue and proper support. There are quite a few child sized desks available with a surface that raises to an angle. If you child is a wiggler; consider a ball chair with an appropriate height table that allows for that 90-90-90 ankle, knee, hip alignment, or consider using a standing desk. In each case, the keyboard, mouse and screen still need to be adjusted for alignment as above.

The most important thing you can do is make sure your kids take a break and MOVE every 30 minutes according to both the Cornell University Ergonomics Web and Canada Safety Council. Active breaks are necessary not just for the body, but for the eyes as well. The best ergonomics for kids doing schoolwork at home cannot substitute for these breaks.

Here are some ideas for quick movement breaks to keep the aches and pains away:

Stand and stretch arms up overhead. Grasp hands interlocking fingers, flip palms up to the ceiling and stretch.
Bring arms behind your back at hip height, grasp hands or hand to wrist and try to pull shoulder blades down and together.
Stand with hands against a wall, place one leg back with knee straight and foot flat on the floor. Keeping your body straight like a board, lean into the wall and stretch the back of the calf.
If you have a yoga ball, lie back over the ball with feet flat on the floor, raise your arms out to the sides like a “T” and take some deep breaths.
Go outside in the yard and play!
No yard? Raining? Have a dance party or play “Simon Says.”

Stay home. Stay safe… and keep moving.

Deborah Stack, PT DPT PCS
©2020 Two Peds in a Pod®

We thank Dr. Stack for contributing to twopedsinapod.org— Drs. Lai and Kardos

Dr. Stack is a board certified specialist in pediatric physical therapy and the owner of the Pediatric Therapy Center of Bucks County, LLC in Doylestown, PA. In addition to treating children ages 0-21 for conditions such as torticollis, coordination, neurologic and orthopedic disorders, she also instructs physical therapists across the country in pediatric development and postural control and is a Certified Theratogs fitter.

Vaccinate your children during the COVID-19 pandemic

Social distancing? Take the time to immunize

Parents are calling us and asking to cancel their well baby visits to the pediatrician. Tempted to cancel? Think again. If families allow their babies to get behind on their vaccines, we will risk other epidemics. It is important to vaccinate your children during the COVID-19 pandemic.

Before vaccines, babies died of polio, bacterial meningitis, pneumonia, blood infections, measles, and whooping cough. All of these infections are contagious. Babies need to stay on track to get immunized against these potentially lethal illnesses.

Vaccine preventable illnesses such as polio are still alive in the memories of those now experiencing the COVID-19 pandemic. Pictured to the right is a photo of members of Dr. Lai’s family. Great-Uncle Holloway, with the broken arm, and his cousin Billy were slated to go swimming soon after the photo was taken. Cousin Billy went, was exposed to polio at the pool, and died shortly after. In a twist of luck, Great-Uncle Holloway was spared because he had broken his arm and thus did not go to the crowded swimming pool that day.

Billy (L) and Holloway (R) in the 1930’s

We understand your fear of leaving home with your baby. We know that some families have difficulty obtaining transportation. But we know also that vaccine preventable illnesses are MUCH more dangerous than COVID-19 for our youngest children.

One day socially distancing will end, and on that day, babies will be more vulnerable to vaccine preventable illness. We cannot possibly catch up every single baby on our first day out of isolation. It is far better to keep your babies up to date on vaccines all along.

In the US, our American Academy of Pediatrics strongly urges pediatricians to continue to vaccinate our infants and younger children on time.

Pediatricians across the country, and the world, are adjusting how they see patients in their offices in order to protect their patients, as well as themselves, from acquiring COVID-19 in their offices. Ask what steps your baby’s doctor is taking to provide extra protection for your family.

Vaccines not only protect your own children, but they also protect everyone around them. Remember that some babies with immune system disease or other underlying medical reasons cannot receive some vaccines. Immunizing your child can protect these children as well as themselves.

We cannot stress more how important it is to vaccinate your children during the COVID-19 pandemic. Please share this post with anyone you know that has young children, especially babies, who are due for vaccines.

The lesson of coronavirus

For my college graduate whose graduation ceremonies will most likely not happen, and my other kid who is now online and vacating her school, I think it will be the best lesson of their lives …how privilege can be taken away in an instant. A privilege to learn, to travel, to breathe…many people have never been on an airplane or ever lived in a dorm room. As a pediatrician, I am surrounded by worried families. Tell your kids that we’re all in this together, this is the time to use their youth and creativity to spark good-although they may not have our wisdom, they are not locked in an adult mindset of how things “should be.” There is much to be done-an economy to revive, cures to be found. Somehow they have been blessed with an illness that is kinder to the young. The time they have ahead of them may look different than what they expected, but it is the same…full of hope and promise that they will use their energy and creativity for the greater good.

Naline Lai, MD

How to tell the difference between spring allergies and coronavirus disease (or any other respiratory virus)

spring allergies or novel coronavirus?

Every spring I find bunched up tissues wedged everywhere- in the cup-holders of the car, in couch crevices, and in the bottom of back packs. Yes, beautiful flowering spring is here in the United States along with lots of pollen to tickle everyone’s noses. But this year, along with the pollen, the coronavirus disease, aka COVID-19, has swept in.

So how can you tell when your children’s noses become congested and they start coughing, if your child has spring allergies or coronavirus disease? While there is an overlap in symptoms between allergies and viruses, there are a few distinguishing features:

Allergies Itch

Itchy nose, itchy eyes, itchy throat. If your child is doing a lot of facial rubbing or throat clearing, you can fairly accurately blame allergies. If needed, treat these annoying itches with allergy medicine such as cetirizine (brand name Zyrtec), loratadine (brand name claritin), or fexofenadine (Brand name Allegra). You can also read our prior post about spring allergies. Allergy medicine does not improve these symptoms if your child has a virus.

Fever: Viruses can cause fever. Allergies do not.

If your child has a fever along with their runny or stuffy nose, coughing, sore throat, and watery eyes, think VIRUS. Also, think “contagious.” In contrast, allergies do not trigger fevers. So if your child has sudden onset of respiratory symptoms WITH FEVER, you can’t blame it on allergies.

Age

If your child is younger than a year, it is unlikely that they will show signs of spring allergies because they have never been exposed to spring pollen. A person needs to be sensitized to something before they can be allergic to it. If it is only your child’s first spring, they will not show signs of allergies. Usually, cold symptoms in a child this young means that your child does, in fact, have a cold virus.

While we do have medications to treat allergies, respiratory viruses, including the one caused by covid-19, have to run their course.

The following are helpful websites to keep up with emerging information about the novel coronavirus disease, or COVID-19:

Centers for Disease Control (www.cdc.gov)
Your state’s Health Department (You can click here for the PA Health Department)
World Health Organization (https://www.who.int/)

“Take heart” as we explain heart murmurs

First, tell your children that you love them. Then, read this post where we explain heart murmurs.

We hope you have a Valentine’s Day that can’t be beat!

Teen vegetarian diet basics

veggies, veggies, veggies

“Monitor your child’s diet closely to make sure they are getting enough calories… Some teens need 4,000 calories a day when they’re in a growth spurt!”

Check out the Children’s Hospital of Philadelphia Tip of the Week- a post on vegetarian teen diet basics with input from Dr. Lai!