The first of many first days of school.

Parents, let’s admit it. Many of the tears shed on the first day of school are our own. The first day of school for parents is not easy. There is genuine sadness and ache that goes beyond the bittersweet as our kids approach momentous milestones such as kindergarten entry and college send off. As our pediatrician friend Dorothy Novick posted on Facebook, “Because here’s a thing no one ever says out loud on Facebook: as all the balloons and congrats explode on our feeds, many of us parents of graduates are experiencing some pretty serious grief. There’s true pride in the photos, yes, but there’s also honest to goodness grief.”

For your kid-remember the rules of drop off:

• For kids of all ages, convey to them 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. Kids, no matter the age, mirror the emotions their parents convey.
• For daycare and preschool, take your child and place her into the arms of a loving adult- do not leave her alone in the middle of a room.
• Say good bye. Let your child know that you are leaving. Don’t try to sneak off. At any age, it’s unsettling for you to suddenly disappear.
• Do not linger. Prolonging any tears, only prolongs tears. The faster you leave, the faster happiness will start.
• For the younger ones- 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. For the older ones-let them have their independence- this is what you’ve trained them for. In fact, encourage their independence. When your young adult asks you a question, ask it back. Chances are, they already know the answer. Just remind them that you are always available. Send the care packages and answer their midnight texts.

For yourself:

Congratulate yourself on reaching a family milestone. The first day of school for parents and children is momentous. Yes, the configuration of your family has changed and it will not be the first or last time. Acknowledge the ache of the passage of time, and reach out to others in similar situations.

Just as your child delights you with all of their unique interests and attributes, go show them all the amazing unique things you do. Take up ball room dancing, start a business painting colorful furniture or join an adult soccer league …these are all real life examples of things we know people embarked on when their kids went off to school.

Cry those “happy tears.” But be aware, sentimental “happy tears” can tip over into depression.

If negative thoughts or worries constantly impinge on your thoughts and weigh you down, then seek help. Talk to your doctor for advice. Also, the National Alliance on Mental Illness maintains a lists of resources.  Depression looks like sadness much of the time but it can also manifest as anger or anxiety.

Warning signs of depression include:

• Acting out of control
• Losing interest in activities which normally bring pleasure
• Changes in sleep patterns-difficulty falling asleep, numerous awakenings, or excess sleeping
• Having feelings of worthlessness about yourself or other
• Poor work performance
• Low energy or fatigue or conversely restless or “hyper” (excessive shopping binges)
• An increase in alcohol or drug use (attempts at “self-medicating”)
• Thoughts of being better off dead or a desire to hurt yourself or others

To end on an upbeat (and ok, bittersweet) note, we invite you to read the letter Dr. Lai wrote the day before her first child left for kindergarten.

A letter to my child

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 for the first time.

Until then, I hold my breath each time you take a step.

Love,
Mommy

Naline Lai, MD and Julie Kardos, MD
©2018, 2023 Two Peds in a Pod®

Perfect timing. I have been seeing a lot of kids starting table foods in the office lately and my sister (an Emergency Medicine doctor) just came out with a video on what to do when someone is choking. She goes over what do with any age group, so worth a peek even if your kids are bigger than you are.

Prevention hints: As a toddler parent you will find kitchen shears perfect for cutting up food into bite sized pieces. But watch the number of little pieces that your child eats at one time- kids get into trouble when they scoop a pile into their mouths. As for toys, anything that can fit into a paper towel roll is a choking hazard.

Hoping you will never have the opportunity to use the information in the video!

Naline Lai, MD with Julie Kardos, MD

©2023 Two Peds in a Pod®

When preparing to travel with your kids, do you sometimes you wonder if it’s worth all the time and effort? Click here to find an article from the Children’s Hospital of Philadelphia where your two Peds and colleagues give some tips to get you through.

Happy travels!

Julie Kardos, MD and Naline Lai, MD

©2023 Two Peds in a Pod®

Wondering about signs of anxiety in your child or teen? Interested in everyday ways to help calm them? Take a peek at this post that one of your two peds contributed to: When Your Child’s Anxiety Is Worth Worrying About — and How to Help in The Children’s Hospital of Philadelphia’s Health Tips.

A Bucks or Montgomery County, Pennsylvania parent or caretaker? May is mental health awareness month and NAMI Bucks County and CHOP Primary Care, Doylestown have teamed up to give an in-person talk this week! Registration information above- hope to see you there!

Julie Kardos, MD and Naline Lai, MD

©2023 Two Peds in a Pod®

Everything has a season, incluing seasonal allergies.

In our area near Philadelphia, we associate spring with the Phillies opener and also with the onset of spring allergies.

Here is a nice summary of how to treat allergies, from The Children’s Hospital of Philadelphia (note that one of your Two Peds was a contributor). And following are some of our prior posts that can help you treat your child’s seasonal allergies this spring:

The Best Allergy Medicine for Kids

The Best Allergy Medicine for Kids aged 2-5 years old

Allergy Eyes: when spring rubs you the wrong way

How to tell the difference between Covid (or any viral cold) and allergies

We hope this post answers all that you are itching to know about seasonal allergies.

Julie Kardos, MD and Naline Lai, MD

©2023 Two Peds in a Pod®

Did your child wake up in the middle of the night crying from ear pain? Fortunately, not every child with an earache has an actual ear infection. However, all children with earaches deserve to have their pain treated, no matter what is causing their pain. Here is our post about what to do for your child’s earache.

Julie Kardos, MD and Naline Lai, MD

©2023 Two Peds in a Pod®

“Mom, Dad, my head hurts!”

Sound familiar? It’s probably not the first time ‘round this rodeo, but ever wonder if your child’s headache could be a sign of something more problematic? The good news is, while kids get headaches for many reasons, there are telltale signs every parent can look for at home to distinguish normal headaches from bad headaches in children.

Tension Headaches

For most kids with headaches, the odds are in their favor.  The most common culprit is the tension headache—the kind we have all experienced at least once in our lifetimes.  Fortunately, they are also the least scary kind of headache.

Tension headaches usually begin gradually and can last a few hours at a time.  Most children will complain of a dull, achy, or even “band-like” pain squeezing both sides of their head or across their forehead. Typical triggers include stress, inadequate sleep, excessive screen time, not drinking enough water during the day, hunger or poor diet, or a need for glasses. Targeting these triggers are key to preventing these pesky headaches.

Migraines

Okay, so we know tension headaches are the most frequent, but can kids have migraines? Children can have migraines and there are key distinguishing characteristics that set these headaches apart. 

Migraines usually start in school-aged children, and for girls, often get worse with their periods. In older kids these headaches are typically throbbing or pounding, as opposed to dull, and can be one-sided.  They can also be associated with other symptoms like sensitivity to light and sound, nausea or vomiting, and strange changes in vision or smell preceding the start of a migraine (the “migraine aura”). Taking a nap almost always makes a migraine go away.

Family members will often have a history of migraines or frequent headaches.

Parents should also be aware of the occasional “abdominal migraine,” where migraine symptoms like those described above occur with stomach pain instead of headaches.

Head Trauma and Concussions

Did your child just hit their head? Or suffer a sports injury? As a parent, it’s normal to worry about headaches after head trauma. While most post-traumatic headaches are not a cause for alarm, parents need to know signs of serious injury such as bleeding inside the head. You can review these signs here.

Concussions are also caused by head trauma. Read more about concussions here.

Red Flags

While most headaches are not cause for alarm, there are warning signs to keep an eye out for. Sometimes, headaches are more sinister in nature—caused by tumors, brain bleeds, strokes, abnormal anatomy, or infection (like meningitis). And while these occurrences are fortunately rare in children, the earlier they are diagnosed, the better.

Headaches that interrupt your child’s sleep, happen first thing in the morning after waking, are becoming more frequent or severe, are associated with unsteadiness, weakness, visual changes, seizures, fever, funny eye movements, neck stiffness, early morning vomiting, changed mental state (too tired or too irritable to play) or are described by your child as as the “worst headache they’ve ever had” should all lead you to seek medical attention promptly. Finally, headaches in very young children under the age of five should not be taken lightly.

A Word on Mental Health

While headaches happen for several reasons, depression and anxiety are commonly overlooked offenders.  If you are noticing other signs like sadness, worry, poor appetite, weight change, or less interest in prior activities, talk to your pediatrician about further evaluation.

Still not sure what’s causing your child’s headache? 

It’s okay!  Headaches are complicated, and keeping track of your child’s symptoms can be hard. Maintaining a headache diary to track headache features can help both you and your pediatrician figure out the next best steps for your child.

Nitya Rajeshuni, MD MS

©2023 Two Peds in a Pod®

Guest blogger Dr. Nitya Rajeshuni completed her pediatric residency at the Children’s Hospital of Philadelphia. She attended medical school at Stanford University, and is a contributing writer to ABC News and the health humanities journal Synapsis.

Death, politics, mental illness, and sex- all difficult topics for parents to talk about with their kids. Your Two Peds joined a social worker, school guidance counselor, and former teacher in a lively panel discussion at the Haverford Township Library in Haverford PA on how to normalize conversations on difficult topics between parents and their children. Watch as we talk about on ways parents can give kids give information while limiting their anxiety .

Past posts about ways to share difficult information with your children include the topics of suicide, stillbirth/miscarriage, death of a person, and death of a pet.

Warmly,

Julie Kardos, MD and Naline Lai, MD

©2023 Two Peds in a Pod®

Is your child’s sore throat “dragon” them down? This month we contributed to The Children’s Hospital of Philadelphia’s Health Tip of the Week on the subjects of sore throats and strep throat. We hope you find our tips helpul if your your child’s throat feels like it’s on fire.

Julie Kardos, MD and Naline Lai, MD

©2023 Two Peds in a Pod®

Parents ask us every day the difference between the flu (influenza), RSV (respiratory syncytial virus), or COVID (coronavirus disease 2019). While no method is fool proof, here are some typical differences among these viruses:

The flu, caused by influenza virus, comes on suddenly and makes you feel as if you’ve been hit by a truck.

Flu almost always causes fever of 101°F or higher and some respiratory symptoms such as runny nose, cough, or sore throat (many times, all three). In addition to the usual respiratory symptoms, the flu causes

body aches, headaches, and often the sensation of your eyes burning. Fever can last 5-7 days. Children, more often than adults, can vomit and have diarrhea along with their respiratory symptoms, but contrary to popular belief, there is no such thing as “stomach flu.” All symptoms come on at once; there is nothing gradual about coming down with the flu.

COVID can cause the same symptoms. Since home COVID tests are readily available, you can answer the question of “Flu or COVID?” at home.

Colds, even really yucky ones from RSV, come on more gradually.

RSV, a common cause of the common cold, is notorious for causing very thick mucus. The mucous is why some babies and young children have more severe coughing and breathing difficulties with this particular cold virus. Our immune systems are not good at mounting a lasting immunity to RSV so kids and adults tend to get this virus again and again. The first time someone is hit with RSV is usually their worst episode.

Symptoms usually start out with a sore throat or mild runny nose. Gradually, the nose runs more and a cough starts. Sometimes RSV can cause fevers for a couple of days and some hoarseness. Children are often tired from interrupted sleep because of cough or nasal congestion. This tiredness leads to extra crankiness. To further complicate things, Covid can cause identical symptoms.

Usually kids still feel well enough to play and attend school with colds like RSV.

The average length of a cold is 7-10 days although sometimes it takes two weeks or more for all coughing and nasal congestion to resolve.

Wondering about the color of mucus?

The mucus from a cold can be thick, thin, clear, yellow, green, or white, and can change from one to the other, all in the same cold. The color of mucus in the first few days does NOT tell you if your child needs an antibiotic and will not help you differentiate between a cold and the flu.

So, is it the flu, RSV, or COVID?

• Flu = sudden and miserable
• Colds, including RSV = gradual and annoying
• COVID = either

If your child has several days of runny nose and cough, but is drinking well, playing well, sleeping well and does not have a fever, the illness is unlikely to “turn into the flu.” A home test can help tease out COVID from a cold or the flu.

And yes, a kid can have multiple respiratory viruses at the same time. Let’s hope that does not happen this winter.

Julie Kardos, MD and Naline Lai, MD

©2022 Two Peds in a Pod®