Enterovirus D68, RSV, The flu! How do I know my kid’s having trouble breathing?

Mid-west respiratory virus, RSV, The Flu! Lots of respiratory-distress-causing- germs. Although Enterovirus D68 is in the news these days, a slew of infections can hit the lungs hard. So even if you think your child has a simple cold, it’s important to recognize when your child is having difficulty breathing. Share this information with all of your child’s caretakers, including teachers. As this cartoon illustrates, many people wear medical hats. Too often we get a child in our office with labored breathing which started during school hours but was not recognized until parent pick up time.

Signs of difficulty breathing:

Your child is breathing faster than normal.
Your child’s nostrils flare with each breath in an effort to extract more oxygen from the air.
Your child’s chest or her belly move dramatically while breathing—lift up her shirt to appreciate this.
Your child’s ribs stick out with every breath she takes because she is using extra muscles to help her breathe—again, lift up her shirt to appreciate this. We call these movements “retractions.”
You hear a grunting sound (a slight pause followed by a forced grunt/whimper) or a wheeze sound at the end of each exhalation.
A baby may refuse to breast feed or bottle feed because the effort required to breathe inhibits her ability to eat.
An older child might experience difficulty talking.
Your child may appear anxious as she becomes “air hungry” or alternatively she might seem very tired, exhausted from the effort to breathe.
Your child is pale or blue at the lips.

In this video, the child uses extra chest muscles in order to breath. He tries so hard to pull air into his lungs that his ribs stick out with each inhalation.

[youtube https://www.youtube.com/watch?v=MydbWObLzDU?rel=0]

For those with sensitive asthma lungs, review our earlier asthma posts. Understanding Asthma Part I explains asthma and lists common symptoms of asthma and Understanding Asthma Part II tells how to treat asthma, summarizes commonly used asthma medicine, and offers environmental changes to help control asthma symptoms.

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®

updated from our previous 2012 post

On letting go and coming back

Friends make birthdays better

I have been musing ever since our hosting site told us they were switching blog platforms. In a blink of an eye, our blog was slated to disappear. The dynamic Two Peds in a Pod community would be plunged into silence. At first, disbelief gave away to intrigue. Was this a sign to change personal paths? As I started to think of all the things I could do with the time that I would have spent writing the blog, my to-do list grew and grew. I could hear my son’s closet, overflowing with outgrown clothing, crying out to be re-organized.

When I told friends of the opportunity to dissolve the blog, I heard time and time again “I think you should save it.” Even friends without children were aghast. When I told my own children that the blog was on the verge of imploding they looked at me blankly and said, “Why would you stop writing for Two Peds?”

Then I remembered the mom who read our article on croup seven times in one night. I remembered Dr. Kardos’s patient whose dad said our strep throat article helped him decide not to cut his family’s vacation short. I thought of the many times parents thanked me for posts which allayed their fears of fever.

The blog did eventually stop when the old hosting site went down. But as my friends and family reminded me, the goal of the blog is to positively impact children globally by guiding their caretakers; and by the time the blog went down, we had reached nearly three million views. Two Peds in a Pod is “Practical pediatrics for parents on the go.” After more thought, I decided it would be difficult to accomplish this goal from the back of one of my kid’s closets.

So today, I am happy to post that the stop was just a temporary suspension. I credit my friends and family for reminding me of the original goal of the blog. In particular, thanks to Dr. Kardos. While I was mulling, Dr. Kardos was busy staying up past midnight valiantly importing posts from the rapidly fading old site.

We’re back, albeit a little rough around the edges as we construct the new site. And it’s just in time for our 5th birthday!

Thanks, my friend, Dr. Kardos. I wouldn’t be able to blow those candles out without you.

Happy 5th Birthday Two Peds in a Pod- may there be many more.

Dr. Lai

Naline Lai, MD and Julie Kardos, MD
©2014 Two Peds in a Pod^®

Your thoughts on fatherhood

Avoid TV Heads: how to place limits on your kids’ screen time

screen time for kids Wondering how to place limits on your kids’ screen time? We know that winter break often finds kids spending more time in front of screens: watching TV, playing video games, or surfing the internet. Today we post our suggestions to help limit screen time in your home.
Drs. Kardos and Lai

“Mom, can we do screen?”

My kids ask me this question when they are bored. Never mind the basement full of toys and games, the outdoor sports equipment, or the numerous books on our shelves. They’d watch any screen whether television, hand-held video game, or computer for hours if I let them. But I notice that on days I give in, my children bicker more and engage in less creative play than on days that I don’t allow some screen time.

Babies who watch television develop language slower than their screen-free counterparts (despite what the makers of “educational videos” claim) and children who log in more screen time are prone to obesity, insomnia, and behavior difficulties. The American Academy of Pediatrics recommends no more than two hours of television watching a day for kids over the age of two years, and NO television for those younger than two.

Over the years, parents have given me tips on how they limit screen time in their homes. Here are some ideas for cutting back:

- Have children who play a musical instrument earn screen time by practicing music. Have children who play a sport earn screen time by practicing their sport.
- Set a predetermined time limit on screen time, such as 30 minutes or one hour per day. If your child chooses, she can skip a day to accumulate and “save” for a longer movie or longer video game.
- Take the TV, personal computer, and video games out of your children’s bedrooms. Be a good role model by taking them out of your own bedroom as well.
- Turn off the TV as background noise. Turn on music instead.
- Have books available to read in relaxing places in the house (near couches, beds, etc.). When kids flop on the couch they will pick up a book to relax instead of reaching for the remote control.
- Give kids a weekly “TV/screen allowance” with parameters such as no screen before homework is done, no screen right before bed, etc. Let the kids decide how to “spend” their allowance.

Not that I am averse to “family movie night,” and I understand the value of plunking an ill child in front of a video in order to take his mind off his ailment. In fact, Dr. Lai lives in a house with three iPod Touches, two iPhones, a Nintendo DS and three computers. But I do find it frightening to watch my otherwise very animated children lose all facial expression as they tune in to a video.

For more information about how screen time affects children, see the American Academy of Pediatrics web site (www.aap.org) and put in “television” in the search box.

Let us know how you dissuade your children from the allure of the screen.

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

Happy Thanksgiving 2013 from your Two Peds

thanksgiving paper turkey We love being pediatricians because it’s an honor to be a part of your family, it’s intellectually challenging, and it gives us a chance to teach. But mostly, we love to make people feel better.
We love not only when our patients feel better, but also when their parents feel better.

Parents feel better when we say:

Not strep throat. It’s a viral sore throat.
Not pneumonia. It’s a viral cough.
Not a broken foot. It’s an ankle sprain.
Not appendicitis. It’s constipation.
Not an ear infection. It’s fluid behind her ear drum.
Not cancer. It’s a lymph node infection.

In other words, our favorite diagnosis is “Not what you are worried about.”

Parents, including us, fear the worst when their children are ill. Some parents apologize to us when we give the diagnosis of “Not what you are worried about.” They feel they have wasted our time or their time. But this diagnosis is never a waste of time for anyone. It is a stress relieving, sometimes guilt relieving, diagnosis that we are happy to give. Too often we wish with all our hearts that we could give this diagnosis, but instead, we must confirm a parent’s fears.

So this Thanksgiving, we take time to be grateful for the diagnosis “Not what you are worried about.”

May you find lots of Happy in your Thanksgiving.

With gratitude,

Drs. Kardos and Lai
©2013 Two Peds in a Pod®

So Big: A Happy Fourth Birthday

We are so proud: Two Peds in a Pod® turns four years old today and our colleague, pediatrician Dr. Robert Sasson, wrote a sweet poem for us to share with our readers. Thank you, Dr. Bob!

Transition to Parenthood

Her fingers stroked her glistening stretched skin

A kick…and yet another… her baby calling

A wondrous Soul has chosen her

To partake in this Divine right of passage

A smile…a glint of Joy

Rises from deep within

A boy…perhaps a girl

So many emotions

Excitement. Anticipation.

Moments of anxiety…uncertainty…fear

So many choices

Stay at home…return to work

Breast or bottle

Clothes…diapers…daycare

Unexplored territory…

Challenges that may at times seem insurmountable

Arm yourselves with knowledge

For in knowledge there is power

Gird yourselves with courage

For a unified heart is the soil

For your baby’s nourishment

Strengthen your shared purpose for

You will find yourselves on rocky ground

When in conflict

Seek not to find your partner’s weakness

Return always to a place of Love

And seek first to understand

For when your baby looks up and smiles at you

You will know the beauty of her Soul

Because she is yours and you are hers

Bonded together for Eternity

Love her…squeeze her…comfort her

Give her the proverbial

“Roots to grow and wings to fly”

This you must always remember!

Bob Sasson, MD
Dr. Sasson’s collection of poetry and photographs Visions of Thought can be found at www.authorhouse.com

Announcing a partnership with the Jack and Jill family of magazines

Jack and Jill We are proud to provide content for the parenting site of the Jack and Jill family of magazines—Turtle Magazine for Preschool Kids (ages 3-5), Humpty Dumpty (ages 5-7), and Jack and Jill (ages 7-12). The site US Kids Magazines, promotes “the healthy physical, educational, creative, social, and emotional growth of children.”

Doctor Dad Kris Taylor- A Father’s Day Story

Dr. Kardos’s dad is a pediatrician and during our long grueling hours of residency training he’d always serve as a source of encouragement. One of my favorite memories will always be the proud look in his eyes years later as he watched his daughter present at a physician conference.

Today we honor all Dr. Dads- dads or father figures- who help their children in times of crisis, illness, or injury. Following is a tribute sent by one of our readers, Jennifer Taylor.

Happy Father’s Day!

Dr. Lai with Dr. Kardos
_________________________

Kris taylor father's day We are parents to three boys so needless to say, our house is always full of cuts, bruises or injuries of some sort. Band-Aids and “feel better” kisses are a regular part of our daily activity. And while my husband is a great “Doctor Dad” to all three boys, it is his every day involvement in my youngest son’s medical care that makes him a truly amazing father.

My son Luke is 4 years old. At the age of 6 months, he was diagnosed with an in-utero stroke. We were told at the time of his diagnosis that he may never talk or walk based on where the stroke hit. We’ve had several years of therapy, doctor’s appointments and testing. Throughout it all, Kris has been an amazing supporter- both for Luke and me.

While I tend to see the glass half-empty, Kris is perpetually positive. He always says “When Luke can” instead of “If”. He does research on therapies that might shake things up in Luke’s progress and is certainly a very active participator in all the therapies we receive. Kris stops in to chat with all the therapists so that they know he is Luke’s Dad. He is at every medical appointment: driving us to CHOP at 7:00 in the morning because he knows I hate driving on Route 76 by myself; heading up to Lehigh Valley Hospital for a speech consult; sitting by me while Luke has some sort of test done, holding my hand and telling me it will be okay. He is compassionate throughout it all and yet he still pushes Luke to succeed, knowing that our little boy can accomplish anything. When Luke gets frustrated, it is my husband who can calmly get him to try, try again. And they say laughter is the best medicine so my husband pulls out all the jokes and silly behavior he knows to get Luke to go “one more time.”

I really could go on and on about what a wonderful Dad my husband is but the true testament to him is sitting on the floor next to me singing and playing. Luke wouldn’t be where he is now without Kris.

And for that, I am eternally grateful.

Seeing is not always believing

summer pediatric hints Yesterday morning we were aghast to read medical misinformation in the print edition of our local newspaper. Aghast, because we were the pediatricians interviewed for the content of a summer time tips article.

Although a more accurate online version appeared, the print version contained several inaccuracies.

How can you tell if the medical article you are reading is accurate?

Readers should always question what they read, and cross check to see if the information is consistent when compared with other credible sources. In this instance, we served as the “expert” sources of two articles for the same publication (print and online), yet the articles contain conflicting medical information. Cross reference our information with other experts in our field, such as the American Academy of Pediatrics, the Centers for Disease Control, and of course your own pediatrician.
Look twice if the interpretation of the information is coming from a secondary source. The information we give on Two Peds in a Pod is “straight from the horse’s mouth.” We edit and publish our own material. In our office, we talk to patients directly. Remember that “telephone” game you played at birthday parties? The message changes the more intervening people are involved in relaying information.
Medical information changes as new discoveries occur and more studies are conducted. There is a saying in medical school, “Even though half of what you learn in medical school will be inaccurate in ten years, learn it all, because you don’t know which half will be disproven.” We keep up with evolving knowledge in pediatrics by reading journals, taking courses, reviewing cases with our colleagues, and retaking our medical boards on a scheduled rotation. Be sure you read information that is current as well as backed by credible sources.

Despite our dismay at the inaccuracies in the print version, you will find the online article helpful. In addition, please check our prior summertime posts about bee stings, Lyme disease, tick removal, poison ivy, splinter removal, and stay tuned for near-future articles about swimming and sunscreen.

Whoever said, “You can’t believe everything you read on the internet,” was right… except perhaps this time.

WOW-Thanks a million!

pediatrician blog Two Peds in a Pod has reached over ONE MILLION visits!

That’s a lot:

-One million diapers piled up would reach higher than Mount Everest.

-One million peas lined up would reach from Maine to Florida.

-Kids would need 182 boxes of tissues to blow their noses one million times.

-To eat one million Cheerios, you would need to eat 200 boxes .

-One million views to our site…each affecting the life of a child.

Let’s make it a billion!