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^®

We’re seeing a lot of this stuff around the office. It’s “hand-foot-mouth” disease, a common, self-limited illness caused by the Coxsackie virus, and it strikes most often in the spring and summer. Named for rashes which can affect the hands, feet, or mouth, this illness can cause fever for the first few days as well as some loose stools.

What does it look like?

If you look carefully at the photos, you will see faint red bumps on this child’s feet. The rash may also look like tiny blisters and will always blanch (if you press on it and lift up your finger, the redness will briefly disappear- just as if you pressed on a sunburn). The same rash may appear on the hands and is not itchy. The child’s throat above is red in the back and has several ulcers, or canker sores. The hands, feet and mouth are not always simultaneously affected, and although we don’t call the illness “hand-foot-mouth-tush” disease,  sometimes kids also get a red bumpy rash on their buttocks.

Is hand-foot-mouth disease painful?

The throat ulcers can be quite painful and the rash on the feet may be slightly tender.  Usually the rash on the hands is not felt by the child. You can alleviate your child’s throat pain with acetaminophen (brand name Tylenol) or ibuprofen (brand names Advil or Motrin). For toddlers and older, Magic Mouthwash, a mix of 1/4 tsp diphenhydramine (plain liquid Benadryl) and 1/4 tsp Maalox (the regular adult stuff) squirted over mouth ulcers prior to eating a meal (three times a day) is an age-old way to sooth sores.

How is it spread?

This virus is contagious through saliva. Prevent kids from sharing cups, eating utensils, and tooth brushes, and clean up toddler drool. This vigilance can help prevent the virus from spreading to family members and friends. Children with this virus can still attend daycare as long as they are not feeling ill. Typically after the first few days of illness, fever and pain subside. Most commonly the rash and mouth ulcers last about a week or two.

What is the treatment?

Unfortunately there is no treatment for hand-foot-mouth disease, but fortunately your child’s body is fully capable of fighting off the virus. Your role is to help soothe pain. Otherwise, kids may refuse to drink and end up dehydrated. When my son had this illness at age two, he liked sucking on a washcloth soaked in very cold water. I also gave him lots of sherbet, ice cream, milk shakes, and noodles.  These foods were easier for him to swallow while his throat was sore.

When should I call my kid’s doctor?

Kids can get this virus more than once, and many strains of this virus circulate. Even parents are not always immune. So now add Coxsackie virus, or hand-foot-mouth disease, to your Dr. Mom and Dr. Dad list of manageable diseases. Knowledge is power. However, if your child’s fever lasts more than three days, if he does not drink enough to urinate his baseline amount, if he is inconsolable, seems disoriented, or if your parent gut-instinct tells you something more might be wrong, do get your child to medical attention.

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

Originally posted June, 2011, and right on cue, Coxsackie is back again this summer.

This year we asked our dad readers to help us write our Father’s Day post. They completed this thought: “Before I became a dad, I never thought I’d…”

…Learn to curl hair for cheerleading competitions

…BE RESPONSIBLE

…Become a stay at home dad AND love it so much after everything I’ve been through!!

…Learn all of the names of Thomas The Tank Engine’s friends and the many songs associated with them.

…Have a toys r us in my house.

…Go food shopping at midnight.

…Make so many pancakes on Sunday mornings.

…Volunteer in a dunk tank and have pie thrown at me.

One of our readers summed up his thoughts on becoming a dad:

Since I’ve become a father, nearly seven years and two beautiful daughters later, my life has become a series of jobs that I never thought I would have to tackle. These include:

Beautician: I never thought in a million years that I would be learning how to do pony tails, side pony’s, braids (not that I can braid yet), and painting little finger and toe nails.

Disney Princess Aficionado: At one point in my life I thought I was cool because I knew a lot about beer, how it was made, where it was from, where the best IPA’s were being poured. Now I am “cool” because I know where Mulan lived, and because I know the story about Ariel falling in love with Prince Eric.

Doctor: I am well versed here and can cover almost everything from the simple band-aid application and boo-boo kissing, to the complex answering of why daddy is different and why he gets to go to the bathroom standing up.

Cheerleader: Both of my daughters enjoy participating in sports. It’s been such a great experience to cheer them both on from the side line. I enjoy watching them grow with the sport and gain confidence game after game.

Becoming a father was one of the best choices I have made with my life. I love being a dad, and I look forward to the future dad challenges, good and bad, and beingthe best mentor I can be.

Thank you to our readers for contributing to this post.

Happy Father’s Day!

Julie Kardos, MD and Naline Lai, MD

©2014 Two Peds in a Pod®

Babies and children love bath time and are drawn to water play. Today we bring you the splash on swimming.

We’re going to the beach- can my baby go swimming? How about a pool?

• Most pools, oceans, and lakes are much colder than bath water. Babies feel colder more quickly than adults. Remember your own parent telling you to come out of a pool because your lips were blue? Limit a baby’s exposure to cold water accordingly.
• Chlorine will not hurt babies, but it can dry out skin. Apply moisturizer after swimming if your child’s skin gets dry. Kids with eczema can be particularly sensitive to chlorinated water.
• Salt water is safe for babies and kids to swim in.
• Young kids try to drink the water they swim in. Don’t let them. It’s not just your nephew who pees through his swim diaper that you need to worry about. Unfortunately chlorine and salt fail to kill all viruses, bacteria, and parasites that might lurk in swimming water.
• If your child swims outside, remember that sunburns occur more easily because sunlight reflects off the water. Apply sunscreen liberally before and after swimming. Better yet, try to keep that baby hat on and have your child wear a sun protective shirt.

When should I start swim lessons for my child?

Start swim lessons as early as toddlerhood — it is a great life skill. However, swim lessons will not make your child “drown proof.” You can find more data in this drowning prevention article from The American Academy of Pediatrics. Unfortunately, even under adult supervision, drownings occur. When an adult’s attention is briefly diverted to answer the phone, their meal, etc, a drowning can take place. The bottom line:

• Always stay arm’s length of babies and toddlers in the water. Also stay at arm’s length of your older children who have not yet learned to swim.
• Even if your child can swim well, never let your child or teen swim alone or without a life guard.

A note about Baby Swim Lessons:

• Babies can take “swim lessons,” meaning “spend quality time with a parent in the pool.” Despite the claims of some swim instructors, no studies have shown that infant swim lessons make infants “drown proof.” 

Any other water safety tips?

A few years ago, Dr. Lai’s toddler-aged neighbor waddled over to the ice bucket at a Fourth of July party. Toddlers have big pumpkin shaped heads and before Dr. Lai could blink an eye, her neighbor tumbled into the water head first. Luckily Dr. Lai’s husband was standing next to the bucket and pulled the toddler out.

• As this case shows, you can’t let your guard down, even if no pool or large body of water is in sight.
• Small blow-up backyard pools are the same as bath tubs in terms of drowning risk, so never leave kids unattended around these pools. Stay at arm’s length of your babies and toddlers when they play in these pools.
• Additionally, never leave kids unattended, even briefly, in the bathtub.

Ideas on how to play with water?

• Water tables (which can double as sand tables in the spring, leaf tables in the fall and indoor snow tables in the winter) allow young toddlers to stand and play with toys in very shallow water.
• Fill a bunch of different sized stacking cups with water for kids to pour, dump, or perhaps to mix with rocks, dirt, or leaves.
• Simple squirt bottles are great fun. When Dr. Kardos’s twins were little they spent large amounts of time “watering” every plant, bush, flower, and blade of grass in the yard.
• Fill small cupcake tins with water and supply your kids with water-color paint to decorate the sidewalk or walkway of your house. Kids become entranced by the colors created as they rinse off the brushes. Warning— make sure the paint is water soluble. Dr. Lai still has the name of one of her children in fluorescent orange written on her driveway.
• Wet down your walkway and blow bubbles onto the cement – they will cling onto the walkway for a long period of time.

Grab a towel and enjoy the summer with your children.

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®
originally published June 2013, updated May 2019

Just in time for Field Day and pool openings, today we provide sunburn protection information. 
 
Hot!

Until I became a mother I never thought…

I’d care if a birthday party was cancelled

I’d obsess about bowel movements and gas

I’d remember to reapply sunscreen

I’d bake zucchini muffins and count them as a vegetable serving

I’d wipe someone else’s nose

I’d relearn my most dreaded school subject in order to help my child with homework

I’d feel compelled to ask if anyone needs to go to the bathroom before I go anywhere in a car

I’d go on nauseating upside-down amusement park rides because my kid needed to be accompanied by an adult

I’d spend my Friday night driving and picking up kids from parties and then spend my Saturday morning driving and picking up kids from the ice hockey rink starting at 5:00am.

I’d get to play Tooth Fairy

I’d (try to) answer questions such as “What does God look like?” and “Who was the mom of the first man?”

I’d willingly read the same book out loud night after night after night

And finally-

Until I became a mother I never thought… I’d wipe away tears when reading sappy Mother’s Day cards.

Happy Mother’s Day from your two Peds

Naline Lai, MD and Julie Kardos, MD

©2014 Two Peds in a Pod®

When it comes to our children, we want the best that money can buy. But the best is not necessarily the most expensive. Today we offer our pediatrician perspective on ways you can save money without compromising your child’s health or safety.

Buy generic infant formula: Common store brands of iron-containing Food and Drug Administration regulated infant formulas cost less than big name brands and have equal nutritional value.

Do not buy toddler formula. This is a marketing coup. Children over one year of age can drink milk.

No need to buy only organic milk and food.  Read here for more information about organic vs conventional foods. 

Make your own baby food- from the start you can grind up part of your breakfast, lunch or dinner in a blender for your baby. Grind up cooked chicken or cooked vegetables, pasta or soft fruits, mix with a little formula or breast milk if you need to get the pureed consistency just right, and commence spoon feeding! You will save tons of money from not buying bad-for-the-environment plastic containers of baby food. When your babies advance to finger foods, simply cut up pieces of your foods.  

Do NOT spend money on “toddler junk food” such as Puffs for portable finger food practice. Instead buy “toasted oats” (brand name = Cheerios) which are low in sugar, contain iron, and are much less expensive. One exception: do buy the baby cereals (rice, oatmeal, barley, or mixed grains) because they contain more iron than “grown-up” oatmeal and babies need the extra iron for their development.

Buy generic medicine: acetaminophen (brand name Tylenol), ibuprofen (brand name Motrin, Advil), diphenhydramine (brand name Benadryl), loratadine (Claritin), ceterizine (Zyrtec). If your child’s doctor prescribes amoxicillin (for ear infection, Strep throat, sinusitis), ask the pharmacist how much the medication would cost if you paid cash. The cost for this commonly prescribed antibiotic may be less than your insurance co-pay.

Accept hand-me-down clothes, shoes, etc. The purpose of shoes is to protect feet. Contrary to what the shoe sales-people tell you, cheap shoes or already-worn shoes will protect feet just as well as expensive, new ones. Just make sure they fit properly.

Don’t buy “sleep positioners” for the crib. Place your newborn to sleep on his back and he will not/cannot roll over. If you need to elevate your baby’s upper body to prevent spit-up or to provide comfort from gas, don’t buy a “wedge” but instead put a book under each of the 2 crib legs so the entire head of the crib is elevated. There is NO evidence that wedges or sleep positioners prevent SIDS (Sudden Infant Death Syndrome) and these products are NOT endorsed by the American Academy of Pediatrics. Dr. Kardos advises her patients to return any sleep positioners that they received at the baby shower and use the money for diapers instead.

The best toys are ones that can be reconfigured and used again and again. Legos, blocks, crayons/markers/chalk, small cars, dolls, balls come to mind. Avoid one-time only assembly type items, breakables, etc. Have a “toy recycle” party or a pre-Halloween costume recycle party: everyone brings an old costume/toy they would like to trade and everyone leaves with a “new” item (kids don’t care if things are brand new or not, they care only if you teach them to care). Along the same lines, inexpensive paint can turn a pink “girl’s bike” into her younger brother’s blue “boy bike.” Read our article on gift ideas for kids for more ideas that do not “break the bank.”

Borrow books from libraries instead of buying them new or look for previously owned ones at yard sales, thrift shops and online.

Don’t buy “Sippy cups.” Teach your child to drink out of regular open cups. Sippy cups are for parents who don’t like mess-they are not a developmental stage. They are actually bad for teeth when they contain juice or milk and they do not aid in child development. They can also cause harm to children who run and fall while drinking out of them.

Skip over potty training pants.  Go straight to underwear. 

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®
revised from our earlier 2009 post

Put poison control’s phone number on the back of your cell phone, on your cell phone case, and on your wall phone. Put it everywhere:  1–800-222-1222.

Did your toddler eat dog food? Or a berry from your backyard bush? Did you give the wrong medication to your child? Call poison control. Experts at poison control will direct your next step. They have access to extensive data on poisoning, and they can give you that information much quicker than a drug-manufacturer or pharmacist or even your own doctor. One of Dr. Lai’s kids ate a mushroom from the yard when she was 20 months old—she called poison control. A mom asked Dr. Lai about carbon monoxide exposure—she called poison control. If doctors have a question about any ingestion or poisoning—we call poison control. But don’t wait for us to call, go ahead yourself and call.
People often first jump to the internet for information. However, a recent small study found that the internet is NOT the best place to research questions about toxins. Many sites fail to direct readers to the US Poison Control Center, and those who do, fail to supply the proper phone number – again, that’s 1–800-222-1222.

If your child needs emergent treatment, surfing the internet for what to do next wastes precious time. Don’t reach for your phone to “google it,” in the case of a possible poisoning, reach for your phone and make a CALL. It could be life-saving.

Julie Kardos, MD and Naline Lai, MD

© 2014 Two Peds in a Pod®

this post has been updated, please visit here

Despite what your grandmother says, teething is not the underlying cause of diaper rash. The underlying cause of all diaper rash is, well…the diaper. Whether your baby wears cloth or plastic diapers, the first treatment for diaper rash is to take the diaper off.

Yuck, you say? We agree. This first treatment isn’t practical. Luckily there are other ways to combat the common diaper rashes:

Contact rash- This diaper rash appears as  patches of red, dry, irritated skin. Poop smooshed  against a baby’s sensitive skin is the main source of irritation for this type of rash. Contact rash is often accentuated where the elastic part of a plastic diaper rubs against the skin. Experiment to see if one brand of disposable diapers causes more irritation than others or if the detergent used for a cloth diaper is the culprit.  Even the soap on a wipe or the friction from scrubbing off poop can exacerbate a contact rash.

Treatment: If you see a rash, use a soft, wet cloth with a gentle moisturizing soap to clean off poop or splash water gently on your baby’s bottom. Try to avoid rubbing an already irritated bottom—splash and dab, don’t  scrub. Just urine in the diaper? Just pat or fan dry the bottom and change the diaper. Don’t bother to wipe all of the urine off. After all, urea, a component of urine, is used in hand creams. In addition, after  every diaper change apply a barrier cream (one containing zinc oxide or petroleum jelly) to prevent your baby’s skin from coming into contact with the next round of irritants.

Yeast rash– This rash is caused by a type of yeast called Candida. The rash typically looks beefy red on the labia or the scrotum. “Satellite lesions” or tiny red bumps surround the beefy red central rash. Babies on antibiotics are particularly susceptible to candidal rashes. Yeast love warm, wet, dark environments  so  remove the diaper as much as possible to create a cool, dry, light environment.

Treatment: Since yeasts are a type of fungus, yeast rashes respond to antifungal creams such as clotrimazole (sold over the counter as Lotrimin in the anti-foot fungus aisle) or nystatin (prescription). Treatment can take as long as 2-3 weeks.

Pimples– Sometimes you will see a pimple, or a several pimples, in the diaper area . Pimples that look like they have pus inside of them are usually caused by overgrowth of bacteria that live on the skin or around poop. Sometimes a tiny pimple transforms into a boil, or abscess.   Suspect an abcess when a pimple grows, reddens, and becomes tender. 

Treatment: In addition to usual washing poop off with soap and water, apply an over-the-counter topical antibiotic cream or ointment to the pimples with diaper changes. Soak your baby’s bottom in a bath a couple of times a day in warm water. If you suspect a boil or abscess, take your baby to her doctor who may drain the infection and/or prescribe a prescription topical or oral antibiotic.

Eczema– If your baby has red, dry, itchy patches on her body she may have eczema and eczema  may appear anywhere… including in the diaper area. 

Treatment: In addition to applying barrier creams, treat eczema in the diaper area with hydrocortisone 1% ointment four times daily for up to one week.  

Viral– Viruses such as molluscum contageosum may cause flesh colored bumps in the diaper area. Other viruses, like the ones which cause hand-foot-mouth disease, may cause red bumps in the diaper area. Be suspicious of hand-foot-mouth disease if your see red bumps on your child’s hands and feet as well as sores in her mouth.

Reasons to bring your child to her doctor: If you are unsure of the cause or treatment for your baby’s diaper rash, then it’s time to call your pediatrician. Don’t worry… no one will think you are acting rashly. 

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