Photo by Lexi Logan

Picture the Mission Impossible theme song in your head… da da da DUM DUM da da da DUM DUM dadada…dadada…dadada…DA DA! Keep this background music playing as you read.

Recently, Two Peds in a Pod® went undercover as two unsuspecting moms surveying the scene on the shelves of a local chain pharmacy, seeking to uncover what medicines, ointments, and therapies avail themselves to the unsuspecting consumer. Today we break open the case.

All medication labels have an “active ingredient” list. This list contains the actual medicine that acts on your child’s body to hide symptoms or cure a condition.  Read this list carefully so that you know what you are actually giving your child. For example, Flu-Be-Gone claims it “cures the aches and cough of flu and helps your child sleep better.” In order to know just what is actually in Flu-Be-Gone, you need to read the active ingredients. Included might be acetaminophen (brand name Tylenol), a fever reducer and pain reliever, and diphenhydramine (brand name Benadryl), allergy medicine that has the common side effect of causing drowsiness and has some mild anti-cough properties. Notice neither active ingredient actually kills the flu germ. Additionally, you may already have these two medications in your medicine cabinet, or you might have already given your child diphenhydramine recently and giving Flu-Be-Gone would overdose your child.

Also note, diphenhydramine is everywhere. If you see the word “sleep” or “PM” in the name of a product, you will usually find diphenhydramine in the active ingredient list.

Now, let’s hone in on your choices for the anti-itch therapy, hydrocortisone. When your child’s health care provider advises treating an itchy bug bite, poison ivy, or allergic rash with hydrocortisone, make sure that the ACTIVE INGREDIENT in the product is “hydrocortisone 1%.” Hydrocortisone comes as a cream, ointment, spray, or stick (looks like a glue stick) and can have aloe, menthol, or other ingredients thrown in as well. Don’t bother with anything less than maximum strength. Regular strength is 0.5% and is generally ineffective.  Also, keep in mind that while ointment is absorbed a bit better, it is more greasy/messy than cream.

Don’t be fooled into thinking products with the same brand name contain similar active ingredients. Also, do not depend on your doctor to necessarily know the difference between the all the formulations. We noticed that the same brand name pain reliever, such as Midol, can have different active ingredients depending on which one you choose. Midol Teen contains acetaminophen, Midol liquid gels contains ibuprofen, and Midol PM contains acetaminophen and diphenhydramine.

Let’s talk bellyache. Did you know that kids should not take adult pepto bismol because it has a form of aspirin in it? Aspirin may cause Reye’s syndrome, a fatal liver disorder. However, we did see a product called Children’s Pepto Bismol and guess what the active ingredient is? It is calcium carbonate, which is the SAME active ingredient as in Tums, and is safe to give kids. However, watch your wallet: the children’s pepto bismol that we found cost $6.00 for a box of 24 tablets. The TUMS that we found cost $4.50 for a bottle of 150 tablets of the same stuff, just in slightly higher dose. Check with your child’s doctor but in most cases, the kids can take the adult dose.

Also, be aware that cold and cough medicine have not been shown to treat colds successfully or even to actually relieve symptoms in most kids. In fact these medicines have potential for harmful side effects, accidental overdose, or accidental ingestion and are just not worth giving your children. However, we found tons of cold and cough medicines marketed for children. Here are the three most commonly used active ingredients:

• If you see “suppressant” you will likely find “dextromethoraphan” in the active ingredient list.
• If you see “expectorant” you will likely find “guaifenesin” in the active ingredient list.
• If you see “decongestant” you will likely find “phenylephrine” in the active ingredient list.

Many products combine two or all three of the above. We ask, even if these ingredients did work well in kids and were not potentially dangerous, what is the POINT of combining a cough suppressant with an expectorant? Can you really have it both ways? (Remember, that Mission Impossible theme is still playing in the background.)

A few other tidbits. “Dramamine,” used for motion sickness, gets broken down in the body to diphenhydramine, that allergy medicine that we already talked about. So look at cost differences when choosing a motion sickness medicine. Both have the same side effect: sleepiness.

Many cough drops contain corn syrup and sugar. This is the same stuff lollipops are made of, so just call a candy a candy and keep your child’s throat wet with the cheaper choice, if you choose to do so.

Finally, we found one “natural children’s cough medicine” which claimed that it is superior because of its “all natural ingredients.” The first active ingredient listed? Belladonna. Sure it’s natural because it comes from a plant. So does marijuana. Just because it’s “natural” doesn’t mean it’s safe. Belladonna can cause delirium, hallucinations, and death and in fact has been used in high doses as a poison! Leave the cough medicine on the store shelf, and read our post about other ways to soothe a cough and cold symptoms.

Bottom line:  remember always to check the “active ingredient” list when buying any over-the-counter medication for your children.

As we were wrapping up our mission, one of the pharmacy employees came over to us, raised an eyebrow at our clipboard, and asked, “Can I help you ladies with anything?” We were tempted to answer “YES, can you help us take notes?”  but we just smiled and said “No, we’re fine, thanks. Just checking out what’s available.”

So now, we will don our stethoscopes and come out of hiding, go back into our offices and onto our website. Thanks for tuning in to this episode of Two Peds in a Pod®…. Da da da, DUM DUM da da da, DUM DUM dadada…dadada…dadada…DA DA!!!

Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®

As we head into this year’s cold and flu season, we re-release this post in response to recent questions  about “the best cold medicine for my kid.” Originally posted May 27, 2011

“DaDu.”

That’s how my oldest used to say “Thank you” when he was about two years old. Now that he is thirteen I find myself still reminding him to say “thank you” when he goes to a friend’s house or to a birthday party or when a friend’s parent drives him to school.

From Two Peds in a Pod®:  We are thankful for our readers, our facebook friends, and our subscribers for continuing to send us ideas and for telling parents around the world about our down-home source of “sound pediatric advice for parents on the go”. We’ll keep writing as long as you all keep reading. 

Today, may you enjoy cramming in folding chairs to your dining room table, the sleepy post Thanksgiving feast lull, and the sight of heaps of children piled onto a tiny couch.

Dadu and Happy Thanksgiving, 

Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®

It’s gift-giving season. Yes, we could write a soppy post about how the best gifts in life are not material. Or that you should donate money to charity in a child’s name. However, sometimes you just want to buy something. To help you find a perfect gift, or at least one a kid will play with this season, we present a review of child development and a corresponding set of gift ideas.

0-3 months: Babies this age have perfect hearing and enjoy looking at faces and objects with contrasting colors. Music, mobiles, and bright posters are some age appropriate gift ideas.

3-6 months:  Babies start to reach and grab at objects, so they enjoy rattles and toys that are big enough to hold onto and safe enough to put in their mouths- try bright colored teething rings and large plastic “keys.” Because babies learn by mouthing objects, buy your niece some first books made of cloth or vinyl knowing they will be heavily drooled on.

6-12 months: Around six months, babies begin to sit alone or sit propped. Intellectually, they begin to understand “cause and effect.” Good choices of gifts include toys with large buttons that make things happen with light pressure.  Toys which make sounds, play music, or cause Elmo to pop up will be a hit. For a nine-month-old old just starting to pull up to standing, a water or sand table will provide hours of entertainment in the upcoming year. Right now you can bring winter inside and fill it with a mound of snow. Buy some inexpensive measuring cups and later in the summer your toddler will enjoy standing outside splashing in the water.

12-18 months: This is the age kids learn to stand and walk. They enjoy things they can push while walking such as bubble blowers, plastic lawn mowers or plastic “poppers” that have little balls inside that pop around when pushed.

18-24 months: Kids this age still like to push toys while walking, and although kids can not pedal, they enjoy riding on toys such as big wheels “Fred Flintstone” style. Dexterous enough to drink out of a cup and use a spoon and fork, toddlers can always use another place setting. Toddlers are also able to manipulate shape sorters and toys where they put a plastic ball into the top and the ball goes down a short maze/slide. They also love containers to collect things, dump out, then collect again.

2-3 years: To encourage motor skills, offer tricycles, balls, bubbles, boxes to crawl into and out of. Go with crayons over markers because crayons require a child to exert pressure and therefore develop hand strength. Dolls, cars, and sand boxes all foster imagination. Don’t forget those indestructible board books so kids can “read” to themselves.

3-4 years: Now kids engage in elaborate imaginary play. They enjoy “dress up” clothes to create characters- super heroes, dancers, princesses, kings, queens, animals. They become adept at pedaling tricycles or even riding small training-wheeled bikes. Other gift ideas include crayons, paint, markers, Play-doh®, or side-walk chalk. Children this age understand rules and turn-taking and can be taught simple card games such as “go fish,” “war,” and “matching.”  Three-year-olds know colors but can’t read- so they can finally play the classic board game Candyland®, and they can rote count in order to play the sequential numbers game Chutes and Ladders®.

5-year-olds: Since 5-year-olds can hop on one foot games like Twister® will be fun. Kids this age start to understand time. In our world of digital clocks, get your nephew an analog clock with numbers and a minute hand… they are hard to come by. Five-year-olds also begin to understand charts— a calendar will also cause delight. They can also work jig-saw puzzles with somewhat large pieces.

8 years old: Kids at this point should be able to perform self help skills such as teeth brushing. Help them out with stocking stuffers such as toothbrushes with timers. They also start to understand the value of money. The kids will appreciate gifts such as a wallet or piggy bank.  Eight-year-olds engage in rough and tumble play and can play outdoor games with rules. Think balls, balls, balls- soccer balls, kickballs, baseballs, tennis balls, footballs. Basic sports equipment of any sort will be a hit.

10-year-olds: Fine motor skills are quite developed and intricate arts and crafts such as weaving kits can be manipulated. Also ten-year-olds value organization in their world and want to be more independent. Therefore, a watch makes a good gift at this age. And don’t forget about books: reading skills are more advanced at this age. They can read chapter books or books about subjects of interest to them.

Tweens: Your child now has a longer attention span (30-40 minutes) so building projects such as K’nex® models will be of interest to her, as well as puzzles with hundreds of pieces. This is a time when group identity becomes more important. Sleepovers and scouting trips are common at this age so sleeping bags make great gifts. Tweens value their privacy – consider a present of a journal with a lock or a doorbell for her room.

Teens:  If you look at factors which build a teen into a resilient adult, you will see that adult involvement in a child’s life is important. Create opportunities for one-on-one interaction by giving gifts such as a day of shopping with her aunt, tickets to a show with her uncle, or two hours at the rock climbing gym with dad. Teens usually have enough “stuff” anyway.

However, if you want to give “stuff,” here are some suggestions:

Since it’s best for kids back to carry the weight of school books on two shoulders (see our post about backpack safety), find your teen a cool backpack.

Encourage physical activity. Sports equipment is always pricey for a teen to purchase- give the fancy sports bag he’s been eying and encourage physical activity with a gym membership.

Hunched over the computer is not an ergonomically correct way to study.  Prevent your kids from growing into adults with strained necks and backs by getting a key board and chair set which is kind to their bodies.

Happy shopping.

Naline Lai, MD and Julie Kardos, MD

©2012 Two Peds in a Pod®

A decade ago, we wondered if arsenic was in pressurized wood-containing playground equipment . Then we worried about the toxin turning up in apple juice . Now recent reports say arsenic is in the US rice supply .

Uh oh.

As an Asian-American I often cook rice for my family, so I emailed my toxicologist sister when the reports of arsenic in rice first surfaced.

“It’s okay,” my sister emailed back, “Just wash/rinse the rice several times. It’s not like we’re drinking water in Bangladesh.”

“That’s it?” I thought to myself and decided to call her. After all, I figured she is one of a small number of board certified medical toxicologists and an author of a paper on arsenic.

“What is arsenic anyway?” I asked when I got her on the line.

“It’s a naturally occurring element,” she said. To be more precise, it’s number 33 on the periodic table. Like other elements such as iron, lead or calcium, arsenic is found in the earth’s crust.

Here’s what  I learned about arsenic:

Why did my sister reference Bangladesh in her email? In the 1970’s drinking water
was in short supply in Bangladesh. Contamination of water by sewage and
monsoons lead to diarreheal illness and high infant mortality rates.
Hundreds of thousands of wells were drilled in order by well meaning aid
organizations. Unfortunately, unbeknownst to the drillers, Bangladesh
sits over a pocket of arsenic rich soil. As a result, some estimate one
in five of the drilled wells is contaminated with arsenic.

How does arsenic affect humans?

Organic arsenic is not toxic and is found in seafood. The inorganic form of arsenic, however, interferes with Adenosine–Tri- Phosphate (ATP), which is a building block for cellular energy. When a large amount is ingested at one time, the body goes haywire, causing many vital organs in the body to shut down.

Chronic effects of low amounts of poisoning are more subtle. Exposures to low levels over time are linked to some cancers such as bladder and skin cancer.

How does arsenic enter the body?

By eating or drinking of tainted substances. Rarely, arsenic is inhaled. Absorption of arsenic will not occur via touch.

Can I tell if something is tainted?

No. Arsenic is colorless and tasteless when dissolved in water. In fact, arsenic’s nick name is “Inheritance Powder” because it was used to speed up royal inheritances in medieval and renaissance Europe.

Should I run out and have my kids tested?

No. Arsenic does not accumulate in the body. It moves in and out quickly. A spot test is not meaningful. Think of eating trace amounts of arsenic like eating the charred part of a piece of steak.

To lower arsenic levels or any other potential contaminant on food, wash, wash, wash:

-Wash your hands before you prepare food.

– Wash your child’s hands before she eats.

–Wash your produce (meat does not need to be washed).

Also, serve a variety of foods to minimize the chances your family will be exposed to a large quantity of any potential toxin found in one food source.

What about rice cereal? Is it safe for my baby?

The jury is still out. For now, limit the amount of rice cereal you give to your baby. For details and the latest updates www.aap.org

Tonight my family will be eating ribs and rice…just hold the arsenic.

Naline Lai, MD with Julie Kardos, MD

With thanks to Melisa Lai Becker, MD, director of medical toxicology of the Cambridge Health Alliance

©2012 Two Peds in a Pod®

Before babies gain the ability to say, “Mama, please hand me my cup from that table,” they will point at their cup. In other words, babies naturally use their own sign language to communcate. Today, teacher Kacey Slack writes about teaching American Sign Language as a way to help your child communicate before she masters spoken language.

–Drs. Lai and Kardos

Have you ever noticed your baby using hand gestures to express her needs? Most babies will raise their arms when they want to be held, wave goodbye, and point to what they need or want. What if your baby could tell you what she wanted before she learns to speak? Teaching babies to sign is simple and beneficial. According to child developmental psychologists Drs. Linda Acredelo and Susan Goodwyn, in Gaining a window into your baby’s mind, “Using signs with babies reduces tears, tantrums, and frustration, allows babies to express needs and share their worlds, enriches interactions between adults and babies and strengthens the parent-child bond, reveals how smart babies are, and increases parents’ respect for them and helps build babies’ self-confidence and self-esteem.”

Teaching signs is easy. You can use this link to learn basic signs. First demonstrate the sign while saying the word. You can also guide your baby’s hands if she will allow you. Praise any approximation of the sign. It will take some time before your baby will understand the sign and perform it. Be consistent and repeat the signs as often as possible. The more your baby sees the sign, the better she will understand it and be able to do it herself.

When beginning, choose a few signs that are useful to your baby such as “eat,” “more,” and “all done.” These are signs that babies encounter numerous times each day. Once your baby begins to sign, the possibilities are endless. She may want to learn zoo animals or you may want to teach her safety words in order to express if something is hot or cold or if she is hurt. Signing can also be used while reading books with your child. It is a great way to engage her and allow her to interact with literature.

You do not need expensive products or costly classes in order to teach sign. Play groups, however, offer parents the opportunity to receive guidance from an instructor, preferably one with experience signing as well as interacting with young children. Play classes also allow your child to interact with other children and learn from babies who may already know how to sign.

Helpful Links: the first link shows how to sign many common words.

http://www.aslpro.com/cgi-bin/aslpro/aslpro.cgi

https://www.babysigns.com/index.cfm?id=120

http://www.babies-and-sign-language.com/index.html

[youtube https://www.youtube.com/watch?v=WYbJgw9tOfU&w=560&h=315]

Kacey Slack

Independent Certified Instructor

Kacey Slack holds teaching certifications in elementary and special education. She has taught in various classroom settings and is an adjunct professor at Manor College. A mom of a young signing toddler, Ms. Slack is part of the Baby Signs® Program which helps guide other parents through their signing journey. She can be reached through www.babysignsprogram.com/bykacey.

© 2012 Two Peds in a Pod®