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

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®

We can tell from this past week at the office that croup season has started. DON’T PANIC! Read on to learn what to look for and what to worry about. Please also listen to our podcast on this same subject.

You wake up in the middle of the night to the sound of a seal barking…inside your house. More specifically, from inside a crib or toddler bed. Unless you actually have a pet seal, that sound is likely the sound of your child with croup.

“Croup” is the lay term for any viral illness causing swelling of the voice box (larynx)  which produces a seal-like cough. The actual medical term is “laryngotracheobronchitis.”  In adults, the same viruses may cause laryngitis and hoarseness, but minimal cough. In children the narrowest part of a child’s airway is his voice box. So not only does the child with croup sound hoarse when he talks and cries, but since he breathes through a much narrower opening, when he forces air out with a cough, he will sound like a barking seal. When a kid with croup breathes in, he may produce a weird guttural noise, called “stridor.”

Many viruses  cause croup, including  flu (influenza) viruses. Therefore, a flu vaccine can protect against croup. While no antibiotic or other medicine can kill the croup causing viruses, here are some ways to help your child feel better.

What to do when your child has croup:

Stay calm. The noisy breathing and barky cough frighten children and their parents alike. It’s easier for the child to breathe when he is calm rather than anxious and crying. So, even if you are scared, try to act calmly since children take their cues from their parents.

Try steam. Run the shower high and hot, close the bathroom door and sit down on the bathroom rug with your child and sing a song or read a book or just rock him gently. The steam in the bathroom can help shrink the swelling in your child’s voice box and calm his breathing.

Go outside. For some reason, cool air also helps croup. The more misty the better. In fact, many a parent in the middle of the night has herded their barking, noisy breathing  child outside and into the cold car to drive to the hospital. Once in the emergency room, the parents are surprised to find a happily sleeping, or  wide awake, chatty child, “cured” by the cold night ride.

Run a humidifier. A cool-mist humidifier running in your child’s room will also help. Make her room feel like a rain forest, or the weather on a  really bad hair day, and often the croupy cough will subside. Cool-mist humidifiers in the child’s room are safer than hot air vaporizers because vaporizers pose a burn risk. It’s the mist that helps, not the temperature of the mist.

Offer ibuprofen or acetaminophen. Your child may cough, and then cry, because her throat is sore. Pain relief will make her more comfortable and allow her to get back to sleep.

Who needs further treatment?

Most kids, more than 95%, who come down with croup, get better on their own at home. Typically, croup causes up to three nights of misery punctuated by trips into the cold night air or steam treatments. During the day, kids can seem quite well, with perhaps a slightly hoarse voice as the only reminder of the night’s tribulations. Why croup is worse at night and much better during the daytime hours remains a medical mystery. One theory is, just like ankles swell after one is upright all day, swelling in the voice box increases when people lie down. After the three nights, your child usually just exhibits typical cold symptoms with runny nose, a regular sounding cough, watery eyes, and a possible ear infection at the end. Then brace yourself for next time—kids predisposed to croup tend to get croup the next time a croup causing virus blows into town. But take heart, most kids outgrow the disposition for croup around six years of age.

Some kids do develop severe breathing difficulties. If your child shows any of these symptoms, get emergency medical care:

Turns pale or blue with coughing. Turning red in the face with coughing is not as dangerous.

Seems unable to swallow/unable to stop drooling.

Breathing fails to improve after steam, cool air, humidity, or breathing seems labored– nostrils flare with every breath or chest heaves with every breath—pull up their night shirts to check for this. See this link for an example of labored breathing.

Mental state is altered: your child does not recognize you or becomes inconsolable.

Child is unimmunized and has a high fever and drooling along with his croup symptoms: he may not have croup but rather epiglottitis, most commonly caused by a vaccine-preventable bacteria. This is a separate illness that can be fatal and requires airway management as well as antibiotics in a hospital.

We searched the internet for a good example of what the “seal bark” cough of croup. The best imitation we found is actually the sound of a sea lion. We will have to ask a veterinarian sometime if seals and sea lions get croup. If so, what do they sound like?

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

Many families know from the start  they plan to formula feed their babies. For some, this decision is based on the mom’s medical condition which precludes breastfeeding. Some base the decision  on cultural beliefs, some on personal preference. Still others have tried to breast feed but nursing does not work out.

Whatever the reason, any maternal guilt over not breastfeeding should be left behind once the decision is made to bottle feed.  We point out, “Just think of all of those college graduates who were formula fed as infants!”

Here are some tips for formula feeding:

1. Remember that babies may not be equally hungry at all meals. Sometimes newborns are full after drinking just ½ an ounce, other times they may suck down 2-3 ounces.
2. Formula takes a little longer to digest than breast milk, so while some formula fed babies eat every two hours, others feed every 3-4 hours.
3. You only have to sterilize the bottles the first time you use them. After that, washing them with warm soapy water or putting them in your dishwasher will get them clean enough.
4. If using powder formula, you may mix it with tap water to whatever temperature your baby prefers. If you drink tap water, no need to boil the water first for your baby or to buy bottled water or “nursery water” or any other special gimmicky water. For those adults who routinely boil or filter their own drinking water, continue to do the same for your infant.
   
5. When rewarming formula do not put a bottle of formula directly in the microwave Microwaving produces hotspots and most plastic bottles are not microwave safe. The American Academy of Pediatric’s advice is to rewarm a bottle in a bowl of lukewarm water. But, we know in real life, everyone smiles at us and sneaks off to use the microwave. If you must use the microwave, first transfer formula into a microwave safe container, heat for only a few seconds at a time and then mix the formula very, very well and transfer back into a bottle. Before giving the bottle to your baby, test the formula’s temperature on the inside of your wrist. This is all moot if your baby takes formula at room temperature… try room temperature… you never know.
   
6. Let your baby decide when she has had enough to eat. Don’t force her to finish up the last drop—this is the infant equivalent of your insisting on a clean plate. Teach your baby to eat when hungry and stop when she is no longer hungry. Parents have to be okay with “wasting” some formula. Make up more than you think she will need and throw out the rest.
   
7. Standard FDA-approved cow-milk based formula with iron meets most babies’ needs. Some parents have coupons for one brand over another, or prefer to buy the store brand over the name brands. Fine to toggle between brands or types of formulations (eg ready-to-feed vs. powder).
   
8. Do NOT give your infant “low iron” formula, homemade formula, goat milk, or regular cow’s milk. Call your child’s doctor if you are worried that your baby is not tolerating her standard infant formula.
9. The American Academy of Pediatrics recommends giving babies formula until one year of age, at which time you can transition your baby to whole cow’s milk. No need to go onto the toddler formulas.
   

Enjoy feeding your child. Hold her close and allow her to study your face as you feed her. Talk or sing during her meals. Formula and
breast milk have the same calorie count and a similar nutrition content. Love and food can come through a bottle. Ultimately, what works within your family is what is right for your family.

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

Wondering about preschool and toddler discipline? sleep? potty training ? emotional well being?

I always tell new moms that if you can breastfeed for two weeks, then you can breastfeed for two years. The point is, while our species has been breastfeeding for millions of years, sometimes it’s not intuitive. Getting to the two week point isn’t always easy, but once you’re there, you’ll be able to continue “forever.”

So, how to get through those first two weeks of breastfeeding?

Practice. Fortunately, your newborn will become hungry for a meal every two hours, on average, giving you many opportunities to practice. For the first few meals, a newborn can feel full after eating only one teaspoon of colostrum (the initial clear milk). The size of a person’s stomach is the size of his fist. For a baby, that’s pretty small. So relax about not making a lot of milk those first few days.

But remember, your baby’s needs will change and she will start to require more milk. A nursing baby tells the mom’s body to produce more milk by stimulating the breast. Nurse more often and production will increase. Traditionally, moms are told to attempt a feeding every 2-3 hours. But babies do not come with timers, and Dr. Lai tells moms the interval of time between feeds is not as important as the number of times the breast is stimulated. Around 8-12 feedings a day is usually enough to get a mom’s milk to “come in.”

How many minutes should your baby breastfeed at each feeding?

Some lactation consultants advocate allowing the baby to feed on one breast as long as she wants before switching sides. I am more of a proponent of efficiency (I had twins, after all). What works well for many of my patients for the first few days is to allow the baby to nurse for 5-8 minutes on one breast, then break suction and put the baby on the other breast for the same amount of time. If your baby still seems hungry, you can always put her back on the first breast for another five minutes, followed by the other breast again for five minutes. Work your way up to 10-15 minutes on each side once your milk is in, which can take up to one week for some women. Nursing the baby until a breast is empty gives the baby the rich hind milk as well as the initial, but less fatty fore milk. Close mom’s kitchen for at least an hour after feedings. Beware of being used as a human pacifier.

Advantages for this feeding practice:

1. Prevents your newborn from falling asleep before finishing a feeding because of the activity of changing sides
2. Stimulates both breasts to produce milk at every feeding
3. Prevents mom from feeling lopsided
4. Prevents mom from getting too sore
5. Allows time in between feedings for mom to eat, drink, nap, use the bathroom, shower (remember, these are essentials of life)
6. Teaches baby to eat in 30 minutes or less.

I have seen improved weight gain in babies whose moms breast feed in this way. However, if your baby gains weight well after feeding from one breast alone each feeding, or if you are not sore or dangerously fatigued from allowing your baby to feed for a longer time, then carry on!

How do you know if your baby is getting enough milk?

While all babies lose weight after birth, babies should not lose more than 10% of their birth weight, and they should regain their birth weight by 2-3 weeks of life. Babies should also pee and poop a lot (some poop after EVERY feeding) which is a reflection of getting enough breast milk. Your child’s doctor should weigh your baby by two weeks of life to make sure he “makes weight.”

Many good sources can show you different suggestions for feeding positions. Experiment to see which is most comfortable for you and your baby. If you notice one spot on a breast is particularly full and tender, position your baby so that his chin points towards that spot. This may make for awkward positions, but in this way, he drains milk more efficiently from the full spot.

When you first get home with your newborn, if the visitors in your house aren’t willing to do your dishes, then kick them out. It’s time to practice feeding.

Stay tuned for our next post where we address breastfeeding beyond two weeks.

Helpful websites:

To find a  lactation consultant near you see the International Lactation Consultant Association

For our moms across the world and the States- La Leche League International and The Children’s Hospital of Philadelphia- breastfeeding tips for beginners

For moms in Bucks, Montgomery, and Philadelphia Counties, Pennsylvania- Nursing Mother’s Advisory Council

Julie Kardos, MD and Naline Lai, MD

©2012 Two Peds in a Pod®

fodder for tetanus…don’t get this stuck under your foot

Look at this rusty old anchor atop an old fort. Rust plus dirt equals a perfect breeding ground for tetanus. As my kids scampered between different anchors last week, I quickly calculated in my mind whether their preventative tetanus shots were up to date.

“Getting the tetanus shot” is part of the American societal childhood rite of passage, but most people don’t know much about why their kids are vaccinated. Everyone knows they want to avoid IT, but what is IT? Because it is somewhat rare in the United States, I still remember asking one dad about his child’s family history. I was startled when he erupted onto peals of laughter after he told me the child’s grandfather had died of tetanus. “Why are you laughing?” I said in disbelief.

“You’re right, it’s not funny… It’s just the look on your face is funny,” he said. “Everyone has the same shocked expression when I tell them that he died from tetanus.”

Also known as Lock Jaw, tetanus is an organism which thrives in places with little oxygen. Thus, it tends to live on rusty nails (and anchors!) and deep in dirt. Tetanus secretes a poison which causes muscles to spasm painfully and severely and also causes seizures. Exposed to tetanus, your jaw muscles clench into a sardonic smile which prevents eating – hence the name Lock Jaw. Eventually, the tetanus poison infiltrates the chest muscles that help you breathe, and if you are like nearly 40 percent of cases, you will stop breathing and eventually die.

We have no antidote for the poison of tetanus- but we do have a preventative immunization which causes our bodies to preemptively prepare antibodies as self-defense. At the time of a high risk injury, if needed, doctors will boost your child’s tetanus immunization. If your child is under- immunized, the doctor will also inject your child with tetanus antibodies (tetanus immunoglobulin) to further ensure that your child will not contract this disease.

Because tetanus thrives away from oxygen, it easily multiples in deep wounds contaminated by the germ. The germ surrounds us in soil and also lives in intestines of humans and animals. Since tetanus lives in dirt, the following are considered “high risk” injuries:

   -Bites from animals which dig and “eat” dirt such as dogs.

    -Deep puncture wounds from dirty, rusty nails.

    -Wounds with embedded rocks and gravel.

Be wary of tetanus in wounds possibly contaminated with stool, dirt ,or saliva. In developing countries, there are continued cases of infantile tetanus because poultices of mud are used to take care of the umbilical cord stump of newborns.

For kids, the recommended ages for tetanus shots are at 2 months old, 4 months old, 6 months old, 15-18 months old, 4-6 years old, 11-12 years old, and then every ten years through adulthood. Note, if a high risk wound is sustained, the last shot should be within five years. Thus, a kid around 9 years old may be up-to-date for shots, but because he received a tetanus vaccine at four-years-old (on time) he will still need an immunization at the time of a risky injury. Watch out also if you have a teen. His pediatrician will immunize him at 11-12 years of age, but after 16-17 years old he will need a booster if he sustains a dirty wound.

Nowadays, the tetanus immunization is in the same solution as an immunization against diptheria (a disease that causes a choking-inducing coating at the back of your throat), and usually in the same solution as pertussis (whooping cough). If your doctor gave your child an immunization recently against pertussis, she also received a tetanus immunization.

Kids are expected to get dirty. Enjoy the dirt—just not the tetanus.

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

Two Peds in a Pod® turns three years old! In honor of our third birthday, we bring you our top ten parental experiences through the years list:

1. “Helping” your child manage his ice-cream cone (especially when he orders the soft chocolate kind with the chocolate sprinkles)
2. Coaching a sport you have not played in twenty years.
3. Playing hours of Mario Cart or Just Dance on the Wii (and losing every time)
4. Building snowmen
5. Coloring with brand new crayons (and the aroma of opening that new box of Crayolas!)
6. If you are a mom, discovering your teen daughter is the same shoe size and you can borrow her hip shoes
7. Experiencing your child’s first bike ride without training wheels
8. Getting to be the Tooth Fairy (shhh… don’t tell!)
9. Re-reading your favorite kid books (Dr. Seuss really was a genius)
10. Realizing your child honestly believes that you have a really good singing voice

We hope to celebrate many more birthdays with you. Please continue to send us your ideas at twopedsinapod@gmail.com, comment on our posts and tell your friends about us. 

Happy,

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

Let’s think about universal parental admonishments:

                “Hold on tight.”

                “Be careful.”

                “Look out!”

                “Don’t let go.”

Now let’s think about the universal goal of parenting: to create children who grow up to become independent.

That means that at some point, after your child learns to hold tight, be careful, and look out, your child will need to let go.

This inevitable march toward independence does not begin when your child turns eighteen, but rather years before. Kids learn independence in small steps starting when they are still babies in our eyes.

For instance, take feeding. First you breastfeed or bottle feed. Eventually you encourage your young child to drink out of her own cup as SHE holds it. When she’s able to pick up lint from the floor and stuff it into her mouth, you know she’ll be able to feed herself finger foods from the family dinner table.  At 18 months, children are capable of wielding their OWN spoons and fork—so let her do so, no matter the mess. By constantly challenging her with self feeding, your toddler becomes the preschooler who eats lunch with her friends at “lunch bunch” and the college student who chooses to eat salad at the cafeteria. 

How does a child learn to maneuver stairs? If you always carry her, she will never learn. Older siblings often teach the younger ones how to crawl backwards to the top of the steps and then go down safely buttocks first. I have fond memories of my son crawling backwards like a dump truck nearly the entire length of the hallway before reaching the steps. I would imagine a high pitched beeping sound as he inched backwards. As walking becomes steadier, your kid will learn to hold onto the banister as she goes up and down. Fast-forward and someday she will be the dexterous mom who carries her coffee in one hand, the laundry basket in the other and her phone between her ear and shoulder as she heads downstairs.

What does “be careful” mean? I find that kids often have no frame of reference for “careful” So be specific with your advice. When my kids were toddlers and carried cups of milk to the table, instead of only saying “be careful” I would remind them to “walk slowly.” If they (gasp) cut paper with scissors, I would say, “watch where your fingers are.” 

For kids, personal safety is often not enough of a motivation to listen to advice. When my twins were almost two years old, I realized that I belted them in their double stroller so often in public, they did not have an opportunity to learn how to stay with me. So, one day I had them hold my hands as we crossed the parking lot at their older brother’s school. They immediately tried to escape and run in opposite directions. I instructed them to “hold tight to my hands” or “Mommy will have to carry you like a baby.” The thought of walking into their older brother’s school like “big boys,” kept them holding on. 

Sometimes we need to allow children to fall, literally and figuratively. If missing the carpeted step that leads to the living room means your toddler falls, then let her learn from her mistake. An older child who insists on leaving his jacket at home will learn from natural consequences if he is too cold outside (remember you can’t catch a cold from the cold, you just feel cold). Remember all those skinned knees you sustained as a child? Yet now you can ride a two wheeler bike and you run faster because you practiced running, even if you fell a few times. If you make your child too afraid of falling, then he will be unable to take the risks involved in learning new skills.

Let your child complete his own homework from a young age. Offer to proofread but don’t nag. Teachers already have consequences in place for children who do not complete homework, or for those who do a sloppy job. Let your middle schooler choose which foreign language or musical instrument or sport he wants to learn without pointing out the practicalities of what you consider the “better” choice.

Of course we need to protect and guide our children. But we need to learn to relinquish control over our children’s actions at the appropriate ages. 

As the viral internet sage Eva Witsel says, “I can spend my energy on limiting my child’s world so that he will be safe and happy or I can spend my energy on helping my child learn the skills to navigate our world himself so that he will be safe and happy. I think the latter has a better chance of success in the long term.”

In grade school I remember holding tight to the chains of the playground swing as I swung higher and higher. But I also remember that glorious feeling as I let go, sailed through the air, and landed on my feet.

Don’t deprive your child of that same glorious feeling of letting go.

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