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

One of Dr. Kardos’s kids yelled in our office a few years ago: “I’m getting a SHOT?! NOOOO! GET AWAY FROM ME!!”

Even the front desk staff could hear him, and he was in the exam room farthest to the rear of the building. Meanwhile, his twin brother just sat and pouted but did not flinch.

Even a pediatrician’s child does not always approach the prospect of an immunization or blood draw with a grin on his face. Here are ways you can take away the sting of a needle:

Set the stage. Your child looks to you for clues on how to act. If mommy and daddy are trembling in the corner of the room, it will be difficult to convince your child that the immunization is “no big deal.” Do not tell your child days in advance that she will be immunized. The more you perseverate, the more your child will perceive that something terrible is about to happen. Simply announce to your child right before you leave to get the immunization, “We are going to get an immunization to protect you from getting sick.”

Do not say “I’m sorry.” Say instead,”Even if this is tough, I am happy that this will protect you.”

Never lie. If your kid asks “Will it hurt?” say “Less than if I pinched you.”

Watch your word choice. Calling an immunization “a shot” or “a needle” conjures up negative images. In general, avoid negative statements about injected vaccines. I cringe when parents in the office threaten children with,” If you don’t behave, then Dr. Lai will give you a shot.” Remember, shots protect against deadly diseases and are in no way punishments for children.

Kids talk. Be aware that kids, especially those in kindergarten, like to scare each other with tall tales. Ask your child what they have heard about vaccines. Let children know that Johnny’s experience will not be their experience.

The moment is here.

You may have heard about a topical cream which numbs up an area of skin. Unfortunately, because the creams anesthetize the surface of the skin and most vaccines go into muscle, I do not find the creams very effective at taking the pain away.

Instead, practice blowing the worries away. Have your child practice breathing slowly in through her nose and blowing out worries through her mouth. For the younger children, bring bubbles or a pin wheel for your child to blow during the immunization. In a pinch, rip off a piece of the exam paper from the table in the room and have your child blow the paper.

The cold pack: holding something very cold, placing a cold pack on your child’s arm around the area to be vaccinated,  or placing a cold pack on the NON-vaccine arm can distract your child’s brain from feeling the pain of an injection.

“Transfer” the immunization to mommy or daddy. Have your child squeeze your hand and “take the immunization” for him.

Tell your child to count backwards from 10 and it will be over. In reality, it will be over before your child says the number seven.

Have as much direct contact with your child as possible. The more surfaces of his body you touch, the less your child’s brain will focus on the injection. Again, this is the distraction principle at work. By touching your child, you are also sending reassuring signals to him. For the younger child, if he is on the table, stay close to his head and hug his arms, or have him on your lap. Holding him firmly will make him feel safe and will prevent him from moving during the injection. Movement causes more pain or even injury.

For the older child and teens, hold their hands. I sometimes see parents of older teens and college students leave the room, believing that their kids are beyond the age of fearing vaccines. However, we find that even the big kids may need company during vaccines.

After the drama is over.

Have your older child sit quietly for a moment. As the anxiety and tension suddenly falls away, the body sometimes relaxes too suddenly and a child will start to faint. This phenomenon seems to happen most often with the six foot tall stoic teenage boys, but we’ve also seen teen girls and some younger kids get a bit light-headed. We have a saying in my office- “The bigger they are, the more likely they are to fall.” If your child becomes pale (or green) have him lie down for a few minutes until he feels better.

Compliment your child. Remind him that you will never let anyone really hurt him.

Now my story:

When my middle daughter was two years old, my family trouped into my office for our flu shots. We all sat calmly in a circle and smiled.

First, the nurse gave me my immunization. I smiled. My middle daughter smiled.

Second, the nurse gave my husband his immunization. He smiled. My middle daughter smiled.

Then the nurse gave my oldest daughter her immunization. She smiled. My middle daughter smiled.

Then the nurse gave my middle daughter her immunization. She did not smile. She did not cry. Instead, she slugged the nurse with her little fist. I think the nurse felt more pain than my child.

Someday all immunizations will be beamed painlessly into children via telepathy. Until then, I have no advice on how to take the sting away from the punch of a two year old.

Naline Lai, MD with Julie Kardos, MD
©2014 Two Peds in a Pod®
Revised from 2009 post on this topic.

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®

I wash my hands about sixty times a day, maybe more.  This frequent washing, in combination with cold Pennsylvania air, leads to chapped hands.

• Whenever possible, use water and soap rather than hand sanitizers. Hand sanitizers are at minimum 60% alcohol- very drying. Be sure to fully dry hands after washing.

• Wear gloves or mittens as much as possible outside even if the temperature is above freezing. Remember chemistry class- cold air holds less moisture than warm air and therefore is unkind to skin. Gloves will prevent some moisture loss.

• Before exposure to any possible irritants such as the chlorine in a swimming pool, protect the hands by layering heavy lotion (Eucerin cream) or petroleum based product (i.e. Vaseline or Aquaphor) over the skin.

To rescue dry hands:

• Prior to bedtime, smother hands in 1% hydrocortisone ointment. Avoid the cream formulation. Creams tend to sting if there are any open cracks. Take old socks, cut out thumb holes and have your child sleep at night with the sock on his hands. Repeat nightly for up to a week. Alternatively, for mildly chapped hands, use a petroleum oil based product such as Vaseline or Aquaphor in place of the hydrocortisone.

• If your child has underlying eczema, prevent your child from scratching his hands. An antihistamine such as diphenhydramine (Benadryl) or cetirizine (Zyrtec) will take the edge off the itch. Keep his nails trimmed to avoid further damage from scratching.

• For extremely raw hands, your child’s doctor may prescribe a stronger cream and if there are signs of a bacterial skin infection, your child’s doctor may prescribe an antibiotic.

Happy moisturizing. Remember how much fun it was to smear glue on your hands and then peel off the dried glue? It’s not so fun when your skin really is peeling.

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

More polar vortex! Here in Bucks County, PA,  we are recovering from power outages and preparing for yet another winter blast. As the generators are started up, we remind our readers about a potentially deadly exposure.

Unfortunately, one of the biggest winter hazards is not loud and obvious. As the temperature drops, deaths rise from this insidious poisonous gas: carbon monoxide.

According to the Centers for Disease Control, about 400 unintentional deaths occur a year from carbon monoxide poisoning.

Carbon monoxide results from the incomplete combustion of fuel. The gas causes a chemical suffocation by competing with oxygen in your body. The colorless, odorless gas is impossible for human senses to detect, and unfortunately, loss of consciousness usually occurs before any symptoms appear. Those lucky enough to have warning symptoms before passing out may experience headaches, nausea, vomiting, or confusion.

Because carbon monoxide is a by-product of incomplete combustion, sources are related to energy use. Poisoning occurs more during the winter months when fuel is used to heat closed spaces and ventilation from exhausts is poor. My sister, toxicologist and Harvard medical school instructor, Dr. Melisa Lai, tells the story of a snowplow operator a few years ago who left the house early in the morning to plow snow, only to return and find his family dead. The reason—snow blocked the exhaust pipe from the furnace and caused lethal levels of carbon monoxide to accumulate in his home.

Carbon monoxide also occurs in warm weather. To avoid carbon monoxide buildup in all climates:

–Install carbon monoxide detectors. My sister says a $20 detector such as Kidde works as well as the $150 models. Put them on every level of your home and check that the batteries work. Smoke detectors are not the same as carbon monoxide detectors. However, combination detectors are available.

–Ventilate all appliances, heating units, and your chimney adequately. Have them serviced yearly.

–Shovel well around vents: While some furnaces vent out of a home’s chimney, other vents are located just two feet off the ground on the side of the house. If these vents become blocked with snow, deadly carbon monoxide levels can build up inside the home. Aim for three feet of snow clearance around the vents.

–Be wary of the exhaust from of any vehicle.

Parents have put their infants in running cars while they shovel snow, unaware that the car’s tailpipe is covered in snow. By the time they return to the car, the infant, who is extremely susceptible to carbon monoxide poisoning because of his size, is dead. Even opening the garage door when you run your car is not enough ventilation to prevent poisoning.

Like cars, boats also produce carbon monoxide. Since boats are less energy efficient than cars, they spew more of the gas. While your teen boogie boards behind a motor boat, the carbon monoxide can knock her tumbling unconscious into the water.

–Keep anything meant to burn fuel outdoors, OUTDOORS. Even an innocent barbeque can turn into a nightmare if you decide to grill inside your garage. Emissions from any type of grill, charcoal or gas, can send carbon monoxide levels skyrocketing. Additionally, hurricane season in the southern United States is known by toxicologists as “Carbon Monoxide Season.” During hurricanes (as with winter storms), people buy outdoor generators and auxiliary heating units. They work so well that people then bring them indoors, trapping fumes in their homes.

My sister says she has hundreds of stories about carbon monoxide poisoning, all which end tragically. Maybe I’ll let my husband store that larger-than-life-take-up-car-space neighborhood snow blower here this winter. Then, at least I know I’ll be able to make sure no one starts up the blower in a garage.

For more details please visit http://www.cdc.gov/co/faqs.htm.

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

Adapted from our 2010 post

Parents often ask how they can tell if their child has the flu or just a common cold. Here’s how:

Colds, even really yucky ones, start out gradually. Think back to your last cold: first your throat felt scratchy or sore, then the next day your nose got stuffy or then started running profusely, then you developed a cough. Sometimes during a cold you get a fever for a day or two. Sometimes you get hoarse and lose your voice. Kids are the same way. They often feel tired because of interrupted sleep from coughing or nasal congestion.

Usually kids still feel well enough to play and attend school with colds, as long as their temperatures stay below 101°F and they are well hydrated and breathing without any difficulty. 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 peter out.

Important news flash: 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 does NOT tell you if your child needs an antibiotic and will not help you differentiate between a cold and the flu.

The flu, caused by influenza virus, comes on suddenly and makes you feel as if you’ve been hit by a truck. Flu always causes fever of 101So, if your child has a runny nose and cough, but is drinking well, playing well, sleeping well and does not have a fever and the symptoms have been around for a few days, the illness is unlikely to “turn into the flu.”

Remember: colds = gradual and annoying. Flu = sudden and miserable.

Fortunately, a vaccine against the flu can prevent the misery of the flu. In addition, vaccines against influenza save lives by preventing flu-related complications that can be fatal such as pneumonia, encephalitis (brain infection), and severe dehydration.  

Be sure to read our article on ways to prevent colds and flu and our thoughts on over the counter cold medicines.  Now excuse us while we go out to buy really yummy smelling hand soap to entice our kids to wash germs off their hands. After that you’ll find us cooking up a pot of good old-fashioned chicken soup, just in case…

Julie Kardos, MD and Naline Lai, MD
revised from a Sept 2009 post

©2014 Two Peds in a Pod®