Every child with a lemonade stand hopes for hot sunny days to drive in customers. But if your kids squeeze fresh lemons for their stand, make sure they wash their hands after squeezing the lemons. Otherwise, after a sunny day, your child’s hands may turn out looking like the kid’s feet pictured to the left.The juice of some fruits or plants will cause a dark discoloration of the skin if exposed to sunlight. The reaction, called phytophotodermatitis, usually starts a day after the juice comes into contact with the skin. Redness and mild blistering eventually leads into a discoloration which can that can last for months. Citrus fruits are the most common culprits, but wild parsnip, wild dill, wild parsley and buttercups also cause the photosensitivity. Often the initial redness and blistering is missed. The kid in the photo was walking in bare feet on leaves near an apple tree. Makes you almost want to only use powdered lemonade mix…almost.

©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 my kids were younger, I realized one way to avoid the pre-dinner time meltdowns was to enlist their help in cooking. In addition, baking muffins or cookies with kids is a great rainy day activity with a built-in reward at the end. Much has been written about the nutritional and psychological merits of a shared family meal. Instead, this post is about sharing the mealtime prep. For those of you who do not love to cook yourselves, here are reasons to find your inner cook and encourage your child’s development at the same time:

1-Toddlers LOVE pouring, mixing, and measuring, and when you teach toddlers these skills, you are strengthening their fine motor skills. Why else are toy kitchens and Play-doh so popular? Nothing beats “playing” with REAL ingredients in a REAL kitchen.

2-Teach young kids to count measurements, let older kids do the measuring themselves.

3-Kids who are learning to read now see WHY they need this skill- as you follow a recipe kids see how to read with a purpose. You can let your budding reader read the directions to you.

4- Time spent with a parent in the kitchen fosters more shared attention which can build self-esteem.

5-You will build good memories for your child.

6-For the picky eaters: kids are more likely to taste what they cook themselves.

7-Kids love water play, so even the clean-up is fun.

8- Kids as young as 7 or 8 can learn to cut with a knife. Teach them this life skill while cooking instead of when they are hungry and trying to eat dinner-it causes less frustration.

9-Kids take pride in what they help create. They can also take pride in completing a project. Pride in accomplishments develops self-esteem.

10- Cooking with you teaches your child how to help others as well as how to receive help graciously.

Finally, cooking is one of those life skills needed for when kids grow up and live on their own. Just as you teach them to use the potty, brush their own teeth, dress themselves and tie their own shoes, you should teach them how to cook.

Are you parents who don’t cook? Call Grandma or Grandpa for some tutoring, or take a cooking class with your child!

Julie Kardos, MD and Naline Lai, 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

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.