We enjoyed meeting Pediatric media expert Dr. Don Shifrin, whose interviews have appeared in numerous publications including Good Housekeeping, the Wall Street Journal, and Time blogs. Today he writes about the “fifth season” of the year. 
—Drs. Kardos and Lai

image by Pixabay

“Red and yellow and pink and green, purple and orange and blue…”

 Please imagine the “I Can Sing a Rainbow” song playing in the background of this post as you “listen with your eyes.”

 In the same order as the song, we proudly present colors with medical meaning:

RED It’s okay to turn red while coughing. Red shows that a person has enough oxygen and is not short of breath. Of course redness of the skin is NOT a good color when it results from sunburn or infection. It is also not a good color in the whites of the eyes. Red eyes are irritated eyes, and red can be a sign of infection, allergies or sleep deprivation.

YELLOW In the “whites of the eyes” or sclera, yellow is a sign of jaundice. Jaundice in only the eyes of newborns is very common and usually does not require treatment. In anyone older than a newborn, jaundice points towards liver disease. So yellow, other than in the newborn period, is a problem color.

 PINK Children of all races and ethnicities should have pink inner eyelids, pink lips, and pink nails. Pink in these body areas implies normal blood flow and normal blood count.

 GREEN We can see this color in a child’s face before an episode of vomiting or fainting.  If you see this color in your child’s face, lie him down on his side to encourage blood flow to his head and to prevent him from hitting his head on the floor if he faints. And get a bucket!

 PURPLE A bad rash called “purpura” is purple. It can be seen with a high fever or with leg and belly pain. If you see a purple rash on your ill child, take him to a doctor ASAP.

 ORANGE Orange skin in an older baby WHOSE SCLERAE (EYES) ARE STILL WHITE may be seen in kids who love to eat orange fruit and veggies such as carrots, peaches and squash. This condition, called hypercarotinemia, is a result of the build-up of beta carotene from orange foods. We see this often in 9-12 month olds. Hypercarotinemia is not dangerous . An easy way to change the skin color is to feed more green veggies to balance out the orange ones.

 BLUE In general, blue is not a good color. Turning blue while coughing means NOT enough air/oxygen is flowing to the body. Low oxygen levels in kids with heart or lung diseases cause a blue coloration in their faces, mouths, and fingernails.

 WHITE White inner eyelids, lips, or fingertips implies anemia or poor blood flow in the body. However, white is a normal color for sclera, the “whites of the eyes.”

 Speaking of color— kids cannot get a tattoo legally in the USA under age 18 years without parental consent. In case you were thinking of letting your underage child permanently color his or her skin, read this article about an infection caused by one kind of grey tattoo ink.

 Hopefully you can now “sing a rainbow too.” If any of our medical colleagues are reading this post, please fill in any color we forgot!

  Julie Kardos, MD and Naline Lai, MD
©2013 Two Peds in a Pod®

The classic punk rock song lyric “Should I stay or should I go now?” will run through your head many times during parenthood as you wonder when your kid should go to the doctor’s office. Today we turn to pediatric orthopedic surgeon and author Dr. Gleeson Rebello for advice on whether an injured limb needs immediate medical attention – Drs. Lai and Kardos. 

We’ve heard some interesting things about cow’s milk over the years. I am going to share with you four myths about milk that I continue to hear from my patients’ parents. Spoiler: reading myth #4 can save you lots of money.

Myth #1: Don’t give milk to a child with a fever, the milk will curdle (or some other variant).

Truth: As long as your child is not vomiting, milk is a perfectly acceptable fluid to give your febrile child. In fact it is superior to plain water if your child is refusing to eat, which is very typical of a child with a fever. Fevers take away appetites. So if your child stops eating while she is sick, at least she can drink some nutrition. Milk has energy and nutrition, which help fight infection (germs). Take milk, add a banana and a little honey (if your child is older than one year), and maybe some peanut butter for added protein, pour it into a blender, and make a nourishing milk shake for your febrile child. Children with fevers need extra hydration anyway. Even febrile infants need formula or breast milk, NOT plain water. The milk will not curdle or upset them in any way. If, on the other hand, your child is vomiting, then stick to clear fluids until her stomach settles.

Myth #2: Don’t give children milk when they have a cold because the milk will give them more mucus.

Truth: There is NOTHING mucus-inducing about milk. Milk will not make your child’s nose run thicker or make his chest more congested. Let your runny-nosed child have his milk! Yet my own mother cringes when I give my children milk when they have colds. Never mind my medical degree; my mom is simply passing on the wisdom of HER mother which is that you should not give your child milk with a cold. Then again, my grandmother also believed that your body only digests vitamin C in the morning which is why you have to drink your orange juice at breakfast time. But that’s a myth I’ll tackle in the future.

Myth #3: You can’t over- dose a child on milk.

Truth: Actually, while milk is healthy and provides necessary calcium and vitamin D, too much milk CAN be a bad thing. To get enough calcium from milk, your child’s body needs somewhere between 16 to 24 ounces of milk per day. Of course, if your child eats cheese, yogurt, and other calcium-containing foods, she does not need this much milk. New recommendations for healthy Vitamin D requirements have been increased recently to 400 IU (international units) daily which translates into 32 ounces of milk daily. BUT we pediatricians know from experience that over 24 ounces of milk daily leads to iron-deficiency anemia: calcium competes with iron absorption. You’re better off giving an over-the-counter vitamin such as Tri-Vi-Sol or letting older children chew a multivitamin that contains 400 IU of vitamin D. In addition to iron-deficiency anemia, drinking all that extra milk is bad for teeth (all milk contains sugar) and can also lead to obesity from excessive calories or can in fact lead to poor weight gain in children who are picky eaters to begin with: the milk fills them up too much for them to have any appetite left for food.

Myth #4: Organic milk is healthier than non-organic milk.

Truth: If you compare organic milk to non-organic milk, the nutrients on the label of the milk carton are the SAME. “But what about the growth hormones in milk,” you may wonder. First of all, cows may be supplemented with growth hormone, but their milk is not. In addition, let me explain about growth hormone. Some children are actually born without growth hormone, and other kids develop growth hormone deficiency because of kidney failure, or cancer treatment, or other medical problems. These children need supplemental growth hormone. Unfortunately for these kids, the only way that we have to give growth hormone to these kids is by injection (a shot) every day. Do you know why? Growth hormone gets DIGESTED in the stomach and is not active if a child eats/drinks it. SO, even if non-organic milk contained growth hormone (which it doesn’t) then your child would have no effects of it anyway because their guts would break it down before it could act on their bodies. WHEW! So unless you just like the taste better, you do NOT have to spend twice as much money on organic milk. Just buy regular milk. Put that extra money away in your college funds.

In summary, you can safely continue serving your children milk in sickness and in health, in moderation, at a lower cost than organic, every day. Now, all this talk about milk really puts me in the mood to bake cookies…

Julie Kardos, MD with Naline Lai, MD
©2013 Two Peds in a Pod®

Update: Please read this article , by the American Academy of Pediatrics in 2012, for a comprehensive, unbiased review of the data comparing health benefits of conventional vs organic milk and other foods–Drs. Kardos and Lai, October 6, 2013.

Revised from the original post from 10/5/2009

Pediatricians associate Back to School with “Time to get your flu vaccine.” At least this pediatrician mom does. As I try to figure out when I can get my own three children over to my office to get their flu vaccines, we want to give you a flu vaccine update.

Good News.

Last year we responded to your concerns about arsenic in food, particularly rice, and shared with you the FDA’s recommendation at that time.

We are relieved that after considerable research which included analyzing over 1300 samples of rice products, the FDA scientists determined that “… the levels of inorganic arsenic found in the samples are too low to cause immediate health damage.” Please see this link for the details of the investigation and recommendations.

Bottom line: continue to offer a well-balanced diet to your children and vary the types of grains that you serve to your families.

Julie Kardos, MD and Naline Lai, MD
©2013 Two Peds in a Pod®

Some kids simply don’t like team sports. Today, childhood obesity specialist Dr. Patricia Cantrell and Youth Fitness Expert Anna Renderer, share a piece from their fitness site on activities which encourage kids to move without signing them up on a roster. Enjoy—and join in!
Drs. Lai and Kardos

KFIT Health, LLC

“You just don’t appreciate a picky eater until you have one. ”
—Overheard at Dr. Lai’s dinner table.

Picky eaters come in two major varieties. One kind is the child who eats the same foods every day and will not vary her diet; for example, cereal, milk, and a banana for breakfast, peanut butter and jelly with milk or juice for lunch, and chicken, rice, and peas for dinner. This diet is nutritionally complete (has fruit, vegetable, protein, dairy, carbohydrate) but is quite “boring” to the parent.

The other kind of picky eater is the child who either leaves out entire food groups, most commonly vegetables or meat, or leaves out meals, such as always eats breakfast but never eats dinner.

My own children range from the One Who Tries Anything to the One Who Refuses Everything (these are my twins!). My oldest child lived on cheerios and peanut butter and jelly for about two years and now eats crab legs and bulgur wheat and other various foods. My point: I know where you’re coming from, I feel your frustration, and I will give you advice that works as well as optimism and a new way of thinking about feeding your children.

Fortunately, from a medical point of view, toddler/child nutrition needs to be complete as you look over several days, not just one meal. For example, if every 3 days your child has eaten some fruit, some vegetables, some protein, some dairy, and some complex carbohydrates, then nutritional needs are met and your child will thrive! 

Twelve ways to outwit, outplay, and outlast picky eaters

1) Never let them know you care about what they eat. If you struggle with your child about eating, she will not eat and you will continue to feel bad about her not eating. Talk about the day, not about the food on the table. You want your child to eat for the simple reason that she feels hungry, not to please you or anyone else, and not because she feels glad or mad or sad or because of what you the parent will feel if she eats or doesn’t eat. Along these lines, NEVER cook a “special meal” for your toddler. I can guarantee that when she knows how desperately you want her to eat your cooking, she will refuse it.

2) Let them help cook. Even young children can wash vegetables and fruit, arrange food on platters, and mix, pour, and sprinkle ingredients. Older kids can read recipes out loud for you and measure ingredients. Kids are more apt to taste what they help create.

3) Let them dip their food into salad dressing, apple sauce, ketchup etc., which can make their food more appealing or interesting to eat.

4) Let them pick their own food. Whether you grow your own foods, visit a farm or just let your kids help you in the supermarket, kids often get a kick out of tasting what they pick.

5) Hide more nutritious food in the foods they already like (without them knowing). For example, carefully mix vegetables into meatballs or meatloaf or into macaroni and cheese. Let me know if you want my recipe for zucchini chocolate chip muffins or Magic Soup.

6) Offer them foods that you don’t like—THEY might like it. Here’s an example: a few years ago, my children were decorating Easter eggs with Dr. Lai’s children. My kids asked if they could eat their decorated hard boiled eggs. Now, hard boiled eggs are one of the few foods that I do NOT like. I don’t like their smell, their texture, and I really don’t like the way they taste. Yet, all three of my kids, including my pickiest, loved those hard boiled eggs dipped in a little bit of salt. Go figure. Now I have an inexpensive, easy, healthy protein source to offer even though I can’t stand the way my kitchen smells when I cook them… but hey, if my kids actually will EAT them…

7) Continue to offer foods even if they are refused. Don’t force feed; just have them on the table. It could take 20 -30 exposures before your kids might try them so don’t despair. It took eight years of exposure to brocoli until two of my three kids decided they loved it.

8) Hunger is the best sauce. Do not offer junk food as snacks. Pretzels, crackers, cookies, candy, and chips have NO nutritional value yet fill up small bellies quickly. Do not waste precious stomach space with junk because your insightful child will HOLD OUT for the junk and refuse good nutrition if they know they can fill up on snacks later. Along these lines, never bribe food for food. Chances are, if you bribe eating vegetables with dessert, all the focus will be on the dessert and a tantrum will follow. You and your child will have belly aches from stress, not full bellies.

9) It is okay to repeat similar meals day after day as long as they are nutritious. We might like variety as grownups but most toddlers and young kids prefer sameness and predictability.

10) Turn off the TV. Trust me and trust numerous scientific behavioral studies on this, while it sometimes works in the short term, it never works in the long term. In addition, watching TV during meals is antisocial and promotes obesity.

11) Do not become a “short order” chef. If you do, your child will take advantage of you and likely will not end up eating anyway. When your child says, I don’t want this dinner/lunch/breakfast, I want something else,” you say “The meal is on the table.”
One variation of this that works in some families is to have one back-up meal that is the same every day and for every meal and must be completely non-cook and nutritious, for example, a very low sugar cereal and milk, peanut butter and jelly sandwich, or yogurt with nuts or fruit mixed in it, etc, that you agree to serve if your child does not want to eat what the rest of the family is eating.

12) You can give your child a pediatric multivitamin. This tactic is not “giving up,” nor is it cheating, and it can give the Parent as Provider of Nutrients peace of mind. You can either give a multivitamin every day or just on the days that you are convinced that your child has eaten nothing.

If all else fails, your consolation is that your child will likely become a parent of a picky eater too, and she will ask you how to cope. You’ll be able to tell her what worked for you when she was a picky eater.

Julie Kardos, MD with Naline Lai, MD
©2013 Two Peds in a Pod®
Originally posted on July 24, 2009, with modifications

As you stand watching your budding baseball star at his five o’clock practice, the rest of your kids start to whine. “Please, please, please,” they say. “Can we go to the snack stand? We can’t wait for dinner.” Feeling faint from hunger yourself, you begrudgingly acquiesce and later cringe as you see them trouping back from the snack stand with fluorescent nacho cheese covered chips and candy. Sound familiar? Today we bring you thoughts from a mom who did the unthinkable… she revamped her kids’ sports snack stand menu. Now she brings you ideas to overhaul yours. We are impressed. –Drs. Kardos and Lai

Skittles, hot dogs, nachos, soda, and ice cream.  If you have been to your child’s sporting event recently, then this should sound like a typical snack stand menu.  Somehow, sports and junk food are synonymous.  But doesn’t that contradict itself?  Aren’t we having our children participate in sports to keep them healthy?  Well, then, why are we feeding our children junk food at the very moment that they need fuel to help them perform better?  These foods are laden with sugar, trans fat, and sodium, foods which will adversely affect the health of your family.

As parents, we need to take back control of what we are feeding our children. Statistics show that type 1 and type 2 diabetes are on the increase among children.  According to the SEARCH for Diabetes in Youth study, the prevalence of type 2 diabetes increased 21 percent among American youth from 2001-2009, while type 1 diabetes rose 23 percent.  The effects of diabetes are staggering:  heart disease, blindness, kidney disease, nervous system disease, and poor circulation leading to amputation.  And diabetes is only one of the many negative results of eating processed junk food.  

You may be thinking, what’s the harm in eating a little junk food at snack stands?  Well, it wouldn’t be overly harmful if snack stands were the only place that our children occasionally purchase junk food.  Think about all of the other locations that our children consume unhealthy food:  school lunches, fast food restaurants, vending machines, and convenience stores.  All of these poor food choices add up and will eventually lead to serious health consequences.

Over the past few weeks, I revamped the menu of the snack stand for my daughters’ summer swim team.  I was apprehensive about making these changes because I was concerned about how the parents and children would react.  Would my own children be subjected to teasing because I took away the M&M’s?  I was able to transform the menu from items riddled with sugar and trans fat to whole foods fresh from our grocery store.  Here’s a sample of items that we offered:

Old Menu                                                       New Menu

Skittles                                                             Fresh Fruit Salad

Cupcakes                                                         Smoothies made from fruit

Brownies                                                         Chocolate Covered Frozen Bananas

Cow Tails                                                         Trail Mix

Soft Pretzels                                                    Air Popped Popcorn

Hoagies on White Bread                                 Subway Hoagies on Whole Wheat Bread

Snapple (with more sugar than soda!)           Water

Gatorade                                                         100% Fruit Juice

Of the hundreds of families that we served, I only had one person who complained.  One!  Instead, I had an outpouring of support and many families who appreciated having fresh, healthy food choices for their family.  One dad went as far as emailing the president of our board to compliment us on our healthy snack stand. 

So, what can you do if your snack stand does not yet offer healthy choices?   Here’s a bit of food for thought:

• Pack your own snacks!  You can control what your family is eating by giving them healthy choices.*  Here are my favorite items to pack in our cooler:
  • Water
  • Peanut Butter and Banana Sandwiches on whole wheat (cut them into quarters for little snacks to share)
  • Make your own trail mix with a variety of nuts, plain cheerios, and toss in a few mini chocolate chips to make this feel like a sweet treat!
  • Nature Valley Honey Oat Snack Bars
  • Fruit Kabobs
  • Applesauce cups (natural, no sugar)
  • Fruit cups (packed in fruit juice)
  • Cheese sticks
  • Air popped popcorn – pop enough in an air popper to store in a new trash bag.  Add a little melted butter and salt and shake.  Bring solo cups and scoop out for your child to share with their friends. 
• If you must purchase an unhealthy choice from a snack stand, then try splitting it into two portions.  Ask your child to eat half of it now, and save the other half.  Cutting the portion size down is an important step towards getting healthy. 
• Try feeding your family before you leave for an event.  You will have more control and choices about what your child eats. 
• Talk to the board of your child’s team and ask them to revisit the food that is served in your snack stand.
• If you are visiting another team, then find the name and email address of the board members and email about making a change.

Together, let’s make steps towards changing the way that we think about the food that we feed our children.  The next generation’s life depends upon it.  If that is not enough incentive, then think about how much money you will be saving.  Maybe you can save enough to treat yourself to a little something nice.  Now, we’re talking!

*NOTE:  If you child is resistant towards making these changes, focus on one area (i.e. drinks, sandwiches, or snacks) and make that your focus.  Do not try to make too many changes all at one.  You may find that your chances of success increase when you only focus on one food area at a time.

Mary McDonald, MA

© 2013 Two Peds in a Pod®

Mary McDonald holds a Masters of Education from Arcadia University and a health coach certification from Institute of Integrative Nutrition.  She is a high school teacher, a mom of four daughters, and an advocate for healthy food choices.  For more information on her health coaching services, please contact her at nutrition101withmary@gmail.com or visit her website at nutrition101withmary.com.