We had such a great response to our Two Peds in a Pod® visual diagnosis post that we are posting another summertime picture puzzle:

What is it? Pictured below are the toes of one of my best friend’s toddler. She is happy, has no fever, and plays nearly everyday in the neighborhood pool. The round shiny pink bumps and dots on her toes appeared yesterday morning and haven’t changed much in a day. They don’t seem to bother her very much… answer below.

It’s Swimming pool pulpitis- a fancy word for a reaction of the pulp (the meaty tip) of fingers or toes. Mostly seen on the finger tips, the pulpitis is usually caused by irritation of the fingers by the rough side of the swimming pool as kids pull themselves in and out. Kids are sometimes annoyed by the dots, but they go away on their own as soon as the kids decide to use the ladder. In this case, this little swimmer irritated her toes, not her fingers, while “monkey walking” along the side of the swimming pool in the water.

Naline Lai, MD with Julie Kardos, MD

We interrupt your summertime to present another Two Peds in a Pod® visual diagnosis learning session. Do you recognize this rash? Hint: it is mildly itchy and painful and can result from scratching bug bites or a skinned knee. Read on for the answer.

The rash on this child’s arm is impetigo. Impetigo is just a fancy name for a crusty skin infection on the surface of the skin. The infection is caused by the common germs that often lurk on our skin, Staphylococcus and Streptococcus. (You may recognize the germ Streptococcus from our sore throat post because it can also cause Strep throat). The germs wait for a break in our skin, from a tiny cut, pimple or a scrape, then invade the skin and spread. Impetigo is often seen next to the nose because the germs love to lurk in the nasal passages and kids often pick at the skin under the nose when it gets irritated from a cold virus.

Doctors tend to describe infections with appetizing food analogies (yes, we know- eew). In this case, impetigo is often described as having honey-colored-crusted lesions. The areas are tender and red, and often itchy. Kids often spread this infection on themselves when they scratch at the infection and then touch other areas of their skin.

Pediatricians treat impetigo with either a topical antibiotic or oral antibiotic for anywhere from 7 to 10 days. The choice of how to treat depends in part how much of the skin is affected and which body surfaces are involved. The infection is contagious until 24 hours after starting treatment.

Prevent this infection: Hand washing is a great way to prevent spread of impetigo. Washing all skin wounds well with soap and water is another way to prevent the emergence of this infection. See our prior post on wound care.

Ok, now back to the pool and barbeques for all our summertime readers. Just remember your bug spray and remind your children not to scratch and pick at their skin.

Naline Lai, MD and Julie Kardos, MD

©2013 Two Peds in a Pod®

A favorite pediatrician party game is to guess the age of a child by observing his skills and body habitus. Most people are stumped when it comes to differentiating between preschoolers. Here’s a hint: while three-year-olds look a bit pot-bellied because of weak abdominal muscles, four-year-olds look lankier because their muscles are stronger.  

Here are other ways to recognize and understand four-year-olds.

They start recognizing letters and numbers. Do NOT run out and buy flash cards! Teach them simple words that are useful in everyday life. For example, point out STOP or EXIT signs. Point out key words while you read to them.  Teach them simple math: “I am giving you and your sister four stickers to share—how many would each of you get to make it fair?”

Their speech is more fluent and expressive than three-year-olds’, and if you listen to them play, you will hear elaborate make-believe stories and scenarios. Make sure you limit TV/screen time so your kids have a chance to “act out” their favorite story lines.

Watch out! Four-year-olds often try potty talk for the first time, especially at the dinner table. Try not to laugh or to shush them angrily, as it only encourages them. Better to ignore and change the subject. If you respond emotionally, you give their words much more power, and they will persist to see if you continue to give an “entertaining” reaction to their words.

They are better rule followers. At preschool they absorb the rules of the classroom. At home you can encourage them to follow house rules such as hand washing before meals, no shoes on the couch, food stays in the kitchen, etc. In the context of house rules, you can introduce “no potty talk at the dinner table.” Four-year-olds  will tattle on siblings who fail to follow the rules. This same rule-following skill will now allow your child to play board games that are a bit more complex.

They are hero worshippers. Four-year-olds admire their parents, older siblings, teachers, and fictional heroes who are stronger, more powerful, and larger than themselves. Feed their egos by allowing them to beat you at games or races some of the time.

In their eyes, the world still revolves around them. If you need to occupy a four-year-old, tell her a story where she is the main character. If you feel that you are not up to the creative challenge, just tell her a known fairy tale but give your four-year-old the starring role. Tell the story of “Goldilocks” but rename it “Elizabeth and the Three Bears.”

They tell riddles and understand simple jokes. Amusingly, they tell the same joke over and over again, with peals of laughter.  For those of you who remember, “Riddle cups” were very popular with four-year-olds.

Kids this age like rituals. Four-year-olds more actively participate in family prayers. They often latch onto a favorite shirt or dress and insist on wearing it every day of the week. Choose your battles over this, or just buy duplicate favorites so you have time to launder the favorite outfit.

Physically they are more coordinated. They can now hop on one foot, run, climb, skip, throw and catch balls much more accurately. Kids appreciate outdoor play and playgrounds for longer time periods at this age.

Most have given up naps by now: make sure bedtime is early enough so they are not too exhausted to enjoy your bedtime ritual and that they get enough sleep. Most four-year-olds are still “early birds” and wake up with the sunrise.

Enjoy your four-year-old; elementary school is just around the corner!

Julie Kardos, MD and Naline Lai, MD

©2013 Two Peds in a Pod®

Remember when we used to call sun screen lotion “suntan lotion,” and tolerating red blistering shoulders was considered a small price to pay for a tan?  Live and learn.

Dr. Kardos’s dad is a pediatrician and during our long grueling hours of residency training he’d always serve as a source of encouragement. One of my favorite memories will always be the proud look in his eyes years later as he watched his daughter present at a physician conference.

Today we honor all Dr. Dads- dads or father figures- who help their children in times of crisis, illness, or injury.  Following is a tribute sent by one of our readers, Jennifer Taylor.

Happy Father’s Day!

Dr. Lai with Dr. Kardos
_________________________

We are parents to three boys so needless to say, our house is always full of cuts, bruises or injuries of some sort. Band-Aids and “feel better” kisses are a regular part of our daily activity. And while my husband is a great “Doctor Dad” to all three boys, it is his every day involvement in my youngest son’s medical care that makes him a truly amazing father.

My son Luke is 4 years old. At the age of 6 months, he was diagnosed with an in-utero stroke. We were told at the time of his diagnosis that he may never talk or walk based on where the stroke hit. We’ve had several years of therapy, doctor’s appointments and testing. Throughout it all, Kris has been an amazing supporter- both for Luke and me.

While I tend to see the glass half-empty, Kris is perpetually positive. He always says “When Luke can” instead of “If”. He does research on therapies that might shake things up in Luke’s progress and is certainly a very active participator in all the therapies we receive. Kris stops in to chat with all the therapists so that they know he is Luke’s Dad. He is at every medical appointment: driving us to CHOP at 7:00 in the morning because he knows I hate driving on Route 76 by myself; heading up to Lehigh Valley Hospital for a speech consult; sitting by me while Luke has some sort of test done, holding my hand and telling me it will be okay. He is compassionate throughout it all and yet he still pushes Luke to succeed, knowing that our little boy can accomplish anything. When Luke gets frustrated, it is my husband who can calmly get him to try, try again. And they say laughter is the best medicine so my husband pulls out all the jokes and silly behavior he knows to get Luke to go “one more time.”

I really could go on and on about what a wonderful Dad my husband is but the true testament to him is sitting on the floor next to me singing and playing. Luke wouldn’t be where he is now without Kris.

And for that, I am eternally grateful.

Jennifer Taylor
©2013 Two Peds in a Pod®

What you forgot to tell the babysitter

The first time my husband and I went out to dinner after our daughter was born, we walked out the door, got into the car, and sat in the driveway as my husband fretted over how our daughter was doing with the babysitter. “Did you see?” he said. “She looked sad when we left.” After a few minutes elapsed, he still had not started the car engine. Finally, to allay his fears, I told him to sneak back to the house and peek into the window. He came back amazed. “She’s fine,” he said with relief.

Finding someone to appropriately look after your child can be a difficult task. Even if you resist the urge to run back and check on your child when you leave the house, you may wonder as you pull away if there is anything you forgot to tell the babysitter. Chances are, you didn’t think of much beyond leaving your cell phone number and the name of your destination. Linda Miller, a nurse who taught a babysitting course for years for Child, Home, and Community (a United Way agency serving Bucks and Montgomery Country, Pennsylvania), shares with us the information she leaves her own babysitters:

Parents’ cell numbers

Kids’ names, ages and birthdays

House address (chances are, if your sitter lives down the street, she or he doesn’t know your house number)

The full name of the town you live in (is it Borough or Township?) In Nurse Miller’s case, there is a street of the same name in the neighboring township. Ever since the pizza delivery guy went to the wrong house one hungry night, her family is careful to be very clear as to where they live.

The nearest cross street. This important piece of information helps emergency responders confirm they are heading to the correct address. (It could also be helpful if your sitter is old enough to order pizza!)

Where you are going – name and address and phone number.

Phone number to call in an emergency: For most it is 911

Poison control center phone number : 1-800-222-1222

Height and weight of each child – for emergency medication administration

Allergies – to Foods and Medications

Since seconds count in an emergency, even if your sitter is a regular fixture in your home, it doesn’t hurt to point out the safety information each time, should he or she need it.

Remember to bring your sitter’s cell phone number with you so you can reach her, in case you cannot get through on your own house phone.

When is my child old enough to babysit?

Somehow the years passed quickly, and the tables have turned. My daughter herself is a babysitter. How will you know when your own child is old enough to babysit? First ask yourself whether he will be too scared to stay home without an adult. Then ask yourself if he can solve problems on his own. The age that kids start to babysit themselves or younger siblings varies. Ultimately parents need to judge their child’s maturity for themselves. Tweens can be mature enough to babysit themselves and a younger sibling for short period of time. In fact, the American Red Cross babysitting training course (which can be taken online) is offered to kids 11 years and older. Even if your child is not babysitting anyone else, but staying by himself at home, a course will give your child valuable self-care tips.

Outline specific Do’s and Don’ts for your child. Walk them through what to do if the doorbell rings or if the phone rings. What activities are they allowed to do? Are they allowed to eat? Cook? Can friends come over? What will they do in a power outage? What if someone gets injured or sick while you are out? Familiarize him with basic first aid.

Keep anything which is potentially harmful such as medications, guns, and alcohol inaccessible. Make sure you are comfortable with parental controls for computers and the television.

And of course…give them Nurse Miller’s list from above.

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

 In honor of  Father’s Day, we would love to hear your anecdotes of any “Doctor Dad” moments your children have experienced.  Tell us about how your child’s dad or any father figure in your child’s life helped your child through a tough time, an illness, or an injury. Send us your anecdotes to twopedsinapod@gmail.com by June 4 and we will include the top stories in our Father’s Day post. 

Thank you in advance,

Drs. Kardos and Lai   

You tuck your child into bed and five minutes later he cries for you. You bolt back in to find him moaning that his legs hurt. You rub his legs, he feels better, and drifts back off to sleep. Later you can’t put yourself to sleep. “What was that all about?” you wonder.

Growing pains cause recurring leg pain at night that sometimes awakens children from sleep. They usually affect boys and girls in two age groups:  three to five years old and eight to twelve.  We don’t really know what causes growing pains. We do know that massaging the legs, one dose of pain reliever (acetaminophen or ibuprofen), and warmth can help. The kids are always fine in the morning. Often growing pains occur after a particularly active day. Fortunately, growing pains do not cause any long term problems, just temporary discomfort and some disturbed family sleep.

Before you chalk up  leg pain to growing pains, you need to be sure that some other ominous source of pain is not waking your child. If you see any of these symptoms, schedule an office visit with your child’s doctor:

                Leg swelling

                Leg redness

                The pain is always in the same spot on the same leg

                Your child is limping

                Your child stops participating in her usual activities because of the pain

                The pain comes on during exercise         

                Fever is present with the pain

                Simple massage or Tylenol fails to relieve the pain.

                Your child is losing weight or seems otherwise sick

     Leg pain is accompanied by night sweats: your child’s pajamas and sheets are soaking wet

    The pains seem to be getting more frequent or worse

     Pain in the daytime

Even without the above symptoms, if your parent intuition is telling you to get your child checked, then please do.

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

This Mother’s Day we bring you definitions inspired by our children and our patients. Don’t think we’ll out-hip Urban Dictionary, but we’re moms…. by definition we are not hip. Enjoy your day.

Sleep walker: the daytime state of a new mom.

Sweater: a garment worn by a child when his mother feels cold.

Displacement:  a vacation with toddlers.

Sick: something moms are not allowed to become.

WOW: MOM upside-down.

Mommometer: a mom’s hand on a feverish forehead.

One zillion: number of times a mom says “wash your hands” to her children over the course of their childhoods.

Yesterday: when the sports/camp/school field trip form was due.
Today: when the child hands the mom the sports/camp/school field trip form.

Working mother: Every Mom

Water torture: a grade-school son’s interpretation of a mom’s announcement of “shower night.”

Boomerang: a mom’s realization that her child is acting like she did at the same age.

Happy Mother’s Day from your two Pediatrician Moms,

Julie Kardos, MD and Naline Lai, MD

©2013 Two Peds in a Pod®