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®

About half of all children in the United States with an autistic spectrum disorder are diagnosed at age five or older according to a May 2012, NCHS (National Center for Health Statistics) data brief. However, many parents are suspicious much sooner. As part of autism awareness month, we bring you clues in toddler development that can alert you to a potential issue. This post follows up on our earlier post “How can I tell if my baby has autism?”

Pediatricians often use a questionnaire called the M-CHAT (Modified Checklist for Autism in Toddlers) as a screening tool . This test can be downloaded for free. In our office we administer the M-CHAT at the 18-month well child visit and again at the two-year well visit, but the test is valid down to 16 months and in kids as old as 30 months. Not every child who fails this test has autism, but the screening helps us to identify which child needs further evaluation.

At 15-18 months of age, children should show the beginnings of pretend play. For example, if you give your child  a toy car, the toddler should pretend to drive the car on a road, make appropriate car noises, or maybe even narrate the action: “Up, up, up, down, down, rrrroooom!” Younger babies mouth the car, spin the wheels, hold it in different positions, or drag a car upside down, but by 18 months, they perceive a car is a car and make it act accordingly. Other examples of pretend play are when a toddler uses an empty spoon and pretends to feed his dad, or takes the T.V.  remote and then holds it like a phone and says “hello?” You may also see him take a baby doll, tuck baby into bed, and cover her with a blanket.

Eye contact in American culture is a sign that the child is paying attention and engaged with another person. Lack of eye contact or lack of “checking in” with parents and other caregivers can be a sign of delayed social development.

Kids try periodically to get their parents to pay attention to what they are doing. Lack of enticing a parent into play or lack of interest in what parents or other children are up to by this age is a sign of delayed social development. Ask yourself, “Does my child bring me things? Does he show me things?”Also, although they may not share or take turns, a toddler should still be interested in other children.

Many two-year-olds like to line things up. They will line up cars, stuffed animals, shapes from a shape sorter, or books. The difference between a typically-developing two-year-old and one that might have autism is that the typically-developing child will not line things up the exact same way every time. It’s fine to hand your child car after car as he contently lines them up, but I worry about the toddler who has a tantrum if you switch the blue for the green car in the lineup.

Two-year-olds should speak in 2-3 word sentences or phrases that communicate their needs. Autism is a communication disorder, and since speech is the primary means to communicate, delayed speech may signal autism. Even  children with hearing issues who are speech-delayed should still use vocal utterances and gestures or formal sign language to communicate.

Atypically terrible “terrible twos”. Having a sensory threshold above or below what you expect may be a sign of autism.  While an over-tired toddler is prone to meltdowns and screaming, parents can often tell what triggered the meltdown. For example, my oldest, at this age, used to have a tantrum every time the butter melted on his still-warm waffle. Yes, it seemed a ridiculous reason to scream, but I could still follow his logic. Autistic children are prone to screaming rages beyond what seems reasonable or logical. Look also for the child who does not startle at loud noises, or withdraws from physical contact because it is overstimulating.

By three years, children make friends with children their own age. They are past the “mine” phase and enjoy playing, negotiating, competing, and sharing with other three-year-olds. Not every three year old has to be a social butterfly but he should have at least one “best buddy.”

Regression of skills at any age is a great concern. Parents should alert their child’s pediatrician if their child stops talking, stops communicating, or stops interacting normally with family or friends.

It’ s okay to compare. Comparing your child to other same-age children may alert you to delays. For example, I had parents of twins raise concerns because one twin developed communication skills at a different pace than the other twin.

Although you may wonder if your child has autism, there are other diagnoses to consider. For instance, children need all of their senses intact in order to communicate well. I had a patient who seemed quite delayed, and it turned out that his vision was terrible. He never complained about not seeing well because he didn’t know any other way of seeing. After my patient was fitted with strong glasses at the age of three, his development accelerated dramatically. The same occurs for children with hearing loss—you can’t learn to talk if you can’t hear the sounds that you need to mimic, and you can’t react properly to others if you can’t hear them.

If you or your pediatrician suspect your child has autism, early, intensive special instruction, even before a diagnosis is finalized, is important. Every state in the United States has Early Intervention services that are parent-prompted and free for kids. The sooner your child starts to works on alternate means of communication, the quicker the frustration in families dissipates and the more likely your child is to ultimately develop language and social skills. Do not be afraid of looking for a diagnosis. He will be the same child you love regardless of a diagnosis. The only difference is that he will receive the interventions he needs.

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

The antihistamine quandry
 Junior’s nose is starting to twitch
His nose and his eyes are starting to itch.
 As those boogies flow
You ask oh why, oh why can’t he learn to blow? 
 It’s nice to finally see the sun
But the influx of pollen is no fun. 
Up at night, he’s had no rest,
But which antihistamine is the best?

It’s a riddle with a straight forward answer. The best antihistamine, or “allergy medicine” is the one which works best for your child with the fewest side effects. Overall, I don’t find much of a difference between how well one antihistamine works versus another for my patients. However, I do find a big difference in side effects.

Oral antihistamines differ mostly by how long they last, how well they help the itchiness, and their side effect profile.  During an allergic reaction, antihistamines block one of the agents responsible for producing swelling and secretions in your child’s body, called histamine. Prescription antihistamines are not necessarily “stronger.” In fact, at this point there are very few prescription antihistamines. Most of what you see over-the-counter was by prescription only just a few years ago. And unlike some medications, the recommended dosage over-the-counter is the same as what we used to give when we wrote prescriptions for them.

The oldest category, the first generation antihistamines work well at drying up nasal secretions and stopping itchiness but don’t tend to last as long and often make kids very sleepy.  Diphendydramine (brand name Benadryl) is the best known medicine in this category.  It lasts only about six hours and can make people so tired that it is the main ingredient for many over-the-counter adult sleep aids.  Occasionally, kids become “hyper” and are unable to sleep after taking this medicine. Other first generation antihistamines include Brompheniramine (eg. brand names Bromfed and  Dimetapp) and Clemastine (eg.brand name Tavist).

The newer second generation antihistamines cause less sedation and are conveniently dosed only once a day. Loratadine (eg. brand name Alavert, Claritin) is biochemically more removed from diphenhydramine than Cetirizine (eg. brand Zyrtec) and runs a slightly less risk of sleepiness. However, Cetirizine tends to be a better at stopping itchiness.
Now over-the-counter, fexofenadine (eg brand name Allegra) is a third generation antihistamine.  Theoretically, because a third generation antihistamine is chemically the farthest removed from a first generation antihistamine, it causes the least amount of sedation. The jury is still out.

If you find your child’s allergies are breaking through oral antihistamines, discuss adding a different category of oral allergy medication, eye drops or nasal sprays with your pediatrician.
Because of decongestant side effects in children, avoid using an antihistamine and decongestant mix.

Back to our antihistamine poem:
Too many choices, some make kids tired,
While some, paradoxically, make them wired. 
Maybe while watering flowers with a hose,
Just turn the nozzle onto his runny nose. 

Naline Lai, MD with Julie Kardos, MD

©2013 Two Peds in a Pod®

Updated  from the original  post April 10, 2011