A parent was interested in our thoughts about placement for twins in school: Should parents separate them into different classrooms or keep them together?

Results of studies that look at how twins fare academically and socially when placed together versus in separate classrooms come as no surprise – it depends on the twins. Most teachers recommend placing twins separately to avoid competition and to encourage a stronger sense of self-identity. The importance of self-identity should not be taken lightly. My twins at seven, who look nothing alike and who do not dress alike, still refer to “our birthday” rather than “my birthday.”

Ask yourself, would putting them together help make each individual child more confident, more able to accept new people and situations, and encourage better behavior? Or would the two children cause one another to become more competitive? Does one tend to speak for the two of them? Does one become jealous of the other if one tries to befriend another child?

Twins, just like singletons, have endless personality differences. Some twins truly are like “two peas in a pod” while others could not be more different from each other. Sometimes one twin has more difficulty learning, or socializing, or behaving than the other twin. In some cases, placing these twins in the same class may inspire confidence, improved behavior, and security. Or placing them separately may help the “weaker” twin to “grow into his own.”

While parents should take into account the teacher’s recommendation, parents need to trust themselves to make the correct decision. Some schools give parents the final vote and some schools insist in separating twins unless, of course, there is only one class for the given grade. I had a family place their first grade twins apart only to have one join his sibling half way through the year to cure his separation anxiety and daytime “urine accidents.” Reuniting these twins helped both to perform better for the rest of the school year. Although they did poorly with separation in first grade,  two years later they adjusted fine to separate classrooms.

Try to refrain from doing what is easier only for yourself. Of course one set of homework and one birthday party class list is easier for a parent but it’s more important to do what is right for the twins. Parents can encourage individual interests, hobbies, and athletic abilities, even if that means forming carpools to make sure that each twin can make his own team practice or music lesson. It helps to think of twins as “two children with the same birthday” rather than “one set.”

Although we encourage our twins’ individuality, sometimes they just want to be alike. I cracked up when my twins came downstairs both dressed in blue jeans and Eagles t-shirts and said, “Look, Mom, we’re TWINS!”

Julie Kardos, MD with Naline Lai, MD
©2011 Two Peds in a Pod®

Guest blogger Lee Anne Hartwell, a licensed clinical social worker, joins Two Peds in a Pod® with advice on how to tell your children about divorce.

Telling your children about the decision to divorce is one of the most agonizing tasks parents face as they navigate the divorce and separation process. How do you maintain focus on the best interests of the children while you are suffering tremendous emotional upheaval?

Following these guidelines can keep you on track and lay the foundation for creating a co-parent team that gives your children the security and support they need as the family situation changes.

*Work together as a couple to develop a plan of what is appropriate to share with your children. But above all else, children need to hear that they are not at fault for your failed marriage.

* Tell your children about your divorce together, in the comfort of their own home and during a relaxed family time.

*Convey to your children your love and ongoing assurance that their needs are important.

*Communicate that as their parents you will be working together to make the transition as smooth as possible. Explain the process of determining visitation, custody, and changes in their living situation. Avoid placing major decisions on their shoulders.

*Give your children space and time to ask questions and to share their reactions. Validate their feelings. Answer their questions as factually as you can and with an eye to keeping details of marital struggles separate. Children may also need time to themselves after hearing the news.

Preparation can go a long way to helping all members of the family adjust to this challenging time. Oftentimes, when parents are ending their own relationship, seeking the guidance of trained professionals can be instrumental in giving everyone in the family much needed support and direction.

Lee Anne Hartwell, M.S.W., L.C.S.W. is a licensed clinical social worker in private practice in New Hope and Yardley Pennsylvania with expertise in individual, couples, and family therapy.

©2011 Two Peds in a Pod®

The bad news is that influenza is now circulating in all 50 states. The good news is that according to the Centers for Disease Control, the vaccine covers all currently circulating strains. 

You may not think of your kitchen as a convenient pharmacy, but parents used common kitchen items successfully to treat various maladies long before CVS and Walgreens were invented. 

Crisco– may not be healthy to eat, but smeared on skin, it’s an old fashioned but effective treatment for eczema or dry skin.

Oatmeal– crush and put into the end of a hosiery sock. Float in the bathtub for a natural way to moisturize skin.

Olive Oil– a couple drops into the ear three times a day will loosen ear wax (don’t put in if your child has a hole in their ear drum eg. myringotomy tubes). For cradle cap, rub into your baby’s scalp and use your fingernail or a soft brush to loosen the greasy flakes. Use to kill lice through suffocation.  Work the oil through the scalp, tuck hair into a shower cap and wash off in the morning. Although studies are unclear on how well this method works on lice, it certainly is worth a try.

White vinegar– dilute vinegar in water and soak feet to stop athlete’s foot. If swimmer’s ear is suspected, mix rubbing alcohol one to one with vinegar and drop a couple drops in the ear to stop the swimmer’s ear from progressing.

Ginger– boil ginger to make a tea to take the edge off nausea

Honey– shown to soothe coughs-give a teaspoon of dark (buckwheat, for example) honey three times a day. However, NEVER give honey to a child who is younger than one year of age because it may cause infant botulism

Lemon– an old singer’s trick—combine with honey in tea to alleviate hoarseness

Baking soda: Mix with water to make a paste to help soothe itchy skin, from maladies such as poison ivy . Can also be mixed with water to make toothpaste if you run out of your usual minty whitener.

Sugar: mix into weak tea (or your ginger tea from above) and give small amounts frequently to soothe your older child’s nausea and help rehydrate after vomiting.

Kitchen sink: excellent place to wash any cut, scrape, or bleeding wound under running water with soap. Also immediately after a burn, rinse the burned skin under cold water for several minutes to limit the extent of the heat injury. Contrary to popular lore, DO NOT put butter on a burn. You may, however, put butter on your toast. In small amounts.

Naline Lai, MD and Julie Kardos, MD

©2011 Two Peds in a Pod®

Come visit us in Bucks County Monday February 28 from 7-8:30 pm for an interactive session on the prevention of childhood obesity. The talk, sponsored by Doylestown Hospital and CBCares, will be held at the Health and Wellness Center, VIA auditorium, Warrington PA   register here for this free talk

I spent all day doing laundry. All right, maybe it wasn’t all day but it sure felt like it. Cleaning up after a vomiting child can be tough in the winter time. Unfortunately, it’s too cold to rinse off any sour curds outside. As I scraped off the sheets into the kitchen sink, I wondered how long the germs could live. I turned to my Disease Prevention Manager, Clare Edelmayer  at Doylestown Hospital, PA to find the answer.

She says depending on the germ and the surface it lands on, a germ can live for hours to days and sometimes months.

Most bacteria and viruses die within hours if they are outside the body. Surprisingly, survival does not depend on how deadly the germ is. For example, HIV virus in blood will die as soon as the blood dries outside the body.  However, some strains of flu viruses can survive 24-48 hours on non-porous surfaces such as your kitchen counter or on the handle of a plastic spoon and 2-8  hours on porous surfaces such as your toddler’s sleeve or on paper tissues. 

Methicillin Resistant Staphylococcal Aureus (MRSA), a bacteria which can cause skin infections filled with pus, stays alive for several hours to several days on surfaces.  Hepatitis B virus, a cause of liver disease, can stay viable on surfaces for 2 weeks or more, and the bloody-diarrhea producing Clostridium Difficile can live on surfaces up to 5 months. 

In other words, most germs die within hours, but don’t count on germs dying before they have a chance to enter your unsuspecting child’s mouth or nose. A dilute bleach solution works well to clean surfaces outside the body and of course, have your children frequently wash their hands.

The next time one of my kids throws up this winter, I’m tempted just to bury the sheets under the snow out back and fetch them in the spring.

Naline Lai, MD with Julie Kardos, MD
©2011 Two Peds in a Pod®

A mom recently wrote to us about her grade school aged child’s bedtime creeping later while her wake up time stayed the same. She wondered how to reclaim the earlier bedtime.

Many parents notice as their kids get older, they seem to take longer to fall asleep at night or push their parents for a later bedtime. This trend is largely biological— the older kids get, the less sleep they need. Also as kids age, their body clocks naturally signal them to stay up later at night and sleep later in the morning. Sometimes children are worried about something and this stress prevents them from falling asleep. Parents should ask their kids what they think about while lying in bed at night. However, many times the child is just fine emotionally but begins shifting sleep patterns anyway.

According to sleep experts, adults function best on 7-8 or more hours of sleep per night. In kids and teens, a wide variation exists for how much sleep is sufficient for any individual. In general, if your child is easy to awaken in the morning, cheerful, able to concentrate during the day, easily completes school work and homework and is not having emotional outbursts, then she is sleeping enough. So, when your grade school child transitions from getting 11-12 hours of sleep per night to getting 10, if her days are still rosy, then this sleep shift is okay. Some people just don’t need very much sleep.

If your child needs more sleep, it’s tough to simply move his bedtime up earlier. To him, the sudden change will feel like he flew from California to New York. A gradual approach works best. Put your child to bed first very near the time that he is already falling asleep, even if that seems inappropriately late.

For instance, if your child won’t fall asleep until 11:00 pm, establish a soothing night time routine that ends with reading in bed or listening to soothing music for a few minutes, and turn out the lights out at 10:45 pm. Avoid television within an hour of sleep time because this can interfere with falling asleep. No matter how late he fell asleep, even on weekends, make sure he wakes up at the same time every morning. Once he falls asleep consistently within a few minutes of lights out, move the bedtime another fifteen minutes earlier.  Continue to do this until the daytime sleep-deprivation symptoms have resolved. A child may still need an alarm to wake up in the morning but if he is well rested, he should wake easily.

Be sure to limit or avoid caffeine (found in soda, tea, coffee, some sports drinks, and chocolate) because caffeine stays in the body 24 hours and hinders falling asleep. Also, make weekend sleep routines, including wake up times, as similar to weekdays as possible. If you allow a child to sleep until noon on Saturday and Sunday, he will never be able to fall asleep early on Sunday night and he will start the school week sleep deprived.

Time to end this post. I’ve got to go put my kids to bed. Sweet dreams.

Julie Kardos, MD and Naline Lai, MD
©2011 Two Peds in a Pod®

While much of the US is getting pummeled by the latest snow storm, we want to remind everyone to shovel out space around your home’s furnace vent. 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.

We thank Dr. Lai’s sister Melisa Lai, MD, toxicologist and emergency room physician in Boston who has treated patients with carbon monoxide poisoning, for reminding us of this winter storm hazard. For more about keeping safe from carbon monoxide, please see our earlier post on this subject.

Naline Lai, MD and Julie Kardos, MD
©2011 Two Peds in a Pod®

Reporter Melanie Cutler interviews Two Peds in a Pod for Five Tips to Keep Your Child Healthy This Winter  in the online news source  Newtown.Patch.com.

Take a look at the February 2011 issue of Real Simple magazine. We are two of the experts cited on page 124. The good news is that some of our thoughts on the essentials of a medicine cabinet were integrated into a photo-essay piece. The bad news is that children’s cough medicine is listed as a component of the medical cabinet.  While the other contributors to the piece may encourage use of over-the-counter cold and cough medications, we discourage use.

Of concern, safety and effectiveness of cough and cold medicine has never been fully demonstrated in children.  In fact, in 2007 an advisory panel including American Academy of Pediatrics physicians, Poison Control representatives, and Baltimore Department of Public Health representatives recommended to the U.S. Food and Drug Administration (FDA) to stop use of cold and cough medications under six years of age.

Thousands of  children under twelve years of age go to emergency rooms each year after over dosing on cough and cold medicines according to a 2008 study in Pediatrics . Having these medicines around the house increases the chances of accidental overdosing. Cold medications do not kill germs and will not help your child get better faster. Between 1985 and 2007, six studies showed cold medications didn’t have significant effect over placebo.  

So why are children’s cough and cold medicines still around? A year after the advisory panel published their recommendations, FDA advised  against using these medications in children younger than two years but data about these medications in older children is still rolling in.   FDA continues to advise caution with these medications. The producers of cold medicines said at that point they would launch new studies on the safety of medication for those two to twelve years of age. In the meantime pharmaceutical companies stopped manufacturing cold medicine products for those under two years of age and changed the labels to read “for four years old and above.”

Yes, watching your child suffer from a cold is tough. But why give something that doesn’t help her get better and has potential side effects?  There is plenty to do besides reach for cold medicine.  Give honey for her cough  if she is over one year of age. Run a cool mist humidifier in her bedroom, use saline nose spray or washes, have her take a shower with you, and teach her how to blow her nose. Break up that mucous by hydrating her well- give her a bit more than she normally drinks.

If you have young children and want to make your medicine cabinet truly “real simple” then take out the over the counter cough and cold medication. 

Naline Lai, MD and Julie Kardos, MD
©2011 Two Peds in a Pod®