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®

It’s confirmed. Dr. Wakefield was a fraud. Recently, on January 5, 2011, reporter Brian Deer published a report in the British Medical Journal   exposing more flaws in the Wakefield study- the study which proposed a link between Measles, Mumps, and Rubella vaccine (MMR vaccine) and autism. Of note:

• Lawyers who were trying to win a law suit for parents who believed that the MMR caused their children’s autism paid Wakefield to do the study.
• Wakefield falsified his findings. The medical records of all 12 children in the study were inconsistent with Wakefields’s data.
• Almost half of the children in the study already showed signs of developmental abnormalities before they received the MMR vaccine. Therefore, the MMR vaccine did not cause their disabilities.
• Rather than randomly choosing the children for the study, Wakefield obtained most of his subjects through an anti-MMR campaign group.
• Ten out of twelve other authors of Wakefield’s paper have withdrawn their support of the paper.

To read about the original study and the controversy around it, please see our earlier post, “Do vaccines cause autism?” For more information about how vaccines work, please read “How vaccines work.”  To learn signs of early communication delays in your infant, please see “How do I know if my baby has autism?”

Too bad it’s too late for some children. Since Wakefield published his paper, measles cases have steadily risen in the UK. Hopefully the damage caused by Wakefield’s 1998 paper will be mitigated by more parents who vaccinate their children.

Julie Kardos, MD with Naline Lai, MD

©2011 Two Peds in a Pod℠

“The Great Recession has truly changed peoples’ attitudes towards money and parents are in need of help.” Thus observes award winning author John Lanza, our guest blogger today, who gives us ways to teach kids the value of money.

Just as New Years kicks off the “goal-setting season,” a powerful way to teach kids the value of money is setting goals. I’ve seen goal-setting work first hand with my kids. I’ve also seen how frivolous spending increases when a savings goal is absent. Teaching your kids to set goals, not just monetary ones, is an essential life skill. 

To get started, kids must receive some type of steady stream of money – an allowance. I use David McCurrach’s Allowance Magic as a guide. David’s short workbook makes a strong case with which most money experts and I agree –- that parents should not tie chores to allowance. Because most parents were given an allowance tied to chores when they were kids, they believe that they should do the same. Times change and just as we’ve learned that a five-point harness beats a single-point one for car seats used when we were kids (see Drs. Kardos and Lai’s carseat safety post ), we money experts realize that allowance is a tool to teach kids to become comfortable with money.

It’s okay to pay your children for “above-and-beyond” chores as noted kids money expert, Karyn Hodgens, author of Raised for Richness, calls them. Clearing the table, for example, is a chore they must do because it’s a family requirement, but mowing the lawn might be an “above-and-beyond” chore for which they could be paid. For more on the allowance/chores debate, I highly recommend Karyn’s piece on Motivation Theory.

Learning to be money smart is largely about learning to make choices.  Therefore, allowance distributions should be split into three parts. One of the first things parents should do when creating an allowance system is to set up a system of three jars –- one for sharing (charity), one for saving and one for spending smart. You can certainly create your own jars or simplify the process and purchase them from companies, such as my own, that provide inexpensive three-jar systems (www.themoneymammals.com).

So here’s what my wife and I do. We give our seven-year-old six dollars per week. She is required to save two dollars and to put one dollar into her share jar. She can do what she wants with the other three dollars. To encourage saving, we “match” any additional dollar put into the save jar with a quarter, a novel idea straight out of Allowance Magic. The matching program, along with pasting a picture of a specific, achievable goal on the save jar, truly helps influence the saving behavior you want to encourage in kids. To set an achievable goal, consider the horizon with which a young child can cope. Four to eight weeks for a five- or six-year-old is a good starting point. 

One of the most difficult aspects of giving your kids money is relinquishing control of the money to them, within reason. Just remember that your purpose for an allowance system is to teach your kids to be money smart. They need some autonomy to make decisions and they will, inevitably, make mistakes. Learning from small mistakes now will help prevent devastating choices years down the road. Though I’m not a big fan of those $104 American Girl dolls (with tax), that’s what my oldest wanted. Saving six months for it taught her a valuable lesson that she wouldn’t have learned had I nixed the idea.

We parents have an opportunity to raise a money smart generation and I hope some of the pointers in this article are helpful.

John Lanza

John Lanza is the Chief Mammal at Snigglezoo Entertainment and is the Creator of The Money Mammals DVD that helps kids learn to “Share & Save & Spend Smart Too.” John also runs The Money Mammals Saving Money Is Fun Kids Club and blogs, tweets and writes often about youth financial literacy. His new children’s book, “Joe the Monkey Saves for a Goal” was just awarded a Dr. Toy Best Pick of 2010. Find out more at www.themoneymammals.com.

©2011 Two Peds in a Pod?

We know the first time your child rides a two wheel bike or loses a tooth is a momentous occasion. In honor of January first, we’ve compiled a list of some of our favorite, lesser known, firsts. Have we missed any of your favorites? Please add to this list.

First time he tries peas

First time she walks on sand or grass in bare feet

First time he sees snow

First time she explains to you how to work your computer

First time she sleeps through the night (if ever)

First he calls grandpa on the telephone

First poop in potty- remember saving it to show your spouse?

First time she buckles herself into the car, with no help from you

First time she sleeps over someone else’s house

First time he gives you a handmade gift

First time finding the restroom by himself in a restaurant, and you allow him to “got it alone”

First time you leave her home alone to babysit herself

First time he is too old to qualify for the restaurant’s kids menu

First time she shaves her legs or first time he shaves his face

First time your teen drives herself to a sports practice

First day your youngest starts kindergarten

We wish you a year filled with many successful “firsts.”

Naline Lai, MD and Julie Kardos, MD with mommy of three Steffie MacDonald 
©2010 Two Peds in a Pod℠

I often pass a parent on her way out of my office carrying an infant in an infant car seat. As I stop to elicit a goodbye smile from the baby, I check to see that the car seat straps are buckled properly. I say to the parent, please make sure that the cross strap is across his chest, not down at his lap. And please tighten the shoulder straps; I should not be able to pinch the strap above his shoulders. These are too loose.

Car seats save many lives every year. After immunizations, they are the most effective way to prevent death in children, but car seats need to be used properly. Many families travel this time of year and that means it’s time to update your car seat safety knowledge.

Until recently, experts recommended that babies in car seats need to weigh at least 20 pounds AND be at least one year old until they could face forward. Newer recommendations say babies should stay rear facing in a car seat until two years old, or until they no longer fit facing backward. The reason for this change is that in a crash, children suffer fewer injuries when they face backward. Different car seat brands have different weight and height specifications so be sure to read the literature that comes with your car seat. If the seat fits well, the middle of the back seat is the best spot to install a car seat. Rear facing infant seats are the most difficult to install correctly. Luckily, many police stations and gas stations offer programs to check if car seats are installed properly. Check with your local police.

Children should remain in car seats as long as they correctly fit. For some kids this is age four years and for smaller kids this may be five or even six years. If your child is particularly tall or obese he may require a high-backed booster soon after age three. My friend had a tall child that unfortunately ended up in a car accident recently. Again, read the literature that comes with your car seat for the height and weight limit; this is more important than the age of your child. The more restraints, the safer the seat. Five point harnesses are safer than three point. After five years a car seat should be replaced. Usually the third born ends up with a new seat. Because of the risk of hairline cracks, also replace a car seat if it was in an accident.

When your child outgrows the car seat, he graduates to a booster. Again, remember the more restraints, the safer the seat. A high backed booster is preferable until your child outgrows it. Keep your child in his booster seat until he is tall enough for the chest strap of a car’s seatbelt to lie diagonally across his chest without hitting his neck and for the lap strap to lie straight across the bony parts of his hips, not his stomach. To provide neck support and minimize whip lash, his ears should not jut up past the top of the back of the booster or car headrest. Keep children 12 years old and younger in the back seat. The force of an air bag can harm a young child. 

Parents can call 1-800-CARBELT to access the American Academy of Pediatrics car safety seat hot line for their more specific car seat questions.

To ingrain good car safety habits in your children, remember to be a role model and buckle up yourself 100 percent of the time, even if you are driving only next door. Your children are watching you.

Julie Kardos, MD with Naline Lai, MD
©2010 Two Peds in a Pod?

Addendum: Please note that the official updated car restraint policy of the American Academy of Pediatrics as of March 2011 include the above recommendations of staying rearfacing until age two years and avoiding riding in the front seat until at least age thirteen years. In addition, more specific guidelines about boosters were added: children should stay in a booster seat until the car’s seat belt fits properly, at the minimum height of 4’9″ and between 8-12 years of age.

Dashing through the mall, having traded your one-horse open sleigh for a minivan, you have secured gifts for all creatures, including the mouse. Now you are ready to  leave on a plane tomorrow to spend the holidays with forty of your closest relatives.

How will you avoid illness this holiday season? How best to travel with children? We take you to a couple posts to help you out: Traveling with Children, and A happy, healthy holiday part 2: more holiday sanity hints .

We wish you all good health this season.

Julie Kardos, MD and Naline Lai, MD

©2010 Two Peds in a Pod℠

Our pediatric offices are getting busier as the winter germs start to circulate!  We have a great way to demonstrate to your children good hand washing techniques during this cold and flu season. Lightly cover your children’s hands with petroleum jelly and sprinkle “germs” in the form of glitter over their hands. Use different colors for each child. Then have them high-five each other. Observe how the “germs” spread from hand to hand. Then wash under water for a few seconds and observe how much comes off.  Share with your kids that 10-15 seconds (the time it takes to sing the “ABC song”) of hand washing is most effective at decreasing germs. Another fun way is to use a substance called Glo Germ . The pretend invisible germ is rubbed on the hands. Only a black light reveals the Glo Germ. Have your children wash their hands, then use a black light again to see if they successfully washed off the Glo Germs.

Enjoy the glitter but not the germs of the winter holiday season.

Naline Lai, MD with Julie Kardos, MD

©2010 Two Peds in a Pod℠