Subduing stress: relaxation techniques

As the school year comes barreling to an end, I always find an assortment of students parading through my office with stress related ailments. Struggling to keep up in class can be extremely stressful for a child. Whether the child is college aged or elementary school aged, concerned parents want to know how to prevent their child from internalizing stress. Today, psychologist Dr. Sandy Barbo provides us with relaxation techniques to deflect tension. The mom of two college-aged daughters, Dr. Barbo has worked with children and their families for over twenty years. – Dr. Lai
 
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Hurry, hurry, hurry!!! Off to soccer practice, or the orthodontist’s office, or swim class, or a scout meeting, or a violin lesson. Don’t forget homework, that spelling test… oh no! Wasn’t there a special poster project due soon? Quick, run into Staples to get that poster board. Oh, and yes, we can’t forget to grab some take-out because with all the rush, who had time to make dinner?
 
Sound familiar? We tend to live very busy lives these days and our children’s schedules reflect that in all the many activities they engage in. Even our youngest and smallest have schedules!
 
Busy-ness can lead to stress, but so can a host of other experiences our children live through day to day. Our kids have to juggle performance in school (getting assignments done, managing academic and extracurricular challenges), survival in social groups (peer pressure,bullying, overcoming shyness), and even the occasional external stress that filters down from the adult world (news of a disaster, parental job stress, illness in an extended family member).
 
How do we as parents help inoculate our kids so they can better manage the various stresses and anxieties that come their way? There are many possibilities. Here are a few:
 
One of the easiest and most effective stress busting strategies you can teach your child (and yourself!) has to do with the deep, diaphragmatic breath. Lie down on the floor with your child or sit upright in a comfortable chair. The trick is to align the chest above the pelvis. Make a diamond shape with your thumbs and index fingers.Show your child how to position the belly button in the middle of the diamond. Now instruct her to slowly take in a deep, filling breath so that the belly starts to raise her hands up as far as they can go. Slowly, exhale and allow the belly to sink back down. When empty, fill up again slowly, but comfortably. For some kids, it helps them to imagine they are filling a balloon with their breath and then letting it all out. When you’ve completed 3 belly breaths you’ve created a “mini”. And “minis” are wonderful as they can be done almost anywhere, anytime, incognito! Remind your child on the way to school, “Let’s do a mini”; or before going into an anxiety provoking situation; or even at the end of the day, in bed to help settle everyone down. The deep breath counters our body’s response to stress and is incompatible with anxiety which provokes shallow chest breathing. Try modeling “minis” for your child and encourage him to practice them at least 3 times each day. When you teach your child how to do “minis”, he’s learned a powerful stress buster that he can put to use whenever or wherever the need arises.
 
Don’t forget the good old fashioned belly laugh. We know that humor helps us reframe and relieve stress, but the deep belly laugh is also diaphragmatic and forges a healthy mind/body connection. Don’t be bashful. Suggest a tickle fest. Have a book of age-appropriate jokes around that you can share with your kids. Belly laughs are infectious. It almost doesn’t matter what silly idea starts them. Show your kids that the sillies can get the better of you too and laugh all of yourselves to the point of exhaustion.
 
We tend to hold our tension in our “stress triangle”the area between the shoulders and up towards the neck. Show your kid show to gently press their shoulders up towards their ears, then roll them back and relax along with those wonderful deep breaths they’ve already learned. Also, indulge in massage. Rub between your child’s shoulders. At bedtime, offer a foot massage.
 
Another helpful de-stressor at bedtime can be a guided imagery exercise. You become your child’s guide. Help her create her imaginary safe, relaxed place by engaging all of the senses. Pick, or have your child pick, her favorite vacation setting. Beach? Be ready to customize your guided tour to her most wonderful fantasies. Have her close her eyes, start deep breaths and use her imagination to picture herself stepping down a series of 10 steps into the setting as you slowly and in your most soothing voice count. For example:
 
1. You’re at the top of a set of stairs that go down the dunes to the beach. You see the beautiful beach below you.Imagine what you see. Imagine the colors all around you. (Deep breath)
 
2. You can see the wonderful beach scene before you,the boats on the water, the few wispy clouds in the beautiful blue sky, the gulls that fly over the water. (Deep breath)
 
3. You can feel the sun on your skin. It’s deliciously warm. (Deep breath)
 
4. A cool breeze, just the right temperature is gently blowing through your hair. (Deep breath)
 
5. You can hear the sound of the waves lapping at the shore. The sun is sparkling off the water. Imagine the other sounds you hear on the beach. (Deep breath)
 
6. You can smell all those wonderful beach smells, the sunscreen, the wet sand. You can almost taste the salty ocean water droplets as they reach your lips. (Deep breath)
 
7. You feel your toes in the sand. It is just the right warm temperature, soft and comfortable under your feet. (Deep breath)
 
8. You are at the water now. Just let your toes wiggle and feel the wonderful temperature of the water. As you wriggle your toes you can see the sea foam and the sand make wonderful patterns between your toes. (Deep breath)
 
9. All around you are the people you love. (Deep breath)
 
10. You lie down on the beach feeling so relaxed and comfortable, just resting and enjoying the wonderful sounds, smells, feelings,tastes, views of the beach. You are restful and relaxed. You are breathing deep steady breaths. Enjoy this feeling of relaxation in this safe, warm, wonderful place. In a minute, when you are ready, you can gently open your eyes or allow yourself to drift off to sleep.
 
The above mentioned guided imagery exercise can become a beloved ritual. My daughter’s favorite involved a meadow with a family of unicorns. Each night, I learned to tap all my creative resources to keep the characters on interesting adventures in the meadow all the while engaging my daughter’s sensory system within her fantastic imagination, as she continued to deep breathe and leave the stressors of her day behind.
 
Invite your kids to share when they’ve used their stress busters during the day. Model for them how to take a “mini” to manage some aggravation that comes your way. With just a little bit of practice, your child can start to use these stress-busting strategies, when challenged, to reestablish a sense of calm. It’s truly a gift that keeps on giving over and over again.
 
Sandy Barbo, Ph.D.
© 2010 Two Peds in a Pod
 
Dr. Barbo is a licensed psychologist and the mom of two college-aged daughters. She has been working with children, parents and families for over 20 years. In addition to providing psychotherapy for anxiety, depression, trauma, Dr. Barbo has developed sub-specialties in infertility, pre and post-adoption, and ADHD. Contact her at: drsandybarbo@comcast.net or P.O. Box 196, New Hope, PA 18938 telephone (215)297-5092



Managing Munchies: More healthy weight ideas

Standing in line at a fast food restaurant off an East coast highway during spring break, I overheard the cashier greet the family in front of me by name. I cringed. Was the family a regular customer at the chain? Hopefully, they were just friends with the cashier.

Most of us, including me, are not always health food angels. However, a family who is a regular customer at a fast food restaurant may simply not know how to break the habit. For those who still need to get those healthy eating New Year’s resolutions rolling, our February podcast, “Helping the Overweight Child,” gave the 5-4-3-2-1-0 rules for healthy eating.  This post gives more hints:

BMI, or Body Mass Index (weight in kg divided by height in meters squared) is a number which indicates whether your child’s weight is normal for his or her height and age. Normal weight school aged kids DO look a bit scrawny.Children’s bellies should NOT hang over their pants. On the other hand, normal weight toddlers do look a bit pudgy. The Centers for Disease Control and Prevention has a nice BMI calculator

Snacks aren’t needed at sports games which last only an hour. Supply water bottles and forget the snack.

Don’t feed your younger child snacks to keep him occupied during an older sibling’s event. Bring books, paper and crayons, a doll, or a matchbox car instead.

 Make a stack of peanut butter and jelly or cheese sandwiches and keep them wrapped, ready to go, in the fridge. Keep some washed apple slices or carrot sticks along side the sandwiches and this stash can be your “fast food” at those times you need to feed your family “on the run”. 

 Don’t give your children a junky snack in order to carry them over until dinner. If your kids come home from school STARVING!!, give them a REAL dinner, and then give them a fruit or vegetable when the entire family later sits down.

holiday is one day, Halloween is October 31st. . Why eat the candy for days and weeks afterwards?

Don’t keep junk food in your home. This will avoid arguments about what to eat.

Have your children ask you if they can have something to eat, rather than allowing “free access” to your pantry/refrigerator. That allows you decide if it is too close to mealtime to have a snack (remember from the Picky Eaters blog post,“hunger is the best sauce”) and will allow you to choose an appropriate snack and portion size. If kids inherently knew healthy choices and portion sizes, they wouldn’t need parents! Also this allows you to determine if the child is truly hungry, bored, or attention seeking. 

Now back to the the fast food establishment I find myself in with my family. “Maybe this restaurant chain should offer a Two Peds in a Pod kid’s lunch box,” I mused as my family finished up their greasy, salty meal. Everyone’s curiosity was piqued. My husband and I began to hypothesize what kind of food would be inside a Two Peds box.

“What do you think?” I asked the kids.

“We’re actually more interested in what kind of prize would you would offer,” they said.

Gotta love my regular customers.

 

Naline Lai, MD and Julie Kardos, MD

©2010 Two Peds in a Pod®

 




Making Sense of Ear Pain

“Help, help, my EAR HURTS!!!”

I admit to having no statistics on this observation, but as a pediatrician and a mom, I have observed that ear infections strike disproportionately on Friday nights. Have you observed this as well?

I wish children had some kind of external ear indicator that would flash “infection” or “not an ear infection” when they have middle of the night attacks of pain. Unfortunately, most people can not diagnose their child in the middle of the night. Even I can’t diagnose my own children at home because my portable otoscope, the instrument used to examine ears, died from overuse a year ago.  However, there are ways to treat ear pain no matter what the cause.

Of course we all want to know the cause of our children’s pain. However, there is no danger in treating pain while we investigate the cause, or until daytime comes and pediatricians open their offices.  Good pain relievers such as acetaminophen (brand name Tylenol) or ibuprofen (brand names Advil and Motrin), given at correct doses, will treat pain from any source. Treating pain does not “mask” any physical exam findings so go ahead and ease your child’s misery before going to your child’s health care provider. I feel bad for my young patients whose parents tell me, “We didn’t give him any pain medicine because we wanted you to see how much his ear is hurting him.”

Heat in the form of warm wet compresses or a heating pad will also help. Prop your child upright. If the pain is from an ear infection, the position will relieve pressure. Distraction such as a 2:00 am Elmo episode will also blunt pain.

Only about half of all patients seen in the office with ear pain or “otalgia” actually have a classic middle ear infection. Pain can stem from many sources, including the outer part of the ear. Swimmer’s ear, which is an outer ear infection (see swimmer’s ear blog post) is treated differently than a middle ear “inside” infection. Nearby body parts can also produce pain. Throat infections (pharyngitis), from strep throat (see strep throat posts) or viruses, often cause pain in the ears. Even pain from jaw joint strain and dental issues can show up as ear pain. Over the years I have sent several children straight from my office to the dentist’s office for treatment of tooth ailments masquerading as ear pain.

No article on ear pain would be complete without addressing“ear tugging.” Many babies by nine months of age discover their ears and then play with them simply because they stick out (I will leave to your imagination what boy babies tug on). Babies often tug on ears when they are tired. Therefore, tugging on ears alone may not indicate an ear infection, especially if not coupled with other symptoms.

Although ear infections are one of the most common ailments of childhood and most children have at least one ear infection by age three,  remember that not all ear pain is caused by ear infections. In the middle of the night, and even in the middle of the day, it IS okay to give some pain relief before seeing your child’s health care provider.

Why ear pain always seems to awaken a child in the middle of the night, I’ll never know.  All I know is that I have to remember to buy a new otoscope for home.

Julie Kardos, MD
©2010 Two Peds in a Pod




Child (or anyone) abduction prevention tips

Mud is everywhere. My jeans are splattered—the result of chasing after my dog who was running loose in the neighborhood.  Unlike my children, my dog might go home with any stranger. Then again, I wonder, would my children ever be tricked into wandering off with a stranger? Every week there seems to be a story about an attempted child abduction circulating via email. I brought this up with Doylestown Township Pennsylvania Police Chief Stephen White who shared with me a few ideas on how to protect your children beyond telling them “don’t take candy from strangers.”

  • In order to distinguish between a real police officer and an impostor, tell your child that if he is confronted by someone who claims to be a police officer, have him tell the officer to call for another one. Real officers rarely work without a partner.
  • Never allow your child to give her home address or other personal information out in an online chat room or email exchange. Tell her not to assume that new “friends” online are children. Pedophiles constantly cruise through social networking sites and chat rooms looking to hook up with juveniles.
  • Go to a Megan’s Law website and familiarize yourself with offenders living in your zip code. Megan’s Law is an informal name for laws in the United States requiring law enforcement to make information about registered sex offenders public. The determination of what information is released is decided on a state-by-state level. Here is state by state information about Megan’s Law.  In Pennsylvania http://www.pameganslaw.state.pa.us/ and in New Jersey http://www.state.nj.us/njsp/info/reg_sexoffend.html

 

 

Naline Lai, MD
© 2010 Two Peds in a Pod




Traveling With Children

As I pack for an upcoming family vacation, I am reminded of the numerous questions over the years that parents have asked me about traveling with children. Often they ask, what is the best way to travel that will allow everyone to enjoy the vacation?

Ha,ha, I think to myself. The real answer is to hire a sitter or enlist grandparents to babysit and leave the kids at home. My husband and I always refer to family vacations as “family displacements.” 

No, really, family vacations are wonderful experiences as long as you hold realistic expectations. First you have to get there.

Easier said than done.

When traveling by air, parents wonder if they should bring a car seat for the plane. Young children who sit in a car seat in the car should sit in a car seat in an airplane. Unfortunately, not all car seats fit into the airplane seat properly. The best advice I can give is to bring your car seat and make an attempt to fit it properly. If it doesn’t fit properly, you will still need it for the car ride from the airport after you arrive at your destination. Not all car rental facilities provide car seats.

Another question I am frequently asked about long plane rides is “Should I give my child Benadryl (diphenhydramine) so he/she will sleep through the flight?” Unfortunately, Benadryl’s reliability as a sleep aid is spotty at best. Most kids get sleepy, but the excitement of an airplane ride mixed in with a “drugged” feeling can result in an ornery, irritable child who is difficult to console. I advise against this practice. On the other hand, Benadryl can help motion sickness and is shorter acting than other motion sickness medications.

Ear pain during an airplane’s descent is also a common worry. Yes, it is true that ears tend to “pop” during the landing as the air pressure changes with altitude. Some young children (and their parents) find this sensation very unpleasant. However, most babies are lulled to sleep by the noise and vibration of an airplane and are unaffected. If your child is safely in a car seat, I do not advise taking him out of it to breastfeed during landing. Offer a pacifier if you feel he needs to suck/swallow during the landing, and offer an older child a snack so she can swallow and equalize ear pressure if she seems uncomfortable during the landing.

Speaking of food, try to carry healthy snacks rather than junk food when traveling. Staying away from excessively salty or sweet food will cut down on thirst. Also, keep feeding times similar to home schedules in order to prevent toddler meltdowns.

Remember that young children hate to wait for ANYTHING and that includes getting to your destination. Bring along distractions that are simple and can be used in multiple ways. For example, paper and crayons or pencils can be used for: coloring, drawing, word games, origami, tic-tac-toe, math games, etc.

When traveling internationally, check the Center for Disease Control website www.cdc.gov for the latest health advisories for your travel destination. Do your research several weeks in advance because some recommended vaccines are available only through travel clinics. Also, some forms of malaria prevention medicine need to be started a week prior to travel.

Please refer to our “Happy, Healthy Holiday” blog post from 12/10/2009 for further information about keeping kids on more even keel during vacations. In general, attempt to keep eating and sleeping routines as similar to home as possible. Also remember to wash hands often to prevent illness during travel. Finally, locate a pediatrician or child friendly hospital ahead of time in case illness does strike. Unfortunately, most illnesses cannot be diagnosed by your child’s health care provider over the phone.

While traveling with young children can seem daunting, the memories you create for them are well worth the effort. And it DOES get easier as the kids get older. Now I can laugh at the image of my husband with two car seats slung over his back lugging a large diaper bag and a carry-on, leading my preschooler struggling with his own backpack filled with snacks and air plane distractions, while I am balancing two non-walking twin babies, one in each arm, as we all take our shoes off for the airplane security checkpoint.

We’ve come a long way, and so can you. Happy Travels!

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




Do Vaccines Cause Autism?

Do vaccines cause autism?


Concerned parents ask me this question, and I am relieved to be able to tell them “NO.”


Amazingly, most of the autism/vaccine hoopla can be traced to one very small report.


In 1998 a doctor named Andrew Wakefield published a paper in a well respected British medical journal called The Lancet. He said that in his study of twelve children who were patients in a GI (Gastroenterology) clinic, eight of them had evidence of abnormal intestines and abnormal behavior that began after they received the MMR vaccine.  He wondered if the combined MMR vaccine may have triggered abnormalities in the gut, allowing unspecified toxins to leak out from the gut, causing brain damage.


Unfortunately, this one small paper involving 12 children caused huge controversy about the safety of vaccines. Many parents lost confidence in the very vaccines that were so successful at protecting the lives of their children.  They stopped vaccinating and caused the measles rate to increase. For evidence of this please see:


http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5733al.htm


http://www.parliament.uk/commons/lib/research/briefings/snsg-02581.pdf.


On February 6, 2010, The Lancet published a retraction of this paper because the study design was flawed and thus any conclusions cannot be reliable. Specifically, the UK General Medical Council’s Fitness to Practise Panel, after investigations, concluded that the children in the study were not “consecutively referred,” meaning that they were not “random samples” as stated in the paper.


In addition, the panel discovered that Dr. Wakefield did not have permission from any institutional review board (panels that review the ethics of research done on people) to perform the lumbar punctures, MRIs, EEGs, endoscopies, and intestinal biopsies that he conducted on the children whom he studied.


Despite the original study being flawed, a question about a connection between MMR and autism had been raised. In the years since 1998, scientists performed subsequent studies to see if the MMR vaccine might have a link to autism. No association was found. These studies involved thousands of children and showed that the rate of autism in vaccinated children is THE SAME as the rate of autism in unvaccinated children. To read these articles as well as the original article that caused the controversy, you can go to www.TheLancet.com and register to view the articles for free.


I urge all parents reading this blog post to speak with your child’s health care provider if you have ANY doubts about vaccinating your children. In addition, if you are going to conduct your own research on this subject on the Internet, I urge you to consult the following credible sites:


www.aap.org, www.cdc.gov, www.vaccine.chop.edu, www.webmd.com,  www.mayoclinic.com


Vaccines save lives. Unfortunately, for those too young to be vaccinated, those who have immune system diseases, and those who do not receive immunizations, vaccine preventable diseases still can potentially cause severe  illness and death.


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

January 10, 2011: The above links to the CDC and UK parliament are down. For more information on trends in measles rate, please see http://news.bbc.co.uk/2/hi/health/7872541.stm.




“There’s a monster under my bed”: all about nightmares, night terrors, night wandering and bedwetting

Just last night my ten year old sounded the “MOMMY, MOMMY!!!” alarm in the middle of the night. Almost without opening my eyes I went to his room and calmly walked him to the bathroom where he emptied his bladder with gusto and went right back to bed. Witness: A nightmare with a purpose.

Ever wonder when you, the parent, get to sleep through the night? Now that your child has graduated from the crib, tune into this podcast to learn how to handle situations that sabotage sleep in children: nightmares, night terrors, night wanderings, and bedwetting.

Julie Kardos, MD and Naline Lai, MD

©2010 Two Peds in a Pod




Holes In Your Head: Sinus Infections

 

You have a hole in your head.

Actually, you have several.

You, your children, and everyone else.  These holes are called sinuses.

 

These dratted air pockets in your skull can fill with puss and cause sinus infections.  Scientists hypothesize they once helped us equilibrate water pressure during swimming. Now, sinuses seem only to cause headaches.

 

Sinuses are wedged in your cheek bones (maxillary sinuses), behind your nose (ethmoid sinuses) and in the bones over your forehead (frontal sinuses).  When your child has a cold or allergies, fluid can build up in the sinuses. Normally, the sinuses drain into the back of your nose.  If your child’s sinuses don’t drain because of unlucky anatomy, the sludge from her cold may become superinfected with bacteria and becomes too thick to move. Subsequently, pressure builds up in her sinuses and causes pain.  A sinus infection of the frontal sinuses manifests itself as pressure over the forehead.  The pain is exacerbated when she bends her head forward because the fluid sloshes around in the sinuses.  Since frontal sinuses do not fully develop until around ten years old, young children escape frontal sinus infections. 
 
Another sign of infection is the increased urge to brush the top row of teeth because the roots of the teeth protrude near the  maxillary sinuses. Bad breath caused by bacterial infested post nasal drip can also be a sign.

 

The nasal discharge associated with bacterial sinus infections can be green/yellow and gooey.  However, nasal drainage from a cold virus is often green/yellow on the third to fourth day.  If your child has green boogies on the third or fourth day of a cold, does not have a fever, and is comfortable, have patience. The color should revert to clear. However, if the cold continues past ten days, studies have shown that a large percentage of the nasal secretions have developed into a bacterial sinus infection.  
 
Because toddlers in group childcare often have back-to-back colds, it may seem as if he constantly has a bacterial sinus infection. However, if there is a break in symptoms, even for one day, it is a sign that a cold has ended.

 

Hydrate your child well when she has a sinus infection. Your child’s body will use the liquid to dilute some of the goo and the thinner goo will be easier for her body to drain.  Since sinus infections are caused by bacteria, your pediatrician may recommend an antibiotic.  The usual duration of the medicine is ten days, but for chronic sinus infections, two to four weeks  may be necessary. Misnamed, “sinus washes” do not penetrate deep into the sinuses; however, they can give relief by mobilizing nasal secretions. When using a wash, ask the pharmacist for one with a low flow. Although the over the counter cold and sinus medicines claim to offer relief, they may have more side effects than good effects. Avoid using them in young children and infants.

 

Who knows. Someday we’ll discover a purpose to having gooey pockets in our skulls. In the meantime, you can tease your children about the holes in their heads.

 

Naline Lai, MD
© 2010 Two Peds in a Pod

 

 




Dry winter skin – guidance from a guru

It’s that itchy, scratchy time of year. Today our guest blogger, dermatologist Mary Toporcer MD, gives us hints on how to combat dry skin. For the past 21 years, Dr. Toporcer has practiced general medical dermatology in Doylestown, PA.  She did her dermatology training at Hahnemann University and at St Christopher’s Hospital, both in Philadelphia, PA.

Many patients suffer from severe dry skin (xerosis) in the winter when the air is cold and the humidity low.  Those who are atopic (have a personal or family history of eczema, allergies, asthma, hayfever or sinus problems) are much more affected by their environment.  A few MUST DO’s include:
1.  Moisture every day especially after bathing with Cerave Cream or Lotion. It contains ceramides which “waterproofs”the skin and keeps moisture in, but without that greasy feel.
 
2.  Use gentle soaps such as Dove in the shower and keep the shower water luke warm, not hot. Hot water just irritates and ultimately dries the skin even more. It also increases itch.
 
3.  Avoid irritants such as anti-static sheets in the dryer. Even if they say “free”, they still put a coating on your clothing in an effort to prevent it from sticking together. This substance is very irritating to dry, sensitive skin. Liquid, fragrance-free fabric softener is much gentler on skin.
 
4.  Lastly, for those terribly dry, scaly, fissured hands and feet, try vaseline or Aquaphor under the soft stretchy gloves and socks that you can buy at Bath and Body Works…they’re often impregnated with aloe for extra moisture.

Mary Toporcer, MD
© Two Peds in a Pod
 
 




Count down the pounds: six simple guidelines to helping overweight children

A common question that many parents ask us in the office is “How can I help my overweight child?”

Our newest podcast provides six simple rules for healthy eating. Listen in to find out the “5-4-3-2-1-0” rules of what to feed your children, how to portion their foods, and how to change their behavior to help them lose excess pounds and maintain a healthy weight.

(If the podcast is not embedded in your RSS reader page,visit the www.TwoPedsInAPod.com home page directly.)

 

Julie Kardos, MD and Naline Lai, MD

©2010 Two Peds in a Pod