One of Dr. Kardos’s kids yelled in our office a few years ago: “I’m getting a SHOT?! NOOOO! GET AWAY FROM ME!!”

Even the front desk staff could hear him, and he was in the exam room farthest to the rear of the building. Meanwhile, his twin brother just sat and pouted but did not flinch.

Even a pediatrician’s child does not always approach the prospect of an immunization or blood draw with a grin on his face. Here are ways you can take away the sting of a needle:

Set the stage. Your child looks to you for clues on how to act. If mommy and daddy are trembling in the corner of the room, it will be difficult to convince your child that the immunization is “no big deal.” Do not tell your child days in advance that she will be immunized. The more you perseverate, the more your child will perceive that something terrible is about to happen. Simply announce to your child right before you leave to get the immunization, “We are going to get an immunization to protect you from getting sick.”

Do not say “I’m sorry.” Say instead,”Even if this is tough, I am happy that this will protect you.”

Never lie. If your kid asks “Will it hurt?” say “Less than if I pinched you.”

Watch your word choice. Calling an immunization “a shot” or “a needle” conjures up negative images. In general, avoid negative statements about injected vaccines. I cringe when parents in the office threaten children with,” If you don’t behave, then Dr. Lai will give you a shot.” Remember, shots protect against deadly diseases and are in no way punishments for children.

Kids talk. Be aware that kids, especially those in kindergarten, like to scare each other with tall tales. Ask your child what they have heard about vaccines. Let children know that Johnny’s experience will not be their experience.

The moment is here.

You may have heard about a topical cream which numbs up an area of skin. Unfortunately, because the creams anesthetize the surface of the skin and most vaccines go into muscle, I do not find the creams very effective at taking the pain away.

Instead, practice blowing the worries away. Have your child practice breathing slowly in through her nose and blowing out worries through her mouth. For the younger children, bring bubbles or a pin wheel for your child to blow during the immunization. In a pinch, rip off a piece of the exam paper from the table in the room and have your child blow the paper.

The cold pack: holding something very cold, placing a cold pack on your child’s arm around the area to be vaccinated,  or placing a cold pack on the NON-vaccine arm can distract your child’s brain from feeling the pain of an injection.

“Transfer” the immunization to mommy or daddy. Have your child squeeze your hand and “take the immunization” for him.

Tell your child to count backwards from 10 and it will be over. In reality, it will be over before your child says the number seven.

Have as much direct contact with your child as possible. The more surfaces of his body you touch, the less your child’s brain will focus on the injection. Again, this is the distraction principle at work. By touching your child, you are also sending reassuring signals to him. For the younger child, if he is on the table, stay close to his head and hug his arms, or have him on your lap. Holding him firmly will make him feel safe and will prevent him from moving during the injection. Movement causes more pain or even injury.

For the older child and teens, hold their hands. I sometimes see parents of older teens and college students leave the room, believing that their kids are beyond the age of fearing vaccines. However, we find that even the big kids may need company during vaccines.

After the drama is over.

Have your older child sit quietly for a moment. As the anxiety and tension suddenly falls away, the body sometimes relaxes too suddenly and a child will start to faint. This phenomenon seems to happen most often with the six foot tall stoic teenage boys, but we’ve also seen teen girls and some younger kids get a bit light-headed. We have a saying in my office- “The bigger they are, the more likely they are to fall.” If your child becomes pale (or green) have him lie down for a few minutes until he feels better.

Compliment your child. Remind him that you will never let anyone really hurt him.

Now my story:

When my middle daughter was two years old, my family trouped into my office for our flu shots. We all sat calmly in a circle and smiled.

First, the nurse gave me my immunization. I smiled. My middle daughter smiled.

Second, the nurse gave my husband his immunization. He smiled. My middle daughter smiled.

Then the nurse gave my oldest daughter her immunization. She smiled. My middle daughter smiled.

Then the nurse gave my middle daughter her immunization. She did not smile. She did not cry. Instead, she slugged the nurse with her little fist. I think the nurse felt more pain than my child.

Someday all immunizations will be beamed painlessly into children via telepathy. Until then, I have no advice on how to take the sting away from the punch of a two year old.

Naline Lai, MD with Julie Kardos, MD
©2014 Two Peds in a Pod®
Revised from 2009 post on this topic.

Put poison control’s phone number on the back of your cell phone, on your cell phone case, and on your wall phone. Put it everywhere:  1–800-222-1222.

Did your toddler eat dog food? Or a berry from your backyard bush? Did you give the wrong medication to your child? Call poison control. Experts at poison control will direct your next step. They have access to extensive data on poisoning, and they can give you that information much quicker than a drug-manufacturer or pharmacist or even your own doctor. One of Dr. Lai’s kids ate a mushroom from the yard when she was 20 months old—she called poison control. A mom asked Dr. Lai about carbon monoxide exposure—she called poison control. If doctors have a question about any ingestion or poisoning—we call poison control. But don’t wait for us to call, go ahead yourself and call.
People often first jump to the internet for information. However, a recent small study found that the internet is NOT the best place to research questions about toxins. Many sites fail to direct readers to the US Poison Control Center, and those who do, fail to supply the proper phone number – again, that’s 1–800-222-1222.

If your child needs emergent treatment, surfing the internet for what to do next wastes precious time. Don’t reach for your phone to “google it,” in the case of a possible poisoning, reach for your phone and make a CALL. It could be life-saving.

Julie Kardos, MD and Naline Lai, MD

© 2014 Two Peds in a Pod®

I wash my hands about sixty times a day, maybe more.  This frequent washing, in combination with cold Pennsylvania air, leads to chapped hands.

• Whenever possible, use water and soap rather than hand sanitizers. Hand sanitizers are at minimum 60% alcohol- very drying. Be sure to fully dry hands after washing.

• Wear gloves or mittens as much as possible outside even if the temperature is above freezing. Remember chemistry class- cold air holds less moisture than warm air and therefore is unkind to skin. Gloves will prevent some moisture loss.

• Before exposure to any possible irritants such as the chlorine in a swimming pool, protect the hands by layering heavy lotion (Eucerin cream) or petroleum based product (i.e. Vaseline or Aquaphor) over the skin.

To rescue dry hands:

• Prior to bedtime, smother hands in 1% hydrocortisone ointment. Avoid the cream formulation. Creams tend to sting if there are any open cracks. Take old socks, cut out thumb holes and have your child sleep at night with the sock on his hands. Repeat nightly for up to a week. Alternatively, for mildly chapped hands, use a petroleum oil based product such as Vaseline or Aquaphor in place of the hydrocortisone.

• If your child has underlying eczema, prevent your child from scratching his hands. An antihistamine such as diphenhydramine (Benadryl) or cetirizine (Zyrtec) will take the edge off the itch. Keep his nails trimmed to avoid further damage from scratching.

• For extremely raw hands, your child’s doctor may prescribe a stronger cream and if there are signs of a bacterial skin infection, your child’s doctor may prescribe an antibiotic.

Happy moisturizing. Remember how much fun it was to smear glue on your hands and then peel off the dried glue? It’s not so fun when your skin really is peeling.

Naline Lai, MD and Julie Kardos, MD
©2014 Two Peds in a Pod®
Adapted from our 2009 post

More polar vortex! Here in Bucks County, PA,  we are recovering from power outages and preparing for yet another winter blast. As the generators are started up, we remind our readers about a potentially deadly exposure.

Unfortunately, one of the biggest winter hazards is not loud and obvious. As the temperature drops, deaths rise from this insidious poisonous gas: carbon monoxide.

According to the Centers for Disease Control, about 400 unintentional deaths occur a year from carbon monoxide poisoning.

Carbon monoxide results from the incomplete combustion of fuel. The gas causes a chemical suffocation by competing with oxygen in your body. The colorless, odorless gas is impossible for human senses to detect, and unfortunately, loss of consciousness usually occurs before any symptoms appear. Those lucky enough to have warning symptoms before passing out may experience headaches, nausea, vomiting, or confusion.

Because carbon monoxide is a by-product of incomplete combustion, sources are related to energy use. Poisoning occurs more during the winter months when fuel is used to heat closed spaces and ventilation from exhausts is poor. My sister, toxicologist and Harvard medical school instructor, Dr. Melisa Lai, tells the story of a snowplow operator a few years ago who left the house early in the morning to plow snow, only to return and find his family dead. The reason—snow blocked the exhaust pipe from the furnace and caused lethal levels of carbon monoxide to accumulate in his home.

Carbon monoxide also occurs in warm weather. To avoid carbon monoxide buildup in all climates:

–Install carbon monoxide detectors. My sister says a $20 detector such as Kidde works as well as the $150 models. Put them on every level of your home and check that the batteries work. Smoke detectors are not the same as carbon monoxide detectors. However, combination detectors are available.

–Ventilate all appliances, heating units, and your chimney adequately. Have them serviced yearly.

–Shovel well around vents: 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.

–Be wary of the exhaust from of any vehicle.

Parents have put their infants in running cars while they shovel snow, unaware that the car’s tailpipe is covered in snow. By the time they return to the car, the infant, who is extremely susceptible to carbon monoxide poisoning because of his size, is dead. Even opening the garage door when you run your car is not enough ventilation to prevent poisoning.

Like cars, boats also produce carbon monoxide. Since boats are less energy efficient than cars, they spew more of the gas. While your teen boogie boards behind a motor boat, the carbon monoxide can knock her tumbling unconscious into the water.

–Keep anything meant to burn fuel outdoors, OUTDOORS. Even an innocent barbeque can turn into a nightmare if you decide to grill inside your garage. Emissions from any type of grill, charcoal or gas, can send carbon monoxide levels skyrocketing. Additionally, hurricane season in the southern United States is known by toxicologists as “Carbon Monoxide Season.” During hurricanes (as with winter storms), people buy outdoor generators and auxiliary heating units. They work so well that people then bring them indoors, trapping fumes in their homes.

My sister says she has hundreds of stories about carbon monoxide poisoning, all which end tragically. Maybe I’ll let my husband store that larger-than-life-take-up-car-space neighborhood snow blower here this winter. Then, at least I know I’ll be able to make sure no one starts up the blower in a garage.

For more details please visit http://www.cdc.gov/co/faqs.htm.

Naline Lai, MD and Julie Kardos, MD
©2014 Two Peds in a Pod®

Adapted from our 2010 post

Parents often ask how they can tell if their child has the flu or just a common cold. Here’s how:

Colds, even really yucky ones, start out gradually. Think back to your last cold: first your throat felt scratchy or sore, then the next day your nose got stuffy or then started running profusely, then you developed a cough. Sometimes during a cold you get a fever for a day or two. Sometimes you get hoarse and lose your voice. Kids are the same way. They often feel tired because of interrupted sleep from coughing or nasal congestion.

Usually kids still feel well enough to play and attend school with colds, as long as their temperatures stay below 101°F and they are well hydrated and breathing without any difficulty. The average length of a cold is 7-10 days although sometimes it takes two weeks or more for all coughing and nasal congestion to peter out.

Important news flash: the mucus from a cold can be thick, thin, clear, yellow, green, or white, and can change from one to the other, all in the same cold. The color of mucus does NOT tell you if your child needs an antibiotic and will not help you differentiate between a cold and the flu.

The flu, caused by influenza virus, comes on suddenly and makes you feel as if you’ve been hit by a truck. Flu always causes fever of 101So, if your child has a runny nose and cough, but is drinking well, playing well, sleeping well and does not have a fever and the symptoms have been around for a few days, the illness is unlikely to “turn into the flu.”

Remember: colds = gradual and annoying. Flu = sudden and miserable.

Fortunately, a vaccine against the flu can prevent the misery of the flu. In addition, vaccines against influenza save lives by preventing flu-related complications that can be fatal such as pneumonia, encephalitis (brain infection), and severe dehydration.  

Be sure to read our article on ways to prevent colds and flu and our thoughts on over the counter cold medicines.  Now excuse us while we go out to buy really yummy smelling hand soap to entice our kids to wash germs off their hands. After that you’ll find us cooking up a pot of good old-fashioned chicken soup, just in case…

Julie Kardos, MD and Naline Lai, MD
revised from a Sept 2009 post

©2014 Two Peds in a Pod®

Does it make sense to change your car’s tires one at a time? (A vaccine parable)

Ron was puzzled. He had been a mechanic for many years, and had known Ms. McCarthy through two previous vehicles. But what could he say to a request like this?

“I don’t see why you wouldn’t want to do it this way. What’s the harm?” The mother of two seemed sincere and earnest. Ron knew she wanted to take good care of her car, and the kids who rode with her every day.

“It’s just not done this way. You need four new tires, let’s just replace them all at once.” Ron stuck his finger into a well-worn tread, showing his customer how shallow the grooves had become.

“But isn’t that too hard on the car? I mean, that seems like a lot to do, all at once. Let’s space them out, one tire every two weeks. I’ll just come back.”

Ron scratched his head. Cars: that’s what he knew. Light trucks, electrical systems, AC systems too. He had even studied and learned how to fix and maintain foreign cars, and hybrids, and the newer electric cars—more computer than car, really. If it rolled on wheels, Ron knew how to fix it. It was his job.

“No, you see, it’s a safety thing. A tire could blow—see how bare these are? And you won’t get good steering on these, which is also unsafe.” Safety, thought Ron, that will convince her. He took safety very seriously, and imagined that this nice lady with the kids would put safety first. “Besides, cars are designed to have their tires replaced. Tires wear out, so the car was designed to safely go up on this lift so we can replace the tires. No problem!”

“But how do I know it’s safe? I read on the internet that replacing all of the tires at once can stress out the suspension, and lead to premature angulation of the mesmerglobber, and on Oprah I saw this actress and she said three months after she had all four tires replaced, her transmission broke!” Ms. McCarthy started to sob.

“OK, look, it’s ok, look, um…” Ron looked for one of his less-greasy rags to offer as a handkerchief.

“Waiting a few weeks between each tire won’t really hurt, will it?”

“Probably it’ll be OK, I guess. But tires are an important part of your safety system, like good brakes and seat belts and air bags.”

“Oh, I make sure we never wear seat belts! I heard that once a guy was wearing his seat belt, and he went into a lake, and he couldn’t get it off, and he drowned! I’m not wearing anything that isn’t 100% safe!”

Ron felt lost. “Look, nothing’s 100% safe! A seat belt might occasionally make an accident worse, but 99 times out of 100 it’s much better to wear your belt.”

“I can’t risk that 1 out of 100 chance!”

The mechanic tried another avenue. “But it’s the law, you have to wear your seat belt, and your kids need to be in the right kind of car safety seats too.”

Ms. McCarthy’s eyes grew dark. “Yeah, the law. That’s just it—the government is forcing these seat belts and new tires on us, because the government is controlled by the car manufacturers and the insurance industry! If seat belts really saved lives would there have to be a law about it? That’s why I disconnected my front brakes.”

“What?”

“The front brakes are just a booster anyway. If the brakes work as well as they’re supposed to, why do we need a booster? It’s just more money, it’s all about the money!”

Ron had been fixing cars for years, and he owned his own shop. He made pretty good money, but selling new tires and simple brake maintenance jobs weren’t really profitable. He did those things to keep cars running well, and to prevent bigger problems later. In fact, if he let more rotors go bad and transmissions fail, he’s probably make even more money from the expensive jobs needed to fix them.

“Tell you what—I’ll fix up your brakes for free, just my cost for parts, OK? Really, it’s not safe for you and the other drivers if you don’t have good brakes and tires.”

“What do you mean, the other drivers? They have their own brakes! That’s exactly what this web site I found was explaining, that you’d come up with all of these dumb reasons to take more of my money and hurt my car! You’re not really interested in keeping my car healthy, are you?”

Are you?

Roy Benaroch, MD
©2014 The Pediatric Insider 

In practice near Atlanta, Georgia, Dr. Roy Benaroch is an assistant clinical professor of pediatrics at Emory University, a father of three, and the author of  The Guide to Getting the Best Health Care for your Child and Solving Health and Behavioral Problems from Birth through Preschool. We enjoy his blog The Pediatric Insider and also enjoy his posts on Web MD.

When I was a child, a special treat was to have a sleepover at my grandparents’ house. My grandfather was an early riser and to this day I can still hear him roaring “When Pop-Pop’s up, EVERYBODY’S UP!” as I awoke to the aroma of my grandmother’s hot breakfast.

As all parents know, when BABY’s up, EVERYBODY’s up. What‘s the secret to good sleep? It’s all in the bedtime routine.

Parents should establish a good bedtime routine when their children are babies and should continue to enforce the routine until their children grow up and leave home. Just as prevention of heart disease begins with establishing healthy eating and exercise habits when your children are young, prevention of adult insomnia starts with establishing a healthy bedtime routine.

Here are ways to help your kids sleep from infancy through young adulthood: Start with our most commented upon podcast: how to help your baby to sleep through the night. Parents of preschool-aged kids will appreciate“sleep invaders”: nightmares, night terrors, and other monsters under the bed.  Even if you don’t have a teen, read our post on the Tired Teen.

Now that winter break is a memory, it’s time to buckle down and rid your child of the jet lag that persists from the “vacation sleep schedule.” For more ways to do this, refer to “Get your child back on a school sleep schedule.”

May you have a good night this and every night!

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®

Resolve to raise self-esteem, foster a sense of security, and encourage independence in your children in the new year. Here are our top parenting ideas for this year:

1-Read aloud to your children, even if they already know how to read to themselves.

2-Get rid of the smart phones at the dinner/lunch/breakfast table and turn off the TV. Focus on food and family instead.

3-Compliment your child’s effort – from using the potty, to dressing himself, to not fighting with a sibling. Praise the effort, not the outcome.

4-Teach a new skill  such as how to fold socks, how to cook eggs, how to put a book back neatly in a bookshelf, how to do his algebra correctly.

5-Have your child do something he’s never done to encourage independence. For example, have your 6 year old order for himself at a restaurant, have your 9 year old call and arrange his own get-together with a friend before you get on the phone with the parent, or have your tween call (on the phone, not “googling”) a store to find out what time it opens.

6-Tell a personal anecdote in order to teach a lesson. For a young child, tell them how: “I remember when I forgot to wear my gloves and my hands were SOOO cold…”

7-Listen to your child when he talks to you. Put down the phone, put down the newspaper, turn off the TV, put aside the mail, and really pay attention.

8-Make your child laugh daily. Tell a corny joke, make a funny face, read a funny book, play a funny game, whatever it takes.

9-Tuck your child into bed or at least visit your teen’s room before he goes to sleep. Bedtime brings out stories from your children you might not hear about during the day. And it shows you care about them.

10-Hug them. Even if they are now bigger than you are. Remind your child that you will always be there for him.

Wishing you all a happy and healthy 2014,

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®