Last week we all sat on the couch watching the Super Bowl. If your kids are still on the couch, this post on indoor exercises by Dr. Deborah Stack is for you:

Let’s face it, it’s hard to move when it’s cold and it’s freezing at my home.  I believe today’s high is 20 degrees Fahrenheit.  Now while this may not deter younger children from bundling up and going sledding, teen couch potatoes are busy whining that it’s “too cold.”  So there they sit.

What’s the secret to keeping them active in the winter months?  Have them schedule an activity, and be an example yourself.  Ideas for teens (and you) to do when it’s cold outside:

Have a 15-minute dance party

Have a Wii contest

Try swimming (indoors please!)

Dust off the treadmill or stationary bike in the basement and GET ON IT

Play ping-pong

Do a few chores

Jump rope

Jog during T.V. commercials

Pull out some “little kid games” such as hopscotch, hula-hoop or Twister

Let each child in your house choose an activity for everyone to try

Teens, like everyone else, need exercise to stay healthy.  Staff from the Mayo Clinic recommend kids ages 6-17 years should have one hour of moderate exercise each day.  Exercise can help improve mood (through the release of endorphins), improve sleep and therefore attention (critical with finals coming up), and improve cardiovascular endurance. Those spring sports really ARE just around the corner. 

Here are some numbers to get the kids moving:  All activities are based on 20 minutes and a teen who weighs 110 pounds.  The number of calories burned depends on weight.  If your teen weighs more, he will burn a few more calories, if he weighs less, he’ll burn a few less.  Below the table are links to some free and quick calorie calculators on the web so your teen can check it out for him self.  For those attached to their phones, there are web apps too.

What’s the worst that can happen?  You’ll have a more fit, better rested, and happier teen!  Or at least you’ll have a cleaner home!

Try these activity calculators:

http://primusweb.com/fitnesspartner/calculat.htm

www.caloriesperhour.com/index_burn.php

http://www.caloriecontrol.org/healthy-weight-tool-kit/lighten-up-and-get-moving

References:

www.mayoclinic.com/health/fitness/FL00030.   
www.caloriesperhour.com/index.burn.php

Deborah Stack, PT, DPT, PCS

With over 15 years of experience as a physical therapist, guest blogger Dr. Stack heads The Pediatric Therapy Center of Bucks County in Pennsylvania www.buckscountypeds.com. She holds both masters and doctoral degrees in physical therapy from Thomas Jefferson University.

“Mommy, I throwed up.”
Few words are more dreadful for parents to hear, especially at 2:00am (my children’s usual time to start with a stomach bug).

In my house, I am the parent who comforts, changes pajamas and sheets, washes hands and face, and sprays the disinfectant. My husband scrubs (and scrubs, and scrubs) the rug. Little kids never throw up neatly into a toilet or into the garbage can. Sometimes even big kids can’t seem to manage to throw up conveniently.

What should you do when your child vomits?

After you finish cleaning up her and her immediate environment, I suggest that you CHANGE YOUR OWN CLOTHES AND WASH YOUR HANDS! The most common cause of vomiting in kids is a stomach virus, and there are so many strains, we do not develop immunity to all of them. And trust me, stomach viruses are extremely contagious and often spread through entire households in a matter of hours. Rotavirus, a particularly nasty strain of stomach virus, is preventable by vaccine, but only young babies can get the vaccine. The rest of us are left to fend for ourselves.

Stomach viruses usually cause several episodes of vomiting and conclude within 6-8 hours. Concurrently or very soon thereafter, the virus makes an exit out the other end in the form of diarrhea, which can last a week or so.

The biggest problem children face when they vomit is dehydration. Kids need to replace fluids lost from vomiting.  Pedialyte® or other oral rehydration solutions (ORS) such as Kaolectrolyte® or CeraLyte® are useful and well tolerated beverages for rehydrating kids. They contain salt, sugar, electrolytes and water, all substances that kids need when they throw up and have diarrhea.  For babies however, try to “feed through” with breast milk or formula unless otherwise directed by your child’s doctor. Most oral rehydration guidelines are based on diarrheal illnesses such as cholera, so you will find slight variations on how to rehydrate. Basically, they all say to offer small frequent amounts of liquid. I council parents to wait until no throwing up occurs for 45 minutes to an hour and then start offering very small amounts of an ORS (we’re talking spoonfuls rather than ounces) until it seems that the vomiting has subsided. In her house, Dr. Lai uses the two vomit rule: her kids go back to bed after the first vomit  and she hopes it doesn’t occur again. If vomiting  occurs a second time, she starts to rehydrate. Continue to offer more fluids until your child urinates- this is a sign that her body is not dangerously dehydrated.

Can’t immediately get out to the store? The World Health Organization has recommended home based oral rehydration solutions for years in third world countries.  Also, while the oral rehydration solutions are ideal, any fluid is better than none for the first hours of a stomach bug. You can give older kids watered down clear juices, broth or flat ginger-ale with lots of ice.  Now, some kids hate the taste of Pedialyte®. Plain, unflavored Pedialyte® splashed with juice often goes down better than the flavored varieties. For some reason, plain water tends to increase nausea in sick kids and copious amounts of plain water can lower the salt in a child’s bloodstream. So, offer a fluid other than plain water while  your child is vomiting.

Even if your child drinks the Pedialyte®, once the stomach symptoms have subsided, don’t forget that  Pedialyte®, while excellent at “filling the tank,” has no nutrition. The gut needs nutrition to overcome illness. Start to offer small amounts of food at this point. Easy-to-digest foods include complex carbohydrates such as rice, noodles, toast with jelly, dry cereal, crackers, and pretzels.  Additionally, give protein such as bits of turkey or baked chicken. Thicker fluids such as milk and orange juice do not sit as well in upset bellies, nor do large quantities of anything, food or drink. So offer small bits of nutrition fairly frequently and let kids eat as their appetite dictates. Warning- just when everything blows over, toddlers in particular, may go a day without vomiting and vomit one more time as a last hurrah.

Vomiting from stomach viruses typically does not cause severe pain. A child curled up whimpering (or yelling) on the floor with belly pain might have something more serious such as appendicitis, kidney stones, or a urinary tract infection. Call your child’s doctor about your child’s vomiting if you see any of the following:

• Blood in vomit or in stools
• Severe pain accompanying vomiting (belly pain,  headache pain, back pain, etc.)
• No urine in more than 6 hours from the time the vomiting started (dehydration)
• Change in mental state of your child- not responding to you appropriately or  inconsolable
• Vomit is yellow/green
  
• More fluid is going out than going in
• Illness not showing signs of letting up
  
• Lips and mouth are dry or eyes sunken in
  
• Your own gut tells you that something more is wrong with your child

Of course, when in doubt, call your child’s doctor .

Hope this post wasn’t too much to stomach!

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

Breathless after a stint on the treadmill at the gym, I burst out of the building yesterday into the bitter cold. Startled by the frigid air, I reached into my winter coat pocket and pulled out… a pair of stinky socks. One of my kids handed them to me after swimming the other day and I had stuffed them into my pocket. Instantly all my visions of myself as a wonder-workout -woman dissipated as I scurried towards my car with my new sock-mittens. What would have happened if I hadn’t thrown on the socks? Probably not much beyond dry chapped hands. But if you live in a cold area of the world, and your kids refuse to wear mittens (or socks) on their hands in this chilly weather… this post is for you:

Three little kittens, they lost their mittens, and they began to cry.

Oh, mother dear, we sadly fear

That we have lost our mittens.

What! Lost your mittens, you naughty kittens!

Then you shall have no Xbox today. 

-the modern version of a traditional poem

It’s only January and already my kids’ mittens are missing some mates.

Prolonged exposure to cold can lead to injury in body parts with relatively less blood flow such as the ears, fingers and toes. In frostbite, injury occurs secondary to ice crystals which form within or between the cells in your body. Injury can be so severe that the tissue dies and infection sets in.

Early signs of frostbite include tingling or aching. Without treatment, the area will become pale and lose all sensation.

If you suspect your child’s hands are  frostbitten, first remove all wet clothing. Rewarm the area by placing immediately in warm water. Think opposite of a burn- where you use cold water. Do not massage the hand as this may cause further injury, but do encourage your child to move his hands. As very cold hands warm up, they will become blotchy and painful or itchy. Ibuprofen (brand names Motrin and Advil)or acetaminophen (Tylenol) will be helpful. Warm for at least half an hour even if it is painful.

Signs of actual frostbite are blistering, numbness, or color changes. As my sister, an emergency room doctor says, red is good. Black and white are not.

Head over to the emergency room if you think your child has frostbite. To avoid the risk of over-heating and to manage the pain of treating frost bite, thawing for frost bite should be medically supervised. Just as you would seek care for a burn, seek medical care for a cold induced injury. To rewarm properly, the frostbitten part of the body should be submerged in warm 37-to-40 C (98 -to-104 F) water. No higher because then it’s like trying to defrost a chicken. You will end up cooking rather than thawing the tissue, says my sister. Also a big no-no: starting to thaw but then not completing the thaw. Thaw-refreeze-thaw will injure tissue, same as it ruins a defrosting chicken. So again, seek medical attention for your child if you suspect frost bite has set in.

For an interesting but somewhat technical article with photographs on a case of frostbite, check out this New England Journal of Medicine article.

Naline Lai, MD with Julie Kardos, MD

© 2013 Two Peds in a Pod®

modified from original post on 1/20/2010

Staphylococcus aureus, is a bacterial strain that has become quite famous – rightly or wrongly depending on the context. In this post, I will share a pediatric infectious diseases specialist’s perspective on the fact and fiction surrounding this germ.

What is MRSA?

MRSA is a particular subtype of Staph aureus bacteria. Staph aureus is everywhere and many people are “colonized” with Staph aureus. In other words, the bacteria live happily on our skin with all the other bacteria, minding their own business. Sometimes, if a person is colonized with Staph aureus, and there is a break in the skin from a cut or other injury, the Staph aureus can cause an infection. This can happen even if a person is not colonized with Staph aureus, because the bacteria are everywhere – in the environment on surfaces, on other people, etc. On people, Staph aureus like to live in the nose and other warm moist places like the armpits and groin area. MRSA is just like regular Staph aureus in where it lives and how it spreads – the major difference between the two is that the antibiotic choices for treating an infection caused by MRSA are more limited because MRSA is resistant to more antibiotics.

Isn’t MRSA rare?

No. In the Philadelphia area where I trained, at least half of skin infections tested are caused by MRSA. In other words, a child having a MRSA skin infection is not a unique event for a community. MRSA is more prevalent than most people realize. In addition to colonization, which you would never know from just looking at someone, many people have minor skin infections for which they never see their doctors because the infection comes and goes on its own with no treatment, or maybe with a little antibiotic ointment. Because samples from these infections are not tested for bacteria, we will never know what caused them and many could be caused by MRSA.

Rarely, a child can have a severe illness as a result of MRSA. This does happen, and appears to be happening more frequently now compared with 10 or 20 years ago, but far more common are simple skin infections caused by MRSA, and the vast majority of these do not progress to serious illnesses.

My grandmother was in a nursing home and died of MRSA. Now my child’s friend had a skin infection caused by MRSA – is this the same thing?

No. MRSA infections that people acquire in hospitals are different from community-associated (CA-MRSA) in a few ways. First, people in hospitals are there because they are ill, often with conditions that make it difficult to fight infections, like being elderly or getting cancer treatment. Second, people in hospitals often have devices that allow entry of bacteria into their bodies more easily, like IV lines or breathing tubes. Third, the strains of MRSA found in hospitals often have different characteristics from those found in the community. In hospitals, MRSA tend to be resistant to more antibiotics and have different properties that make the bacteria more harmful. Also, MRSA infections people get in hospitals are usually not the simple skin infections that children in the community get. Most children who get MRSA skin infections, even recurrent ones, don’t seem to go on to develop other more invasive infections caused by MRSA.

My child was diagnosed with a MRSA skin infection. Will it happen again?

Maybe. If you’ve been told your child has MRSA, don’t panic! In many cases, a single infection caused by MRSA is a one-time occurrence. Some children have recurrent infections with MRSA, but this is far more likely to be an annoyance and inconvenience rather than a serious illness. Recurrent MRSA infections can occur for a period of time, and then not happen again. Some of the time, changes in hygiene practices can stop the cycle of recurrent infection. If your child has recurrent infections, ask your doctor for more information about strategies to try. One important thing to keep in mind is that having MRSA, and even having recurrent MRSA infections, does not mean something is wrong with your child or her immune system – it is just bad luck.

Does someone have MRSA forever?

Maybe, but probably not. As I mentioned above, a significant proportion of the population is colonized with MRSA. The bacteria that colonize our bodies change over time due to a variety of factors, like age, antibiotic use, and environmental exposures. A person could be colonized with MRSA for a period of time, and then never again or not again for years.

Should the school be closed and decontaminated if there is a child with a MRSA infection?

No. Schools should be cleaned as they normally are to reduce bacteria and viruses on surfaces. MRSA and other Staph aureus predominantly live on people, in the nose and other moist body areas, so unless people are decontaminated (not advised!) MRSA can’t be eliminated.

Should kids with MRSA be excluded from school?

Absolutely not. For every one child with a diagnosed MRSA infection there are many more who are colonized with the bacteria, so it does not make sense to exclude a child on the basis of a diagnosis. A child with a MRSA skin infection is not a danger to other children or adults. As with any skin infection, open wounds should be covered. MRSA, while it can in some cases be more harmful than regular Staph aureus, is not any more contagious than regular Staph aureus. A much better strategy than exclusion is to teach children to wash their hands well and to avoid nose-picking, as these interventions will protect them against hundreds of diseases.

Can my child play with his friend who has MRSA?

Yes! As discussed above, a MRSA diagnosis does not say anything about a person’s overall health or make them more likely to transmit disease. Also, your child could very well be colonized with MRSA too and you wouldn’t know it. The best way to prevent the spread of MRSA is to encourage routine hand washing and to discourage nose-picking. Also, avoid sharing towels and sharing sports equipment that rubs against the skin, such as soccer shin guards and football pads. Remember, your child is much more likely to catch a cold or stomach virus from a friend than they are to catch a MRSA infection.

Amanda Paschke, MD, MSCE

©2013 Two Peds in a Pod®

Parents ask us about fever more than any other topic, so here is what every parent needs to know:

Fever is a sign of illness. Your body makes a fever in effort to heat up and kill germs without harming your body.

Here is what fever is NOT:

· Fever is NOT an illness or disease.
· Fever does NOT cause brain damage.
· Fever does NOT cause your blood to boil.
· Unlike in the movies and popular media, fever is NOT a cause for hysteria or ice baths.
· Fever is NOT a sign of teething.

Here is what fever IS:

· In many medical books, fever is a body temperature equal to or higher than 100.4 degrees Farenheit.
· Many pediatricians, consider 101 degrees Farenheit or higher as the definition of fever once your child is over 2 months of age.
· Fever is a great defense against disease, and thus is a SIGN, or symptom, of an illness.

To understand fever, you need to understand how the immune system works.

Your body encounters a germ, usually in the form of a virus or bacteria, that it perceives to be harmful. Your brain sends a message to your body to HEAT UP, that is, make a fever, to kill the germs. Your body will never let the fever get high enough to harm itself or to cause brain damage. Only if your child is experiencing Heat Stroke (locked in a hot car in July, for example), or if your child already a specific kind of brain damage or nervous system damage (rare) can your child get hot enough to cause death.

When your body has succeeded in fighting the germ, the fever will go away. A fever reducing agent such as acetaminophen (e.g. Tylenol) or ibuprofen (e.g. Motrin) will decrease temperature temporarily but fever WILL COME BACK if your body still needs to kill off more germs.

Symptoms of fever include: feeling very cold, feeling very hot, suffering from muscle aches, headaches, and/or shaking/shivering. Fever often suppresses appetite, but thirst should remain intact: drinking is very important with a fever.

Fever may be a sign of any illness. Your child may develop fever with cold viruses, the flu, stomach viruses, pneumonia, sinusitis, meningitis, appendicitis, measles, and countless other illnesses. The trick is knowing how to tell if your child is VERY ill or just having a simple illness with fever.

Here is how to tell if your child is VERY ill with fever vs not very ill:

Any temperature in your infant younger than 8 weeks old that is 100.4 (rectal temp) degrees or higher is a fever that needs immediate attention by a health care provider, even if your infant appears relatively well. For kids over 2 months of age, take the temperature anyway you’d like, just let your pediatricians know how you took it.

Any fever that is accompanied by moderate or severe pain, change in mental state (thinking), dehydration (not drinking enough, not urinating because of not drinking enough), increased work of breathing/shortness of breath, or new rash is a fever that NEEDS TO BE EVALUATED by your child’s doctor. In addition, a fever that lasts more than three to five days in a row, even if your child appears well, should prompt you to call your child’s health care provider. Recurring fevers should also be evaluated.

Should you treat fever? As we explained, fever is an important part of fighting germs. Therefore, we do NOT advocate treating fever UNLESS the side effects of the fever are causing harm. Reduce fever if it prevents your child from drinking or sleeping, or if body aches or headaches from fever are causing discomfort. If your child is drinking well, resting comfortably or playing, or sleeping soundly, then he is handling his fever just fine and does not need a fever reducing agent just for the sake of lowering the fever.

A note about febrile seizures (seizures with fever): Some unlucky children are prone to seizures with sudden temperature fluctuations. These are called febrile seizures. This tendency often runs in families and usually occurs between the ages of 6 months to 6 years. Febrile seizures last fewer than two minutes. They usually occur with the first temperature spike of an illness (before parents even realize a fever is present) and while scary to witness, do not cause brain damage. No study has shown that giving preventative fever reducer medicine decreases the risk of having a febrile seizure. As with any first time seizure, your child should be examined by a health care provider, even if you think your child had a simple febrile seizure.

Please see our “How sick is sick?” blog post for further information about how to tell when to call your child’s health care provider for illness.

Julie Kardos, MD and Naline Lai, MD

rev © 2015 Two Peds in a Pod®

Happy 2013! Time start those new year resolutions. If you are like many families, your kids are up early anyway so you might as well get started (or maybe they never went to bed). To jump start your list, we’re sharing a list of New Year’s health resolutions we’ve come up for our own families over the years.

1- I will make sure my child is up to date on her vaccines, including the yearly flu vaccine (there’s still time).

2- I will start to sleep train (if older than 6 months old).

3- I resolve to wean the bottle if my baby is older than one year.

4- I will read aloud to my child every day, even after he is old enough to read to himself.

5- I resolve to go through the medicine closet, dispose of out-of-date medications, and renew important rescue-type medicines such as epi-pens and albuterol.

6- I resolve to check to see that my child’s bike helmet still fits (consider putting name and contact telephone number on outside…just in case something were to happen) and tuck emergency phone numbers into her backpack.

7- I will start to read my child’s facebook page and phone texts. I’ll look for signs of bullying and signs of mental distress from my child’s friends as well as from my child. I will take action to address any problems.

8- I will remember to praise my child for acts of kindness and for working hard on school assignments.

9- I’ll get to know my kid’s friends and their families. I will start by getting out of the car to say hello when I drop my kid off at someone’s house.

10- I plan to encourage more self-sufficiency in my child. I’ll stop doing household tasks for my child when he shirks his duties. 

11-I will turn off my cell phone while I am doing an activity with my child.

12- I will listen carefully to my child’s own New Year’s Resolutions.

Have a wonderful, healthy 2013,

Drs. Kardos and Lai

©2013 Two Peds in a Pod®

Many times parents bring their children with sore throats to our office to “check if it’s strep.” Some are disappointed to find out that their child does NOT have strep. Moms and Dads lament, “But what can I do for him if he can’t have an antibiotic? At least strep is treatable.”

Take heart. Strep or no strep, there are many ways to soothe your child’s sore throat:

• Give  pain medication such as acetaminophen (Brand name Tylenol) or ibuprofen (brand names Advil or Motrin).  Do not withhold  pain medicine before you bring her in to see her pediatrician. Too many times we hear “We wanted you to see how much pain she is in.” No need for this! Pediatricians are all in favor of treating pain as quickly and effectively as possible. Pain medicine will not interfere with physical exam findings nor will it interfere with strep test results.
• Give lots to drink. Some kids prefer very cold beverages, others like warm tea or milk. Avoid citrus juices since they sometimes sting sore throats.  Frozen Slurpies on the other hand feel great on sore throats. Tell your child that the first three sips of a drink may hurt, but then the liquid will start to soothe the throat. Watch for signs of dehydration including dry lips and mouth, no tears on crying, urination less than every 6 hours and  lethargy.
  
• Provide soft foods if your child is hungry. For example, noodles feel better than a hamburger on a sore throat. And ice-cream or sherbet therapy is effective as well.
• Try honey (if your child is older than one year) – one to two teaspoons three times a day. Not only can it soothe a sore throat but also it might quiet the cough that often accompanies a sore throat virus. Give it alone or mix it into milk or tea.
  
• Kids older than three years who don‘t choke easily can suck on lozenges containing pectin or menthol for relief. Warning: kids sucking on lozenges may dupe themselves into thinking they are hydrating themselves. They still need to drink and stay hydrated.
  
• Salt water gargles are an age-old remedy.  Mix 1 teaspoon of salt in 6 ounces of warm water and have your kid gargle three times a day.
  
• Magic mouthwash: For those older than 2 years of age, mix 1/2 teaspoon of liquid diphenhydramine (brand name Benadryl 12.5mg/5ml) with 1/2 teaspoon of Maalox Advanced Regular Strength Liquid (ingredients: aluminum hydroxide, magnesium hydroxide 200 mg, and simethicone) and give a couple time a day to coat the back fo the throat prior to meals. Do not use the Maalox formulation which contains bismuth subsalicylate. Bismuth subsalicylate is an aspirin derivative and aspirin is linked to Reye’s syndrome.
  
• For kids three years and older, try throat sprays containing phenol (brand name Baker’s P&S and Chloraseptic® Spray for Kids). Use as directed.
  

Strep throat does not cause cough, runny nose, ulcers in the throat, or laryngitis. If your child has these other symptoms in addition to her sore throat, you can be fairly sure that she does NOT have strep. For a better understanding of strep throat see our posts: “Strep throat Part 1: what is it, who gets it and why do we care about it” and “Strep throat Part 2: diagnosis, treatment, and when to worry.”

Any sore throat that prevents swallowing or prevents your child from opening his mouth fully, pain that is not alleviated with the above measures, fever of 101F or higher for more than 3-4 days, or a new rash all merit a prompt visit to your child’s doctor for further evaluation. Please see our prior post on how to tell if you need to call your child’s doctor for illness.

Julie Kardos, MD and Naline Lai, MD

©2012 Two Peds in a Pod®

Photo by Lexi Logan

Picture the Mission Impossible theme song in your head… da da da DUM DUM da da da DUM DUM dadada…dadada…dadada…DA DA! Keep this background music playing as you read.

Recently, Two Peds in a Pod® went undercover as two unsuspecting moms surveying the scene on the shelves of a local chain pharmacy, seeking to uncover what medicines, ointments, and therapies avail themselves to the unsuspecting consumer. Today we break open the case.

All medication labels have an “active ingredient” list. This list contains the actual medicine that acts on your child’s body to hide symptoms or cure a condition.  Read this list carefully so that you know what you are actually giving your child. For example, Flu-Be-Gone claims it “cures the aches and cough of flu and helps your child sleep better.” In order to know just what is actually in Flu-Be-Gone, you need to read the active ingredients. Included might be acetaminophen (brand name Tylenol), a fever reducer and pain reliever, and diphenhydramine (brand name Benadryl), allergy medicine that has the common side effect of causing drowsiness and has some mild anti-cough properties. Notice neither active ingredient actually kills the flu germ. Additionally, you may already have these two medications in your medicine cabinet, or you might have already given your child diphenhydramine recently and giving Flu-Be-Gone would overdose your child.

Also note, diphenhydramine is everywhere. If you see the word “sleep” or “PM” in the name of a product, you will usually find diphenhydramine in the active ingredient list.

Now, let’s hone in on your choices for the anti-itch therapy, hydrocortisone. When your child’s health care provider advises treating an itchy bug bite, poison ivy, or allergic rash with hydrocortisone, make sure that the ACTIVE INGREDIENT in the product is “hydrocortisone 1%.” Hydrocortisone comes as a cream, ointment, spray, or stick (looks like a glue stick) and can have aloe, menthol, or other ingredients thrown in as well. Don’t bother with anything less than maximum strength. Regular strength is 0.5% and is generally ineffective.  Also, keep in mind that while ointment is absorbed a bit better, it is more greasy/messy than cream.

Don’t be fooled into thinking products with the same brand name contain similar active ingredients. Also, do not depend on your doctor to necessarily know the difference between the all the formulations. We noticed that the same brand name pain reliever, such as Midol, can have different active ingredients depending on which one you choose. Midol Teen contains acetaminophen, Midol liquid gels contains ibuprofen, and Midol PM contains acetaminophen and diphenhydramine.

Let’s talk bellyache. Did you know that kids should not take adult pepto bismol because it has a form of aspirin in it? Aspirin may cause Reye’s syndrome, a fatal liver disorder. However, we did see a product called Children’s Pepto Bismol and guess what the active ingredient is? It is calcium carbonate, which is the SAME active ingredient as in Tums, and is safe to give kids. However, watch your wallet: the children’s pepto bismol that we found cost $6.00 for a box of 24 tablets. The TUMS that we found cost $4.50 for a bottle of 150 tablets of the same stuff, just in slightly higher dose. Check with your child’s doctor but in most cases, the kids can take the adult dose.

Also, be aware that cold and cough medicine have not been shown to treat colds successfully or even to actually relieve symptoms in most kids. In fact these medicines have potential for harmful side effects, accidental overdose, or accidental ingestion and are just not worth giving your children. However, we found tons of cold and cough medicines marketed for children. Here are the three most commonly used active ingredients:

• If you see “suppressant” you will likely find “dextromethoraphan” in the active ingredient list.
• If you see “expectorant” you will likely find “guaifenesin” in the active ingredient list.
• If you see “decongestant” you will likely find “phenylephrine” in the active ingredient list.

Many products combine two or all three of the above. We ask, even if these ingredients did work well in kids and were not potentially dangerous, what is the POINT of combining a cough suppressant with an expectorant? Can you really have it both ways? (Remember, that Mission Impossible theme is still playing in the background.)

A few other tidbits. “Dramamine,” used for motion sickness, gets broken down in the body to diphenhydramine, that allergy medicine that we already talked about. So look at cost differences when choosing a motion sickness medicine. Both have the same side effect: sleepiness.

Many cough drops contain corn syrup and sugar. This is the same stuff lollipops are made of, so just call a candy a candy and keep your child’s throat wet with the cheaper choice, if you choose to do so.

Finally, we found one “natural children’s cough medicine” which claimed that it is superior because of its “all natural ingredients.” The first active ingredient listed? Belladonna. Sure it’s natural because it comes from a plant. So does marijuana. Just because it’s “natural” doesn’t mean it’s safe. Belladonna can cause delirium, hallucinations, and death and in fact has been used in high doses as a poison! Leave the cough medicine on the store shelf, and read our post about other ways to soothe a cough and cold symptoms.

Bottom line:  remember always to check the “active ingredient” list when buying any over-the-counter medication for your children.

As we were wrapping up our mission, one of the pharmacy employees came over to us, raised an eyebrow at our clipboard, and asked, “Can I help you ladies with anything?” We were tempted to answer “YES, can you help us take notes?”  but we just smiled and said “No, we’re fine, thanks. Just checking out what’s available.”

So now, we will don our stethoscopes and come out of hiding, go back into our offices and onto our website. Thanks for tuning in to this episode of Two Peds in a Pod®…. Da da da, DUM DUM da da da, DUM DUM dadada…dadada…dadada…DA DA!!!

Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®

As we head into this year’s cold and flu season, we re-release this post in response to recent questions  about “the best cold medicine for my kid.” Originally posted May 27, 2011

“DaDu.”

That’s how my oldest used to say “Thank you” when he was about two years old. Now that he is thirteen I find myself still reminding him to say “thank you” when he goes to a friend’s house or to a birthday party or when a friend’s parent drives him to school.

From Two Peds in a Pod®:  We are thankful for our readers, our facebook friends, and our subscribers for continuing to send us ideas and for telling parents around the world about our down-home source of “sound pediatric advice for parents on the go”. We’ll keep writing as long as you all keep reading. 

Today, may you enjoy cramming in folding chairs to your dining room table, the sleepy post Thanksgiving feast lull, and the sight of heaps of children piled onto a tiny couch.

Dadu and Happy Thanksgiving, 

Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®