Who would have thought? Walking in a prewinter wonderland

If you live on the East Coast of the United States, you were bombarded today by a surprise pre-Halloween snowstorm. Now that we have our power back, we thought we’d share with you a few posts we were reminded of today:

As Dr. Lai struggled with chimney flues, she was reminded about hidden sources of carbon monoxide.

Scrambling around for a halloween costume reminded Dr. Kardos of ways to keep the candy intake down to a reasonable amount.

Squeezing children’s toes into snow boots from last year reminded us of how to dress your child appropriately for cold weather.

Looking for matching mittens reminded us of home remedies to prevent dried chapped hands.

Surely the cold, harsh weather is the fault of the retail industry- the big box stores lined their shelves with winter-holiday knick-knacks halfway through October. Mother Nature, like other mothers, was not pleased.

Naline Lai, MD and Julie Kardos, MD

Two Pediatricians return from Boston: dispelling myths about pot, steroids and prescription drugs

We’re back from the national American Academy of Pediatrics conference in Boston and we’re galvanized to make a positive impact on youth. Just in time for Red Ribbon Week, the national campaign for halting substance abuse Oct 23-31 (www.redribboncoalition.com), we bring you facts for you to use as you talk about three drugs kids generally consider “harmless”: marijuana, anabolic steroids, and prescription medications.

Marijuana: In 2010, one out of five high school seniors and eight percent of eight graders reported using marjuana. Unlike popular belief, marijuana is addictive. Use starting in adolescence is associated with an almost 20 percent risk of dependence. It’s strong stuff. As little as five uses of pot can lead to addiction and withdrawal symptoms are similar to withdrawal symptoms from heroin. The good news is that a teen can withdraw safely at home. If your kid tells you he is not addicted and can quit at any time, challenge him to stop smoking for two weeks. If he can’t, then he is in deeper than he realizes.

Pot clouds up the brain and makes it more difficult to remember recent events. Although kids say they can drive after smoking weed, their reaction time is impaired, just as it is with alcohol use. In the past researchers thought brains did not develop much in adolescence. However, brain development does continue to the early twenties, and pot can affect that development by altering mood and executive function (planning) centers in the brain. In short, marijuana causes brain damage.

Steroids: It’s just as likely to be the kid who wants to look “buff,” and not just the athlete who wants to play better, who uses anabolic steroids. Addiction does occur… and in a lot of users. One-third of all users end up addicted. Not only do steroids affect muscles, but also they affect the brain. Adolescents are already known for emotional volatility and steroids heighten aggressiveness. Additionally, sex organs pay a price for steroid. In males, testicles can atrophy and breast development can occur. For females, non-reversible facial hair growth and deepening of voice are side effects.

Prescription medications: Throw away those unused prescription pain killers and lock up controlled substances still in use. Prescription medications seem unintimidating to kids because they are prescribed legally and they see their parents taking them. Over the last few years, reported use of Vicodin in the past year by 12^th graders ranged from about eight to ten percent. Deaths occur from overdose or from accidents from impaired driving.

Data show teens listen to advice they hear from their parents and their pediatricians, even if they sometimes take time to digest and act on that advice. We pledge to do our part when we talk to your kids about the harmful effects of drug use. We urge you to continue communicating with your children, even if they are away at college. One helpful website to assist you in talking to your kids about drugs is The National Institute on Drug Abuse: http://www.nida.nih.gov/nidahome.html.

Culled from talks given at the American Academy of Pediatrics National Convention and Exibition, 2011, by Patricia Kokotailo, MD, MPH and Greg Landry, MD, FAAP University of Wisconsin School of Medicine and Public Health, Madison, WI, John Kulig MD, MPH,FAAP, Tufts University School of Medicine, Boston. If you live in the Central Bucks area of Pennsylvania contact CBCares for more information on local Red Ribbon Week events.

Naline Lai, MD and Julie Kardos, MD

Should I vaccinate my child?

Yes, yes, yes.

However, in the face of overwhelming evidence of safety and benefits of vaccines, we pediatricians despair when we see parents playing Russian roulette with their babies by not vaccinating or by delaying vaccinations. We hope fervently that these unprotected children do not contract a preventable debilitating or fatal disease that we all could have prevented through immunizations.

Should you vaccinate your child?

YES!

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

Visit these posts for more information about vaccines: Evaluating Vaccine Sites on the Internet, and Closure: there is no link between the MMR vaccine and autism

How to check for scoliosis: as easy as 1-2-3

Ever wonder what the school nurse or your kid’s pediatrician is looking for during a scoliosis screen? Here, in three steps, you can also monitor your child. If you are concerned, see your child’s doctor.

And dat is how to check dee spine!

Naline Lai, MD and Julie Kardos, MD

When your back “throws you a curve”: Scoliosis

I remember during my middle school days in New Jersey lining up once a year at the school nurse’s office, feeling awkward and nervous. Not only was the nurse checking our height and weight as she did every year in grade school, but now she was going to check our backs for some mysterious entity called “scoliosis.” Where I live now in Pennsylvania, many school nurses also screen students for scoliosis, a curve in the spine.

Although pediatricians check children’s spines for scoliosis throughout childhood, school based screens occur during pre-teen and teenage years. This timing is appropriate for school screens because most cases of idiopathic scoliosis, scoliosis with no known cause, occur during the rapid growth spurt of puberty. Eight times more common in girls than boys, scoliosis is painless and often detectable only to health care providers; minor curves are neither obvious nor disfiguring. Caught early, scoliosis can be ameliorated or corrected before adulthood when it can lead to back pain, difficulty breathing and disfigurement.

Unlike what some parents think, scoliosis does not cause “bad posture.” Likewise, “bad posture” does not cause scoliosis.

Depending on the degree of the curve, a child with idiopathic scoliosis might be re-examined every 4-6 months, might get an x-ray of her spine, or her health care provider might refer her to an orthopedic doctor, a specialist who cares for kids with scoliosis. Kids whose spinal curves are severe or are likely to get worse may need bracing until they stop growing. At that point the chances of the curve continuing to increase is low. Wearing a brace does not correct the curve; rather, it prevents any further curvature. Scoliosis braces are much more inconspicuous now than in the past, and can be hidden easily under clothing. Some children require surgery to correct a severe curve.

So, while it may cause an awkward middle school moment, scoliosis screening can actually have far reaching consequences for the future.

Next up: stay tuned for a “do-it-yourself “scoliosis screen.

Julie Kardos, MD and Naline Lai, MD

“Because I said so?” – getting your kids to listen

While many good books have been written on the subject of how to get your kids to listen to you, today we boil this topic down to a few key sticky points. The goal is to make sure your child hears, “Please clean your room,” as well as,“Let’s go get ice cream.”

Here are ways to make requests which yield results:

Validate feelings, then make the request. For example, “I know you are tired. Please pick up your clothes from the floor and put them in the hamper so I can wash a load with the soccer shorts you need for tomorrow.”

Give kids a time parameter for getting a task done so they do not feel you are interrupting their fun. For example, “Dinner is in one-half hour. In the next half an hour, I expect your toys to be cleaned up.”

Make a request sandwich. Use two positive statements with the request in between. For example, “I like how creative you’re being. Remember the crayons need to be put away before bedtime. I can’t wait to see your finished picture!”

Give warnings about transitions. For example, “We are having so much fun at the playground. We will need to leave in fifteen minutes.” And then, “We will leave in five minutes. Do your last thing.” And finally, “We need to leave now.”

Use the phrase, “I expect” rather than “I want” For example, “I expect your homework to be done by dinner time,” rather than, “I want you to do your homework before dinner time.”

Stay on topic. For example, your child is trying to get out of taking out the garbage and starts giving you a multitude of reasons for not completing the task. He also starts to prattle on about his upcoming baseball game. You say, “I understand you feel it’s your brother’s turn to take out the garbage. I know you would rather continue playing your computer game. I will listen to you talk about the game later. Right now I expect you to contribute to our household by taking out the garbage.” Try to keep your own frustration out of your voice.

Don’t nag. Kids, like all people, get irked by nags. Repetitive nagging only gives them practice at ignoring you.

Remember where your child is developmentally. A thirteen year old can be told to eat after others are served at a restaurant. A thirteen month old can not.

Make eye contact when making a request. Don’t text and talk. Show your children you respect them as people.

A special note about bribes and threats: By three years old, most kids understand bribes and threats. Sounds terrible, doesn’t it? However, both can be useful when used sparingly. For example, you could offer to take your child out for ice cream, or a bike ride, or a special event, in exchange for cleaning his particularly horrendously messy room. But bribes used too often create a kid who expects to get “paid” for performing reasonable and customary personal and household tasks.

Likewise, threatening a negative consequence must also be used sparingly or else you will end up with a resentful child who will have even more motivation to not listen to you. Remember to take away “extras” rather than essentials. For example, failing to listen may result in losing a finite amount of TV/videogame time. Do NOT threaten to take away eating dinner, reading with your child before bedtime or going to her best friend’s birthday party. Remember to follow through on the consequence immediately. Giving empty threats or putting off threats put you into the “nag” category.

Most importantly, during any ice cream outing, bike ride, or special trip to the park, regardless if it was a planned event or a bribe, flip the table and take the time to listen to what your child has to say.

Julie Kardos, MD and Naline Lai, MD

Special thanks for input from Kim Ross. A first grade teacher for the past 19 years, Mrs. Ross holds a Bachlor’s degree in Early Childhood Elementary education and a Masters degree in Educational Psychology, both from Temple University. Mom of two, she also is a Certified Parenting Educator.

That bites: recognizing spider bites

Wondering what crawled into your child’s room and bit her in the middle of the night? If you see two little pinpricks side by side, it’s probably a spider. Spider fangs make two little bite marks. Unfortunately, by the time you examine it in the morning, the bite may be so puffy and red that the two marks are no longer visible. With the exception of the Black widow spider and the Brown recluse spider, most spider bites are harmless and cause only a little bit of irritation. Over-the-counter hydrocortisone 1% ointment, ice, and an analgesic such as acetaminophen or ibuprofen can take the edge off of the itch and/or pain.

Some advice for Back-to-School 2011

Happy Start of School Year 2011! In case you missed these school related posts earlier, here are guides to packing a healthy school lunch, backpack weight guidelines, and deciding when to keep your children home for medical reasons.

We wish your children a rewarding, educational, and healthy year.

Bye-bye food pyramid, hello myplate

Teach nutrition with MyPlate We love it! With MyPlate, the United States Department of Agriculture’s new depiction of “a good diet” is easier to understand than the food pyramid. Mentally cut your kid’s plate in half. On one side are fruits and veggies, on the other side are grains and protein. The dairy is represented by a cup. Check out choosemyplate.gov for all sorts of hints including a personal plan which calculates the amount of each food group kids (and adults) above two years old need daily.

We’re wondering when people will start hearing about the “new pyramid”. We think the food pyramid gained prominence partially because of it’s visibility on cereal boxes. After all, we all stare groggily at the back of cereal boxes while eating breakfast. In the food pyramid days, grains were a large part of the pyramid base. Will the cereal companies have as much incentive to post MyPlate if grains have been relegated to a quarter of the plate?

We’ll find out.

Naline Lai, MD and Julie Kardos, MD

French without the fry

I love French fries, I mean really, who doesn’t? They’re probably one of the most delicious treats on the planet, but unfortunately they’re also one of the worst treats when it comes to our health. You’ll likely want to opt for baked “fries.”

It’s about overall diet. Ideally we should enjoy a diet that includes lots of fresh fruits and vegetables, fish, grains, and legumes, and one that is devoid of processed foods and sugary sodas. Even diet sodas may be harmful as they are laden with sweeteners made from chemicals.

Also very important, according to doctors, is maintaining a healthy weight. If you’ve had the pleasure of eating baked “fries,” you know what a tasty option they are; if not, please give the baked variety a chance.

You can cut some russet potatoes a bit thick and coat them and coat them with a little extra-virgin olive oil, some rosemary, a little salt and pepper and bake them until golden at 350 degrees, usually between 30-35 minutes. You can do the same with sweet potatoes, but use a little cracked black pepper instead of the rosemary. I normally boil my sweet potatoes first for about 15 minutes. They are a lot easier to peel that way. The recipe is in my book, My Italian Kitchen on amazon.com.

There is no reason to give up the foods you love, just find healthier ways to make them. This way of thinking has become my mantra. It could well become yours too, if it isn’t already.

Buona Salute! To Your Health~

Janet

Returning guest blogger Janet Zappala is a certified nutritional consultant and author of My Italian Kitchen — Home-Style Recipes Made Lighter & Healthier. She is also a six-time emmy award winning television journalist and the host of Wealth of Health at www.janetzappala.tv. Janet is a busy mom as well and is always creating ways to offer up delicious, nutritious foods that are quick and easy to make.