One of Dr. Lai’s patients burned his arm on a hot cookie sheet. The child stopped further injury by immediately running the area under cool water. However, his well-meaning great-aunt decided to then apply butter to the burn. Please, do NOT put butter immediately on a burn. It’s like putting butter on a hot skillet.

We’re not sure where the myth of putting butter on a burn comes from. A better idea for pain control, after applying cool water for a few minutes, is to offer the child a pain reliever such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).

Burns caused by fire or burns covering large body areas are best treated at a hospital, but your first response, as you call 911, should be to get that burn in cool water. Run the water for several minutes. To avoid shock or extreme cold injury, do not use ice water. Don’t remove clothing stuck to skin but go ahead and put the burn and the stuck clothing in cool water. 

Most burns sustained at home are mild or may cause blisters. Burns are easily infected because when you burn away skin, you burn away an excellent barrier to germs. Washing the affected area with soap and water and applying a topical antibiotic such as Bacitracin twice daily can prevent infection. Avoid popping blisters- you will take away a protective layer of skin.

Please remember that unlike for cookie batter, butter is not better for burns. Please pass this post on to anyone you know who cares for your children…it’s “hot off the press.”

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

Revised 5/17/2015

The antihistamine quandry

Junior’s nose is starting to twitch

His nose and his eyes are starting to itch.

As those boogies flow
You ask oh why, oh why can’t he learn to blow?

It’s nice to finally see the sun

But the influx of pollen is no fun.

Up at night, he’s had no rest,

But which antihistamine is the best?

It’s a riddle with a straight forward answer. The best antihistamine, or “allergy medicine” is the one which works best for your child with the fewest side effects. Overall, I don’t find much of a difference between how well one antihistamine works versus another for my patients. However, I do find a big difference in side effects.

Oral antihistamines differ mostly by how long they last, how well they help the itchiness and their side effect profile.  During an allergic reaction, antihistamines block one of the agents responsible for producing swelling and secretions in your child’s body, called histamine.  

Prescription antihistamines are not necessarily “stronger.” In fact, at this point there are very few prescription antihistamines. Most of what you see over-the-counter was by prescription only just a few years ago. And unlike some medications, the recommended dosage over-the-counter is the same as what we used to give when we wrote prescriptions for them.

The oldest category, the first generation antihistamines work well at drying up nasal secretions and stopping itchiness but don’t tend to last as long and often make kids very sleepy.  Diphendydramine (brand name Benadryl) is the best known medicine in this category.  It lasts only about six hours and can make people so tired that it is the main ingredient for many over-the-counter adult sleep aids.  Occasionally, kids become “hyper” and are unable to sleep after taking this medicine. Other first generation antihistamines include Brompheniramine (eg. brand names Bromfed and  Dimetapp) and Clemastine (eg.brand name Tavist).

The newer second generation antihistamines cause less sedation and are conveniently dosed only once a day. Loratadine (eg. brand name Alavert, Claritin) is biochemically more removed from diphenhydramine from than Cetirizine (eg. brand Zyrtec) and runs a slightly less risk of sleepiness. However, Cetirizine tends to be a better at stopping itchiness.

Now over-the-counter, fexofenadine (eg brand name Allegra) is a third generation antihistamine.  Theoretically, because a third generation antihistamine is chemically the farthest removed from a first generation antihistamine, it causes the least amount of sedation. The jury is still out.

If you find your child’s allergies are breaking through oral antihistamines, discuss adding a different category of oral allergy medication, eye drops or nasal sprays with your pediatrician.

Because of decongestant side effects in children, avoid using an antihistamine and decongestant mix.

Back to our antihistamine poem:

Too many choices, some make kids tired,

While some, paradoxically, make them wired.

Maybe while watering flowers with a hose,

Just turn the nozzle onto his runny nose.

Naline Lai, MD with Julie Kardos, MD

©2011 Two Peds in a Pod®

As spring break approaches, here are some ways to handle sickness while traveling with your children when you are far away from your children’s primary care provider.

• If your child has a health condition that is intermittent, such as asthma, bring his inhaler, spacer, or any other medication. Even if he hasn’t had a flair up for months, it is much safer to travel prepared. Don’t forget your child’s epi-pen if she has a history of food allergies. If your child’s healthcare provider holds a United States license and you are not in the United States, your healthcare provider can not call in routine medications.
• If your child has a complicated health history, bring a typed summary of his health history including current medications. 
• Decide beforehand where you will seek medical help if your child becomes ill . Maybe it is a pediatric or family medicine office that accepts new patients, a walk-in clinic, or an emergency room that sees children. Your child’s health care provider’s ability to diagnosis and treat your child is limited over the phone. Kids are much safer diagnosed in person with the benefit of a thorough physical exam.
• Travel with the basics: 1) pain reducer such as ibuprofen or acetaminophen for headaches, minor injuries, or aches associated with fever, 2) a quick acting allergy medicine such as diphenhydramine (brand name Benedryl) in case of an allergic reaction such as hives, 3) anti-itch cream such as hydrocortisone in case of annoying bug bites or contact rashes such as poison ivy, 4) a topical over the counter antibiotic in case of skin scrapes, and 5) band aids. Remember to first wash any break in skin with soap and water.
• Bring your child care provider’s telephone number. Even if she cannot provide a final diagnosis, she can provide advice and guidance as to whether or not you need to take your child to a local health care provider.
• Make sure your child is fully vaccinated. You can’t vouch for the health of other people you encounter on your travels. It is much easier to prevent illness than chase it after it strikes. Likewise, practice good hand washing hygiene.
• Travel outside of the United States may require specific vaccinations or preventative medications.  Call a local travel clinic or check www.cdc.gov for advice on specific countries.

Kids have a knack for knowing just which week of the year their family will travel and then get sick during that one planned-for week.  I remember the spring vacation that our twins awoke with fevers on our first day away from home. Fortunately, my children travel with their pediatrician. Families who leave their pediatrician behind when they go on vacation can empower themselves with the knowledge of how to handle illness away from their medical home.

Or, there’s the option of inviting the pediatrician along… especially if you’re headed somewhere warm…

Julie Kardos, MD with Naline Lai, MD

©2011 Two Peds in a Pod®

Spring break has arrived for many college students. While students certainly deserve a vacation from the stress of school, parents should stay aware of their children’s spring break plans. Unfortunately, students who spend spring break with friends, rather than family, are much more likely to engage in binge drinking and suffer associated consequences such as injury, unprotected sex, and assault. 

Before the spring breaks end, we encourage parents to review earlier posts about binge drinking and how to broach the subject of alcohol and drugs.

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

New American Academy of Pediatric recommendations include a booster vaccine against the cause of meningococcal disease  (Neisseria meningitidis) for older teens in addition to the one routinely given to tweens. Olga Pasick, mom of a teen who died of meningococcal disease, shares her personal experience and talks about the updated guidelines.

I wish I had known the importance of vaccination for meningococcal disease before it was too late for my son. Back in September of 2004, David was a happy, healthy 13 year old, who came down with flu-like symptoms one evening. He first felt cold, then spiked a high fever, and vomited throughout the night. In the morning we called the pediatrician to have him seen. Everything ached, and he needed help getting dressed. That’s when I noticed purplish spots on his chest and arms. I didn’t know how serious that symptom was. As soon as the doctors saw him, they knew he had meningococcal disease. He was rushed to the ER for a spinal tap and treatment. Unfortunately, the disease spread quickly and his organs failed. David died within 24 hours of first developing those flu-like symptoms from a potentially vaccine-preventable disease. Unbelievable… and heartbreaking.

Meningococcal disease is spread through respiratory droplets, such as coughing or sneezing, or through direct contact with an infected person, such as kissing. About 1 in 10 people are carriers, and don’t even know it. It doesn’t affect everyone. It is difficult to diagnose because symptoms are similar to the flu, and include high fever, headache, stiff neck, nausea, vomiting, exhaustion and a blotchy rash. The disease spreads quickly and within hours can cause organ failure, brain damage, amputations of limbs, and death.

The CDC (Centers for Disease Control and Prevention) and the AAP (American Academy of Pediatrics) recommend meningococcal vaccination for all 11-18 year olds. If vaccinated at age 11-12, a booster at age 16 is recommended. If vaccinated at age 13-15, a booster is recommended at age 16-18. No vaccine is 100% effective, but it is the best preventative measure we can take. Since the vaccine only covers four of the five major strains of the disease, continue to be aware of the symptoms.

Because of my experience, I became a member of the National Meningitis Association’s (NMA) Moms on Meningitis (M.O.M.s) program. We are a coalition of more than 50 mothers from across the country whose children’s lives were drastically affected by this disease, and are dedicated to supporting meningococcal prevention.

Visit the NMA website for more information and to view powerful personal stories of those affected.  Talk to your doctor about vaccination. It could save a life. How I wish those recommendations were in place six years ago.

Olga Pasick
Wall, New Jersey

© 2011 Two Peds in a Pod®

The bad news is that influenza is now circulating in all 50 states. The good news is that according to the Centers for Disease Control, the vaccine covers all currently circulating strains. 

A mom recently wrote to us about her grade school aged child’s bedtime creeping later while her wake up time stayed the same. She wondered how to reclaim the earlier bedtime.

Many parents notice as their kids get older, they seem to take longer to fall asleep at night or push their parents for a later bedtime. This trend is largely biological— the older kids get, the less sleep they need. Also as kids age, their body clocks naturally signal them to stay up later at night and sleep later in the morning. Sometimes children are worried about something and this stress prevents them from falling asleep. Parents should ask their kids what they think about while lying in bed at night. However, many times the child is just fine emotionally but begins shifting sleep patterns anyway.

According to sleep experts, adults function best on 7-8 or more hours of sleep per night. In kids and teens, a wide variation exists for how much sleep is sufficient for any individual. In general, if your child is easy to awaken in the morning, cheerful, able to concentrate during the day, easily completes school work and homework and is not having emotional outbursts, then she is sleeping enough. So, when your grade school child transitions from getting 11-12 hours of sleep per night to getting 10, if her days are still rosy, then this sleep shift is okay. Some people just don’t need very much sleep.

If your child needs more sleep, it’s tough to simply move his bedtime up earlier. To him, the sudden change will feel like he flew from California to New York. A gradual approach works best. Put your child to bed first very near the time that he is already falling asleep, even if that seems inappropriately late.

For instance, if your child won’t fall asleep until 11:00 pm, establish a soothing night time routine that ends with reading in bed or listening to soothing music for a few minutes, and turn out the lights out at 10:45 pm. Avoid television within an hour of sleep time because this can interfere with falling asleep. No matter how late he fell asleep, even on weekends, make sure he wakes up at the same time every morning. Once he falls asleep consistently within a few minutes of lights out, move the bedtime another fifteen minutes earlier.  Continue to do this until the daytime sleep-deprivation symptoms have resolved. A child may still need an alarm to wake up in the morning but if he is well rested, he should wake easily.

Be sure to limit or avoid caffeine (found in soda, tea, coffee, some sports drinks, and chocolate) because caffeine stays in the body 24 hours and hinders falling asleep. Also, make weekend sleep routines, including wake up times, as similar to weekdays as possible. If you allow a child to sleep until noon on Saturday and Sunday, he will never be able to fall asleep early on Sunday night and he will start the school week sleep deprived.

Time to end this post. I’ve got to go put my kids to bed. Sweet dreams.

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

Have a teenage couch potato from January through March?  We all tend to decrease our activity level in the winter months. Physical Therapist Deb Stack gives us ideas to keep teens active.

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

Dr. Stack has been a physical therapist for over 15 years and 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.

© 2011 Two Peds in a Pod®

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

First time he tries peas

First time she walks on sand or grass in bare feet

First time he sees snow

First time she explains to you how to work your computer

First time she sleeps through the night (if ever)

First he calls grandpa on the telephone

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

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

First time she sleeps over someone else’s house

First time he gives you a handmade gift

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

First time you leave her home alone to babysit herself

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

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

First time your teen drives herself to a sports practice

First day your youngest starts kindergarten

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

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

Fa-la-la-la-la, THUD.

It’s the sound of junior high bands and choir students practicing during this holiday season. That thud is the sound of a kid fainting mid-way through a long, sweltering rehearsal. Last night Dr. Lai was on the edge of her seat wondering which child would faint during her daughter’s chorus concert. In the past couple of weeks, we had a patient who fell off the stage during a musical performance and several others falling over during choir practice.  Today we discuss causes of fainting and ways you can prevent the most common reasons to faint … Just in time for pageant rehearsals.

Why do people faint? The quick answer is people faint when their brains don’t have enough blood flow. Fainting causes people to fall down. When this happens, their heads become level with their hearts, and thus the body has an easier time getting blood (and oxygen) to the brain. So then the fainted person “wakes up.”

Dehydration and anxiety are two relatively common causes of fainting. So are standing up in place for a long time, sudden pain, and underlying illness. We have had teenagers faint after they received a vaccine which they were dreading. We have seen a high school athlete play an entire soccer game, then faint while standing with her team as her coach gave information about the next practice. Another patient faints every time she suffers an injury that causes her to see her own blood, whether it is a skinned knee or a small paper cut.

Kids who faint in this way usually feel weird before they go down. They can tell that something strange is happening to their bodies. They might feel suddenly very hot and sweaty, or dizzy, or feel like their vision is blurred or sounds are coming from far away. If your child feels this way but hasn’t passed out yet, the best thing to do is have him lie down. Lying down increases blood flow to the brain and can prevent fainting.

Some fainting signals that your child has an abnormal heart or other abnormality in the body. Fainting during exercise can be caused by a heart problem. So can fainting “without warning” or without any obvious inciting event. Fainting with accompanying body shaking or rhythmic movements of arms or legs can be a seizure rather than a faint. Weakness in an arm or leg, difficulty talking or thinking after a faint are all abnormal. Staying unconscious for more than a few seconds also can be a sign of underlying problems. Vomiting, severe headache, or any persistent symptoms such as altered mental state warrant medical attention promptly.  Remember that a child who faints might hit his head when he falls and may also sustain a brain injury.

If your child faints, especially if it is the first time he faints, you should call his health care provider. Some kids need a physical exam, some need an EKG (electrocardiogram), some need blood work, and some need further workup by a specialist.

Fainting should never be ignored, but it is not always a reason for panic. Again, if your child faints, lie him down so his head is level with his heart. You can even raise his legs a few inches to make blood flow to his head even easier. Make sure he is breathing (watch for chest rise and fall, watch to see that his lips stay pink and do not turn blue). When he “comes to,” try to treat the underlying problem (give fluids if your child is dehydrated). And call your child’s health care provider to see what the next step should be.

Just hydrate your child well before his choir concert and tell him not to stand with his knees locked. Then sit back and enjoy the music.

Fa-la-la-la-la!

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