Children master potty training typically between the ages of two and four years. Be patient, not everyone is “typical.” More important than your child’s age is whether she shows she is developmentally ready to train. These signs include:
– is generally agreeable/ can follow directions
– gets a funny expression on her face before passing urine or poop, or runs and hides, then produces a wet or soiled diaper
-asks to be changed/ pulls on her diaper when it becomes wet or soiled

– remains dry during the day time for at least two hours
-NOT because grandparents are pressuring you to start training their grandchild
– NOT if the child is constipated—the last thing you want to do is to teach withholding to a kid who already withholds
-NOT if a newborn sibling has just joined the family. A new baby in the house is often a time of REGRESSION, not progression. However, if your toddler begs to use the potty at this time, then by all means, allow her to try.

Hit play to listen to our potty training podcast:

Naline Lai, MD and Julie Kardos, MD

©2014 Two Peds in a Pod®

Yet another reminder about the signs and symptoms of measles from a health agency landed in our email inbox the other day. The reason? According to the Centers for Disease Control, as of this point, the United States has seen more measles cases this year (almost 600 reported) than in the past decade (typically 60 cases per year). Organizations are reminding physicians about the symptoms of measles because thanks to  vaccinations, many pediatricians have not seen a case of the measles in decades. In this post, we pass the information on to you. After all, you will be the first to recognize that your child is ill.

Measles typically starts out looking like almost every other respiratory virus— kids develop cough, runny nose, runny bloodshot eyes, fever, fatigue, and muscle aches.

Around the fourth day of illness, the fever spikes to 104 F or more and a red rash starts at the hairline and face and works its way down the body and out to arms and legs, as shown here at the Immunization Coalition site. Many kids also develop Koplik spots on the inside of the mouth (small, slightly raised, bluish-white spots on a red base) 1-2 days before rash.

In the US, one in 10 kids with measles will develop an ear infection and one in 20 will develop pneumonia. Roughly one in 1000 kids develop permanent brain damage, and up to two in 1000 who get measles die from measles complications. Kids under age 5 years are the most vulnerable to complications. These statistics are found here. For global stats on measles, please see this World Health Organization page.

There is no cure for measles and there no way to predict if your child will have a mild or severe case. Fortunately, one dose of the MMR (Measles, Mumps, Rubella) vaccine is 92% effective at preventing measles, and two doses are 97% effective at preventing measles. That’s the best we can do, but this 97% protection rate works great when everyone is vaccinated. The American Academy of Pediatrics recommends giving the first dose of MMR vaccine at 12-15 months and the second dose at school entry, between 4-6 years of age.

If parents refuse the MMR vaccination for their children, then more people are left susceptible to measles. This leads to more people who can spread  the disease when it hits a community. Measles is one of the most contagious diseases known: 9 out of 10 unvaccinated people exposed to measles will become sick, and infected people are contagious even before symptoms appear. One of the reasons behind the increase in measles cases is the increase in unvaccinated children. One patient of Dr. Kardos’s was a four-year-old boy who was behind on his vaccines and hospitalized for measles pneumonia. Before he was diagnosed he exposed an entire Emergency Department to measles.

In our global world, another reason for the spike in measles cases is the increase in travel between countries. In fact,  young children traveling internationally often need to get the MMR vaccine outside of the routine schedule. If you plan on traveling,  check here to see if you need to give your child the MMR vaccine on an early schedule.

With increased vigilance and vaccination, hopefully measles will once again become a disease few doctors have ever encountered. After all, vaccines did eradicate small pox. The last case of smallpox in the United States was in 1949, and the last case in the world was in 1977. In the meantime, you’ll know how to “spot” a case of measles too.

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

Friends make birthdays better

I have been musing ever since our hosting site told us they were switching blog platforms. In a blink of an eye, our blog was slated to disappear. The dynamic Two Peds in a Pod community would be plunged into silence. At first, disbelief gave away to intrigue. Was this a sign to change personal paths? As I started to think of all the things I could do with the time that I would have spent writing the blog, my to-do list grew and grew. I could hear my son’s closet, overflowing with outgrown clothing, crying out to be re-organized.

When I told friends of the opportunity to dissolve the blog, I heard time and time again “I think you should save it.” Even friends without children were aghast. When I told my own children that the blog was on the verge of imploding they looked at me blankly and said, “Why would you stop writing for Two Peds?”

Then I remembered the mom who read our article on croup seven times in one night. I remembered Dr. Kardos’s patient whose dad said our strep throat article  helped him decide not to cut his family’s vacation short. I thought of the many times parents thanked me  for posts which allayed their fears of fever.

The blog did eventually stop when the old hosting site went down. But as my friends and family reminded me, the goal of the blog is to positively impact children globally by guiding their caretakers; and by the time the blog went down, we had reached nearly three million views. Two Peds in a Pod is “Practical pediatrics for parents on the go.” After more thought, I decided it would be difficult to accomplish this goal from the back of one of my kid’s closets.

So today, I am happy to post that the stop was just a temporary suspension. I credit my friends and family for reminding me of the original goal of the blog. In particular, thanks to Dr. Kardos. While I was mulling, Dr. Kardos was busy staying up past midnight valiantly importing posts from the rapidly fading old site.

We’re back, albeit a little rough around the edges as we construct the new site. And it’s just in time for our 5th birthday!

Thanks, my friend, Dr. Kardos. I wouldn’t be able to blow those candles out without you.

Happy 5th Birthday Two Peds in a Pod- may there be many more.

Dr. Lai

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

We’re seeing a lot of this stuff around the office. It’s “hand-foot-mouth” disease, a common, self-limited illness caused by the Coxsackie virus, and it strikes most often in the spring and summer. Named for rashes which can affect the hands, feet, or mouth, this illness can cause fever for the first few days as well as some loose stools.

What does it look like?

If you look carefully at the photos, you will see faint red bumps on this child’s feet. The rash may also look like tiny blisters and will always blanch (if you press on it and lift up your finger, the redness will briefly disappear- just as if you pressed on a sunburn). The same rash may appear on the hands and is not itchy. The child’s throat above is red in the back and has several ulcers, or canker sores. The hands, feet and mouth are not always simultaneously affected, and although we don’t call the illness “hand-foot-mouth-tush” disease,  sometimes kids also get a red bumpy rash on their buttocks.

Is hand-foot-mouth disease painful?

The throat ulcers can be quite painful and the rash on the feet may be slightly tender.  Usually the rash on the hands is not felt by the child. You can alleviate your child’s throat pain with acetaminophen (brand name Tylenol) or ibuprofen (brand names Advil or Motrin). For toddlers and older, Magic Mouthwash, a mix of 1/4 tsp diphenhydramine (plain liquid Benadryl) and 1/4 tsp Maalox (the regular adult stuff) squirted over mouth ulcers prior to eating a meal (three times a day) is an age-old way to sooth sores.

How is it spread?

This virus is contagious through saliva. Prevent kids from sharing cups, eating utensils, and tooth brushes, and clean up toddler drool. This vigilance can help prevent the virus from spreading to family members and friends. Children with this virus can still attend daycare as long as they are not feeling ill. Typically after the first few days of illness, fever and pain subside. Most commonly the rash and mouth ulcers last about a week or two.

What is the treatment?

Unfortunately there is no treatment for hand-foot-mouth disease, but fortunately your child’s body is fully capable of fighting off the virus. Your role is to help soothe pain. Otherwise, kids may refuse to drink and end up dehydrated. When my son had this illness at age two, he liked sucking on a washcloth soaked in very cold water. I also gave him lots of sherbet, ice cream, milk shakes, and noodles.  These foods were easier for him to swallow while his throat was sore.

When should I call my kid’s doctor?

Kids can get this virus more than once, and many strains of this virus circulate. Even parents are not always immune. So now add Coxsackie virus, or hand-foot-mouth disease, to your Dr. Mom and Dr. Dad list of manageable diseases. Knowledge is power. However, if your child’s fever lasts more than three days, if he does not drink enough to urinate his baseline amount, if he is inconsolable, seems disoriented, or if your parent gut-instinct tells you something more might be wrong, do get your child to medical attention.

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

Originally posted June, 2011, and right on cue, Coxsackie is back again this summer.

This year we asked our dad readers to help us write our Father’s Day post. They completed this thought: “Before I became a dad, I never thought I’d…”

…Learn to curl hair for cheerleading competitions

…BE RESPONSIBLE

…Become a stay at home dad AND love it so much after everything I’ve been through!!

…Learn all of the names of Thomas The Tank Engine’s friends and the many songs associated with them.

…Have a toys r us in my house.

…Go food shopping at midnight.

…Make so many pancakes on Sunday mornings.

…Volunteer in a dunk tank and have pie thrown at me.

One of our readers summed up his thoughts on becoming a dad:

Since I’ve become a father, nearly seven years and two beautiful daughters later, my life has become a series of jobs that I never thought I would have to tackle. These include:

Beautician: I never thought in a million years that I would be learning how to do pony tails, side pony’s, braids (not that I can braid yet), and painting little finger and toe nails.

Disney Princess Aficionado: At one point in my life I thought I was cool because I knew a lot about beer, how it was made, where it was from, where the best IPA’s were being poured. Now I am “cool” because I know where Mulan lived, and because I know the story about Ariel falling in love with Prince Eric.

Doctor: I am well versed here and can cover almost everything from the simple band-aid application and boo-boo kissing, to the complex answering of why daddy is different and why he gets to go to the bathroom standing up.

Cheerleader: Both of my daughters enjoy participating in sports. It’s been such a great experience to cheer them both on from the side line. I enjoy watching them grow with the sport and gain confidence game after game.

Becoming a father was one of the best choices I have made with my life. I love being a dad, and I look forward to the future dad challenges, good and bad, and beingthe best mentor I can be.

Thank you to our readers for contributing to this post.

Happy Father’s Day!

Julie Kardos, MD and Naline Lai, MD

©2014 Two Peds in a Pod®

Babies and children love bath time and are drawn to water play. Today we bring you the splash on swimming.

We’re going to the beach- can my baby go swimming? How about a pool?

• Most pools, oceans, and lakes are much colder than bath water. Babies feel colder more quickly than adults. Remember your own parent telling you to come out of a pool because your lips were blue? Limit a baby’s exposure to cold water accordingly.
• Chlorine will not hurt babies, but it can dry out skin. Apply moisturizer after swimming if your child’s skin gets dry. Kids with eczema can be particularly sensitive to chlorinated water.
• Salt water is safe for babies and kids to swim in.
• Young kids try to drink the water they swim in. Don’t let them. It’s not just your nephew who pees through his swim diaper that you need to worry about. Unfortunately chlorine and salt fail to kill all viruses, bacteria, and parasites that might lurk in swimming water.
• If your child swims outside, remember that sunburns occur more easily because sunlight reflects off the water. Apply sunscreen liberally before and after swimming. Better yet, try to keep that baby hat on and have your child wear a sun protective shirt.

When should I start swim lessons for my child?

Start swim lessons as early as toddlerhood — it is a great life skill. However, swim lessons will not make your child “drown proof.” You can find more data in this drowning prevention article from The American Academy of Pediatrics. Unfortunately, even under adult supervision, drownings occur. When an adult’s attention is briefly diverted to answer the phone, their meal, etc, a drowning can take place. The bottom line:

• Always stay arm’s length of babies and toddlers in the water. Also stay at arm’s length of your older children who have not yet learned to swim.
• Even if your child can swim well, never let your child or teen swim alone or without a life guard.

A note about Baby Swim Lessons:

• Babies can take “swim lessons,” meaning “spend quality time with a parent in the pool.” Despite the claims of some swim instructors, no studies have shown that infant swim lessons make infants “drown proof.” 

Any other water safety tips?

A few years ago, Dr. Lai’s toddler-aged neighbor waddled over to the ice bucket at a Fourth of July party. Toddlers have big pumpkin shaped heads and before Dr. Lai could blink an eye, her neighbor tumbled into the water head first. Luckily Dr. Lai’s husband was standing next to the bucket and pulled the toddler out.

• As this case shows, you can’t let your guard down, even if no pool or large body of water is in sight.
• Small blow-up backyard pools are the same as bath tubs in terms of drowning risk, so never leave kids unattended around these pools. Stay at arm’s length of your babies and toddlers when they play in these pools.
• Additionally, never leave kids unattended, even briefly, in the bathtub.

Ideas on how to play with water?

• Water tables (which can double as sand tables in the spring, leaf tables in the fall and indoor snow tables in the winter) allow young toddlers to stand and play with toys in very shallow water.
• Fill a bunch of different sized stacking cups with water for kids to pour, dump, or perhaps to mix with rocks, dirt, or leaves.
• Simple squirt bottles are great fun. When Dr. Kardos’s twins were little they spent large amounts of time “watering” every plant, bush, flower, and blade of grass in the yard.
• Fill small cupcake tins with water and supply your kids with water-color paint to decorate the sidewalk or walkway of your house. Kids become entranced by the colors created as they rinse off the brushes. Warning— make sure the paint is water soluble. Dr. Lai still has the name of one of her children in fluorescent orange written on her driveway.
• Wet down your walkway and blow bubbles onto the cement – they will cling onto the walkway for a long period of time.

Grab a towel and enjoy the summer with your children.

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®
originally published June 2013, updated May 2019

Just in time for Field Day and pool openings, today we provide sunburn protection information. 
 
Hot!

Until I became a mother I never thought…

I’d care if a birthday party was cancelled

I’d obsess about bowel movements and gas

I’d remember to reapply sunscreen

I’d bake zucchini muffins and count them as a vegetable serving

I’d wipe someone else’s nose

I’d relearn my most dreaded school subject in order to help my child with homework

I’d feel compelled to ask if anyone needs to go to the bathroom before I go anywhere in a car

I’d go on nauseating upside-down amusement park rides because my kid needed to be accompanied by an adult

I’d spend my Friday night driving and picking up kids from parties and then spend my Saturday morning driving and picking up kids from the ice hockey rink starting at 5:00am.

I’d get to play Tooth Fairy

I’d (try to) answer questions such as “What does God look like?” and “Who was the mom of the first man?”

I’d willingly read the same book out loud night after night after night

And finally-

Until I became a mother I never thought… I’d wipe away tears when reading sappy Mother’s Day cards.

Happy Mother’s Day from your two Peds

Naline Lai, MD and Julie Kardos, MD

©2014 Two Peds in a Pod®

When my kids were younger, I realized one way to avoid the pre-dinner time meltdowns was to enlist their help in cooking. In addition, baking muffins or cookies with kids is a great rainy day activity with a built-in reward at the end. Much has been written about the nutritional and psychological merits of a shared family meal. Instead, this post is about sharing the mealtime prep. For those of you who do not love to cook yourselves, here are reasons to find your inner cook and encourage your child’s development at the same time:

1-Toddlers LOVE pouring, mixing, and measuring, and when you teach toddlers these skills, you are strengthening their fine motor skills. Why else are toy kitchens and Play-doh so popular? Nothing beats “playing” with REAL ingredients in a REAL kitchen.

2-Teach young kids to count measurements, let older kids do the measuring themselves.

3-Kids who are learning to read now see WHY they need this skill- as you follow a recipe kids see how to read with a purpose. You can let your budding reader read the directions to you.

4- Time spent with a parent in the kitchen fosters more shared attention which can build self-esteem.

5-You will build good memories for your child.

6-For the picky eaters: kids are more likely to taste what they cook themselves.

7-Kids love water play, so even the clean-up is fun.

8- Kids as young as 7 or 8 can learn to cut with a knife. Teach them this life skill while cooking instead of when they are hungry and trying to eat dinner-it causes less frustration.

9-Kids take pride in what they help create. They can also take pride in completing a project. Pride in accomplishments develops self-esteem.

10- Cooking with you teaches your child how to help others as well as how to receive help graciously.

Finally, cooking is one of those life skills needed for when kids grow up and live on their own. Just as you teach them to use the potty, brush their own teeth, dress themselves and tie their own shoes, you should teach them how to cook.

Are you parents who don’t cook? Call Grandma or Grandpa for some tutoring, or take a cooking class with your child!

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

When it comes to our children, we want the best that money can buy. But the best is not necessarily the most expensive. Today we offer our pediatrician perspective on ways you can save money without compromising your child’s health or safety.

Buy generic infant formula: Common store brands of iron-containing Food and Drug Administration regulated infant formulas cost less than big name brands and have equal nutritional value.

Do not buy toddler formula. This is a marketing coup. Children over one year of age can drink milk.

No need to buy only organic milk and food.  Read here for more information about organic vs conventional foods. 

Make your own baby food- from the start you can grind up part of your breakfast, lunch or dinner in a blender for your baby. Grind up cooked chicken or cooked vegetables, pasta or soft fruits, mix with a little formula or breast milk if you need to get the pureed consistency just right, and commence spoon feeding! You will save tons of money from not buying bad-for-the-environment plastic containers of baby food. When your babies advance to finger foods, simply cut up pieces of your foods.  

Do NOT spend money on “toddler junk food” such as Puffs for portable finger food practice. Instead buy “toasted oats” (brand name = Cheerios) which are low in sugar, contain iron, and are much less expensive. One exception: do buy the baby cereals (rice, oatmeal, barley, or mixed grains) because they contain more iron than “grown-up” oatmeal and babies need the extra iron for their development.

Buy generic medicine: acetaminophen (brand name Tylenol), ibuprofen (brand name Motrin, Advil), diphenhydramine (brand name Benadryl), loratadine (Claritin), ceterizine (Zyrtec). If your child’s doctor prescribes amoxicillin (for ear infection, Strep throat, sinusitis), ask the pharmacist how much the medication would cost if you paid cash. The cost for this commonly prescribed antibiotic may be less than your insurance co-pay.

Accept hand-me-down clothes, shoes, etc. The purpose of shoes is to protect feet. Contrary to what the shoe sales-people tell you, cheap shoes or already-worn shoes will protect feet just as well as expensive, new ones. Just make sure they fit properly.

Don’t buy “sleep positioners” for the crib. Place your newborn to sleep on his back and he will not/cannot roll over. If you need to elevate your baby’s upper body to prevent spit-up or to provide comfort from gas, don’t buy a “wedge” but instead put a book under each of the 2 crib legs so the entire head of the crib is elevated. There is NO evidence that wedges or sleep positioners prevent SIDS (Sudden Infant Death Syndrome) and these products are NOT endorsed by the American Academy of Pediatrics. Dr. Kardos advises her patients to return any sleep positioners that they received at the baby shower and use the money for diapers instead.

The best toys are ones that can be reconfigured and used again and again. Legos, blocks, crayons/markers/chalk, small cars, dolls, balls come to mind. Avoid one-time only assembly type items, breakables, etc. Have a “toy recycle” party or a pre-Halloween costume recycle party: everyone brings an old costume/toy they would like to trade and everyone leaves with a “new” item (kids don’t care if things are brand new or not, they care only if you teach them to care). Along the same lines, inexpensive paint can turn a pink “girl’s bike” into her younger brother’s blue “boy bike.” Read our article on gift ideas for kids for more ideas that do not “break the bank.”

Borrow books from libraries instead of buying them new or look for previously owned ones at yard sales, thrift shops and online.

Don’t buy “Sippy cups.” Teach your child to drink out of regular open cups. Sippy cups are for parents who don’t like mess-they are not a developmental stage. They are actually bad for teeth when they contain juice or milk and they do not aid in child development. They can also cause harm to children who run and fall while drinking out of them.

Skip over potty training pants.  Go straight to underwear. 

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