Before babies gain the ability to say, “Mama, please hand me my cup from that table,” they will point at their cup. In other words, babies naturally use their own sign language to communcate. Today, teacher Kacey Slack writes about teaching American Sign Language as a way to help your child communicate before she masters spoken language.

–Drs. Lai and Kardos

Have you ever noticed your baby using hand gestures to express her needs? Most babies will raise their arms when they want to be held, wave goodbye, and point to what they need or want. What if your baby could tell you what she wanted before she learns to speak? Teaching babies to sign is simple and beneficial. According to child developmental psychologists Drs. Linda Acredelo and Susan Goodwyn, in Gaining a window into your baby’s mind, “Using signs with babies reduces tears, tantrums, and frustration, allows babies to express needs and share their worlds, enriches interactions between adults and babies and strengthens the parent-child bond, reveals how smart babies are, and increases parents’ respect for them and helps build babies’ self-confidence and self-esteem.”

Teaching signs is easy. You can use this link to learn basic signs. First demonstrate the sign while saying the word. You can also guide your baby’s hands if she will allow you. Praise any approximation of the sign. It will take some time before your baby will understand the sign and perform it. Be consistent and repeat the signs as often as possible. The more your baby sees the sign, the better she will understand it and be able to do it herself.

When beginning, choose a few signs that are useful to your baby such as “eat,” “more,” and “all done.” These are signs that babies encounter numerous times each day. Once your baby begins to sign, the possibilities are endless. She may want to learn zoo animals or you may want to teach her safety words in order to express if something is hot or cold or if she is hurt. Signing can also be used while reading books with your child. It is a great way to engage her and allow her to interact with literature.

You do not need expensive products or costly classes in order to teach sign. Play groups, however, offer parents the opportunity to receive guidance from an instructor, preferably one with experience signing as well as interacting with young children. Play classes also allow your child to interact with other children and learn from babies who may already know how to sign.

Helpful Links: the first link shows how to sign many common words.

http://www.aslpro.com/cgi-bin/aslpro/aslpro.cgi

https://www.babysigns.com/index.cfm?id=120

http://www.babies-and-sign-language.com/index.html

Kacey Slack

Independent Certified Instructor

Kacey Slack holds teaching certifications in elementary and special education. She has taught in various classroom settings and is an adjunct professor at Manor College. A mom of a young signing toddler, Ms. Slack is part of the Baby Signs® Program which helps guide other parents through their signing journey. She can be reached through www.babysignsprogram.com/bykacey.

© 2012 Two Peds in a Pod®

We can tell from this past week at the office that croup season has started. DON’T PANIC! Read on to learn what to look for and what to worry about. Please also listen to our podcast on this same subject.

You wake up in the middle of the night to the sound of a seal barking…inside your house. More specifically, from inside a crib or toddler bed. Unless you actually have a pet seal, that sound is likely the sound of your child with croup.

“Croup” is the lay term for any viral illness causing swelling of the voice box (larynx)  which produces a seal-like cough. The actual medical term is “laryngotracheobronchitis.”  In adults, the same viruses may cause laryngitis and hoarseness, but minimal cough. In children the narrowest part of a child’s airway is his voice box. So not only does the child with croup sound hoarse when he talks and cries, but since he breathes through a much narrower opening, when he forces air out with a cough, he will sound like a barking seal. When a kid with croup breathes in, he may produce a weird guttural noise, called “stridor.”

Many viruses  cause croup, including  flu (influenza) viruses. Therefore, a flu vaccine can protect against croup. While no antibiotic or other medicine can kill the croup causing viruses, here are some ways to help your child feel better.

What to do when your child has croup:

Stay calm. The noisy breathing and barky cough frighten children and their parents alike. It’s easier for the child to breathe when he is calm rather than anxious and crying. So, even if you are scared, try to act calmly since children take their cues from their parents.

Try steam. Run the shower high and hot, close the bathroom door and sit down on the bathroom rug with your child and sing a song or read a book or just rock him gently. The steam in the bathroom can help shrink the swelling in your child’s voice box and calm his breathing.

Go outside. For some reason, cool air also helps croup. The more misty the better. In fact, many a parent in the middle of the night has herded their barking, noisy breathing  child outside and into the cold car to drive to the hospital. Once in the emergency room, the parents are surprised to find a happily sleeping, or  wide awake, chatty child, “cured” by the cold night ride.

Run a humidifier. A cool-mist humidifier running in your child’s room will also help. Make her room feel like a rain forest, or the weather on a  really bad hair day, and often the croupy cough will subside. Cool-mist humidifiers in the child’s room are safer than hot air vaporizers because vaporizers pose a burn risk. It’s the mist that helps, not the temperature of the mist.

Offer ibuprofen or acetaminophen. Your child may cough, and then cry, because her throat is sore. Pain relief will make her more comfortable and allow her to get back to sleep.

Who needs further treatment?

Most kids, more than 95%, who come down with croup, get better on their own at home. Typically, croup causes up to three nights of misery punctuated by trips into the cold night air or steam treatments. During the day, kids can seem quite well, with perhaps a slightly hoarse voice as the only reminder of the night’s tribulations. Why croup is worse at night and much better during the daytime hours remains a medical mystery. One theory is, just like ankles swell after one is upright all day, swelling in the voice box increases when people lie down. After the three nights, your child usually just exhibits typical cold symptoms with runny nose, a regular sounding cough, watery eyes, and a possible ear infection at the end. Then brace yourself for next time—kids predisposed to croup tend to get croup the next time a croup causing virus blows into town. But take heart, most kids outgrow the disposition for croup around six years of age.

Some kids do develop severe breathing difficulties. If your child shows any of these symptoms, get emergency medical care:

Turns pale or blue with coughing. Turning red in the face with coughing is not as dangerous.

Seems unable to swallow/unable to stop drooling.

Breathing fails to improve after steam, cool air, humidity, or breathing seems labored– nostrils flare with every breath or chest heaves with every breath—pull up their night shirts to check for this. See this link for an example of labored breathing.

Mental state is altered: your child does not recognize you or becomes inconsolable.

Child is unimmunized and has a high fever and drooling along with his croup symptoms: he may not have croup but rather epiglottitis, most commonly caused by a vaccine-preventable bacteria. This is a separate illness that can be fatal and requires airway management as well as antibiotics in a hospital.

We searched the internet for a good example of what the “seal bark” cough of croup. The best imitation we found is actually the sound of a sea lion. We will have to ask a veterinarian sometime if seals and sea lions get croup. If so, what do they sound like?

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

The cut of mental illness can be  sharper than any surgeon’s knife. What happens when a child’s emotional turmoil escalates beyond a family’s control?  In the  newly released book Suicide by Security Blanket, and Other Stories from the Child Psychiatry Emergency Service: What Happens to Children with Acute Mental Illness, Drs. Laura Prager and Abigail Donovan bring us behind the scenes of the Massachusetts General Hospital psychiatric emergency room. Although the discussion can be somewhat technical, the real-life stories are poignant and are fascinating not only for healthcare professionals, but for anyone interested in child mental health.

In this excerpt, a dialogue occurs between Dr. E, a child psychiatrist, and Tommy, a depressed fourth grader who has just tried to strangle himself:

“I hate myself. I want to die.” Tommy’s voice lacked any inflection.

“Why?”

“I’m bad. The world is bad. No one likes me. No one wants me as a friend.”

“No one?”

“I’m a loser. No one wants to be friends with a loser. They all hate me.”

“Why are you a loser?”

“I’m fat. I can’t do anything right. I got in to trouble at school.”

“What happened at school?”

“Nothing.”

“Nothing?”

“I wrote bad stuff.”

“Bad stuff?”

“This one kid farts all the time and I wrote ‘fart’ on his notebook.”

“Then what happened?”

“The teacher made me apologize.”

“That’s it?”

“My parents get mad when I do stuff like that.”

“Were they mad this time?”

“I don’t know. I always get in trouble. No one in my family likes me, either. They won’t care if I’m dead.”

…Tommy’s voice got just a bit louder. “After school, I was really mad. I went down to the playroom and I tried to strangle myself. I didn’t have any rope, so I used my scarf. I also thought about going upstairs and trying to jump out a window.”

Did you hurt yourself when you tied the scarf around your neck?”

“No, I couldn’t get it that tight.”

“Did you think that you could kill yourself that way?”

“If I pulled hard enough.”

“So what happened then?”

“My mother came downstairs and found me.”

“I guess it was lucky that your mother was keeping an eye on you. Do you know why she came down?”

“I don’t know. She took the scarf and called the doctor. Here’s the scarf.” Tommy pushed the sheet away from him. He was wearing maroon hospital PJ’s that were slightly too big for him. Around his neck hung a dirty grey-colored knit scarf that looked as if it might once have been another color, perhaps light blue. It had remnants of fringe hanging from each end. The scarf hung loosely, and the ends tumbled into his lap. As he spoke, Tommy absentmindedly started stroking the tattered fringe on one end.

Dr. E tried to regroup. How could the nurses have let this kid sit in a bay with a scarf around his neck when apparently he had just tried to strangle himself with that very scarf?

“Is this the same scarf?”

“Yes. I just told you that. I had it with me.”

“Is this scarf your security blanket? Do you sleep with it?” Dr. E hoped she didn’t sound quite as incredulous as she felt.

“Well, I don’t take it to school, usually. It usually stays on my bed during the day.” He paused before adding, “I had it with me today. It was in my backpack. It used to be light blue. I’ve had it for as long as I can remember. I think my father gave it to my mother but she didn’t like it.”

“You tried to strangle yourself with the scarf you have held on to forever?”

Tommy was silent.

Dr. E fell silent, too.

Reprinted with permission. Courtesy of Praeger Publishers/ABC-Clio, 2012. Available on Amazon.com

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

Wondering about preschool and toddler discipline? sleep? potty training ? emotional well being?

Often parents ask us how to encourage learning in their toddlers. Everyday experiences with parents and toys are more valuable than flashcards or television. To help understand how simple toys enrich toddler development, we bring you an excerpt from occupational therapist Barbara A. Smith’s award winning  book From Rattles to Writing, A parent’s guide to Hand skills. We appreciated how the book gives tips on making your own toys, and lists very specific “to dos” to encourage not only fine motor development, but visual motor and sensory processing skills at different ages.

Ouch! This kid’s index finger has a finger nail infection called a paronychia. Often seen in nail biters and cuticle pickers, this infection occurs in the skin around fingernails. Although most kids are not dexterous enough to bite their toenails, infection can also occur in toes. Bacteria which normally live on skin (Staphylococcus or Streptococcus) find an opportunity to enter the body through openings in broken skin.

The area at the periphery of the nail bed is red, swollen, and painful. At times pus drains from under the nail bed.

Caught early, warm, soapy soaks several times a day may be enough to soften the tense skin and encourage germ-fighting cells to migrate to the infection. After soaking, apply topical antibiotic, such as Bacitracin, to the area.  Often the infection improves after 2-3 days of diligent soaking.

Sometimes the infection persists and oral antibiotics are needed to treat the bacteria. In this photo, the redness of the child’s paronychia is spreading beyond the area immediately next to her nail. Besides increased redness, other worrisome signs of worsening infection include red streaks up the affected digit (a sign that the germs are trying to make it up to the heart),  increasing pain, or fever. Your child’s pediatrician will make the call after examining your child.

Although I do not keep formal track, I do seem to see more of these infections at the start of the school year when kids at their desks begin to bite or pick their nails and cuticles. To prevent infection, remind your kids to wash their hands. If you have a biter/picker, have her substitute a different habit such as picking at a hair scrunchie or Silly Bandz. A more expensive and time consuming option, which Dr. Lai has seen work—offer a fancy manicure.  Kids rarely want to ruin beautifully painted nails by chewing on them.

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

In the office it’s raining school forms. At this time of year, I see many of my patients embarking on their next stage of schooling. Kids I remember starting kindergarten are off to high school. Babies are starting daycare and  teens are starting college. For all the parents who have a child entering a new school, whether it’s preschool or college, this letter is for you:

fodder for tetanus…don’t get this stuck under your foot

Look at this rusty old anchor atop an old fort. Rust plus dirt equals a perfect breeding ground for tetanus. As my kids scampered between different anchors last week, I quickly calculated in my mind whether their preventative tetanus shots were up to date.

“Getting the tetanus shot” is part of the American societal childhood rite of passage, but most people don’t know much about why their kids are vaccinated. Everyone knows they want to avoid IT, but what is IT? Because it is somewhat rare in the United States, I still remember asking one dad about his child’s family history. I was startled when he erupted onto peals of laughter after he told me the child’s grandfather had died of tetanus. “Why are you laughing?” I said in disbelief.

“You’re right, it’s not funny… It’s just the look on your face is funny,” he said. “Everyone has the same shocked expression when I tell them that he died from tetanus.”

Also known as Lock Jaw, tetanus is an organism which thrives in places with little oxygen. Thus, it tends to live on rusty nails (and anchors!) and deep in dirt. Tetanus secretes a poison which causes muscles to spasm painfully and severely and also causes seizures. Exposed to tetanus, your jaw muscles clench into a sardonic smile which prevents eating – hence the name Lock Jaw. Eventually, the tetanus poison infiltrates the chest muscles that help you breathe, and if you are like nearly 40 percent of cases, you will stop breathing and eventually die.

We have no antidote for the poison of tetanus- but we do have a preventative immunization which causes our bodies to preemptively prepare antibodies as self-defense. At the time of a high risk injury, if needed, doctors will boost your child’s tetanus immunization. If your child is under- immunized, the doctor will also inject your child with tetanus antibodies (tetanus immunoglobulin) to further ensure that your child will not contract this disease.

Because tetanus thrives away from oxygen, it easily multiples in deep wounds contaminated by the germ. The germ surrounds us in soil and also lives in intestines of humans and animals. Since tetanus lives in dirt, the following are considered “high risk” injuries:

   -Bites from animals which dig and “eat” dirt such as dogs.

    -Deep puncture wounds from dirty, rusty nails.

    -Wounds with embedded rocks and gravel.

Be wary of tetanus in wounds possibly contaminated with stool, dirt ,or saliva. In developing countries, there are continued cases of infantile tetanus because poultices of mud are used to take care of the umbilical cord stump of newborns.

For kids, the recommended ages for tetanus shots are at 2 months old, 4 months old, 6 months old, 15-18 months old, 4-6 years old, 11-12 years old, and then every ten years through adulthood. Note, if a high risk wound is sustained, the last shot should be within five years. Thus, a kid around 9 years old may be up-to-date for shots, but because he received a tetanus vaccine at four-years-old (on time) he will still need an immunization at the time of a risky injury. Watch out also if you have a teen. His pediatrician will immunize him at 11-12 years of age, but after 16-17 years old he will need a booster if he sustains a dirty wound.

Nowadays, the tetanus immunization is in the same solution as an immunization against diptheria (a disease that causes a choking-inducing coating at the back of your throat), and usually in the same solution as pertussis (whooping cough). If your doctor gave your child an immunization recently against pertussis, she also received a tetanus immunization.

Kids are expected to get dirty. Enjoy the dirt—just not the tetanus.

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