Ways to calm your frustrated toddler: halting the endless tantrum

Time out’s over and your 18 month old is still flailing on the floor, pig-tails flying and tears streaming down her face. “Time out is over,” you say, trying to console her, but she continues to cry, and cry and cry. She cries so long she forgets why she started.

Last week we lead a parenting seminar, “Trials and Tribulations of Toddlerhood: How to grow your child emotionally” for the Play and Learn: a Family Place series at the Pennsylvania Bensalem Bucks County Free Library. One topic of discussion was ways to help your heated up, frustrated toddler “cool off”:

–Offer a favorite stuffed animal or “blankie.” Gripping his familiar comfort toy often helps the toddler to “get a grip” on his emotions. Try to buy several of the same animals and switch off, otherwise you will soon have a pretty grubby toy. If your child’s comfort “blankie” is starting to unravel, cut it up into smaller pieces and sew the pieces onto new fabric.

-Don’t feel guilty about giving a binkie/pacifier: Otherwise known as “the magic cork,” at this age, binkies do no permanent harm to teeth and they will soothe a flustered kid. Thumb sucking is also an effective, benign self-soothing technique at this age. Please see our binkie post for more about binkies and when (and how) to wean, and listen to our earlier podcast for more about thumb sucking.

–Go outside with your toddler– a change of scenery and temperature works instantly to distract your toddler from his woes. Even bad weather works. Dr. Lai remembers many times huddling under a blanket on her porch with her children as it snowed.

–Just walk. Start walking around the house carrying your kid or holding his hand. Or marching. Or “funny-walking.” Sing a silly tune as you go. Your toddler may catch your silliness and forget his woes. If this is not enough, march outside.

–Sit down and start playing WITHOUT your toddler. Or working a puzzle. Or making toy cars drive around. Or setting up stuffed animals for a party. Or coloring. Your toddler will become curious and want to join you. Remember, “time in” is much more attractive than “time out.” Keep bubbles on hand. Blowing bubbles, not only distract, but like the breathing techniques in yoga, blowing bubbles help toddlers relax.

–Read a book. Make it a habit of reading during soothing times such as bedtime, quiet time or before nap time and your child will learn to associate this activity with feelings of peace. When your toddler is “stuck,” reading her a favorite book will return feelings of calmness. In general, reading books about emotions will also give your child a vocabulary to express himself. The inability to communicate to you her emotions will escalate frustration. After she is calm, use books to teach “what to do next time.” For instance in one of Dr. Lai’s favorite books, When Sophie Gets Angry—Really, Really Angry by Molly Bang, the main character Sophie explodes like a volcano. Ask your child when you read the book,” what can Sophie do instead of exploding? What would you do?”

Below are a list of suggested books about emotions complied by Librarian Pat Stephenson, hostess of the Bensalem Play and Learn parenting series.

Hands are not for Hitting, by Martine Agassi

Feelings, by Aliki

Squish Rabbit, by Katherine Battersby

Teach your kids to think! by Maria Chesley Fisk

Grump, Groan, Growl, by Bell Hooks

Understanding myself: a kid’s guide to intense emotions and strong feelings, by Mary C. Lamia

Any book written by Mister Rogers

Calm Down Time, by Elizabeth Verdick

Feeling Sad, by Sarah Verroken

Alexander and the Terrible, Horrible,No Good, Very Bad Day and other Alexander books, by Judith Voist

I Love my New Toy! By Mo Williams

As we discussed in Toddler Discipline “Time Out” is an effective form of discipline. But there is a difference between disciplining your child and teaching your child self calming techniques. When time out is over, it’s over. Help him move on.

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.

Hear ye, hear ye: how can I tell if my child hears?

I just watched “The Miracle Worker” with my oldest son. This classic 1962 movie depicts Helen Keller, who was deaf and blind, struggling to understand language, with the help and supreme patience of her determined teacher Annie Sullivan.

As I watched the movie, I was reminded about how children depend on their senses to learn about the world. Starting today, Two Peds in a Pod will bring you periodic posts about the early development of senses. We start with hearing.

Unlike eyesight, which is limited at birth, babies are usually born with normal hearing. Before leaving the hospital after birth, or by two weeks of age, your newborn should receive a hearing test. Then, at every well child check, your child’s health care provider will ask you questions to confirm your child’s hearing remains the same.

Even though they are unable to localize where sound is coming from, newborns will startle to new or sudden sounds and their eyes will open wider in response to the sound of your voice. All babies babble, even deaf ones, but language progression will stop in children who cannot hear. By six months, kids usually babble one syllable at a time. By nine months, children will produce syllables that sound like whichever language they hear the most. At this point they should also respond to their name. Babies who fail to meet these milestones may do so because they cannot hear.

For older kids, hearing screening may be conducted in schools or the pediatrician’s office. The American Academy of Pediatrics recommends formal hearing screens starting at four years old. These screening tests can detect subtle hearing loss that parents did not notice. Kids who fail the screen should have a more comprehensive hearing evaluation by an audiologist. Many kinds of hearing loss are either reversible or manageable. The earlier the diagnosis the better.

Sometimes speech, behavior, or attention problems are secondary to hearing difficulties. School aged children may mispronounce words because they cannot hear sounds clearly. These children commonly do not distinguish well between the “s,” “ch,” and “sh” sounds (please click here to review language development). Symptoms attributed to Attention Deficit Hyperactivity Disorder such as difficulty focusing or inattentiveness may actually result from hearing loss. Some kids who “just don’t listen” to adults simply can’t hear well enough to follow directions.

As your child’s hearing loss progresses, you may notice your child’s language regresses, or that your child turns the volume up on the TV. Your child may accuse you of mumbling or ask you to often repeat questions. Although a common myth, a child who talks loudly is not necessarily deaf. After all, a child does not need to raise his own voice in order to understand himself.

Finally, I should mention signs of “selective hearing loss.” Many parents describe this form of “hearing loss” to me in the office. In these cases, a child does not hear her mom say “Clean your room,” yet hears her mom whisper “Let’s go out for ice cream.”

We address the topic of listening, as opposed to hearing, in our next post.

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

Beware the bewitching hour

Every day across the United States, sometime between 4:00 to 5:00 PM, millions of small children are crying and whining. Welcome to the bewitching hour.

In our offices it’s bedlam during that hour. The phones start ringing off the hook: daycare called mom to report Johnny has a fever, Mildred came off the school bus bleeding from a gash from a flying lunch box, and help, the coach won’t let Mary play lacrosse until her school form is signed.

Meanwhile, you are trying to get home from work/ fix dinner/ walk a cranky baby/order new cleats for Jared, or all of the above, likely at the same time.

Resign yourself. Even if your kids are well-fed, napped and had a great play date that day, the bewitching hour can still happen. Think of it as Colic: Part Two. Some think colic is related to the difficulty of young nervous systems trying to adjust to nightfall. We’re not sure anyone ever grows out of that stage! We just hide our crankiness better as adults. When you think about it, it’s a hard point of day for adults, even childless ones. After a full day around the house or at work, you’d rather curl up on the couch and read a good book than grapple with, well, anything. Remember those ads for bath soap? “Calgon take me away.”

I remember when my oldest was a toddler. At the bewitching hour I’d stare out the window looking for my husband’s car as he drove home from work. We’d have conversations like this, “Daddy should be home any minute. Let’s go to the window and see. No Daddy? Let’s read a book on the porch and watch for him. No Daddy? Then let’s move to the lawn. I’m sure he will be in the next car.”

Your best defense against your desperation at this time: drill down to the basics: eat, sleep, drink, pee, poop. Make sure they are all going okay entering the bewitching hour- for your kids and for YOU! You may be too harried to notice that you did not drink anything for hours and a dehydrated dad will feel like he’s hallucinating during the bewitching hour.

When my oldest was three and my younger child was one, I surprised the furnace repair guy by cooking dinner at two in the afternoon. The crock pot is your friend. A crock pot dinner will cook itself. Do everything possible: cook the dinner, set the table, give the baths and make your phone calls before the hour hits.

If you are picking the kids up from daycare, make sure you have something healthy for them and yourself to munch on in case everyone is starving. Alternatively, pack a dinner for the daycare teachers to give to your children before you pick them up. These strategies will prevent your children’s hunger from fueling the bewitching hour. Additionally, having a healthy snack prevents them from becoming so full from goldfish crackers that they later refuse to eat their meal. Even if your kids eat dinner before you, they can join the adults at the dinner table and eat some fruit or veggies or have a cup of milk, allowing for some quality family time.

Several years ago during a particularly horrific bewitching hour, Dr. Kardos’s three children melted down simultaneously. In desperation, she grabbed the video camera for some footage of one five-year-old and twin two-year-olds all tantruming at the same time. Now the replay is as entertaining to her family as the funniest of America’s Funniest Videos. Sometimes you have to use humor and remind yourself that you might, one day in the not so far off future, miss this time.

And don’t forget. Just as you are questioning whether or not you will go insane… there are times when the bewitching hour will go smoothly… at least until you wake up!

Naline Lai, MD with Julie Kardos, MD

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.

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

When it’s not comfort food

The preschool class was going on a field trip to a park. It was a breezy spring day and the four-year-old boy with the closely cropped hair was thrilled. Even though he didn’t usually attend school on Fridays, his mom brought him to meet up with his classmates at the park. The four-year-old’s eyes lit up as the yellow school buses rolled into the park just in time for lunch. Out tumbled the children, loud with excitement. In a flash, teachers spread brightly colored floral bed sheets on picnic tables, transforming the park into a little cafeteria. Twenty kids squashed together at the tables and forty sets of hands plunged into brown paper lunch bags. Holding onto his mother with one hand and holding his lunch bag in the other, the four-year-old boy shyly approached the crowd.

Upon spotting the boy, a little girl with a Scooby Doo shirt ran up and jumped up and down in delight.

“You’re here, you’re here!” she squealed.

The boy went happily with his mother to find a seat. But something was wrong. The boy and his mom went from table to table in a futile attempt to find a spot. But each table was the same: every child had a field-trip-friendly peanut butter sandwich in his hand. Peanut butter was everywhere. Some had it on white doughy bread, some had it on crackers. Another had a bag of peanuts mixed in with chocolate chips. The mom recoiled with horror and tightened her grip on the boy’s hand. Allergic to peanuts, the boy stood hesitantly at the edge of the crowd. As a baby, the boy had broken out in hives after his sister touched him with her hands sticky from her own peanut butter and jelly sandwich.

Imagine having to scrutinize the ingredients of all your food. Imagine being wary of a basic necessity that brings not only nutrition, but also feelings of warmth and comfort. Most children with food allergies have a reaction only when they ingest the offending substance, but the allergenic ingredients can pop up in unlikely dishes. The hyper vigilance of families with food allergies can be wearing. Studies on the psychological impact of food allergies show that families with children with food allergies have an overall lower quality of life than families without food allergies. In fact, although not obvious, families with food allergies rate their own lifestyle quality similar to families who have a child with diabetes or even a child who is respirator dependent.

For a moment a sense of isolation overwhelmed the mom. But just as quickly as it came, the feeling dissipated. In the future, the danger would become just a routine part of life, something to add to the long list of items to teach the boy to watch for. Just as the mom would teach the boy to watch out for cars as he crossed the street, she would teach him to watch for nuts in his food. Perhaps his quality of life would be compromised, but as she watched him laugh with his friends, it didn’t matter, he did not perceive it that way. Well loved, his quality of life index was still sky high.

Finally, the mom found a child who had finished eating his sandwich and had cleaned his hands. Half in jest, she fondly called her son “ostracized one” and placed her allergic boy next to the one who was done. There he perched, surrounded by messy children, with their messy peanut butter covered hands. Thankfully, the boy was happy and too busy chatting with his friends to worry. To him, waiting for a lunch spot was a mere nuisance. The potential danger next to him was just an accepted part of his everyday life.

This scenario actually occurred. The little boy was my son. And the mom was me.

Naline Lai, MD

As the beginning of school approaches, Drs. Lai and Kardos remind parents of children with food allergies to check the dates on their Epi-Pens or Twin Jets to make sure they have not expired. Practice discharging expired pens into a grapefruit. Now is the time to update your “allergy action plan” from your child’s health care provider for your child’s teachers and school nurses.

Dr. Lai serves as an advisor for the FAST (Food Allergy Support Team) of Doylestown, PA, a local support group of the national Food Allergy Anaphylaxis Network.

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.

Nipping conflicts between dogs and kids

Many of our patients have dogs in their homes, and many choose to add a dog to their family during summer. Unfortunately, dog bite rates are also highest in summer, and occur most often in five to nine year olds, according to the Centers for Disease Control. Our guest expert today, veterinarian Dr. Sharin Skolnik, provides tips on how to introduce a dog into a home with children and how to best avoid dog bites. Interestingly, we noticed similar behavioral management strategies work for dogs and kids.

–Julie Kardos, MD and Naline Lai, MD

Two Peds: Are some breeds of dogs better for children?

Dr. Skolnik: Breed recommendations are tough, because there are such different personalities within every breed. Breeds bred to protect will tend to guard their family, but may not be friendly with other kids. I have had to euthanize golden retrievers and labs for severe aggression, and know some truly stellar pit bulls. I would like every family bringing a dog into their home to think about how much time and energy they can devote to the following: exercise/walks/play dates/ mental stimulation, grooming, feeding, veterinary care and arranging travel concerns/contingency plans. If I had to pick a good family breed, I would suggest a Cavalier King Charles spaniel, but only if you forced me to pick one!

Two Peds: Any suggestions for screening a dog before bringing it into the family?

Dr. Skolnik: Many rescue groups use experienced foster homes to really get an idea of where a dog is at before placement, which is wonderful. Look for a puppy or dog that is not too hyper or timid, unless you have the time and energy to devote to modifying these behaviors. An inquisitive but not pushy dog is ideal. Having said that, dogs are incredibly trainable in the right hands. Use care when bathing, feeding, or taking things away from a newly adopted dog. Trust is a two-way deal, and positive and gentle first interactions will set the stage for the relationship.

Two Peds: Why are young kids prone to dog bites by the family dog?

Dr. Skolnik: Many factors: kids are usually very bad at reading dog body language. For that matter, many adults I meet think that a wagging tail indicates a friendly dog, when in fact it means the dog is willing to interact, positively or negatively. Kids are usually loud and move unpredictably and quickly. Never leave kids and dogs unsupervised, because the kids may not understand how to be gentle and respectful of the dog. It is important to set clear and consistent expectations for both kids and dogs on what counts as acceptable behavior

Two Peds: What should parents teach their children about approaching a dog?

Dr. Skolnik: Teach them to always ask an owner’s permission with unknown dogs. Look for “soft” features like relaxed ears, floppy wagging tail, wiggling body. Tense body, rigid tail (wagging or not), backing up, dilated pupils– leave that dog alone. Supervision by responsible adults is key.

Two Peds: How can a dog be taught to “respect” a child?

Dr. Skolnik: Same way dogs learn to leave people’s houses and other pets alone. “Claim” items as yours, and not the dog’s, while meeting their needs. When I adopt a new dog: Guinea pigs/cats/shoes/etc. are mine. Every time the dog shows an interest in one of these things, he is told firmly “No.” The dog is given plenty of walks through the woods, praise for desired behaviors, some one-on-one time, and a few weeks later and we usually are on the same page. Consistency in training is key. The dog can’t be allowed to chase the cat when you are not home, so keep them separated! Set the dog up for praise, gently but firmly correct missteps, don’t overcorrect or correct after the fact. The latter only increase anxiety and the likelihood of future behavior problems

A common mistake in dog discipline is relying too much on punishment/ negative corrections and ignoring “good” behavior. For example; yelling at the dog for grabbing at the kids’ clothes, hands, whatever and ignoring the dog when it is chewing one of its own toys. Dogs are pack creatures; they rarely will play by themselves. Single-dog homes especially need to budget enough time each day to meet the dog’s mental and physical needs.

Two Peds: Should a dog that bites a kid be given a second chance? Can dogs be rehabilitated?

Dr. Skolnik: Depends on the scenario. A very forward dog with a history of unprovoked aggression towards kids is going to require a huge commitment to prevent injury and likely needs to go where there are no children, or humanely put to sleep. Most vets are pretty intolerant of dog aggression towards children. Now if an adult dog unfamiliar with kids snaps when a kid grabs an ear, or tries to take something away, or if the dog gave some warning that the kid should back off– I would blame the adults that put those two in the situation. Dogs (and people) can be rehabilitated, but there will always be the possibility of relapse. There are no guarantees with behavior modification.

Sharin Skolnik, DVM, holds a Bachelor’s degree from Cornell University School of Agriculture and Life Science and a veterinary degree from University of Pennsylvania School of Veterinary Medicine. She has been practicing veterinary medicine for 17 years and is a member of the AVMA and the NJVMA. She currently works at Chesterfield Veterinary Clinic in Bordentown, New Jersey.

Her “children” include five horses, eight dogs, eight cats, nine guinea pigs, nine hamsters, six sheep, 40 chickens, and 50 rabbits. She is also a long time friend of Dr. Kardos’s. Their children play well together under close supervision.

Two Years Old!

All about Two

Happy Birthday to us: Two Peds in a Pod is two years old today. In honor of this momentous day, we share some of the ups and downs of two-year-olds.

Upside: They can communicate in two word sentences (“more milk!”).
Downside: They can communicate in two word sentences (“no nap!”).

Upside: They start to play “dress up.”
Downside: They nearly strangle themselves with princess necklaces and super hero capes.

Upside: They have long afternoon naps.
Downside: They start to outgrow long afternoon naps.

Upside: Endearing altered sense of reality
Downside: They have no common sense—they would walk off a cliff.

Upside: They love water play.
Downside: They demand “let go!” in a swimming pool.

Upside: They start to show interest in potty training.
Downside: They still occasionally poop in the bathtub.

Upside: They love to give gooey sticky kisses.
Downside: They love to give gooey sticky kisses to runny nosed-friends, the dog, the pet turtle, and the stuffed animal that accidentally spent the night in the backyard.

Upside: They love to explore and use their hands to finger paint and squish play-dough.
Downside: They will find and poke at every piece of already-chewed gum that they find on the sidewalk.

Upside: They are the perfect size to fit in your lap.
Downside: They are the perfect height for cutting their eyebrow on the corner of the kitchen counter as they run by.

Upside: Their determination.
Downside: How long their tantrums can last.

Upside: All the educating we’ve been able to do over the past two years through Two Peds in a Pod. All of our readers’ comments and suggestions. And there’s so much more to write about.
Downside: None!

We are thrilled to have more-than-doubled our daily hits, our email subscribers, and our Facebook friends this past year. We’re now the second entry when you Google the words “Pediatrician Blog.” Please keep the momentum going, continue the dialogue, tell other parents about us and send ideas for blog posts at twopedsinapod@gmail.com.

Enjoy a birthday cupcake on us.

Julie Kardos, MD and Naline Lai, MD