Parents local to Northampton Township, PA: We welcome you to come hear local pedatricians from The Children’s Hospital of Philadelphia and mental health experts talk about basic ways you can help manage anxiety and some information about medications for children and teens on February 8, 2024 at 6:30pm in the Northampton Library.

The talk is free and there will be time for questions. Please register so we set up enough chairs!

Special note: your Two Peds will be in attendance. Hope to see you there!

Naline Lai, MD and Julie Kardos, MD

©2024 Two Peds in a Pod®

Death, politics, mental illness, and sex- all difficult topics for parents to talk about with their kids. Your Two Peds joined a social worker, school guidance counselor, and former teacher in a lively panel discussion at the Haverford Township Library in Haverford PA on how to normalize conversations on difficult topics between parents and their children. Watch as we talk about on ways parents can give kids give information while limiting their anxiety .

Past posts about ways to share difficult information with your children include the topics of suicide, stillbirth/miscarriage, death of a person, and death of a pet.

Warmly,

Julie Kardos, MD and Naline Lai, MD

©2023 Two Peds in a Pod®

Physical therapist Dr. Deborah Stack brings us quick exercises for kids and teens – Dr. Lai and Kardos

After six months of COVID; yes, it really has been that long already, your family has probably found some favorite outdoor hiking spots or bike routes.  But what can you do when it’s too cold or wet outside?  How can you combat literally HOURS of kids sitting at computers especially if they only have 30-45 minutes until their next class? Here are quick exercises for kids and teens and a table of caloric expenditure for common activities.

Schedule active movement breaks into their day.  Take advantage of that lunch and recess “break” and be an example yourself. 

Here are some short burst ideas:

• Have a 15-minute dance party
• Use your body to make all the letters of the alphabet
• Shadow box to some music
• Dust off the treadmill or stationary bike in the basement
• Play ping-pong
• Do a few chores (carrying laundry baskets up and down is great exercise)
• Jump rope
• Jog in place
• Do jumping jacks
• Pull out some “little kid games” such as hopscotch or hulahoop
• Let each child in your house choose an activity for everyone to try
• Do a family yoga video
• Walk or “run” stairs…kids can try to beat their prior score for a minute of stairs
• Take walking/wheeling/even wheelbarrow laps around the house
• Stretch out calves, quadriceps, arms and back…see ergonomics post for counteracting all the sitting

Don’t forget the teenagers;  they still need activity too especially if their teams are not practicing or competing.  Staff from the Mayo Clinic recommend kids ages 6-17 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 all the online learning), and improve cardiovascular endurance.  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 child 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 kids can check it out for themselves.  For those attached to their phones, there are web apps too.

Try these activity calculators:

http://www.caloriecontrol.org/healthy-weight-tool-kit/lighten-up-and-get-moving

https://www.webmd.com/fitness-exercise/healthtool-exercise-calculator

Keep ’em moving- you’ll have more fit, better rested, and happier kids!  

Deborah Stack, PT DPT PCS
©2020 Two Peds in a Pod®

Dr. Stack is a board certified specialist in pediatric physical therapy and the owner of the Pediatric Therapy Center of Bucks County, LLC in Doylestown, PA. In addition to treating children ages 0-21 for conditions such as torticollis, coordination,  neurologic and orthopedic disorders, she also instructs physical therapists across the country in pediatric development and postural control and is a Certified Theratogs fitter.

Chances are, because of COVID 19, this school year will look different for your children. Here are your Two Peds’ tips for helping your children if they are learning online this fall.

Start with basics such as setting a sleep schedule. Think about how many hours your child slept during the spring quarantine and over the summer. If they woke up refreshed, that is the optimal amount of sleep they need to be alert during class. Incorporate this into your school year expectations.  Falling asleep too late and sleeping too late? Check here on how to get your child’s late schedule under control. 

Set up an eating routine. Healthy eating habits have not changed from when you were a child. Stick to the school year schedule of breakfast, lunch, dinner and a morning and afternoon snack – just like at school. Don’t allow the  kids to graze. Without structure, children tend to throw off their weight- in fact, kids tend to gain weight more quickly  in the summer than during the school year. 

Rehearse mask wearing. Even though they attend school at home, your kids will go to the grocery store, see a good friend or get a haircut. Teach them to wear a mask properly so you don’t need to spend time readjusting their masks outside of the house.  

Keep up the hand hygiene at home: Washing hands always limits germ spread. WHEN–before and after eating, after using the bathroom, after playing outside, and before and after school, the HOW–soap and water preferred for the duration of time it takes to sing the Happy Birthday song twice, or hand sanitizer if a sink is not available, and the WHY–avoid germ spread. See our post on handwashing.

Prevent neck and back strain from continual computer use: Read these posts on ergonomics and proper computer positioning to prevent your children from feeling like pretzels  at the end of the day. Likewise, prevent eye strain.

If you are worried about the amount of additional time your children will spend in front of the computer for entertainment in addition to schoolwork, use the American Academy of Pediatrics’ Family Media Plan tool to create a customized screen time contract.

Create a home learning space that your child can call their own. This will be where your child will complete schoolwork and homework. This is especially important if you child usually spends time doing homework on their bed. You want your child to associate their bed with relaxation and sleep rather than activities that rev up their mind. 

Get your child the flu vaccine this fall. Even if you never immunized in the past, this is the year you should. Please see our post on the benefits of the flu vaccine. 

Help your child to “roll with the punches.” Change, even happy change, can be stressful for adults. After all, we all know how adults often run around frantically during the winter holidays. If you feel frustrated, angry, or fearful about the pandemic, try to keep the brunt of your own negativity from your children. Kids are often more adaptable than you might give them credit for, but they tend to mimic their parents and look to parents about how to respond to new situations. Seek adult help to prevent your own negative feelings from flowing over and smothering your children.

You can do this. Who taught your children their first words? How to walk? The color of an apple? How to organize their homework? You will still have teachers who will teach the content of a class. Your role, as it always has been, is to provide the best possible  learning environment.

No matter how it looks, we wish your family a great start to the school year!

Naline Lai, MD and Julie Kardos, MD

©2020 Two Peds in a Pod®

Kids are spending much more time on computers and other screens learning, staying in touch with friends and family virtually, and playing games. Are glasses with special blue light-blocking filters worth the expense? Our guest blogger, pediatric ophthalmologist Dr. Sheryl Menacker, addresses this question.
-Drs. Kardos and Lai 

There is much buzz about glasses that filter out blue light from computer, phone, and other screen devices.  But are the problems real and are these glasses worth the expense?    

The American Academy of Ophthalmology says no, and here is the explanation from their website.

Are eyeglasses with special blue light-blocking filters worth the expense? 

By absorbing the excess blue light from our devices, the eyeglasses claim to:

• improve sleep
• reduce digital eye strain
• prevent eye disease

We all want to do these things, but it’s not necessary to spend money on special eye wear for computer use. Here’s why:

• Blue light from computers will not lead to eye disease. It is true that overexposure to blue light and UV light rays from the sun can raise the risk of eye disease, but the small amount of blue light coming from computer screens has never been shown to cause any harm to our eyes.
• Sleep can be improved without special eyeglasses. You don’t need to spend extra money on blue light glasses to improve sleep— simply decrease evening screen time and set devices to night mode.
• Digital eye strain is not caused by blue light. The symptoms of digital eye strain are linked to how we use our digital devices, not the blue light coming out of them.

Computer/digital eye strain

While using devices will not damage your eyes permanently, staring at them for a long time can cause temporary discomfort. People experience eye strain in different ways, but symptoms can include:

• dry eyes
• blurry vision
• tearing or watery eyes
• headache

The reason we get digital eye strain is that we blink less when we stare at our devices.

Normally, humans blink around 15 times per minute—but this “blink rate” can be cut in half when staring at screens or doing other near work activities (like reading). To reduce eye strain:

• Take frequent breaks by using the “20-20-20” rule. Every 20 minutes look away from your screen and look at an object 20 feet away for at least 20 seconds. This gives your eyes a chance to reset and replenish themselves.
• Use artificial tears to lubricate your eyes when they feel dry.
• Keep your distance. Sit about 25 inches or at arm’s length from your screen and adjust its height so you’re looking slightly downward at it.
• Reduce glare and brightness. Devices with glass screens can cause glare. To reduce glare, consider a matte screen filter for your device. Adjusting the brightness and contrast of your screen and dimming the lighting near your screen can also help reduce eye strain.
• Wear eyeglasses. If you wear contact lenses, you already know they can increase dryness and irritation. To reduce these symptoms, try wearing eyeglasses instead when working on a computer for longer periods.

Sheryl Menacker, MD
©2020 Two Peds in a Pod®

Dr. Sheryl Menacker, of Tri-County Eye Physicians, is a certified Diplomate of the American Board of Ophthalmology, a Fellow of the American Academy of Ophthalmology, member of the American Association for Pediatric Ophthalmology and Strabismus, and examiner for the American Board of Ophthalmology. In addition to general pediatric ophthalmology, Dr. Menacker has a specialty interest in treating individuals with disabilities. She holds a clinical appointment at the University of Pennsylvania School of Medicine and Emory University, where she is an active teacher and lecturer. 

#homeschooling #computer ergonomics #COVID #admireteachers

Oh my aching back…

Right now, with schools closed, kids of all ages are doing schoolwork at home.  Technology has allowed continuation of learning and even face-to-face check in with teachers.  But it also poses some challenges. School classrooms are designed for children; our kitchen tables are not.  How to sit at the computer? Just as we require ergonomic workstations for our jobs; we need to consider proper fit and alignment for our children as they learn virtually. The following are basic ergonomics for kids doing schoolwork from home that can prevent muscle aches and fatigue.

Where to place the computer screen:

Place the computer screen directly in front of your child with the eyes level with a spot about 2-3” below the top of the screen.  In addition, place the keyboard so that the upper arms and shoulders are relaxed. The forearms should be parallel to the floor and the elbow bent less than 90 degrees.  The chair should have back support and allow the thighs to be supported parallel with the floor. Knees should also be bent to 90 degrees or a bit less with feet supported. This can be a challenge for our elementary school kids who are trying to work at home.  The Canadian Safety Council suggests: “choose a chair that places the child at the proper height in relation to the equipment. If that means a higher chair, provide a footrest to support the feet and a pillow to support the back.”

How can you adjust the chair?

Chairs with adjustable seat and footrest heights are great for this.  If you don’t have an adjustable chair, you may need to create a footrest out of a box, block or storage crate.  Also, since many children are using laptops, it is difficult to position both the screen and keyboard appropriately; it may be best to attach a separate monitor at the right height once the keyboard is set for proper arm and body position.

Avoid back and neck pain:

If children are using an iPad or reading a textbook, an angled book holder may help with proper positioning to avoid back and neck pain.  We have cookbook holders for a reason!

If your child is doing lots of writing or drawing:

An angled writing surface will help with fatigue and proper support.  There are quite a few child sized desks available with a surface that raises to an angle. If you child is a wiggler; consider a ball chair with an appropriate height table that allows for that 90-90-90 ankle, knee, hip alignment, or consider using a standing desk. In each case, the keyboard, mouse and screen still need to be adjusted for alignment as above.

The most important thing you can do is make sure your kids take a break and MOVE every 30 minutes according to both the Cornell University Ergonomics Web and Canada Safety Council.  Active breaks are necessary not just for the body, but for the eyes as well.  The best ergonomics for kids doing schoolwork at home cannot substitute for these breaks. 

Here are some ideas for quick movement breaks to keep the aches and pains away:

1. Stand and stretch arms up overhead.  Grasp hands interlocking fingers, flip palms up to the ceiling and stretch.
2. Bring arms behind your back at hip height, grasp hands or hand to wrist and try to pull shoulder blades down and together.
3. Stand with hands against a wall, place one leg back with knee straight and foot flat on the floor.  Keeping your body straight like a board, lean into the wall and stretch the back of the calf.
4. If you have a yoga ball, lie back over the ball with feet flat on the floor,  raise your arms out to the sides like a “T” and take some deep breaths.
5. Go outside in the yard and play!
6. No yard? Raining?  Have a dance party or play “Simon Says.”

Stay home.  Stay safe… and keep moving.

Deborah Stack, PT DPT PCS
©2020 Two Peds in a Pod®

We thank Dr. Stack for contributing to twopedsinapod.org— Drs. Lai and Kardos

Dr. Stack is a board certified specialist in pediatric physical therapy and the owner of the Pediatric Therapy Center of Bucks County, LLC in Doylestown, PA. In addition to treating children ages 0-21 for conditions such as torticollis, coordination,  neurologic and orthopedic disorders, she also instructs physical therapists across the country in pediatric development and postural control and is a Certified Theratogs fitter.

veggies, veggies, veggies

“Monitor your child’s diet closely to make sure they are getting enough calories… Some teens need 4,000 calories a day when they’re in a growth spurt!”

Check out the Children’s Hospital of Philadelphia Tip of the Week- a post on vegetarian teen diet basics with input from Dr. Lai!

Julie Kardos, MD and Naline Lai, MD
©2020 Two Peds in a Pod®

Now that school has been in session for over a month, it’s not too early for you to learn all about strep throat. It might even save you a trip to the doctor’s office!

Julie Kardos, MD and Naline Lai, MD
©2019 Two Peds in a Pod®

What causes brown spots on feet? In the summer, we see kids with these spots on their feet or hands. Read on for the answer behind the mysterious spots.

Every child with a lemonade stand hopes for hot sunny days to drive in customers. But if your kids squeeze fresh lemons for their stand, make sure they wash their hands after squeezing the lemons. Otherwise, after a sunny day, your child’s hands may turn out looking like this kid’s feet. The juice of some fruits or plants will cause a dark discoloration of the skin if exposed to sunlight.

This reaction, called phytophotodermatitis, usually starts a day after the juice comes into contact with the skin. Redness and mild blistering eventually leads to a discoloration, like those brown spots on feet, which can that can last for months. Citrus fruits are the most common culprits, but wild parsnip, wild dill, wild parsley and buttercups also cause the photosensitivity. Often the initial redness and blistering is missed. The kid in the photo was walking in bare feet on leaves near an apple tree. So now you can tell your kids not to walk barefoot outside to prevent stepping on a bee, to prevent contracting poison ivy, and to prevent phytophotodermatitis!

Makes you think about holding off on fresh lemons and using powdered lemonade mix…almost.

Naline Lai, MD and Julie Kardos, MD
©2014, 2019 Two Peds in a Pod®

It’s pretty annoying to be itchy. Dr. Lai fondly called her itchy oldest child with eczema “itchy, bitty, spider,”or some variant of that, for much of her daughter’s childhood. Fortunately, for your kids with sensitive skin, dermatologist Teresa S. Wright, MD  joins us today with tips for how to treat eczema or atopic dermatitis—Drs. Kardos and Lai

Has your child been diagnosed with eczema? Eczema is a general term that refers to a group of skin conditions characterized by itchy red rashes. The term “eczema” often refers to a skin condition known as atopic dermatitis. Atopic dermatitis may occur in association with allergies and/or asthma and the rash tends to come and go. Common triggers include illness, stress, and changes in the weather or temperature. The cause of atopic dermatitis is not well understood. However, most children with atopic dermatitis tend to have very dry, sensitive skin. Atopic dermatitis cannot be cured, but it can be controlled. Most children with atopic dermatitis gradually improve and many will outgrow it over time. In order to control the rash, a proper daily skin care regimen is extremely important.

Skin care regimen to treat eczema

A daily bath or shower is recommended. It is a common myth that daily bathing “dries out” the skin. This is not true. Bathing puts moisture in the skin and removes irritants and germs. However, the bath or shower should be short (less than 10 minutes) and not too hot. Cleanser should be gentle, fragrance-free, and dye-free. Dove™ for Sensitive Skin or Aveeno™ fragrance-free cleanser are good choices. After bathing, pat the skin dry with a soft cotton towel and apply a  heavy bland moisturizer to all skin to seal in the moisture.

The type of moisturizer you select is very important. It is best to use an ointment (like plain unscented Vaseline™ or Aquaphor™) or a heavy cream (like Vanicream™, CeraVe™ cream, Cetaphil™ cream, or Aveeno™ Baby Eczema Therapy Moisturizing cream, to name a few). Lotions are poor choices because they tend to contain more preservatives and ingredients that can sting open skin or cause irritation.

Apply moisturizer  to the skin at least twice daily, but more often if the child’s skin is unusually dry or the eczema is severe. Apply topical medications sparingly to the affected areas prior to the application of moisturizer. I recommend applying topical medications twice daily, but you should follow the instructions given by your child’s doctor. It is very important that medications are applied only to areas of active eczema and never to normal skin. Apply moisturizer to all skin, including over the areas where you already applied medication.

This time of year, parents ask if swimming is okay for children with atopic dermatitis. In general, swimming should not be a problem for children with atopic dermatitis. In fact, some children improve dramatically with regular swimming. Improvement may be due to the effect of chlorine. Chlorine causes a decrease in the skin residing germs that can play a role in triggering eczema flares. However, chlorinated water can be very drying to the skin, so rinse the skin thoroughly and apply a generous layer of a heavy moisturizer as soon as possible after swimming. For most children, taking these steps prevents significant flares of swimming related atopic dermatitis.

In my practice, I see many children with eczema every day. I understand how challenging and frustrating this condition can be for parents. The recommendations I outlined here are often very helpful and I sincerely hope they will help you control your child’s eczema.

Teresa S. Wright, MD
©2019 Two Peds in a Pod®

Dr. Teresa S. Wright is a board-certified pediatric dermatologist in Memphis, TN, and is Division Chief of Pediatric Dermatology at LeBonheur Children’s Hospital and Associate Professor of Dermatology at the University of Tennessee Health Science Center. She has particular interests in atopic dermatitis, vascular birthmarks, and pigmented skin lesions.