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.

“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.

Do you wonder if any communication actually occurs when you talk to your teen? We invite you to read this post for some coaching on how to talk to your teen in ways that they will find palatable.

Julie Kardos, MD and Naline Lai, MD

©2019 Two Peds in a Pod®

Your child lies. What do you do?

Read our post to learn the truth of why your child might lie.

Julie Kardos, MD and Naline Lai, MD

©2019 Two Peds in a Pod®

“Should I give my kid the Gardasil® vaccine?” Friends and relatives, as well as our patients’ parents, continue to ask us this question.

Our answer is always: “Yes.”

Gardasil® vaccine is the current HPV vaccine on the United States market. The vaccine prevents cancer-causing strains of human papillomavirus from infecting a person’s body. HPV cancers include cervical cancer in women, penile cancers in men, and cancers of the mouth and throat in everyone. The vaccine also protects against genital warts.

According to the  Centers for Disease Control report, nearly 90 million HPV vaccines were distributed from June 2006 through March 2016. That’s a lot of vaccinations. In the US, the large majority of HPV vaccine given was the Gardasil® vaccine.

You can read a detailed report of the way the safety of the vaccine was studied here. 

Here are the updates:

1. The vaccine prevents cancer-causing strains of HPV from infecting teens and young adults. You can read the latest study about this here. 
2. The vaccine is still safe. The HPV vaccine has still NOT caused any deaths, has NOT caused cases of premature ovarian failure, and has NOT caused any new chronic pain syndromes or neurologic diseases. If you read on the internet or on Facebook any gory tales about Gardasil, you can check those stories on “Snopes.” This website determines whether a popular internet story is a myth or a fact. 
3. Your child may need only two doses of HPV vaccine instead of three. We now know that younger teens achieve immunity with fewer doses than older teens. So, if your child gets the FIRST dose of this vaccine prior to his 15th birthday, then he needs only one more dose of vaccine 6 months later. Those starting the Gardasil® vaccine on or after their 15th birthday still need 3 doses of vaccine for maximum protection against the disease.
4. If your child has a weak immune system, they also might need three doses. Children with weakened immune systems (check with your child’s pediatrician) should get 3 doses of Gardasil®.
5. Teens and tweens are more likely to feel dizzy or to faint after all vaccinations, not only after the HPV vaccine. There are reports that HPV vaccine causes kids to faint, but fainting may occur with any teen vaccine. It is well known that surges of anxiety can cause fainting.  Although they are older, teens are often very apprehensive about getting vaccines. Babies and toddlers rarely faint. Although a toddler may be mad about a vaccine injection, they are not anxious. To prevent any light headedness, your teen’s doctor may have them sit for a few minutes after a vaccine. 

There’s a reason why we give the vaccine “so young.” Once people are infected, the vaccine does not work as well. Even though it may be difficult to imagine your child needing protection from a sexually transmitted disease, prevention of cancer-causing strains of human papillomavirus is most effective when HPV immunization is given well before your kids have had any exposure to the virus.

Yes, the HPV vaccine is safe, and yes, we gave it to our own kids.

Julie Kardos, MD and Naline Lai, MD
Ⓒ2019 Two Peds in a PodⓇ

Unfortunately, it is sick season. Fortunately, we have a great post to help you know when you need to call the doctor about your child’s illness. 

Julie Kardos, MD and Naline Lai, MD

©2018 Two Peds in a Pod®

Remember playing “Truth or Dare” as a kid? Some of the dares were silly, some potentially embarrassing, but some were downright risky. Now our children are playing potentially dangerous games. How can you prevent your teen from taking unnecessary risks?

To understand why kids would play risky games such as the Cinnamon Challenge or the Laughing Game, let’s step into the mindset of a teenager. Don’t let their adult-like appearances deceive you. Based on what we know about teenage brain development, teens are more likely to misinterpret or mislead social cues and emotions and to engage in risky behavior. Even though your teens may be taller than you, their deductive reasoning skills are not fully developed until around 25 years old. They have difficulty thinking through long term plans.

Take a simple example of studying. If they stay up very late studying, they do not consider that this will cause impairment in cognition the next day and consequently they are forced to stay upeven later to understand class material. Further, because teens also are impulsive, they will typically check their cell phones multiple times while studying, which further pushes off bedtime. Days later, when it comes to taking a test in class, their cumulative sleep deprivation leads to poor focus and poor memory retrieval.

Applied to more dangerous situations and coupled with peer pressure, even a “good teen” may take unnecessary risks. Teens truly believe that they cannot die. Even if they know others who have died, they don’t think it can happen to them. So they may be more likely to run across a busy street, try getting high off of a friend’s Adderall, or drive distracted while checking social media on their phones.

Teen peer pressure + immature teen brain = disaster potential.

As parents, you do have some power to prevent disaster. You can teach your teens the tools you have acquired through the years to help them consider all potential consequences of their actions.

Here are some ways parents can teach:

• Tell kids to pause first before playing any game. Think “What is the worst that can happen if I play the game, win or lose?” If the worst case scenario is severe injury or death, DON’T PLAY THE GAME. Remember that kids feel invincible.
• Teach directly by allowing kids to take small risks. Like we’ve said before, hold tight, but remember to let go. If your child chooses not to study for a test in school, then let them fail the test. However, make sure they study for the final exam.
• Teach indirectly through anecdotes, either from your own childhood or events you hear about. For example, your kids might not consider that the beach they visit with you every summer can hold danger. Tell them about the family I know who lost their teen to drowning while swimming too far and was caught in a riptide on an unguarded beach.
• Teach kids that you cannot always save them. You cannot magically can save them if they get hit by traffic on a dare.
• Know where your kid and your kid’s friends are developmentally and supervise accordingly. Volunteer to host the gatherings where a game may occur. Hint: Go down into the basement often with food-the kids will be happy to see you and you can be a better spy.
• Keep ’em busy so that they do not play risky games simply out of boredom.
• Give your kid a way out of an uncomfortable situation. Let them know they can always say, “I can’t, my parents would kill me.”

Unfortunately life is not all fun and games. Remind your kids that playing Monopoly or video games is not the same as taking real life risks.

Julie Kardos, MD and Naline Lai, MD
©2018 Two Peds in a Pod®