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

©2011 Two Peds in a Pod®

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. 

Medical mystery: What is that lump?
Hint: Your basketball star now is taller than you and works out daily.
Hint: He talks about pain at this spot.
Answer: Your kid’s tibial tuberosity when affected by Osgood Schlatter disease

First, some knee anatomy. The knee cap (patella) is anchored into place by tendons and ligaments. One called the patellar tendon attaches to the shin bone (tibia) below the knee at a point called the tibial tuberosity .

Repetitive bending movements of the knee, such as running and jumping, cause the patella tendon to pull on the bone where it attaches at the tibial tuberosity. Strain can result in a large tender lump which forms as the body tries to repair this area. This condition called Osgood Schlatter disease is associated with puberty, so most kids eventually “grow out of it.”

Ice, rest, and ibuprofen will alleviate pain. Your child’s health care provider may recommend gentle stretching of the quadriceps muscles or a knee brace. Beware of increased pain because rarely the muscle tears away from the bone and causes stress fractures.

Never know when you will “kneed” this information.

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

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.

©2011 Two Peds in a Pod®

Emmy award winning journalist Janet Zappala, author, nutritionist, chef, and  mom, blogs for us today!

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Summertime is in full swing and the snacking is easy. This is the season to grab all of the fresh fruits and vegetables you can. Berries, for example, are brimming over in your local supermarket. Blackberries, blueberries, raspberries and strawberries: not only are they delicious, they’re also chock full of antioxidants that fend off free radicals to keep our cells healthy, and they’re an excellent source of dietary fiber so they don’t spike your blood sugar and cause a lull in energy. Eating berries will keep your energy up all day, so you can enjoy all of the fun activities that summer has to offer. Keep them refrigerated so they’re nice and cold on a hot summer day. They’ll also last a bit longer than if you leave them out. The same goes for vegetables: what’s more refreshing than chilled cucumber, carrot, celery and bell pepper slices? Want to dip? Check out my spinach dip and/or my hummus recipe at www.janetzappala.com.

Snacking is a great way to avoid overeating as well. By keeping nutritious snacks handy you can snack throughout the day and stay satisfied and energized. The key is knowing which snacks provide the most nutrients, and one of your best bets is whole grains. Whole grain crackers and chips are just sitting on your supermarket shelves, “ripe” for the picking. Vegetable chips are another tasty option. A personal favorite is Terra’s Sweets and Beets, chips made from sweet potatoes and beets. What could be more satisfying? You’re still getting a crunchy treat, but one that’s made from ingredients that will do your body good. Worry-free eating, that’s what it’s all about. One of life’s greatest pleasures is eating, why should we give up the things we love? We don’t, we just have to find healthier options, a much easier task these days as manufacturers are tuning into the consumer’s demand for healthier options.

If you and your kids are sandwich lovers, go for whole grain bread, a couple slices of fresh roasted turkey (not processed), lettuce and tomato, and top if off with a slice or two of Jarlsberg Lite cheese. It’s my favorite for its great taste, and it’s relatively low in fat and calories. Drizzle a little extra virgin olive oil, a splash of red wine vinegar, and a sprinkle of salt and pepper on top, and you have a mouthwatering and nutritious lunchtime treat that will pack the punch you and your family need to keep you going throughout your day.

Finally, a little more food for thought, seeds! Don’t forget to have plenty on hand, everything from sunflower seeds, to sesame seeds, to pumpkin seeds, to flaxseeds. All will provide you with countless nutrients and energy, not to mention a good amount of fiber in every delectable bite. Grab a handful during the day and you’ll be providing your body with everything from protein and iron, to potassium, and magnesium. Flaxseed alone provides heart-healthy omega 3 fatty acids. Go nuts for nuts too! Heart-healthy almonds and omega 3 rich walnuts are especially good for you.

All this said, opt for the raw, unsalted variety if you can. If that’s too big a step at first then try to stay away from salted nuts. As you go along your palate will change gradually and you’ll be able to enjoy raw unsalted seeds and nuts the way mother nature intended.

Enjoy the summer and all of the great foods and fun it has to offer!

– Janet

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. 

Recently, we lost the air conditioning in our home. My family welcomed the sympathy as we fried in an early summer heat wave. My neighbors and co-workers all offered us time in their homes as a respite from the heat. Actually, it wasn’t too bad at home. If anything it showed my family how much energy we in fact waste. With the help of two fans and by pulling down window shades, the homework still got done, meals were eaten, and the kids, although sweaty, still played.

Our weeks in our hot home made me think about a disturbing trend I tend to see over the summer. Often, overweight kids at the end of summer come back to my office heavier than they were in the spring. I’ve always thought of summer as a time for constant outdoor play and physical activity, but for some, the hot summer is as tough as the cold winter when it comes to healthy weight maintenance. As I saw my kids function as they normally do despite the heat, I wonder if we use high temperatures in summer just as we use low temperatures in the winter as an excuse not to send our kids outside. 

Of course we need to be respectful of the dangers of over-heating. As the air conditioner fix it company works in my home, I’ve read at least four articles that came across my computer about the signs of heat stroke. We too have written posts about dehydration in Two Peds in a Pod. Yet I wonder if our own inability to tolerate heat may be curtailing our kids’ activities. As one mom said to me, “I don’t want to send my kids outside, because I don’t want to go out with them.” 

Summer also makes me think “Ice Cream.” I am a great fan of the ice cream truck. In fact, I am friends with the ice cream man and pictured here is a photo of a beautiful gift he gave me before he left last summer. But I wonder if we use the heat as an excuse to give more ice cream and more sugar filled drinks such as lemonade than we do during the school year.  As much as we complain about school systems institutionalizing junk food as part of classroom celebrations and lunches, private camps are not necessarily better regulated.  And for the kids at home, parents often feel obligated to feed play dates “something fun.”

An American Journal of Public Health article in 2007 supports my observations. The study lead by Paul T. Von Hippel found a more rapid rate of weight gain (using body mass index) during kindergarten and first grade summers than during the school year. Unfortunately the study was not structured to shed light on the reasons behind the rate increase, but I’m thinking it’s us… the perfectly-coiffured-not-smelly parents who somehow on the way to adulthood forgot how to turn on the hose and play in the summer heat.

Naline Lai, MD with Julie Kardos, MD

©2011 Two Peds in a Pod®

What is it ? Pictured here are the toes of one of my best friend’s toddler. She is happy, has no fever, and plays nearly everyday in the neighborhood pool. The round shiny pink bumps and dots on her toes appeared yesterday morning and haven’t changed much in a day. They don’t seem to bother her very much… answer below.

Dozens of kids are pouring into our offices or calling from the shore because of swimmers ear. Time to bring up from the archives info about swimmer’s ear and ways you can prevent reoccurrence.

No set of blog posts about summer time plagues would be complete without a discussion on swimmer’s ear (Otitis Externa). 

Ear infections are divided into two main types: swimmer’s ear (otitis externa) and middle ear infections (otitis media).

An understanding of the anatomy of the ear is important to understanding the differences between the two types of infection.  Imagine you are walking into someone’s ear. When you first enter, you will be in a long tunnel. Keep walking and you will be faced with a closed door. The tunnel is called the external ear canal and the door is called the ear drum.

Swimmer’s ear occurs in the ear canal. Dampness from water, and it can be water from any source- not just the pool, sits in the ear canal and promotes bacterial infection.  

Next, open the door. You will find yourself in a room with a set of three bones. Another closed door lies at the far end.  Look down.  In the floor of the room there is an opening to a drainage pipe. This room is called the middle ear. This is where middle ear infections occur.

During a middle ear infection, fluid, such as during a cold, can collect in the room and promote bacterial infection.  Think of the sensation of clogged ears when you have a cold. Usually the drainage pipe called the eustachian tube,  drains the fluid.  But, if the drain is not working well, or is overwhelmed, fluid gets stuck in the middle ear and become infected. 

Because a swimmer’s ear infection occurs in the external canal, the hallmark symptom of swimmer’s ear is pain produced by pulling the outside of the ear.  Since middle ear infections occur farther down in the ear, pain is not reproduced by pulling on the outer ear.

Swimmer’s ear is treated topically by your doctor with antibiotic drops.  To avoid dizziness and discomfort when putting drops in, first bring the ear drop medicine up to body temp by holding the bottle in your hand.

Home remedies to prevent swimmer’s ear:

·     After immersion in the water, tilt your child’s head to the side and towel dry what leaks out. 

·         Mix rubbing alcohol and vinegar in equal parts.  After swimming, place a couple drops in the ear.  Do not put these drops in if there is a hole in your child’s eardrum. 

WE HAVE UPDATED THIS POST and added photos- please read it here. 

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 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.

If you look carefully at the photos above, 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.

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.

Because this virus is contagious through saliva, prevent kids from sharing cups, eating utensils, and tooth brushes and clean up toddler drool. This vigilance can 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.

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.

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, he does not drink enough to urinate his baseline amount, he is unconsolable or 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
©2011 Two Peds in a Pod®