Resolve to raise self-esteem, foster a sense of security, and encourage independence in your children in the new year. Here are our top parenting ideas for this year:

1-Read aloud to your children, even if they already know how to read to themselves.

2-Get rid of the smart phones at the dinner/lunch/breakfast table and turn off the TV. Focus on food and family instead.

3-Compliment your child’s effort – from using the potty, to dressing himself, to not fighting with a sibling. Praise the effort, not the outcome.

4-Teach a new skill  such as how to fold socks, how to cook eggs, how to put a book back neatly in a bookshelf, how to do his algebra correctly.

5-Have your child do something he’s never done to encourage independence. For example, have your 6 year old order for himself at a restaurant, have your 9 year old call and arrange his own get-together with a friend before you get on the phone with the parent, or have your tween call (on the phone, not “googling”) a store to find out what time it opens.

6-Tell a personal anecdote in order to teach a lesson. For a young child, tell them how: “I remember when I forgot to wear my gloves and my hands were SOOO cold…”

7-Listen to your child when he talks to you. Put down the phone, put down the newspaper, turn off the TV, put aside the mail, and really pay attention.

8-Make your child laugh daily. Tell a corny joke, make a funny face, read a funny book, play a funny game, whatever it takes.

9-Tuck your child into bed or at least visit your teen’s room before he goes to sleep. Bedtime brings out stories from your children you might not hear about during the day. And it shows you care about them.

10-Hug them. Even if they are now bigger than you are. Remind your child that you will always be there for him.

Wishing you all a happy and healthy 2014,

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

We have seen many patients with nasty colds lately, and we know that a few cases of flu recently popped up in our area of the United States.  Take a look at  “Top Ten Ways to Prevent Colds and Flu,” a post we wrote recently for Mom365, to get your kids through cold and flu season. 
 
To keep yourself updated on the status of the flu, check the  Centers for Disease Control flu tracker.

The bad news: thus far three pediatric deaths from flu were reported for this 2013-2014 flu season. The good news: the latest allergy guidelines say that even egg-allergic kids, unless they have a history of anaphylaxis (difficulty breathing) to egg, can safely receive the flu vaccine. Talk to your child’s doctor if your egg-allergic child has never received flu vaccine.

Stay healthy and WASH YOUR HANDS,

Julie Kardos, MD and Naline Lai, MD

©2013 Two Peds in a Pod®

We love being pediatricians because it’s an honor to be a part of your family, it’s intellectually challenging, and it gives us a chance to teach. But mostly, we love to make people feel better.
We love not only when our patients feel better, but also when their parents feel better.

Parents feel better when we say:

Not strep throat. It’s a viral sore throat.
Not pneumonia. It’s a viral cough.
Not a broken foot. It’s an ankle sprain.
Not appendicitis. It’s constipation.
Not an ear infection. It’s fluid behind her ear drum.
Not cancer. It’s a lymph node infection.

In other words, our favorite diagnosis is “Not what you are worried about.”

Parents, including us, fear the worst when their children are ill. Some parents apologize to us when we give the diagnosis of “Not what you are worried about.” They feel they have wasted our time or their time. But this diagnosis is never a waste of time for anyone. It is a stress relieving, sometimes guilt relieving, diagnosis that we are happy to give. Too often we wish with all our hearts that we could give this diagnosis, but instead, we must confirm a parent’s fears.

 So this Thanksgiving, we take time to be grateful for the diagnosis “Not what you are worried about.”

May you find lots of Happy in your Thanksgiving.

With gratitude,

 Drs. Kardos and Lai
©2013 Two Peds in a Pod®

A five-year-old boy in the office last week said he planned to go home after his checkup and play “Elf on the Shelf.” In the game, he perches very still in a hiding spot in his house with one leg crossed and both hands on his knee, gazes into the distance, and waits for his sister to find him.

Yup, its that time of the year. Before you know it, a “real” Elf on the Shelf or perhaps a Mensch on a Bench may be visiting your home and you’ll be thinking about holiday gifts. Now that your families are another year older, we brought back our holiday gift idea list arranged by ages and developmental stages.

0-3 months: Babies this age have perfect hearing and enjoy looking at faces and objects with contrasting colors. Music, mobiles, and bright posters are some age appropriate gift ideas. Infants self sooth themselves through sucking- if you can figure out what your nephew’s favorite type of binkie is, wrap up a bunch-they are expensive and mysteriously disappear.

3-6 months: Babies start to reach and grab at objects. They enjoy things big enough to hold onto and safe enough to put in their mouths- try bright colored teething rings and large plastic “keys.” New cloth and vinyl books will likewise be appreciated; gnawed books don’t make great hand-me-downs.

6-12 months: Around six months, babies begin to sit alone or sit propped. Intellectually, they begin to understand “cause and effect.” Good choices of gifts include toys with large buttons that make things happen with light pressure. Toys which make sounds, play music, or cause Elmo to pop up will be a hit. For a nine-month-old old just starting to pull up to standing, a water or sand table will provide hours of entertainment in the upcoming year. Right now you can bring winter inside if you fill the water table with a mound of snow. Buy some inexpensive measuring cups and later in the summer your toddler will enjoy standing outside splashing in the water.

12-18 months: This is the age kids learn to stand and walk. They enjoy things they can push while walking such as shopping carts or plastic lawn mowers. Include gifts which promote joint attention. Joint attention is the kind of attention a child shares with you during moments of mutual discovery. Joint attention starts at two months of age when you smile at your baby and your baby smiles back. Later, around 18 months, if you point at a dog in a book, she will look at the dog then look back at you and smile. Your child not only shows interest in the same object, but she acknowledges that you are both interested. Joint attention is thought to be important for social and emotional growth.

18-24 months: Although kids this age cannot pedal yet, they enjoy riding on toys such as big wheels “Fred Flintstone” style. Dexterous enough to drink out of a cup and use a spoon and fork, toddlers can always use another place setting. Toddlers are also able to manipulate shape sorters and toys where they put a plastic ball into the top and the ball goes down a short maze/slide. They also love containers to collect things, dump out, then collect again.

Yes, older toddlers are also dexterous enough to swipe an ipad, but be aware, electronics can be a double edged sword— the same device which plays karaoke music for your daddy-toddler sing-along can be transformed into a substitute parent. The other day, a toddler was frighted of my stethoscope in the office. Instead of smiling and demonstrating to her toddler how a stethoscope does not hurt, the mother repeatedly tried to give her toddler her phone and told the child to watch a video. Fast forward a few years, and the mother will wonder why her kid fixates on her phone and does not look up at the family at the dinner table. Don’t train an addiction.

2-3 years: To encourage motor skills, offer tricycles, balls, bubbles, and boxes to crawl into and out of. Choose crayons over markers because crayons require a child to exert pressure and therefore develop hand strength. Dolls, cars, and sand boxes all foster imagination. Don’t forget those indestructible board books so kids can “read” to themselves. By now, the plastic squirting fish bath toys you bought your nephew when he was one are probably squirting out black specks of mold instead of water- get him a new set.

3-4 years: Now kids engage in elaborate imaginary play. They enjoy “dress up” clothes to create characters- super heroes, dancers, princesses, kings, queens, animals. They become adept at pedaling tricycles or even riding small training-wheeled bikes. Other gift ideas include crayons, paint, markers, Play-doh®, or side-walk chalk. Children this age understand rules and turn-taking and can be taught simple card games such as “go fish,” “war,” and “matching.” Three-year-olds recognize colors but can’t read- so they can finally play the classic board game Candyland®, and they can rote count in order to play the sequential numbers game Chutes and Ladders®.

5-year-olds: Since 5-year-olds can hop on one foot, games like Twister® will be fun. Kids this age start to understand time. In our world of digital clocks, get your nephew an analog clock with numbers and a minute hand… they are hard to come by. Five-year-olds also begin to understand charts— a calendar will also cause delight. They can also work jigsaw puzzles with somewhat large pieces.

8-year-olds: Kids at this point should be able to perform self help skills such as teeth brushing. Help them out with stocking stuffers such as toothbrushes with timers. They also start to understand the value of money. The kids will appreciate gifts such as a wallet or piggy bank. Eight-year-olds engage in rough and tumble play and can play outdoor games with rules. Think balls, balls, balls- soccer balls, kickballs, baseballs, tennis balls, footballs. Basic sports equipment of any sort will be a hit. Label makers will also appeal to this age group since they start to have a greater sense of ownership.

10-year-olds: Fine motor skills are quite developed and intricate arts and crafts such as weaving kits can be manipulated. Give a “cake making set” (no not the plastic oven with a light bulb) with tubes of frosting and cake mix to bake over the winter break. Buy two plastic recorders- one for you and one for your child to play duets. The instrument is simple enough for a ten year-year-old or a forty-year-old to learn on their own. Ten-year-olds value organization in their world and want to be more independent. Therefore, a watch makes a good gift at this age. And don’t forget about books: reading skills are more advanced at this age. They can read chapter books or books about subjects of interest to them. In particular, kids at this age love a good joke or riddle book.

Tweens: Your child now has a longer attention span (30-40 minutes) so building projects such as K’nex® models will be of interest to her. She can now also understand directions for performing magic tricks or making animal balloons. This is a time when group identity becomes more important. Sleepovers and scouting trips are common at this age so sleeping bags and camping tents make great gifts. Tweens value their privacy – consider a present of a journal with a lock or a doorbell for her room.

Teens: If you look at factors which build a teen into a resilient adult, you will see that adult involvement in a child’s life is important. http://www.search-institute.org/research/developmental-assets

We know parents who jokingly say they renamed their teens “Door 1” and “Door 2,” since they spend more time talking to their kid’s bedroom doors than their kids. Create opportunities for one-on-one interaction by giving gifts such as a day of shopping with her aunt, tickets to a show with her uncle, or two hours at the rock climbing gym with dad.

Encourage physical activity. Sports equipment is always pricey for a teen to purchase- give the fancy sports bag he’s been eying or give a gym membership. Many teens dislike sweating because they fear sweat will promote acne—treat them to moisture wicking shirts and elaborate acne regimes from the high-end department store make-up counter.

Enjoy your holiday shopping!

Naline Lai, MD and Julie Kardos, MD
©2013 Two Peds in a Pod®

We welcome back health coach Mary McDonald (the mom who overhauled her kids’ sports snack stand), to provide advice on how to survive what Dr. Shifrin referred to last week as Candy Season.
—Drs. Lai and Kardos

If your home is like mine, you have an extraordinary amount of Halloween candy lurking in the most unusual locations:  inside an old roasting pan, under a pile of shoes in your daughter’s closet, or tucked in an end table drawer in your living room.  It’s an incredibly hard time of the year to eat healthy and to help your children make good food choices when sweets are so abundant from October to January.  It is disturbing to think about the bad eating habits that start at the holidays and can lead to an addiction to sugar throughout the rest of the year.  In order to combat the inevitable onslaught of sugary treats, here are a few strategies to consider:

1. Invite the “Switch Fairy” or “Switch Witch” to your home. If you’re tired of telling your children, “Step away from the candy!” then make sure it isn’t easy to access. Your kids will love you if you tell them the Switch Fairy will visit your home tonight to replace the candy with a toy, clothing, or their favorite item.  Keeping sweets out of sight will make it easier to replace the candy with a healthier option, such as fruit salad or a yogurt parfait. 
2. So, what can the Switch Fairy do with the extra sweets? Contact your local dentist or do an online search for candy donation sites.  Many local organizations will buy back Halloween candy. This becomes a perfect way to subsidize the present that the Switch Fairy purchases. 
3. Drink Water.  Staying hydrated is a great way to curb cravings.  When you crave sweets, there’s a good chance that you’re actually dehydrated and your brain is craving water.  When your kids are tired, instead of  reaching for a-little-something-sweet as a pick-me-up, try giving them a drink of water. You may be surprised that their cravings are reduced. Are you looking to make water more enticing?  Try purchasing a swirly straw and designate the straw for water only.
4. Don’t drink soda.  Soda is nothing but liquid sugar and void of any nutrition.  Each 12-oz. can of Coke contains approximately 10 teaspoons of sugar.  An easy way to reduce your sweets during the holiday season is to select water as your drink of choice.  If your child must have a soda, suggest splitting the can with your child or with a friend.  Pour a few ounces into each cup and throw away the rest.  It’s okay. 
5. Increase your carbs!  Yes, you heard me correctly.  For years, carbs were given a bad rap.  Low carb diets promoted the idea that all carbs are created the same.  In fact, they are not.  Natural carbohydrates (the ones found in fruits and vegetables such as sweet potatoes, carrots, bananas, and oranges) can help reduce your cravings for sweets.  Try reaching for one of these options before you go for a cookie.  For an added bonus, wash this snack down with a big glass of water.  You will be really surprised at how quickly you cure your sugar craving. Make fruit or veggies more exciting by using toothpicks to pick up the food.  See how many green peas you can fit on a toothpick.  Make it fun – who doesn’t like a pea eating competition?
6. Chew Gum.  According to research from the University of Rhode Island, people who chewed gum consumed 68 fewer calories at lunch and did not compensate by eating more later in the day. Chewing gum also helped the study participants satisfy their cravings and resist fattening treats. And there’s more: Gum chewers actually burned about 5% more calories than non-gum chewers.
7. Just say no.  Social pressure to join in and eat what others are eating can be overwhelming.  Most people are very receptive when you say, “No thanks, I’m full.”  Tell your children that it’s okay to “Just Say No”, whether you’re talking about food or other temptations.
8. Cook from scratch.  Cooking, especially with your children, is a wonderful way to control the ingredients that are in the food that you eat.  There are many wonderful natural substitutions to cane sugar (stevia, agave syrup, maple syrup, dates, raisins, etc.) that provide an equal amount of sweetness to your food.  Become a scientist and experiment with alternative sweeteners.  Click here for recipe ideas. 
9. Understand your labels.  Did you know that every 4 grams of sugar = 1 teaspoon of sugar?  Understanding the basics of a nutrition label is critical to understanding what you are eating. 

So, as you and your family weave your way through the sweetest months of the year, think of inviting the Switch Fairy to your house for a home cooked meal full of natural carbs and a big cup of water.

Mary McDonald
©2013 Two Peds in a Pod®

Mary McDonald holds a Masters of Education from Arcadia University and completed her health coach certification from Institute of Integrative Nutrition.  She is a high school teacher, a mom of four daughters, and an advocate for healthy food choices.  For more information on her health coaching services, please contact her at nutrition101withmary@gmail.com or visit her website at nutrition101withmary.com.

We enjoyed meeting Pediatric media expert Dr. Don Shifrin, whose interviews have appeared in numerous publications including Good Housekeeping, the Wall Street Journal, and Time blogs. Today he writes about the “fifth season” of the year. 
—Drs. Kardos and Lai

We’ve heard some interesting things about cow’s milk over the years. I am going to share with you four myths about milk that I continue to hear from my patients’ parents. Spoiler: reading myth #4 can save you lots of money.

Myth #1: Don’t give milk to a child with a fever, the milk will curdle (or some other variant).

Truth: As long as your child is not vomiting, milk is a perfectly acceptable fluid to give your febrile child. In fact it is superior to plain water if your child is refusing to eat, which is very typical of a child with a fever. Fevers take away appetites. So if your child stops eating while she is sick, at least she can drink some nutrition. Milk has energy and nutrition, which help fight infection (germs). Take milk, add a banana and a little honey (if your child is older than one year), and maybe some peanut butter for added protein, pour it into a blender, and make a nourishing milk shake for your febrile child. Children with fevers need extra hydration anyway. Even febrile infants need formula or breast milk, NOT plain water. The milk will not curdle or upset them in any way. If, on the other hand, your child is vomiting, then stick to clear fluids until her stomach settles.

Myth #2: Don’t give children milk when they have a cold because the milk will give them more mucus.

Truth: There is NOTHING mucus-inducing about milk. Milk will not make your child’s nose run thicker or make his chest more congested. Let your runny-nosed child have his milk! Yet my own mother cringes when I give my children milk when they have colds. Never mind my medical degree; my mom is simply passing on the wisdom of HER mother which is that you should not give your child milk with a cold. Then again, my grandmother also believed that your body only digests vitamin C in the morning which is why you have to drink your orange juice at breakfast time. But that’s a myth I’ll tackle in the future.

Myth #3: You can’t over- dose a child on milk.

Truth: Actually, while milk is healthy and provides necessary calcium and vitamin D, too much milk CAN be a bad thing. To get enough calcium from milk, your child’s body needs somewhere between 16 to 24 ounces of milk per day. Of course, if your child eats cheese, yogurt, and other calcium-containing foods, she does not need this much milk. New recommendations for healthy Vitamin D requirements have been increased recently to 400 IU (international units) daily which translates into 32 ounces of milk daily. BUT we pediatricians know from experience that over 24 ounces of milk daily leads to iron-deficiency anemia: calcium competes with iron absorption. You’re better off giving an over-the-counter vitamin such as Tri-Vi-Sol or letting older children chew a multivitamin that contains 400 IU of vitamin D. In addition to iron-deficiency anemia, drinking all that extra milk is bad for teeth (all milk contains sugar) and can also lead to obesity from excessive calories or can in fact lead to poor weight gain in children who are picky eaters to begin with: the milk fills them up too much for them to have any appetite left for food.

Myth #4: Organic milk is healthier than non-organic milk.

Truth: If you compare organic milk to non-organic milk, the nutrients on the label of the milk carton are the SAME. “But what about the growth hormones in milk,” you may wonder. First of all, cows may be supplemented with growth hormone, but their milk is not. In addition, let me explain about growth hormone. Some children are actually born without growth hormone, and other kids develop growth hormone deficiency because of kidney failure, or cancer treatment, or other medical problems. These children need supplemental growth hormone. Unfortunately for these kids, the only way that we have to give growth hormone to these kids is by injection (a shot) every day. Do you know why? Growth hormone gets DIGESTED in the stomach and is not active if a child eats/drinks it. SO, even if non-organic milk contained growth hormone (which it doesn’t) then your child would have no effects of it anyway because their guts would break it down before it could act on their bodies. WHEW! So unless you just like the taste better, you do NOT have to spend twice as much money on organic milk. Just buy regular milk. Put that extra money away in your college funds.

In summary, you can safely continue serving your children milk in sickness and in health, in moderation, at a lower cost than organic, every day. Now, all this talk about milk really puts me in the mood to bake cookies…

Julie Kardos, MD with Naline Lai, MD
©2013 Two Peds in a Pod®

Update: Please read this article , by the American Academy of Pediatrics in 2012, for a comprehensive, unbiased review of the data comparing health benefits of conventional vs organic milk and other foods–Drs. Kardos and Lai, October 6, 2013.

Revised from the original post from 10/5/2009

Pediatricians associate Back to School with “Time to get your flu vaccine.” At least this pediatrician mom does. As I try to figure out when I can get my own three children over to my office to get their flu vaccines, we want to give you a flu vaccine update.

Good News.

Last year we responded to your concerns about arsenic in food, particularly rice, and shared with you the FDA’s recommendation at that time.

We are relieved that after considerable research which included analyzing over 1300 samples of rice products, the FDA scientists determined that “… the levels of inorganic arsenic found in the samples are too low to cause immediate health damage.” Please see this link for the details of the investigation and recommendations.

Bottom line: continue to offer a well-balanced diet to your children and vary the types of grains that you serve to your families.

Julie Kardos, MD and Naline Lai, MD
©2013 Two Peds in a Pod®