Parents often ask how they can tell if their child has the flu or just a common cold. Here’s how:

Colds, even really yucky ones, start out gradually. Think back to your last cold: first your throat felt scratchy or sore, then the next day your nose got stuffy or then started running profusely, then you developed a cough. Sometimes during a cold you get a fever for a day or two. Sometimes you get hoarse and lose your voice. Kids are the same way. They often feel tired because of interrupted sleep from coughing or nasal congestion.

Usually kids still feel well enough to play and attend school with colds, as long as their temperatures stay below 101°F and they are well hydrated and breathing without any difficulty. The average length of a cold is 7-10 days although sometimes it takes two weeks or more for all coughing and nasal congestion to peter out.

Important news flash: the mucus from a cold can be thick, thin, clear, yellow, green, or white, and can change from one to the other, all in the same cold. The color of mucus does NOT tell you if your child needs an antibiotic and will not help you differentiate between a cold and the flu.

The flu, caused by influenza virus, comes on suddenly and makes you feel as if you’ve been hit by a truck. Flu always causes fever of 101°F or higher and some respiratory symptoms such as runny nose, cough, or sore throat (many times, all three at once). Children, more often than adults, sometimes will vomit and have diarrhea along with their respiratory symptoms. Usually the flu causes body aches, headaches, and often the sensation of your eyes burning. The fever usually lasts 5-7 days. All symptoms come on at once; there is nothing gradual about coming down with the flu.

So, if your child has a runny nose and cough, but is drinking well, playing well, sleeping well and does not have a fever and the symptoms have been around for a few days, the illness is unlikely to “turn into the flu.”

Remember: colds = gradual and annoying. Flu = sudden and miserable.

Fortunately, a vaccine against the flu can prevent the misery of the flu. In addition, vaccines against influenza save lives by preventing flu-related complications that can be fatal such as pneumonia, encephalitis (brain infection), and severe dehydration.  

Be sure to read our article on ways to prevent colds and flu and our thoughts on over the counter cold medicines.  Now excuse us while we go out to buy really yummy smelling hand soap to entice our kids to wash germs off their hands. After that you’ll find us cooking up a pot of good old-fashioned chicken soup, just in case…

Julie Kardos, MD and Naline Lai, MD
revised from a Sept 2009 post

©2014 Two Peds in a Pod®

Does it make sense to change your car’s tires one at a time? (A vaccine parable)

Ron was puzzled. He had been a mechanic for many years, and had known Ms. McCarthy through two previous vehicles. But what could he say to a request like this?

“I don’t see why you wouldn’t want to do it this way. What’s the harm?” The mother of two seemed sincere and earnest. Ron knew she wanted to take good care of her car, and the kids who rode with her every day.

“It’s just not done this way. You need four new tires, let’s just replace them all at once.” Ron stuck his finger into a well-worn tread, showing his customer how shallow the grooves had become.

“But isn’t that too hard on the car? I mean, that seems like a lot to do, all at once. Let’s space them out, one tire every two weeks. I’ll just come back.”

Ron scratched his head. Cars: that’s what he knew. Light trucks, electrical systems, AC systems too. He had even studied and learned how to fix and maintain foreign cars, and hybrids, and the newer electric cars—more computer than car, really. If it rolled on wheels, Ron knew how to fix it. It was his job.

“No, you see, it’s a safety thing. A tire could blow—see how bare these are? And you won’t get good steering on these, which is also unsafe.” Safety, thought Ron, that will convince her. He took safety very seriously, and imagined that this nice lady with the kids would put safety first. “Besides, cars are designed to have their tires replaced. Tires wear out, so the car was designed to safely go up on this lift so we can replace the tires. No problem!”

“But how do I know it’s safe? I read on the internet that replacing all of the tires at once can stress out the suspension, and lead to premature angulation of the mesmerglobber, and on Oprah I saw this actress and she said three months after she had all four tires replaced, her transmission broke!” Ms. McCarthy started to sob.

“OK, look, it’s ok, look, um…” Ron looked for one of his less-greasy rags to offer as a handkerchief.

“Waiting a few weeks between each tire won’t really hurt, will it?”

“Probably it’ll be OK, I guess. But tires are an important part of your safety system, like good brakes and seat belts and air bags.”

“Oh, I make sure we never wear seat belts! I heard that once a guy was wearing his seat belt, and he went into a lake, and he couldn’t get it off, and he drowned! I’m not wearing anything that isn’t 100% safe!”

Ron felt lost. “Look, nothing’s 100% safe! A seat belt might occasionally make an accident worse, but 99 times out of 100 it’s much better to wear your belt.”

“I can’t risk that 1 out of 100 chance!”

The mechanic tried another avenue. “But it’s the law, you have to wear your seat belt, and your kids need to be in the right kind of car safety seats too.”

Ms. McCarthy’s eyes grew dark. “Yeah, the law. That’s just it—the government is forcing these seat belts and new tires on us, because the government is controlled by the car manufacturers and the insurance industry! If seat belts really saved lives would there have to be a law about it? That’s why I disconnected my front brakes.”

“What?”

“The front brakes are just a booster anyway. If the brakes work as well as they’re supposed to, why do we need a booster? It’s just more money, it’s all about the money!”

Ron had been fixing cars for years, and he owned his own shop. He made pretty good money, but selling new tires and simple brake maintenance jobs weren’t really profitable. He did those things to keep cars running well, and to prevent bigger problems later. In fact, if he let more rotors go bad and transmissions fail, he’s probably make even more money from the expensive jobs needed to fix them.

“Tell you what—I’ll fix up your brakes for free, just my cost for parts, OK? Really, it’s not safe for you and the other drivers if you don’t have good brakes and tires.”

“What do you mean, the other drivers? They have their own brakes! That’s exactly what this web site I found was explaining, that you’d come up with all of these dumb reasons to take more of my money and hurt my car! You’re not really interested in keeping my car healthy, are you?”

Are you?

Roy Benaroch, MD
©2014 The Pediatric Insider 

In practice near Atlanta, Georgia, Dr. Roy Benaroch is an assistant clinical professor of pediatrics at Emory University, a father of three, and the author of  The Guide to Getting the Best Health Care for your Child and Solving Health and Behavioral Problems from Birth through Preschool. We enjoy his blog The Pediatric Insider and also enjoy his posts on Web MD.

When I was a child, a special treat was to have a sleepover at my grandparents’ house. My grandfather was an early riser and to this day I can still hear him roaring “When Pop-Pop’s up, EVERYBODY’S UP!” as I awoke to the aroma of my grandmother’s hot breakfast.

As all parents know, when BABY’s up, EVERYBODY’s up. What‘s the secret to good sleep? It’s all in the bedtime routine.

Parents should establish a good bedtime routine when their children are babies and should continue to enforce the routine until their children grow up and leave home. Just as prevention of heart disease begins with establishing healthy eating and exercise habits when your children are young, prevention of adult insomnia starts with establishing a healthy bedtime routine.

Here are ways to help your kids sleep from infancy through young adulthood: Start with our most commented upon podcast: how to help your baby to sleep through the night. Parents of preschool-aged kids will appreciate“sleep invaders”: nightmares, night terrors, and other monsters under the bed.  Even if you don’t have a teen, read our post on the Tired Teen.

Now that winter break is a memory, it’s time to buckle down and rid your child of the jet lag that persists from the “vacation sleep schedule.” For more ways to do this, refer to “Get your child back on a school sleep schedule.”

May you have a good night this and every night!

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

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