Photo quiz: what causes brown spots on feet?

brown spots on feetWhat 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®


Holy Cannoli, Two Peds in a Pod® turns ten!


Two Peds in a Pod® turns 10 years old

This little ten-month-old wishes Two Peds in a Pod® a happy ten-YEAR-old birthday!

Let’s take a stroll back ten years to 2009. Ten years ago Facebook was just five years old. Back then there was no Instagram (2010), no Pinterest (2010), no Snapchat (2011).  People were mesmerized by virtual vegetable picking (FarmVille) and taking care of Zhu Zhu pets. Bulky video gaming consoles ruled. The “New” Super Mario Bros. Wii really was “new.” Apple’s “pile of poo” emoji had just arrived the year before. And ten years ago, Two Peds in a Pod® was born. The idea that doctors would write advice on the internet was so novel that even NPR thought the concept worthy of a story. Today we take a Happy Birthday look back at our first five posts:

Then and now

Our blog’s first five posts, from the summer of 2009, include the very same topics parents ask us about now in the summer of 2019. 

Back then parents wondered about infant sleep, or lack thereof. Please note that we began our infant sleep podcast with the reminder that newborns are not meant to sleep through the night. Fisher Price should have listened to our podcast, because now in 2019 we are writing about rock‘ n play recalls

Two posts tackled  Potty training and picky eating. Spoiler to both posts: you can lead a horse to water but you can’t make him drink!These days, we’re still talking about both topics in the office. But now, people also ask about the need for probiotics to regulate bowels and digestive health in their child. Unfortunately, in 2019 probiotics have not panned out to be the hoped-for panacea for all gastrointestinal ailments. But they are helpful in some types of diarrhea

In 2019 we talked about the tick borne illness Lyme disease and we’re still talking about ticks now. As for the  mystery object Dr. Lai found in a drawer, ten years later the models are kinder and sport a raised lip instead of a contraption that can break off. 

Blog writing a decade later

Internet traffic has grown exponentially. Possibly because of so many sources of misinformation, we see more and anxious parents who receive conflicting information about how to raise their kids. We depend on you to let your friends know about this site. We would rather spend more time on writing than on search engine optimization. Despite the congested writing climate, our mission (read our maiden voyage) remains the same, to bring you practical pediatric advice. What fuels us? Our intense and comprehensive pediatric training from Children’s Hospital of Philadelphia, our combined over forty years of practicing pediatrics, and our passion for helping children and their families, give us the experience and the motivation to continue to help all of you whether online or in our offices.

A last blast from the past

How many of you remember our initial logo penned by the combined efforts of Dr. Kardos’s brother and her sister-in-law? That’s an iPod dangling from Dr. Lai’s neck-remember those?

two peds in a pod original icon

It’s good to be ten.

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



More ticks: We’re in Good Housekeeping and an infographic on where ticks hide


where ticks hide

Where ticks hide.

During tick season ticks love to snuggle up and hide on kids. When you check your kids for ticks, make sure you look in all the places pictured above in our infographic “Where ticks hide.” Find one? We’re quoted in Good Housekeeping talking about ticks. Click here to read on about common questions such as, What happens when you squeeze a tick? and What do you do if a tick’s head stays embedded?

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


Ick! My kid has a tick!

my kid has a tick

ick, a tick

My kid has a tick!

Our office phones were ticking with calls about ticks this week. In our area of Pennsylvania, it seems that no walk in the park is complete without hosting a tick or two. Save yourself a phone call, and read here to learn how to remove a tick from your child.

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



When your dad is a pediatrician, a Father’s Day tale

When your dad is a pediatrician, medicals school graduation is extra special.

Medical school graduation 1994: Dr. Julie Kardos with her pediatrician dad, Dr. Stephen Kardos

When your dad is a pediatrician

When your dad is a pediatrician, you never get to stay home from school for illness, feigned or real. Unless you are vomiting.

When your dad is a pediatrician, people call your home phone and ask you about symptoms of chickenpox, even when you are only ten years old.

When your dad is a pediatrician, you sit in booster seats long after your friends “outgrow” theirs.

When your dad is a pediatrician, you know to give that kid who feels like he is going to pass out in marching band at the 95 degree football game Gatorade or juice, not just plain water, because of “electrolytes.”

When your dad is a pediatrician, you do not have a curfew as a teen, because he is more concerned about you or your friend speeding to get home in time than about what time you get home.

When your dad is a pediatrician and you call home from college with an illness, he makes you go to Student Health because he knows it is very difficult to diagnose an illness on the phone. And he will NOT “just call in an antibiotic.”

When your dad is a pediatrician, you have extra security when leaving him to watch your own children, because not only will he show his grandchildren a grand time, but also he will know what to do if they get sick.

Thank you, Dad.
Happy Father’s Day!

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


How to treat eczema or atopic dermatitis

eczemaIt’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. Continue Reading


New national guidelines for water safety, and free swim lessons in Bucks County


water safety guidelines apply on beaches as well as pools

When one of Dr. Lai’s kids was around two years old, she deliberately let go of Dr. Lai’s hand when wading in waist high water. She exclaimed, “Look mommy, I can swim!” But she couldn’t, and as she started to sink, Dr. Lai scooped her up. What if she had taken swim lessons? Would that have been enough to prevent drowning? It may have helped, but that’s not enough. Kids need layers of protection to prevent tragedy in water.

Just in time for summer, we have new evidence about drowning prevention for both young kids and teens. Read on for updated swimming and water safety tips and an offer for free swim competency lessons for older kids.


Who is most at risk for drowning?

Children age 4 years and younger.

Most of these kids drown when parents do not realize kids have access to water. Think bathtubs, buckets, and toilets as well as ponds, puddles, and pools. Drowning is silent. Parents need to always watch their children around any body of water.

Adolescents aged 15-19.

Several factors contribute, including under-estimating risk (strong tides, swimming out too far), overestimation of skills, and substance use. Be sure to discuss rules of swimming with all of your children even if they are strong swimmers, and instruct them never to swim alone or without a lifeguard. Set an example yourself by wearing life jackets while boating and abstain from alcohol consumption. Alcohol contributes to half of all boating accidents in the United States.

Kids with autism.

Like children with other behavioral disabilities, they often wander away from adults without warning.

Children with seizure disorders.

Drowning is the leading cause of accidental death in children with epilepsy. Like ALL children, kids who have seizures should never be left alone for even a second in pools or baths.

Kids with a predisposition to cardiac arrhythmias.

If your family has a history of heart arrhythmias (eg. Long QT, Brugada syndrome, Ventricular tachycardia), unexplained sudden death at a young age, or an unexplained drowning, bring it to your pediatrician’s attention. In your child, let your pediatrician know about any fainting/near fainting episodes, “funny” heart beats, or chest pain.


When should I start swim lessons for my child? Continue Reading


What do Rock ‘n Play and socks have in common? They’ve both been recalled this year. Predicting what’s up next:

child product recall

Whenever we look at the child product recall lists from The Consumer Protection Safety Commission (CPSC), it never fails to amaze us that even big brand names crop up in product recalls for children. Ironically, most are not new-fangled products. Bouncer seats, high chairs, rattles, and bicycle helmets are often amongst the recalls. We figure after decades of baby product manufacturing, designers and production managers would understand what constitutes a potential hazard for kids.

We urge you to scrutinize the kid merchandise in your house and identify the potential hazards before your child ends up as the reason a product is on the CPSC list. In fact, you might have already missed a recall on your older products. According to, child product recalls occur a couple of times a week, but when a baby product is recalled, only 10-30 percent are ever retrieved. Because recalls occur AFTER injury or death occurs, it is better if parents assess the safety of child products before a recall.

Here are some common reasons for recalls:

Products fail to adhere to the American Academy of Pediatrics safe sleep guidelines. We know parents of crying young infants are often desperate to get some sleep themselves, but many sleep products are not studied. If it seems too good to be true, it probably isn’t. Infants are not ready developmentally to sleep through the night, so any product that promises to help your infant sleep through the night is, by definition, problematic. An example is the Rock ‘n Play sleeper which was recently recalled. The soft squishy inclined cradles clearly did not adhere to the safe sleep guidelines, but often we heard a parent say, ”But that’s the only place they will sleep.” Unfortunately, this recall does not undo the deaths of the 32 reported babies who died in the sleeper. In the wake of the recall, other companies who make similar sleepers are also recalling their products.

We cringe every time a family tells us they are using a new fangled piece of wrap-around-baby sleep gear or sleeping contraption, because
most involve soft surfaces (not advised), inclined surfaces (not advised) or things-in-the-crib-other-than-your-baby (also not advised). Continue Reading


Your mother was right! Health tips from mom

mom health advice
Do you ever wonder if some of the health advice your mom gave you growing up was actually correct?

On this Mother’s Day, we credit those moms who really do know a thing or two about child health.

1- Give your child chicken soup when she is sick.
There is merit to chicken soup. Children need to drink extra fluids when they are sick. Fevers, coughs, diarrhea, vomiting, and infections all can contribute to dehydration. Chicken soup is a great tasting fluid, has electrolytes (salt), and the vegetables that you cook in it leak all of their vitamins into the soup. Basically this is homemade “smart water” heated up. An added bonus: the chicken gives kids protein they need to fight infection.

If your child does not like chicken soup, you can hydrate them with water, apple juice, or milk (yes, kids can drink milk even if they have a cough or a fever).

2-Wear your gloves.
Moms do know how to dress kids for cold weather. Gloves are important because fingertips are at risk for frostbite. So are noses, but you can’t put gloves on that appendage.

3- Give honey for a cough.
We have written about this before- honey beats out placebo and even cough medicine in a few studies of parents’ perception of children’s sleep when sick with a cough. You can put it into tea, warm or cold milk, or give it straight off a spoon. Just be sure to brush their teeth afterward. And we remind you to NOT give honey to babies younger than one year of age because of concern for infant botulism.

4- Get some Vitamin D.
While we advise sunscreen for when your kids play outside, she is right that vitamin D , which comes from sun exposure and certain foods, is important. It not only contributes to bone health, but also modulates the immune system. Just focus on providing vitamin D-containing foods rather than tanning sessions. Continue Reading