According to recent US Census data, 30 percent of households have a child under six years of age. So there is a good chance that you are wondering what to get a baby, toddler or preschooler for the holidays. Before you give up and fall back on electronic screen ideas like you did when you last took your toddler to a restaurant,  here are holiday gift ideas for babies, toddlers, and preschoolers from your Two Peds, by ages and stages of development:

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-soothe through sucking—if you can figure out what your nephew’s favorite type of binky is, wrap up a bunch—they are expensive and often disappear mysteriously.

3-6 months: Babies start to reach and grab at objects. There are all sorts of crinkly, textured baby toys out there for babies to enjoy.  Give items big enough to hold onto but safe enough to put in their mouths. Remember that any object small enough to fit inside a paper towel tube is small enough to be a choking hazard.  Personalize a cloth or vinyl book. The baby will appreciate the book and parents will enjoy the personalization and ability to clean the book.

6-12 months: Around six months, babies begin to sit up. Intellectually, they begin to understand “cause and effect.” Good choices of gifts include toys that allow a baby to activate- to make sounds, play music, or cause animals to pop up.

For a nine-month-old just starting to pull herself up to a standing position, 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 a 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. Give gifts which promote joint attention. Joint attention is the kind of attention a child shares with people during moments of mutual discovery. Joint attention starts at two months of age when a parent smiles at their baby and their baby smiles back. Later, around 18 months, if a parent points at a dog in a book, the child will look at the dog, then look back at the parent, and smile. A child not only shows interest in the same object, but will acknowledge that both she and the parent are interested. Joint attention is thought to be important for social and emotional growth.

Toddlers enjoy making music: there are plenty of percussion sets out there! 

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. Avoid the marble runs though, this age still puts choking hazards in their mouths. They also love containers to collect things, dump out, then collect again.

This is the age when kids love making animal sounds. Consider a zoo membership . When you count up how many words your toddler knows, animal noises count as words. (What does the lion say? “Roar!”) Many zoos have animal cams that you can first watch from afar. Pair with a stuffed animal and the entire family will enjoy making animal sounds together. 

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. Swiping a phone or ipad does not develop fine motor skills in the same fashion. 

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 niece last year are probably squirting out black specks of mold instead of water- get her a new set. 

At three years, kids become more and more capable of self care. They start to pull shoes on themselves and can hang their coat up on a hook. The problem? They often can not reach hooks. Offer to purchase a set of cute hooks to hang low in your grandchild’s room or the mudroom. 

Preschooler gifts

3-4 years: Now kids engage in elaborate imaginary play. They enjoy “dress up” clothes to create characters- superheroes, dancers, wizards, princesses, kings, queens, animals. Kids also enjoy props for their pretend play, such as plastic kitchen gadgets, magic wands, building blocks, pretend food and of course, a stethoscope. They become adept at pedaling tricycles or even riding small training-wheeled bikes and balance bikes. Other gift ideas include art supplies such as  paint, markers, or side-walk chalk. Play-doh helps develop fine motor skills and hand strength. 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®. Preschool kids now understand and execute the process of washing their hands independently. One problem: they can’t reach the faucets on the sink. A personalized, sturdy step stool will be appreciated for years. Likewise, they love to help cook and will use a kitchen counter standing step with study sides for years to come.

Looking ahead, in the spring, a three or four-year-old may start participating in team sports (although they often go the wrong way down the field) or in other classes such as dance or swimming lessons. Give your relatives the gift of shin guards and soccer balls with a shirt. Offer to pay for swim lessons and package the gift certificate with a pair of goggles.

While three-year-olds still do not understand time, four-year-olds start to appreciate time better. Concepts such as yesterday and tomorrow take on more meaning. A good starter clock is a color clock. They signal time by color and are often used to signal to  children when it’s time to get out of bed on weekends.

5-year-olds: Since 5-year-olds can hop on one foot, games like Twister® are fun. Kids this age start to understand time and charts. Get your child a calendar so they can count  ahead to your next visit!.  They can also work jigsaw puzzles with somewhat large pieces.

For any age, consider tickets to a junior high school musical or minor league sports game. Avoiding large venues not only saves money, but saves time parking and affords the ability to get in and out easily if needed. 

The excitement of the surprise is sometimes as exciting as the gift itself. Hence, the reason unboxing youtube videos are as popular as ever. Wrap a child’s gift in layers of sparkly crunchy paper and the smiles will come even before the gift is seen. 

Happy gifting!

Naline Lai, MD and Julie Kardos, MD

©2023 Two Peds in a Pod®

Finally!

Pediatrician and parents have waited patiently for effective protection for babies against severe RSV (respiratory syncytial virus) infections, and we finally have it.

Welcome, nirsevimab – otherwise known as brand name Beyfortus.

Nirsevimab protects against RSV, which is a nasty cold virus that attacks young lungs fiercely. While many babies with RSV end up with “just a cold,“ 20% to 30% with a first time infection end up with lung infections. Year after year hospitals fill with babies battling RSV. An additional problem with RSV: babies sick with RSV have a greater risk of developing asthma than babies who were never infected with RSV.

This viral season every newborn and any baby younger than eight months of age is eligible for a one time shot of nirsevimab. The shot gives protection in the form of antibodies to RSV. 

Not a new type of medicine

A similar medication called palivizumab (brand name Synagis) has been around for years. However, only certain high risk babies, such as those who were born very prematurely, received it. Palivizumab consisted of monthly injections during RSV season (typically October through March).

Conveniently, one dose of nirsevimab gives protection against severe RSV for five months.  All babies under eight months of age during RSV season will be eligible to receive this new protection.

Be sure to discuss nirsevimab with  your pediatrician this fall.

For a more detailed account of nirsevimab recommendations read here.

The arrival of nirsevimab will make every pediatrician and lots of babies breathe a little easier this fall and winter.

Julie Kardos, MD and Naline Lai, MD

©2023 Two Peds in a Pod®

The first of many first days of school.

Parents, let’s admit it. Many of the tears shed on the first day of school are our own. The first day of school for parents is not easy. There is genuine sadness and ache that goes beyond the bittersweet as our kids approach momentous milestones such as kindergarten entry and college send off. As our pediatrician friend Dorothy Novick posted on Facebook, “Because here’s a thing no one ever says out loud on Facebook: as all the balloons and congrats explode on our feeds, many of us parents of graduates are experiencing some pretty serious grief. There’s true pride in the photos, yes, but there’s also honest to goodness grief.”

For your kid-remember the rules of drop off:

• For kids of all ages, convey to them that the transition is a positive experience. You give your child cues on how to act in any situation. Better to convey optimism than anxiety. Kids, no matter the age, mirror the emotions their parents convey.
• For daycare and preschool, take your child and place her into the arms of a loving adult- do not leave her alone in the middle of a room.
• Say good bye. Let your child know that you are leaving. Don’t try to sneak off. At any age, it’s unsettling for you to suddenly disappear.
• Do not linger. Prolonging any tears, only prolongs tears. The faster you leave, the faster happiness will start.
• For the younger ones- it’s ok to go back and spy on them to reassure yourself that they have stopped crying- just don’t let them see you. For the older ones-let them have their independence- this is what you’ve trained them for. In fact, encourage their independence. When your young adult asks you a question, ask it back. Chances are, they already know the answer. Just remind them that you are always available. Send the care packages and answer their midnight texts.

For yourself:

Congratulate yourself on reaching a family milestone. The first day of school for parents and children is momentous. Yes, the configuration of your family has changed and it will not be the first or last time. Acknowledge the ache of the passage of time, and reach out to others in similar situations.

Just as your child delights you with all of their unique interests and attributes, go show them all the amazing unique things you do. Take up ball room dancing, start a business painting colorful furniture or join an adult soccer league …these are all real life examples of things we know people embarked on when their kids went off to school.

Cry those “happy tears.” But be aware, sentimental “happy tears” can tip over into depression.

If negative thoughts or worries constantly impinge on your thoughts and weigh you down, then seek help. Talk to your doctor for advice. Also, the National Alliance on Mental Illness maintains a lists of resources.  Depression looks like sadness much of the time but it can also manifest as anger or anxiety.

Warning signs of depression include:

• Acting out of control
• Losing interest in activities which normally bring pleasure
• Changes in sleep patterns-difficulty falling asleep, numerous awakenings, or excess sleeping
• Having feelings of worthlessness about yourself or other
• Poor work performance
• Low energy or fatigue or conversely restless or “hyper” (excessive shopping binges)
• An increase in alcohol or drug use (attempts at “self-medicating”)
• Thoughts of being better off dead or a desire to hurt yourself or others

To end on an upbeat (and ok, bittersweet) note, we invite you to read the letter Dr. Lai wrote the day before her first child left for kindergarten.

A letter to my child

My Child,

As we sit, the night before kindergarten, your toes peeking out from under the comforter, I notice that your toes are not so little anymore.

Tomorrow those toes will step up onto to the bus and carry you away from me. Another step towards independence. Another step to a place where I can protect you less. But I do notice that those toes have feet and legs which are getting stronger. You’re not as wobbly as you used to be. Each time you take a step you seem to go farther and farther.

I trust that you will remember what I’ve taught you. Look both ways before you cross the street, chose friends who are nice to you, and whatever happens don’t eat yellow snow. I also trust that there are other eyes and hearts who will watch and guide you.

But that won’t stop me from worrying about each step you take.

Won’t stop me from holding my breath­.

Just like when you first started to walk, I’ll always worry when you falter.

I smile because I know you’ll hop up onto the bus tomorrow, proud as punch, laughing and disappearing in a sea of waving hands. I just hope that at some point, those independent feet will proudly walk back and stand beside me. Maybe it will be when you first gaze into your newborn’s eyes, or maybe it will be when your child climbs onto the bus for the first time.

Until then, I hold my breath each time you take a step.

Love,
Mommy

Naline Lai, MD and Julie Kardos, MD
©2018, 2023 Two Peds in a Pod®

Perfect timing. I have been seeing a lot of kids starting table foods in the office lately and my sister (an Emergency Medicine doctor) just came out with a video on what to do when someone is choking. She goes over what do with any age group, so worth a peek even if your kids are bigger than you are.

Prevention hints: As a toddler parent you will find kitchen shears perfect for cutting up food into bite sized pieces. But watch the number of little pieces that your child eats at one time- kids get into trouble when they scoop a pile into their mouths. As for toys, anything that can fit into a paper towel roll is a choking hazard.

Hoping you will never have the opportunity to use the information in the video!

Naline Lai, MD with Julie Kardos, MD

©2023 Two Peds in a Pod®

When preparing to travel with your kids, do you sometimes you wonder if it’s worth all the time and effort? Click here to find an article from the Children’s Hospital of Philadelphia where your two Peds and colleagues give some tips to get you through.

Happy travels!

Julie Kardos, MD and Naline Lai, MD

©2023 Two Peds in a Pod®

Wondering about signs of anxiety in your child or teen? Interested in everyday ways to help calm them? Take a peek at this post that one of your two peds contributed to: When Your Child’s Anxiety Is Worth Worrying About — and How to Help in The Children’s Hospital of Philadelphia’s Health Tips.

A Bucks or Montgomery County, Pennsylvania parent or caretaker? May is mental health awareness month and NAMI Bucks County and CHOP Primary Care, Doylestown have teamed up to give an in-person talk this week! Registration information above- hope to see you there!

Julie Kardos, MD and Naline Lai, MD

©2023 Two Peds in a Pod®

Everything has a season, incluing seasonal allergies.

In our area near Philadelphia, we associate spring with the Phillies opener and also with the onset of spring allergies.

Here is a nice summary of how to treat allergies, from The Children’s Hospital of Philadelphia (note that one of your Two Peds was a contributor). And following are some of our prior posts that can help you treat your child’s seasonal allergies this spring:

The Best Allergy Medicine for Kids

The Best Allergy Medicine for Kids aged 2-5 years old

Allergy Eyes: when spring rubs you the wrong way

How to tell the difference between Covid (or any viral cold) and allergies

We hope this post answers all that you are itching to know about seasonal allergies.

Julie Kardos, MD and Naline Lai, MD

©2023 Two Peds in a Pod®

Did your child wake up in the middle of the night crying from ear pain? Fortunately, not every child with an earache has an actual ear infection. However, all children with earaches deserve to have their pain treated, no matter what is causing their pain. Here is our post about what to do for your child’s earache.

Julie Kardos, MD and Naline Lai, MD

©2023 Two Peds in a Pod®

Remember when feeding your baby was fun? They way he opened his mouth like a baby bird when you fed him oatmeal. They way she thumped her hands on the high chair tray waiting for another bite of mashed bananas. It was hard not to laugh as your nine-month-old slowly picked up each piece of pancake and chewed thoughtfully, or the way your eleven-month-old, covered in tomato sauce, double fisted a messy meal of cut up meatballs and elbow noodles. And then they turned one. You call your pediatrician and search the internet to ask, why won’t my one-year-old eat?

Maybe they actually did not stop eating entirely, but instead of the serene or comic meals you used to enjoy with your baby in the high chair, you now have a one-year-old who deliberately deposits each pea off of the high chair tray and onto the floor, smooshes their potatoes all over the plate, or thrashes like a chained-up wild beast to escape their high chair. You fluster, you offer other previously enjoyed foods, you become convinced they will starve, you offer a cookie, you offer more milk, you cry.

Let us reassure you: your one-year-old most likely is acting in a normal and predictable way. In this post, we explain why many one-year-olds seem to stop eating, and how to handle your suddenly picky, food-averse one-year-old.

Recall that we pediatricians expected your newborn to gain one pound every other week. In contrast, we expect your one-year-old to gain one pound every THREE MONTHS! Your baby is now growing at a slower rate. Correspondingly, their appetites slow down.

Have you heard the saying, “Hunger is the best sauce?” The way to help your one-year-old to eat, and to avoid disordered eating, is to allow them to feel hungry. Typical toddler appetites vary from day to day. Some days they eat as much as you, and sometimes they subsist on air! Most of them thrive anyway. One reason you have pediatrician visits every 3 months with your one-year-old is to be sure they gain weight appropriately.

 Here are some Do’s and Don’ts:

• DO offer the same structured meal times that you had as a child: breakfast, lunch, dinner, and one or two snacks a day. That’s plenty of opportunity to eat.
• DO make mealtime enjoyable. Gather your family together to eat as often as you can. Talk about the day, joke a bit, serve whatever you are eating as long as there are no choking hazards. To avoid frustration, include at least one item – fruit, veggie, protein, carb, or dairy- that you are fairly sure your child will eat.
• DO serve bite sized food in small portions and allow your child to ask for more.
• DO allow your child to enjoy your company while you enjoy theirs, even if your child eats nothing. Respect their short attention span and allow them to go play after a few minutes of not eating anything. They can play on the floor near you while you finish your meal.
• Most importantly, DO pretend that you feel fine if they eat and fine if they don’t eat. Of course you will care, but your only job is to present healthy food. It is your child’s job to decide if they will eat and how much they will eat.

• Avoid letting your child graze from a bottle, breasts, or sippy cup all day. Sucking fluid is a habit. Drinking from a cup at mealtime satisfies thirst. Filling a small toddler belly with fluid all day wards off hunger and almost guarantees that your child will have no room for actual food at meal time.
• Likewise, giving food as a reward or as an activity between meals and snack times will also fill them up before it’s time to actually eat.
• Avoid chasing them with food as they play or offering food while they watch a video. While this might work for a brief time, ultimately it does not improve their eating. Instead, it teaches them to eat for you or for the video, but not for hunger. This practice can lead to disordered eating patterns.
• Avoid feeding them or nursing them in the middle of the night. If you feed them anything substantial, you fill their bellies and they may not be hungry for breakfast in the morning. Besides, you wouldn’t drink something in the middle of the night without brushing your teeth. Do the same for your child.
• Avoid too many choices. Offer the foods you have already prepared for the rest of the family, and leave the choice of “to eat or not to eat” to your toddler.

We invite you to read more about how to outwit, outplay, and outlast picky eaters here. 

Read about many aspects of one-year-old development, including food refusal, here. 

Julie Kardos, MD and Naline Lai, MD

©2023 Two Peds in a Pod®

“Mom, Dad, my head hurts!”

Sound familiar? It’s probably not the first time ‘round this rodeo, but ever wonder if your child’s headache could be a sign of something more problematic? The good news is, while kids get headaches for many reasons, there are telltale signs every parent can look for at home to distinguish normal headaches from bad headaches in children.

Tension Headaches

For most kids with headaches, the odds are in their favor.  The most common culprit is the tension headache—the kind we have all experienced at least once in our lifetimes.  Fortunately, they are also the least scary kind of headache.

Tension headaches usually begin gradually and can last a few hours at a time.  Most children will complain of a dull, achy, or even “band-like” pain squeezing both sides of their head or across their forehead. Typical triggers include stress, inadequate sleep, excessive screen time, not drinking enough water during the day, hunger or poor diet, or a need for glasses. Targeting these triggers are key to preventing these pesky headaches.

Migraines

Okay, so we know tension headaches are the most frequent, but can kids have migraines? Children can have migraines and there are key distinguishing characteristics that set these headaches apart. 

Migraines usually start in school-aged children, and for girls, often get worse with their periods. In older kids these headaches are typically throbbing or pounding, as opposed to dull, and can be one-sided.  They can also be associated with other symptoms like sensitivity to light and sound, nausea or vomiting, and strange changes in vision or smell preceding the start of a migraine (the “migraine aura”). Taking a nap almost always makes a migraine go away.

Family members will often have a history of migraines or frequent headaches.

Parents should also be aware of the occasional “abdominal migraine,” where migraine symptoms like those described above occur with stomach pain instead of headaches.

Head Trauma and Concussions

Did your child just hit their head? Or suffer a sports injury? As a parent, it’s normal to worry about headaches after head trauma. While most post-traumatic headaches are not a cause for alarm, parents need to know signs of serious injury such as bleeding inside the head. You can review these signs here.

Concussions are also caused by head trauma. Read more about concussions here.

Red Flags

While most headaches are not cause for alarm, there are warning signs to keep an eye out for. Sometimes, headaches are more sinister in nature—caused by tumors, brain bleeds, strokes, abnormal anatomy, or infection (like meningitis). And while these occurrences are fortunately rare in children, the earlier they are diagnosed, the better.

Headaches that interrupt your child’s sleep, happen first thing in the morning after waking, are becoming more frequent or severe, are associated with unsteadiness, weakness, visual changes, seizures, fever, funny eye movements, neck stiffness, early morning vomiting, changed mental state (too tired or too irritable to play) or are described by your child as as the “worst headache they’ve ever had” should all lead you to seek medical attention promptly. Finally, headaches in very young children under the age of five should not be taken lightly.

A Word on Mental Health

While headaches happen for several reasons, depression and anxiety are commonly overlooked offenders.  If you are noticing other signs like sadness, worry, poor appetite, weight change, or less interest in prior activities, talk to your pediatrician about further evaluation.

Still not sure what’s causing your child’s headache? 

It’s okay!  Headaches are complicated, and keeping track of your child’s symptoms can be hard. Maintaining a headache diary to track headache features can help both you and your pediatrician figure out the next best steps for your child.

Nitya Rajeshuni, MD MS

©2023 Two Peds in a Pod®

Guest blogger Dr. Nitya Rajeshuni completed her pediatric residency at the Children’s Hospital of Philadelphia. She attended medical school at Stanford University, and is a contributing writer to ABC News and the health humanities journal Synapsis.