Now that school is back in full swing, you might notice your child scratching their head… and maybe you’re starting to scratch your head too. Let’s dive into the topic of lice and clear up some of the confusion.

What Are Lice, Really?

Lice are small, harmless insects that cause itching but don’t spread disease. The itching comes from a reaction to their saliva—similar to how poison ivy causes a reaction on the skin. It sounds gross, we know, but the good news is that lice are more of an annoyance than a health risk.

By the time you spot a live louse on your child, they’ve likely had lice for at least a month. So, while it might seem alarming to spot a louse crawling on their head, it’s not an emergency. Schools shouldn’t send kids home early for lice; after all, they’ve likely been in class with lice for weeks. That said, treating lice promptly can relieve the itching and stop them from spreading. Children can return to school the day after their first lice treatment.

How Do Lice Spread?

Lice can’t jump or fly; they only crawl. For lice to spread, kids’ heads need to be close together. Lice can also spread through shared hats or hair brushes, so remind your kids not to share these items, whether they’re playing dress-up or getting ready for a school dance.

Spotting Lice and Nits (Lice Eggs)

It’s easy to mistake other things—like sand or dandruff—for lice eggs. Here’s a tip: lice eggs (otherwise known as nits) are glued tightly to the hair shaft near the scalp and are difficult to remove with your fingers. Dandruff and sand slide easily along the hair shaft between your fingers. 

Lice Treatment Options

• Topical Permethrin 1% (e.g. Nix): This over-the-counter treatment works well for many families. Follow the directions on the label, and repeat the treatment in 7-9 days. Nix has a comprehensive  website that explains lice and how  to treat them. Permethrin targets both lice and their eggs.
• Topical Ivermectin: Previously branded as Sklice, this treatment is now available over-the-counter. The generic version is as effective as the name brand. Follow the directions, and repeat after 7-9 days.

If neither of these treatments work, doctors can prescribe additional medications. Most cases of lice succumb to permethrin or ivermectin, so you likely won’t need a prescription. Safety tip: avoid using more than one product at a time. This prevents too much medication on your child’s head at the same time.

According to the American Academy of Dermatology, simply combing your child’s hair to remove lice and nits can be effective. Though time-consuming, thorough combing works when done properly. Here’s a helpful 3-minute video from a dermatologist on using medication and combing to treat lice.

All lice shampoos and lotions should be applied to dry hair, left on for the recommended time, and then rinsed off. Make sure to read and follow the directions carefully for whichever product you choose.

Treating Your Home

Once your child is treated, it’s important to treat their environment too. Wash any recently-used sheets, towels, blankets, and hats in hot water (at least 130°F), and dry them on high heat for 20 minutes. Seal non-washable items, like stuffed animals, in plastic bags for two weeks to let any lice and nits to die off.

Got More Questions?

This should cover most of what you need to know about lice, but if you’re still itching for more info, we contributed to this post in The Children’s Hospital of Philadelphia’s “Health Tip of the Week.”

Stay tuned for more tips on what might be “heading” your way!

Julie Kardos, MD and Naline Lai, MD

©2024 Two Peds in a Pod®

Hello, parents! As we gear up for another winter season, we want to share some important RSV prevention updates. RSV, or Respiratory Syncytial Virus, can cause nasty colds, but it’s particularly concerning for babies under 8 months old, as it leads to more hospitalizations than any other illness in this age group.

Good News About Beyfortus!
Last winter, we saw some fantastic results from nirsevimab, better known as the brand name Beyfortus. Beyfortus is RSV antibody designed to protect our littlest ones. It was shown to be 90% effective in reducing hospitalizations due to RSV. That’s a big win for babies and their families.

How Can You Protect Your Baby?
There are two key ways to help keep your young infant safe from severe RSV:

• For Expecting Moms: If you’re pregnant, you can receive an RSV immunization between weeks 32 and 36 of your pregnancy. This helps build immunity for your baby, so they won’t need Beyfortus after they are born. However, if your baby arrives early—within two weeks of when you got the shot—they will need their own dose to ensure protection against severe RSV.

• For Newborns: All babies under 8 months old during RSV season should receive a dose of Beyfortus if their mom didn’t get the immunization. This includes all babies, whether they’re healthy, sick, premature, or full term. Many hospital nurseries and NICUs give these antibodies (given as an injection) before your baby goes home. If your hospital doesn’t have it, your pediatrician can help.

Why Beyfortus is a Game Changer
In the past, we gave an RSV antibody shot that was reserved for severely premature babies and those with serious lung issues. It required monthly doses for 5-6 months during the RSV season. Beyfortus, on the other hand, offers protection for a full 5 months with just one shot—making it much easier for busy parents!

Timing Matters
Beyfortus is given only during RSV season, which runs from October to March. If your baby is under 8 months old and hasn’t had their dose yet, please reach out to your pediatrician for this vital protection. Plus, it’s safe to give Beyfortus alongside any other childhood vaccines.

A Quick Reminder
RSV is an incredibly common illness, with nearly all kids catching it by the age of 2 years. While many childrn will have mild cases, we’re grateful to have options like Beyfortus to help keep your baby from becoming severely ill.

We’re here to support you and your family in staying healthy this season!

Julie Kardos, MD and Naline Lai, MD
©2024 Two Peds in a Pod®

Frustrated that your young child is not listening? This in-person talk gives some basics on ways to set limits and self-calming techniques. Your two peds, Dr. Lai will be on hand to moderate!

Naline Lai, MD and Julie Kardos, MD

©2024 Two Peds in a Pod®

We often hear about ways to chase away anxiety such as “deep breathing” and “grounding exercises” but how do you go about teaching your child those techniques? Drs. Kardos and Lai give three short ways to instill calmness into your child’s day. You can read more about childhood anxiety in this helpful post from The Children’s Hospital of Philadelphia.

Naline Lai, MD and Julie Kardos, MD

©2024 Two Peds in a Pod®

Playing in the great outdoors really is great. But when your kids scamper inside, make sure they wash their hands. Now that the winter viral season has receded, the big reason to wash hands is spring allergy season. The pollen they’ve collected on their hands will make its way to their face exacerbating already itchy noses and eyes.

The easiest way to tell if your young child is experiencing seasonal allergies is if your nose starts to twitch. If your child’s nose also starts to twitch, they probably also have allergies. Allergies have a strong inheritance pattern. If both parents have allergies, up to 50-80 percent of their kids may have allergies. Keep in mind, allergies never cause a fever and since children need to be exposed to an irritant before they can be allergic to it, children under two years of age are less likely to have seasonal allergies—not enough seasons have passed.

For other ways to keep spring allergies in check- read up on this post contributed by Dr. Lai in the CHOP Health TIp of the Week.

Another reason to wash hands after zipping indoors? Poison ivy…but that’s a story for another day.

Naline Lai, MD and Julie Kardos, MD

©2024 Two Peds in a Pod®

We know how it’s easy to spend money on the kids- just wait until they are old enough to get Venmo. Here are some money saving tips for parents to save a little dough and put that saving towards the next family vacation and orthodontia!

Julie Kardos, MD and Naline Lai, MD

©2024 Two Peds in a Pod®

Listen here as Dr. Kardos talks about the latest in pediatrics on “Your Radio Doctor” with Dr. Maryanne Ritchie.

Julie Kardos, MD and Naline Lai, MD

©2024 Two Peds in a Pod®

Parents local to Northampton Township, PA: We welcome you to come hear local pedatricians from The Children’s Hospital of Philadelphia and mental health experts talk about basic ways you can help manage anxiety and some information about medications for children and teens on February 8, 2024 at 6:30pm in the Northampton Library.

The talk is free and there will be time for questions. Please register so we set up enough chairs!

Special note: your Two Peds will be in attendance. Hope to see you there!

Naline Lai, MD and Julie Kardos, MD

©2024 Two Peds in a Pod®

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®