Two Peds in a Pod®

Until I became a mother I never thought…

mother hen cartoon Until I became a mother I never thought…

I’d care if a birthday party was cancelled

I’d obsess about bowel movements and gas

I’d remember to reapply sunscreen

I’d bake zucchini muffins and count them as a vegetable serving

I’d wipe someone else’s nose

I’d relearn my most dreaded school subject in order to help my child with homework

I’d feel compelled to ask if anyone needs to go to the bathroom before I go anywhere in a car

I’d go on nauseating upside-down amusement park rides because my kid needed to be accompanied by an adult

I’d spend my Friday night driving and picking up kids from parties and then spend my Saturday morning driving and picking up kids from the ice hockey rink starting at 5:00am.

I’d get to play Tooth Fairy

I’d (try to) answer questions such as “What does God look like?” and “Who was the mom of the first man?”

I’d willingly read the same book out loud night after night after night

And finally-

Until I became a mother I never thought… I’d wipe away tears when reading sappy Mother’s Day cards.

Happy Mother’s Day from your two Peds

Naline Lai, MD and Julie Kardos, MD

May 11, 2014 by twopedsinapod

Warn your kids: it’s not smart to inhale Smarties

Where do these tween/teen games come from?

Warn your kids about a game that Dr. Kardos learned about from some tweens recently: inhale Smarties ®. Young teens at a party took intact packages of Smarties® candy and used their cell phones (!) to smash the candies into a fine dust inside their cellophane wrappers. Then they peeled off the end of the roll and sucked the dust into their mouths (imagine a “Smarties®” cigarette), and exhaled, causing Smarties® smoke to spew from their mouths. They spit out any candy that was left in their mouths. The thrill came from creating Smarties® smoke.

I was glad that the kids who told me about this game saw that this was a not-so-smart game to play (click here for another example of a not-so smart game). No, this does not count as “smoking” and is likely not addictive, but this story begs several teaching points for parents of tweens/teens:

1- Tweens and teens need supervision at parties.

2- Teach your kids never to inhale anything except AIR. Anything else can cause coughing, irritation to the lungs, and possible infection. Do not inhale Smarties ®!

3- Young teens especially are prone to “mob mentality.” Teach them if their friends do something that they have never done before, to think long and hard about possible consequences before following the crowd. Ask them to think, “What’s the worst that can happen if I do this?”

4- Know your children’s friends. If you know they are thrill seekers, attention grabbers, or prone to engage in questionable behaviors, make sure you have frequent talks with your kid about smart choices. Sign your child up for activities that allow opportunities to become friendly with an alternative crowd.

If you see kids engaged in risky behaviors, even if they are not your own children, stop them. Someone has to care. Hopefully someone else is watching out for your kids, too.

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

May 7, 2014 by twopedsinapod

Bring out the splat mat—cook with your kids.

cartoon family dinner

When my kids were younger, I realized one way to avoid the pre-dinner time meltdowns was to enlist their help in cooking. In addition, baking muffins or cookies with kids is a great rainy day activity with a built-in reward at the end. Much has been written about the nutritional and psychological merits of a shared family meal. Instead, this post is about sharing the mealtime prep. For those of you who do not love to cook yourselves, here are reasons to find your inner cook and encourage your child’s development at the same time:

1-Toddlers LOVE pouring, mixing, and measuring, and when you teach toddlers these skills, you are strengthening their fine motor skills. Why else are toy kitchens and Play-doh so popular? Nothing beats “playing” with REAL ingredients in a REAL kitchen.

2-Teach young kids to count measurements, let older kids do the measuring themselves.

3-Kids who are learning to read now see WHY they need this skill- as you follow a recipe kids see how to read with a purpose. You can let your budding reader read the directions to you.

4- Time spent with a parent in the kitchen fosters more shared attention which can build self-esteem.

5-You will build good memories for your child.

6-For the picky eaters: kids are more likely to taste what they cook themselves.

7-Kids love water play, so even the clean-up is fun.

8- Kids as young as 7 or 8 can learn to cut with a knife. Teach them this life skill while cooking instead of when they are hungry and trying to eat dinner-it causes less frustration.

9-Kids take pride in what they help create. They can also take pride in completing a project. Pride in accomplishments develops self-esteem.

10- Cooking with you teaches your child how to help others as well as how to receive help graciously.

Finally, cooking is one of those life skills needed for when kids grow up and live on their own. Just as you teach them to use the potty, brush their own teeth, dress themselves and tie their own shoes, you should teach them how to cook.

Are you parents who don’t cook? Call Grandma or Grandpa for some tutoring, or take a cooking class with your child!

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

April 30, 2014 by twopedsinapod

Save money: how to penny pinch without hurting your young child

keeping up with the neighbors When it comes to our children, we want the best that money can buy. But the best is not necessarily the most expensive. Today we offer our pediatrician perspective on ways you can save money without compromising your child’s health or safety.

Buy generic infant formula: Common store brands of iron-containing Food and Drug Administration regulated infant formulas cost less than big name brands and have equal nutritional value.

Do not buy toddler formula. This is a marketing coup. Children over one year of age can drink milk.

No need to buy only organic milk and food. Read here for more information about organic vs conventional foods.

Make your own baby food- from the start you can grind up part of your breakfast, lunch or dinner in a blender for your baby. Grind up cooked chicken or cooked vegetables, pasta or soft fruits, mix with a little formula or breast milk if you need to get the pureed consistency just right, and commence spoon feeding! You will save tons of money from not buying bad-for-the-environment plastic containers of baby food. When your babies advance to finger foods, simply cut up pieces of your foods.

Do NOT spend money on “toddler junk food” such as Puffs for portable finger food practice. Instead buy “toasted oats” (brand name = Cheerios) which are low in sugar, contain iron, and are much less expensive. One exception: do buy the baby cereals (rice, oatmeal, barley, or mixed grains) because they contain more iron than “grown-up” oatmeal and babies need the extra iron for their development.

Buy generic medicine: acetaminophen (brand name Tylenol), ibuprofen (brand name Motrin, Advil), diphenhydramine (brand name Benadryl), loratadine (Claritin), ceterizine (Zyrtec). If your child’s doctor prescribes amoxicillin (for ear infection, Strep throat, sinusitis), ask the pharmacist how much the medication would cost if you paid cash. The cost for this commonly prescribed antibiotic may be less than your insurance co-pay.

Accept hand-me-down clothes, shoes, etc. The purpose of shoes is to protect feet. Contrary to what the shoe sales-people tell you, cheap shoes or already-worn shoes will protect feet just as well as expensive, new ones. Just make sure they fit properly.

Don’t buy “sleep positioners” for the crib. Place your newborn to sleep on his back and he will not/cannot roll over. If you need to elevate your baby’s upper body to prevent spit-up or to provide comfort from gas, don’t buy a “wedge” but instead put a book under each of the 2 crib legs so the entire head of the crib is elevated. There is NO evidence that wedges or sleep positioners prevent SIDS (Sudden Infant Death Syndrome) and these products are NOT endorsed by the American Academy of Pediatrics. Dr. Kardos advises her patients to return any sleep positioners that they received at the baby shower and use the money for diapers instead.

The best toys are ones that can be reconfigured and used again and again. Legos, blocks, crayons/markers/chalk, small cars, dolls, balls come to mind. Avoid one-time only assembly type items, breakables, etc. Have a “toy recycle” party or a pre-Halloween costume recycle party: everyone brings an old costume/toy they would like to trade and everyone leaves with a “new” item (kids don’t care if things are brand new or not, they care only if you teach them to care). Along the same lines, inexpensive paint can turn a pink “girl’s bike” into her younger brother’s blue “boy bike.” Read our article on gift ideas for kids for more ideas that do not “break the bank.”

Borrow books from libraries instead of buying them new or look for previously owned ones at yard sales, thrift shops and online.

Don’t buy “Sippy cups.” Teach your child to drink out of regular open cups. Sippy cups are for parents who don’t like mess-they are not a developmental stage. They are actually bad for teeth when they contain juice or milk and they do not aid in child development. They can also cause harm to children who run and fall while drinking out of them.

Skip over potty training pants. Go straight to underwear.

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®
revised from our earlier 2009 post

April 17, 2014 by twopedsinapod

Avoid Allergy Eyes

Arrggh, sitting on top of kid’s items that need to be returned to Target are the allergy eye drops that need to go back to the pharmacy. With growing kids, it’s an endless cycle of buy-return-buy-return. I suppose I was duped by the sale price, but the drops which contain “red out” ingredients are not appropriate for long term use. Hoping the post below doesn’t have you running back and forth from the store this allergy season:

allergy eyes

“I see green stuff all over my car and I park in the garage,” a mom said to me today.

It’s finally spring on the east coast and with it comes green cars and itchy eyes. Eighty percent of the older kids I saw today, including those seen for routine check-ups, had red irritated eyes.

So what to do? Pollen directly irritates eyes, so start with washing the pollen off. One parent told me he applied cool compresses to his child’s eyes. This is not enough- get the pollen off. Plain tap water works as well as a saline rinse. Have your child take a shower. Filter the pollen out of your house by running the air conditioning. Pollen counts tend to be higher in the morning, so plan outdoor activities for later in the day. Some people will leave shoes outside the house and wipe the paws of their dogs in order to keep the green stuff from tracking into the house.

Oral medications do not help the eyes as much as topical eye drops. Over-the-counter antihistamine drops include ketotifen fumarate (eg. Zatidor and Alaway). Prescription drops such as Pataday or Optivar add a second ingredient called a mast cell stabilizer. Avoid use of a product which contains a vasoconstictor (look on the label or ask the pharmacist) for more than two to three days to avoid rebound redness. Contacts can be worn with some eye drops– first check the package insert. Place drops in a few minutes before putting in contacts and avoid wearing contacts when the eyes are red.

Hopefully allergy season will blow through soon. After all, as a couple teens pointed out-prom is around the corner and allergies can make even the young look haggard. One teen male told his mom that he shaved today because having a beard and blood shot eyes made him look THIRTY years old. Miserable allergies!

Naline Lai, MD with Julie Kardos, MD
modified from a 2011 post, ©2014 Two Peds in a Pod®

April 8, 2014 by twopedsinapod

I have Autism.

According to the latest CDC report, 1 in 68 children have some form of autism. April 2 is World Autism Awareness Day, and today we post, with permission, a speech that a 15-year-old friend of mine with autism gave to his classmates when school started last year.
—Dr. Kardos

Good morning everybody. Today, I wanted to talk to you about Autism. I have Autism. Don’t worry, it’s not something you can catch from me… it’s not a like a virus or anything like that. When I was very young, a doctor diagnosed me with Autism. My parents took me to the doctor because I didn’t talk much – I talked a lot less than kids were supposed to. Actually, I still talk a lot less than other kids.

A lot of people think things about Autism that just aren’t true. They really shouldn’t because everybody is different and has different things they do well. Actually, I am pretty smart. So are a lot of my friends with Autism. I just have a hard time with words. So reading, writing, and speaking are kind of hard, but I’m very good at math, science and stuff like that.

Every person with Autism has different things that they do well and other things that they have trouble with. For me, like I said, I have a hard time with words, I have a hard time remembering people’s names, and sometimes, I may have trouble knowing if someone is joking with me. You may see me walking around by myself – sometimes I pace back and forth when I’m thinking. I also sometimes flap my hands when I get excited or frustrated. So, if you see me doing that, just come over and say “Hey, Rob!” or something like that to me. That usually helps me stop right away. It may look funny, but really everybody does this a little bit. Other people may jump up and down when they are excited or clench up when they get angry. Unfortunately, I flap. But don’t worry, I’m OK.

Other than that stuff, I am just like everybody else. I really like movies and music. I go to concerts all the time… the next concert I’m going to is Bruno Mars. By the way, if anyone likes Bruno Mars, let me know – my sister doesn’t want to go… so we have a free ticket!

That’s really all I have to say. Just remember that you shouldn’t judge anyone without getting to know him or her. I’m just a normal kid that happens to have Autism. I don’t mind if you don’t mind.

Thanks for letting me tell you about myself. Does anyone have any questions?

Robbie

2014 Two Peds in a Pod®

April 1, 2014 by twopedsinapod

My tummy hurts! Stomach pain in children

stomach pain It’s 24 hours after your teenager finished up a competition for National History Day. Now she’s curled up in a ball whimpering with belly pain. Post adrenaline let down? Ate something wrong for breakfast? Appendicitis? Just as a mom’s mind goes berserk thinking of all the possible causes, a doctor’s does too. There are many organs that live inside a belly, including the stomach, the intestines, the liver, and the bladder, that cause pain. Then there are the organs next to the belly which can cause pain including the lungs and the female reproductive organs. On top of it all, chemical imbalances and emotional issues can cause or exacerbate pain. So, how can one tell if your teen should ignore the pain and go to the showing of Divergent or consult with her pediatrician?

Here are some “Red Flags” of belly pain. Pay close attention to pain associated with any of the following:

Pain which wakes your child out of sleep
Severe pain – prevents walking, moving, makes kids not want to be touched. Severe pain makes kids unable to jump up and down easily.
Diarrhea or constipation
Vomiting
Blood in the stools
Refusal to eat/not hungry—We do not mean the refusal to eat brussel sprouts, but rather refusal to eat any food
Change in behavior. To gauge severity, it helps to stand back and observe your kid. Block out what he is saying. Instead, watch how she acts. Your child may play with friends, run by you, say “My belly hurts,” and then continue to play. This is not as worrisome as the child who stops playing with friends and goes to lie down by herself on the couch. School avoidance is also a sign that something is not right.
Pain with a pattern– Perhaps you notice that your child experiences pain after downing milk or ice cream (dairy intolerance), or pain only on school mornings and not weekends (possible bullying at school).

Be aware, young kids often use the phrase “my tummy hurts” for any type of belly discomfort. A child whose belly pain disappears after he eats may mean, “I’m hungry.” New potty trainers may mean,” I need to go potty.” Young kids also use the phrase to mean, “I am nauseous.”

Finally, the most important “red flag” is if your child’s belly pain makes YOUR belly hurt; that is, if your gut tells you that something is wrong with your child, consult with your child’s doctor immediately.

Julie Kardos, MD and Naline Lai, MD

March 26, 2014 by twopedsinapod

Take the sting out of vaccines and blood draws

One of Dr. Kardos’s kids yelled in our office a few years ago: “I’m getting a SHOT?! NOOOO! GET AWAY FROM ME!!”

Even the front desk staff could hear him, and he was in the exam room farthest to the rear of the building. Meanwhile, his twin brother just sat and pouted but did not flinch.

Even a pediatrician’s child does not always approach the prospect of an immunization or blood draw with a grin on his face. Here are ways you can take away the sting of a needle:

Set the stage. Your child looks to you for clues on how to act. If mommy and daddy are trembling in the corner of the room, it will be difficult to convince your child that the immunization is “no big deal.” Do not tell your child days in advance that she will be immunized. The more you perseverate, the more your child will perceive that something terrible is about to happen. Simply announce to your child right before you leave to get the immunization, “We are going to get an immunization to protect you from getting sick.”

Do not say “I’m sorry.” Say instead,”Even if this is tough, I am happy that this will protect you.”

Never lie. If your kid asks “Will it hurt?” say “Less than if I pinched you.”

Watch your word choice. Calling an immunization “a shot” or “a needle” conjures up negative images. In general, avoid negative statements about injected vaccines. I cringe when parents in the office threaten children with,” If you don’t behave, then Dr. Lai will give you a shot.” Remember, shots protect against deadly diseases and are in no way punishments for children.

Kids talk. Be aware that kids, especially those in kindergarten, like to scare each other with tall tales. Ask your child what they have heard about vaccines. Let children know that Johnny’s experience will not be their experience.

The moment is here.

You may have heard about a topical cream which numbs up an area of skin. Unfortunately, because the creams anesthetize the surface of the skin and most vaccines go into muscle, I do not find the creams very effective at taking the pain away.

Instead, practice blowing the worries away. Have your child practice breathing slowly in through her nose and blowing out worries through her mouth. For the younger children, bring bubbles or a pin wheel for your child to blow during the immunization. In a pinch, rip off a piece of the exam paper from the table in the room and have your child blow the paper.

The cold pack: holding something very cold, placing a cold pack on your child’s arm around the area to be vaccinated, or placing a cold pack on the NON-vaccine arm can distract your child’s brain from feeling the pain of an injection.

“Transfer” the immunization to mommy or daddy. Have your child squeeze your hand and “take the immunization” for him.

Tell your child to count backwards from 10 and it will be over. In reality, it will be over before your child says the number seven.

Have as much direct contact with your child as possible. The more surfaces of his body you touch, the less your child’s brain will focus on the injection. Again, this is the distraction principle at work. By touching your child, you are also sending reassuring signals to him. For the younger child, if he is on the table, stay close to his head and hug his arms, or have him on your lap. Holding him firmly will make him feel safe and will prevent him from moving during the injection. Movement causes more pain or even injury.

For the older child and teens, hold their hands. I sometimes see parents of older teens and college students leave the room, believing that their kids are beyond the age of fearing vaccines. However, we find that even the big kids may need company during vaccines.

After the drama is over.

Have your older child sit quietly for a moment. As the anxiety and tension suddenly falls away, the body sometimes relaxes too suddenly and a child will start to faint. This phenomenon seems to happen most often with the six foot tall stoic teenage boys, but we’ve also seen teen girls and some younger kids get a bit light-headed. We have a saying in my office- “The bigger they are, the more likely they are to fall.” If your child becomes pale (or green) have him lie down for a few minutes until he feels better.

Compliment your child. Remind him that you will never let anyone really hurt him.

Now my story:

When my middle daughter was two years old, my family trouped into my office for our flu shots. We all sat calmly in a circle and smiled.

First, the nurse gave me my immunization. I smiled. My middle daughter smiled.

Second, the nurse gave my husband his immunization. He smiled. My middle daughter smiled.

Then the nurse gave my oldest daughter her immunization. She smiled. My middle daughter smiled.

Then the nurse gave my middle daughter her immunization. She did not smile. She did not cry. Instead, she slugged the nurse with her little fist. I think the nurse felt more pain than my child.

Someday all immunizations will be beamed painlessly into children via telepathy. Until then, I have no advice on how to take the sting away from the punch of a two year old.

March 19, 2014 by twopedsinapod

Poison Control 1-800-222-1222

Put poison control’s phone number on the back of your cell phone, on your cell phone case, and on your wall phone. Put it everywhere: 1–800-222-1222.

Did your toddler eat dog food? Or a berry from your backyard bush? Did you give the wrong medication to your child? Call poison control. Experts at poison control will direct your next step. They have access to extensive data on poisoning, and they can give you that information much quicker than a drug-manufacturer or pharmacist or even your own doctor. One of Dr. Lai’s kids ate a mushroom from the yard when she was 20 months old—she called poison control. A mom asked Dr. Lai about carbon monoxide exposure—she called poison control. If doctors have a question about any ingestion or poisoning—we call poison control. But don’t wait for us to call, go ahead yourself and call.
People often first jump to the internet for information. However, a recent small study found that the internet is NOT the best place to research questions about toxins. Many sites fail to direct readers to the US Poison Control Center, and those who do, fail to supply the proper phone number – again, that’s 1–800-222-1222.

If your child needs emergent treatment, surfing the internet for what to do next wastes precious time. Don’t reach for your phone to “google it,” in the case of a possible poisoning, reach for your phone and make a CALL. It could be life-saving.

Julie Kardos, MD and Naline Lai, MD

March 9, 2014 by twopedsinapod

Diaper Rash-don’t be bummed

this post has been updated, please visit here

Despite what your grandmother says, teething is not the underlying cause of diaper rash. The underlying cause of all diaper rash is, well…the diaper. Whether your baby wears cloth or plastic diapers, the first treatment for diaper rash is to take the diaper off.

Yuck, you say? We agree. This first treatment isn’t practical. Luckily there are other ways to combat the common diaper rashes:

Contact rash- This diaper rash appears as patches of red, dry, irritated skin. Poop smooshed against a baby’s sensitive skin is the main source of irritation for this type of rash. Contact rash is often accentuated where the elastic part of a plastic diaper rubs against the skin. Experiment to see if one brand of disposable diapers causes more irritation than others or if the detergent used for a cloth diaper is the culprit. Even the soap on a wipe or the friction from scrubbing off poop can exacerbate a contact rash.

Treatment: If you see a rash, use a soft, wet cloth with a gentle moisturizing soap to clean off poop or splash water gently on your baby’s bottom. Try to avoid rubbing an already irritated bottom—splash and dab, don’t scrub. Just urine in the diaper? Just pat or fan dry the bottom and change the diaper. Don’t bother to wipe all of the urine off. After all, urea, a component of urine, is used in hand creams. In addition, after every diaper change apply a barrier cream (one containing zinc oxide or petroleum jelly) to prevent your baby’s skin from coming into contact with the next round of irritants.

Yeast rash– This rash is caused by a type of yeast called Candida. The rash typically looks beefy red on the labia or the scrotum. “Satellite lesions” or tiny red bumps surround the beefy red central rash. Babies on antibiotics are particularly susceptible to candidal rashes. Yeast love warm, wet, dark environments so remove the diaper as much as possible to create a cool, dry, light environment.

Treatment: Since yeasts are a type of fungus, yeast rashes respond to antifungal creams such as clotrimazole (sold over the counter as Lotrimin in the anti-foot fungus aisle) or nystatin (prescription). Treatment can take as long as 2-3 weeks.

Pimples– Sometimes you will see a pimple, or a several pimples, in the diaper area . Pimples that look like they have pus inside of them are usually caused by overgrowth of bacteria that live on the skin or around poop. Sometimes a tiny pimple transforms into a boil, or abscess. Suspect an abcess when a pimple grows, reddens, and becomes tender.

Treatment: In addition to usual washing poop off with soap and water, apply an over-the-counter topical antibiotic cream or ointment to the pimples with diaper changes. Soak your baby’s bottom in a bath a couple of times a day in warm water. If you suspect a boil or abscess, take your baby to her doctor who may drain the infection and/or prescribe a prescription topical or oral antibiotic.

Eczema– If your baby has red, dry, itchy patches on her body she may have eczema and eczema may appear anywhere… including in the diaper area.

Treatment: In addition to applying barrier creams, treat eczema in the diaper area with hydrocortisone 1% ointment four times daily for up to one week.

Viral– Viruses such as molluscum contageosum may cause flesh colored bumps in the diaper area. Other viruses, like the ones which cause hand-foot-mouth disease, may cause red bumps in the diaper area. Be suspicious of hand-foot-mouth disease if your see red bumps on your child’s hands and feet as well as sores in her mouth.

Reasons to bring your child to her doctor: If you are unsure of the cause or treatment for your baby’s diaper rash, then it’s time to call your pediatrician. Don’t worry… no one will think you are acting rashly.

February 25, 2014 by twopedsinapod

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