Two Peds in a Pod®

Another picture puzzle- connect the dots

We had such a great response to our Two Peds in a Pod® visual diagnosis post that we are posting another summertime picture puzzle:

What is it? Pictured below are the toes of one of my best friend’s toddler. She is happy, has no fever, and plays nearly everyday in the neighborhood pool. The round shiny pink bumps and dots on her toes appeared yesterday morning and haven’t changed much in a day. They don’t seem to bother her very much… answer below.

It’s Swimming pool pulpitis- a fancy word for a reaction of the pulp (the meaty tip) of fingers or toes. Mostly seen on the finger tips, the pulpitis is usually caused by irritation of the fingers by the rough side of the swimming pool as kids pull themselves in and out. Kids are sometimes annoyed by the dots, but they go away on their own as soon as the kids decide to use the ladder. In this case, this little swimmer irritated her toes, not her fingers, while “monkey walking” along the side of the swimming pool in the water.

Naline Lai, MD with Julie Kardos, MD

originally posted June 2011

July 24, 2013 by twopedsinapod

Picture Riddle: Whats crusty, tender and red all over?

red crusty rash We interrupt your summertime to present another Two Peds in a Pod® visual diagnosis learning session. Do you recognize this rash? Hint: it is mildly itchy and painful and can result from scratching bug bites or a skinned knee. Read on for the answer.

The rash on this child’s arm is impetigo. Impetigo is just a fancy name for a crusty skin infection on the surface of the skin. The infection is caused by the common germs that often lurk on our skin, Staphylococcus and Streptococcus. (You may recognize the germ Streptococcus from our sore throat post because it can also cause Strep throat). The germs wait for a break in our skin, from a tiny cut, pimple or a scrape, then invade the skin and spread. Impetigo is often seen next to the nose because the germs love to lurk in the nasal passages and kids often pick at the skin under the nose when it gets irritated from a cold virus.

Doctors tend to describe infections with appetizing food analogies (yes, we know- eew). In this case, impetigo is often described as having honey-colored-crusted lesions. The areas are tender and red, and often itchy. Kids often spread this infection on themselves when they scratch at the infection and then touch other areas of their skin.

Pediatricians treat impetigo with either a topical antibiotic or oral antibiotic for anywhere from 7 to 10 days. The choice of how to treat depends in part how much of the skin is affected and which body surfaces are involved. The infection is contagious until 24 hours after starting treatment.

Prevent this infection: Hand washing is a great way to prevent spread of impetigo. Washing all skin wounds well with soap and water is another way to prevent the emergence of this infection. See our prior post on wound care.

Ok, now back to the pool and barbeques for all our summertime readers. Just remember your bug spray and remind your children not to scratch and pick at their skin.

Naline Lai, MD and Julie Kardos, MD

July 23, 2013 by twopedsinapod

Understanding four-year-olds

developmental milestones cartoon A favorite pediatrician party game is to guess the age of a child by observing his skills and body habitus. Most people are stumped when it comes to differentiating between preschoolers. Here’s a hint: while three-year-olds look a bit pot-bellied because of weak abdominal muscles, four-year-olds look lankier because their muscles are stronger.

Here are other ways to recognize and understand four-year-olds.

They start recognizing letters and numbers. Do NOT run out and buy flash cards! Teach them simple words that are useful in everyday life. For example, point out STOP or EXIT signs. Point out key words while you read to them. Teach them simple math: “I am giving you and your sister four stickers to share—how many would each of you get to make it fair?”

Their speech is more fluent and expressive than three-year-olds’, and if you listen to them play, you will hear elaborate make-believe stories and scenarios. Make sure you limit TV/screen time so your kids have a chance to “act out” their favorite story lines.

Watch out! Four-year-olds often try potty talk for the first time, especially at the dinner table. Try not to laugh or to shush them angrily, as it only encourages them. Better to ignore and change the subject. If you respond emotionally, you give their words much more power, and they will persist to see if you continue to give an “entertaining” reaction to their words.

They are better rule followers. At preschool they absorb the rules of the classroom. At home you can encourage them to follow house rules such as hand washing before meals, no shoes on the couch, food stays in the kitchen, etc. In the context of house rules, you can introduce “no potty talk at the dinner table.” Four-year-olds will tattle on siblings who fail to follow the rules. This same rule-following skill will now allow your child to play board games that are a bit more complex.

They are hero worshippers. Four-year-olds admire their parents, older siblings, teachers, and fictional heroes who are stronger, more powerful, and larger than themselves. Feed their egos by allowing them to beat you at games or races some of the time.

In their eyes, the world still revolves around them. If you need to occupy a four-year-old, tell her a story where she is the main character. If you feel that you are not up to the creative challenge, just tell her a known fairy tale but give your four-year-old the starring role. Tell the story of “Goldilocks” but rename it “Elizabeth and the Three Bears.”

They tell riddles and understand simple jokes. Amusingly, they tell the same joke over and over again, with peals of laughter. For those of you who remember, “Riddle cups” were very popular with four-year-olds.

Kids this age like rituals. Four-year-olds more actively participate in family prayers. They often latch onto a favorite shirt or dress and insist on wearing it every day of the week. Choose your battles over this, or just buy duplicate favorites so you have time to launder the favorite outfit.

Physically they are more coordinated. They can now hop on one foot, run, climb, skip, throw and catch balls much more accurately. Kids appreciate outdoor play and playgrounds for longer time periods at this age.

Most have given up naps by now: make sure bedtime is early enough so they are not too exhausted to enjoy your bedtime ritual and that they get enough sleep. Most four-year-olds are still “early birds” and wake up with the sunrise.

Enjoy your four-year-old; elementary school is just around the corner!

Julie Kardos, MD and Naline Lai, MD

July 16, 2013 by twopedsinapod

So Big: A Happy Fourth Birthday

We are so proud: Two Peds in a Pod® turns four years old today and our colleague, pediatrician Dr. Robert Sasson, wrote a sweet poem for us to share with our readers. Thank you, Dr. Bob!

Transition to Parenthood

Her fingers stroked her glistening stretched skin

A kick…and yet another… her baby calling

A wondrous Soul has chosen her

To partake in this Divine right of passage

A smile…a glint of Joy

Rises from deep within

A boy…perhaps a girl

So many emotions

Excitement. Anticipation.

Moments of anxiety…uncertainty…fear

So many choices

Stay at home…return to work

Breast or bottle

Clothes…diapers…daycare

Unexplored territory…

Challenges that may at times seem insurmountable

Arm yourselves with knowledge

For in knowledge there is power

Gird yourselves with courage

For a unified heart is the soil

For your baby’s nourishment

Strengthen your shared purpose for

You will find yourselves on rocky ground

When in conflict

Seek not to find your partner’s weakness

Return always to a place of Love

And seek first to understand

For when your baby looks up and smiles at you

You will know the beauty of her Soul

Because she is yours and you are hers

Bonded together for Eternity

Love her…squeeze her…comfort her

Give her the proverbial

“Roots to grow and wings to fly”

This you must always remember!

Bob Sasson, MD
Dr. Sasson’s collection of poetry and photographs Visions of Thought can be found at www.authorhouse.com

July 14, 2013 by twopedsinapod

How do I know if my kid is high or drunk?

The green crosses in the photo signify that the building is a medical marijuana dispensing site. As the TMZ tour bus director pointed out the crosses when my family was recently on vacation in Hollywood, I saw all the kids on the bus crane their heads to look at the building. As I watched the kids, I was reminded that it is summer time and summer brings late night parties for teens. For parents, it brings late nights of worry. “I’d know if my kid was high or drunk,” you say to yourself. Or would you? Here are some signs you can use to tell:

Your tween or teen wanders in late on a Saturday night and acts like he is in slow motion. “I’m just tired,” he claims. Have him look you straight in the eye as you talk to him. Even if he is lying, the truth will be in his eyes. More specifically, it’s in the size of his pupils (the black part of his eyes). Too big (nearly covers the colored part of his eyes) or too little (like pinpoints) is a sign he is currently high.

Most intoxicants not only affect pupil size, but also affect skin (hot and flushed, or cold and clammy), heart rate, breathing rate, and temperature. Any unusual extreme means there’s something on board or the person is sick.

Unfortunately, with pot it’s more difficult to tell if a person is high because people often have different reactions, and pot does not affect pupil size. Most display the usual well-known side signs of acting mellow (a pothead) and having the munchies. Some experience paranoia. Almost everyone has bloodshot eyes shortly after smoking, although that can also be from any smoke irritation. The most reliable way to detect if your kid has been around marijuana probably is to smell his clothing and hair for the distinctive scent of pot.

How can you tell if your kid is drunk? Again, look at his eyes- if he is drunk you may see pupils dancing in small circles. The dancing eyes give the sensation of “dizziness” to drunk individuals.

Another note on alcohol: Parents, beware. Your kids may have more access to alcohol than you think. The type of alcohol in your beer, ethanol, is the same type of alcohol in your morning mouth wash and perhaps in your medicine cabinet. The difference is that mouthwash contains more alcohol than beer. Beer typically contains up to 5 percent ethanol, wine up to 14 percent ethanol, and liquors usually up to 40 percent ethanol. Compare this to Original Listerine with 27 percent ethanol and Nyquil Nighttime Cold/Cough with 25 percent ethanol. And you wonder why it helps you fall asleep?!

Pharming: We teach our children medicine is not candy, and yet Pharming—consuming prescription substances to get a high—is a big problem among teens. And it’s not just medical marijuana kids are using. Since 2003, according to the Centers for Disease Control, more overdose deaths have involved painkillers like Vicodin and Percocet than heroin and cocaine combined. Among teens, medications prescribed for Attention Deficit Hyperactivity Disorder (ADHD) are the most popularly pharmed drugs. Don’t unwittingly contribute to a pharming party where kids raid medicine cabinets, deposit pills into big bowls, and randomly ingest them.

Worried? Call your pediatrician. Two national useful resources:

Drugfree.org information on getting help and preventing drug and alcohol abuse by teens and young adults

DrugNet.net a comprehensive national drug and alcohol rehabilitation center and addiction treatment program resource guide

Naline Lai, MD with Julie Kardos, MD and toxicologist Melisa Lai Becker, MD
©2013 Two Peds in a Pod® based on original post of 4/23/12

July 12, 2013 by twopedsinapod

Announcing a partnership with the Jack and Jill family of magazines

Jack and Jill We are proud to provide content for the parenting site of the Jack and Jill family of magazines—Turtle Magazine for Preschool Kids (ages 3-5), Humpty Dumpty (ages 5-7), and Jack and Jill (ages 7-12). The site US Kids Magazines, promotes “the healthy physical, educational, creative, social, and emotional growth of children.”

Naline Lai, MD and Julie Kardos, MD
©2013 Two Peds in a Pod®

July 2, 2013 by twopedsinapod

Your burning questions answered:sunscreen and sunburns

Hot!

Pictured is a kid with a second degree burn. No, this burn wasn’t caused by hot water or by touching the stove, but by the sun. A sunburn is still a burn, even if it was caused by sunlight.

Treat sunburn the same as you would any burn:

Apply a cool compress or soak in cool water.
Do NOT break any blister that forms- the skin under the blister is clean and germ free. Once the blister breaks on its own, prevent infection by carefully trimming away the dead skin (this is not painful because dead skin has no working nerves) and clean with mild soap and water 2 times per day.
You can apply antibiotic ointment to the raw skin twice daily for a week or two.
Signs of infection include increased pain, pus, and increased redness around the burn site.
A September 2010 Annals of Emergency Medicine review article found no best method for dressing a burn. In general, try to minimize pain and prevent skin from sticking to dressings by applying generous amounts of antibiotic ointment. Look for non adherent dressings in the store (e.g. Telfa™). The dressings look like big versions of the plastic covered pad in the middle of a Band aid®.
At first, the new skin may be lighter or darker than the surrounding skin. You will not know what the scar ultimately will look like for 6-12 months.
If the skin peels and becomes itchy after a few days, you can apply moisturizer and/or hydrocortisone cream to soothe the itch.
Treat the initial pain with oral pain reliever such as acetaminophen or ibuprofen.

Preventing sunburn is much easier, more effective, and less painful than treating sunburn.

What is SPF? Which one should be applied to children?

SPF stands for Sun Protection Factor. SPF gives you an idea of how long it may take you to burn. SPF of 15 means you will take 15 times longer to burn… if you would burn after one minute in the sun, that’s only 15 minutes of protection!

The American Academy of Pediatrics recommends applying a minimum of SPF 15 to children, while the American Academy of Dermatology recommends a minimum of SPF 30. Dr. Lai and I both apply sunscreen with SPF 30 to our own kids.

Apply all sunscreen liberally and often– at least every two hours. More important than the SPF is how often you reapply the sunscreen. All sunscreen will slide off of a sweaty, wet kid. Even if the label says “waterproof,” reapply after swimming.

Why does the bottle of sunscreen say to ask the doctor about applying sunscreen to babies under 6 months of age?

Sunscreens were not safety-tested in babies younger than 6 months of age, so the old advice was not to use sunscreen under this age. The latest American Academy of Pediatrics recommendation is that it is more prudent to avoid sunburn in this young age group than to worry about possible problems from sunscreen. While shade and clothing are the best defenses against sun damage, you can also use sunscreen to exposed body areas.
Some clothes are more effective than others in blocking out sunlight. Tighter weaves protect better than loose weaves. Cotton t-shirts are horrible for sun protection. Clothing uses a UPF rating. UPF measures the amount of UV light that reaches your skin. Higher numbers are better. For example, a rating of 100 means that 1/100, or one percent of UV rays reach your skin.
Hats help prevent burns as well.
Remember that babies burn more easily than older kids because their skin is thinner.

Which brand of sunscreen is best for babies and kids?

For babies and kids, no one brand of sun screen is better than another. Dr. Lai and I tell our patients to apply a “test patch” the size of a quarter to an arm or leg of your baby and wait a few hours. If no rash appears, then use the sunscreen on whatever body parts you can’t keep covered by clothing.

Remember when we used to call sun screen lotion “suntan lotion,” and tolerating red blistering shoulders was considered a small price to pay for a tan? Live and learn.

June 20, 2013 by twopedsinapod

Doctor Dad Kris Taylor- A Father’s Day Story

Dr. Kardos’s dad is a pediatrician and during our long grueling hours of residency training he’d always serve as a source of encouragement. One of my favorite memories will always be the proud look in his eyes years later as he watched his daughter present at a physician conference.

Today we honor all Dr. Dads- dads or father figures- who help their children in times of crisis, illness, or injury. Following is a tribute sent by one of our readers, Jennifer Taylor.

Happy Father’s Day!

Dr. Lai with Dr. Kardos
_________________________

Kris taylor father's day We are parents to three boys so needless to say, our house is always full of cuts, bruises or injuries of some sort. Band-Aids and “feel better” kisses are a regular part of our daily activity. And while my husband is a great “Doctor Dad” to all three boys, it is his every day involvement in my youngest son’s medical care that makes him a truly amazing father.

My son Luke is 4 years old. At the age of 6 months, he was diagnosed with an in-utero stroke. We were told at the time of his diagnosis that he may never talk or walk based on where the stroke hit. We’ve had several years of therapy, doctor’s appointments and testing. Throughout it all, Kris has been an amazing supporter- both for Luke and me.

While I tend to see the glass half-empty, Kris is perpetually positive. He always says “When Luke can” instead of “If”. He does research on therapies that might shake things up in Luke’s progress and is certainly a very active participator in all the therapies we receive. Kris stops in to chat with all the therapists so that they know he is Luke’s Dad. He is at every medical appointment: driving us to CHOP at 7:00 in the morning because he knows I hate driving on Route 76 by myself; heading up to Lehigh Valley Hospital for a speech consult; sitting by me while Luke has some sort of test done, holding my hand and telling me it will be okay. He is compassionate throughout it all and yet he still pushes Luke to succeed, knowing that our little boy can accomplish anything. When Luke gets frustrated, it is my husband who can calmly get him to try, try again. And they say laughter is the best medicine so my husband pulls out all the jokes and silly behavior he knows to get Luke to go “one more time.”

I really could go on and on about what a wonderful Dad my husband is but the true testament to him is sitting on the floor next to me singing and playing. Luke wouldn’t be where he is now without Kris.

And for that, I am eternally grateful.

June 16, 2013 by twopedsinapod

Seeing is not always believing

summer pediatric hints Yesterday morning we were aghast to read medical misinformation in the print edition of our local newspaper. Aghast, because we were the pediatricians interviewed for the content of a summer time tips article.

Although a more accurate online version appeared, the print version contained several inaccuracies.

How can you tell if the medical article you are reading is accurate?

Readers should always question what they read, and cross check to see if the information is consistent when compared with other credible sources. In this instance, we served as the “expert” sources of two articles for the same publication (print and online), yet the articles contain conflicting medical information. Cross reference our information with other experts in our field, such as the American Academy of Pediatrics, the Centers for Disease Control, and of course your own pediatrician.
Look twice if the interpretation of the information is coming from a secondary source. The information we give on Two Peds in a Pod is “straight from the horse’s mouth.” We edit and publish our own material. In our office, we talk to patients directly. Remember that “telephone” game you played at birthday parties? The message changes the more intervening people are involved in relaying information.
Medical information changes as new discoveries occur and more studies are conducted. There is a saying in medical school, “Even though half of what you learn in medical school will be inaccurate in ten years, learn it all, because you don’t know which half will be disproven.” We keep up with evolving knowledge in pediatrics by reading journals, taking courses, reviewing cases with our colleagues, and retaking our medical boards on a scheduled rotation. Be sure you read information that is current as well as backed by credible sources.

Despite our dismay at the inaccuracies in the print version, you will find the online article helpful. In addition, please check our prior summertime posts about bee stings, Lyme disease, tick removal, poison ivy, splinter removal, and stay tuned for near-future articles about swimming and sunscreen.

Whoever said, “You can’t believe everything you read on the internet,” was right… except perhaps this time.

June 11, 2013 by twopedsinapod