Julie Kardos, MD and Naline Lai, MD
Do you live in the Central Bucks School District in Pennsylvania? We just got back from filming a segment on sleep and breakfast hints on Parent Connections- running through September.
CBTV community cable
Comcast 28/Verizon 40
7:30 pm on Tuesday, Thursday and Sundays
©2012 Two Peds in a Pod®
Ouch! This kid’s index finger has a finger nail infection called a paronychia. Often seen in nail biters and cuticle pickers, this infection occurs in the skin around fingernails. Although most kids are not dexterous enough to bite their toenails, infection can also occur in toes. Bacteria which normally live on skin (Staphylococcus or Streptococcus) find an opportunity to enter the body through openings in broken skin.
The area at the periphery of the nail bed is red, swollen, and painful. At times pus drains from under the nail bed.
Caught early, warm, soapy soaks several times a day may be enough to soften the tense skin and encourage germ-fighting cells to migrate to the infection. After soaking, apply topical antibiotic, such as Bacitracin, to the area. Often the infection improves after 2-3 days of diligent soaking.
Sometimes the infection persists and oral antibiotics are needed to treat the bacteria. In this photo, the redness of the child’s paronychia is spreading beyond the area immediately next to her nail. Besides increased redness, other worrisome signs of worsening infection include red streaks up the affected digit (a sign that the germs are trying to make it up to the heart), increasing pain, or fever. Your child’s pediatrician will make the call after examining your child.
Although I do not keep formal track, I do seem to see more of these infections at the start of the school year when kids at their desks begin to bite or pick their nails and cuticles. To prevent infection, remind your kids to wash their hands. If you have a biter/picker, have her substitute a different habit such as picking at a hair scrunchie or Silly Bandz. A more expensive and time consuming option, which Dr. Lai has seen work—offer a fancy manicure. Kids rarely want to ruin beautifully painted nails by chewing on them.
Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®
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. Until then, I hold my breath each time you take a step. Love, No matter the stage, to smooth your child’s (and your) transition, remember the basic rules of daycare drop-off:
In the office it’s raining school forms. At this time of year, I see many of my patients embarking on their next stage of schooling. Kids I remember starting kindergarten are off to high school. Babies are starting daycare and teens are starting college. For all the parents who have a child entering a new school, whether it’s preschool or college, this letter is for you:
Mommy
For more back-to-school related posts, please be sure to read
How can I motivate my child in school- creating the resilient learner
When children should stay home from school for medical reasons (or listen to our podcast on this subject)
Packing your child’s school lunch: beware of junk food disguised as healthy food
Avoid back strain: what to look for in a school backpack
Wake up, sleepyhead, it’s time for school – how to shift your child’s sleep into a pattern more compatible with school hours
Naline Lai, MD and Julie Kardos, MD
reformatted from original 8/17/09 post
©2012 Two Peds in a Pod®
My kids and I cheered as we watched the Olympic swim races together on TV. Having just finished their first summer swim team season, they were especially interested in these events. While we joked about how much faster Olympian swim times were than their own, we also noted that “just like on swim team” at the end of the races, the Olympians shook hands with the swimmers in the adjacent lanes. It got me thinking about sportsmanship.
The adage says, “It’s not whether you win or lose, it’s how you play the game.” But our society puts such heavy emphasis on winning, coming in first, being the best (and thus beating out others) that kids can feel extreme pressure to win. Parents should resist adding to that pressure.
We, as parents, have to accept that our kids can’t always come in first, get the perfect score, or win everything they do. From an early stage, we need to praise our children’s effort, and also teach them to appreciate other kids’ efforts, skills, and accomplishments. We can say to our kids, “Wow, Bobby sure is a fast runner. I bet if you practiced running (or hitting, or catching, or kicking) you could get better too. I’ll help you if you want.” Teach your child that if she wants to improve a skill or test grade, she will have to work at it. Friendly competition that inspires us is a good thing. Kids cheat when they feel too much pressure to win, and fail to understand that there are no “quick fixes.”
When parents (and coaches) fail to model good sportsmanship, kids blame their pitcher when the other team hits, blame their goalie for letting up scores, blame their parents for not buying the most expensive equipment that would have enhanced their performance. At one of my kid’s games, I saw a young athlete punch a child on the winning team during the end-of-game “high five/good game” ritual because he was so angry that his own team lost the game.
Unfortunately, some teen athletes convince themselves that “because everyone does it,” it’s okay to cheat by taking steroids to enhance their performance. Students without a diagnosis of attention deficit hyperactivity disorder cheat by taking their friends’ ADHD medications so they can concentrate longer when studying for exams or completing homework. Even Olympic athletes cheat. Discuss with your children why eight badminton players were disqualified when they attempted to throw their games in order to get a “better” placement in the tournament. Because they cheated, they were given NO place in the tournament.
The 2012 Olympics is a perfect opportunity for parents to point out examples of good sportsmanship to their children. Even the Olympic athletes who cry from disappointment express support for their teammates and gratitude at the opportunity to compete at such a high level. So as we cheer for our own country or for our favorite athletes, let’s also teach our kids to cheer the athletes’ sportsmanship and performance.
Kids should learn to work hard, study hard, do their best all of the time. We hope that as adults they will value themselves and others for having good work ethics and improving their skills. Of course we should teach our kids to “go for the gold.” But we also need to be clear that we still love them even if they never claim a medal.
For tips on fostering sportsmanship in kids, see this post from the Nemours Children’s Health System.
Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®
Although it’s called ringworm, this rash isn’t caused by a worm. In fact, it barely looks like a worm. Otherwise known as tinea corporis, the patch of ringworm is usually a flesh or light-pink colored, slightly scaly oval with raised, red edges.
Caused by a fungus, sometimes the patch is itchy. The same organism also causes athlete’s foot (tinea pedis), jock itch (tinea cruris) and scalp infections (tinea capitis).
Ringworm falls into the mostly-harmless-but-annoying category of skin rashes (cover it up and no one will notice). Your child’s doctor will diagnose the rash by examining your child’s skin. To treat the rash, apply antifungal medication until the rash is gone for at least 48 hours (about two to three weeks duration). Clotrimazole (for example, brand name Lotrimin) is over-the-counter and is applied twice daily. You will find it in the anti-athlete’s foot section.
On the scalp, ringworm causes hair loss where the rash occurs. Treatment is not so straight forward. Ringworm on the scalp requires a prescription oral antifungal medication for several weeks. The fungus on the scalp lives not only on the skin, but also in hair follicles. So, topical antifungals fail to reach the infection.
Ringworm spreads through direct contact. Wrestling teams are often plagued with this infection. Cats may carry ringworm. If your family cat has signs of feline ring worm such as patches of hair loss, take him to the vet for diagnosis.
If your child’s “ringworm” fails to improve after a week of applying antifungal medication, have your child’s doctor examine (or re-examine) the rash. Other diagnoses we keep in mind include eczema and granuloma annulare. If the rash continues to enlarge we consider Lyme disease.
The sooner you start to treat ringworm, the more quickly it resolves. Just remember, “the early bird catches the…” oh never mind.
Naline Lai, MD and Julie Kardos, MD
©2012 Two Peds in a Pod®
fodder for tetanus…don’t get this stuck under your foot
Look at this rusty old anchor atop an old fort. Rust plus dirt equals a perfect breeding ground for tetanus. As my kids scampered between different anchors last week, I quickly calculated in my mind whether their preventative tetanus shots were up to date.
“Getting the tetanus shot” is part of the American societal childhood rite of passage, but most people don’t know much about why their kids are vaccinated. Everyone knows they want to avoid IT, but what is IT? Because it is somewhat rare in the United States, I still remember asking one dad about his child’s family history. I was startled when he erupted onto peals of laughter after he told me the child’s grandfather had died of tetanus. “Why are you laughing?” I said in disbelief.
“You’re right, it’s not funny… It’s just the look on your face is funny,” he said. “Everyone has the same shocked expression when I tell them that he died from tetanus.”
Also known as Lock Jaw, tetanus is an organism which thrives in places with little oxygen. Thus, it tends to live on rusty nails (and anchors!) and deep in dirt. Tetanus secretes a poison which causes muscles to spasm painfully and severely and also causes seizures. Exposed to tetanus, your jaw muscles clench into a sardonic smile which prevents eating – hence the name Lock Jaw. Eventually, the tetanus poison infiltrates the chest muscles that help you breathe, and if you are like nearly 40 percent of cases, you will stop breathing and eventually die.
We have no antidote for the poison of tetanus- but we do have a preventative immunization which causes our bodies to preemptively prepare antibodies as self-defense. At the time of a high risk injury, if needed, doctors will boost your child’s tetanus immunization. If your child is under- immunized, the doctor will also inject your child with tetanus antibodies (tetanus immunoglobulin) to further ensure that your child will not contract this disease.
Because tetanus thrives away from oxygen, it easily multiples in deep wounds contaminated by the germ. The germ surrounds us in soil and also lives in intestines of humans and animals. Since tetanus lives in dirt, the following are considered “high risk” injuries:
-Bites from animals which dig and “eat” dirt such as dogs.
-Deep puncture wounds from dirty, rusty nails.
-Wounds with embedded rocks and gravel.
Be wary of tetanus in wounds possibly contaminated with stool, dirt ,or saliva. In developing countries, there are continued cases of infantile tetanus because poultices of mud are used to take care of the umbilical cord stump of newborns.
For kids, the recommended ages for tetanus shots are at 2 months old, 4 months old, 6 months old, 15-18 months old, 4-6 years old, 11-12 years old, and then every ten years through adulthood. Note, if a high risk wound is sustained, the last shot should be within five years. Thus, a kid around 9 years old may be up-to-date for shots, but because he received a tetanus vaccine at four-years-old (on time) he will still need an immunization at the time of a risky injury. Watch out also if you have a teen. His pediatrician will immunize him at 11-12 years of age, but after 16-17 years old he will need a booster if he sustains a dirty wound.
Nowadays, the tetanus immunization is in the same solution as an immunization against diptheria (a disease that causes a choking-inducing coating at the back of your throat), and usually in the same solution as pertussis (whooping cough). If your doctor gave your child an immunization recently against pertussis, she also received a tetanus immunization.
Kids are expected to get dirty. Enjoy the dirt—just not the tetanus.
Naline Lai, MD with Julie Kardos, MD
©2012 Two Peds in a Pod®
A picture is worth a thousand words: Dr. Lai joins Dr. Kardos in practice at The Children’s Hospital of Philadelphia Care Network- Newtown, Pennsylvania
It’s a heat wave and in extreme temperatures, kids, like adults, find it tough to go outside for physical activity. We find it perfect timing for the release of Dr. Pat Cantrell’s new kid fitness video (demo below). The video, made in conjunction with kids fitness expert Anna Renderer, gives follow-along exercises along with health advice tailored to kids. We asked Dr. Pat to expand on one piece of advice she gives in the video: eat five servings of fruits and vegetables a day. For many parents, even one serving can be tough to get into a child. Many a parent has asked himself, “Does one bite of zucchini spit back onto the table count as a serving?” If this is you, then you’ll appreciate Dr. Pat Cantrell’s guest blog post.
– Dr. Lai and Dr. Kardos
Not eating enough fruits and vegetables is one of the biggest concerns that parents have regarding their children’s diet. The US department of agriculture recommends that children get at least five servings of fruits and/or vegetables in their diet every day. But most kids aren’t getting that amount. Below are 5 tips that can help children get their 5 a day.
Be creative and persistent and try to offer at least one or two servings of fruits and/or vegetables at each meal.
Pat Cantrell, MD, FAAP
Dr. Pat Cantrell, mother of two young boys (who can be picky eaters at times!), is a board certified pediatrician who has been practicing pediatrics at Southern California Permanente Medical Group for over 14 years. She has a special interest in pediatric obesity and is the President of KFIT Health, LLC (www.kidfitnessandhealth.com) which creates fitness and nutrition DVDs and products for children. A board member of the San Diego Childhood Obesity Initiative, Dr. Cantrell is also the Pediatric Obesity Champion for her medical group. Additionally she serves as Secretary of the San Diego Chapter of the American Academy of Pediatrics.
©2012 Two Peds in a Pod®
Two Peds in a Pod® turns three years old! In honor of our third birthday, we bring you our top ten parental experiences through the years list:
We hope to celebrate many more birthdays with you. Please continue to send us your ideas at twopedsinapod@gmail.com, comment on our posts and tell your friends about us.
Happy,
Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®
Vacation! As I watched my kids scamper across the beach today, I remembered a conversation I had with a family recently. “My kid sometimes coughs up sand,” the mom said to me. “Little hard specks sometimes come out of her mouth. ”
“Hmmm, bring me a speck of the ‘sand’ the next time he spits one out,” I said.
A few days later, rattling inside a small plastic container on my desk, I found a tawny-hued speck which resembled a chip of rock. The mom had kept her promise and now I was the owner of a tonsillolith. Pictured here next to a paperclip, this and other tonsilloliths are harmless hardened pieces of debris which lodge in crevices (crypts) of tonsils. No one is exactly sure why tonsilloliths form, but they do seem to run in families. A combination of the right type of saliva, food, and deep tonsillar crevices produce these white or tan specks which occasionally become the size of a small pebble. In fact, they are also known as tonsil stones. Most people consider tonsilloliths a nuisance, but sometimes they are associated with bad breath. Warm salt water gargles after meals (one teaspoon of salt per 8 ounces of warm water) is usually enough to dislodge the tonsilloliths and prevent new ones from sticking. People have been known to overcome gag reflexes and flick them out with their nails. Addressing any tonsillar irritation such as Strep throat infections (see our previous posts: part one and two) or post-nasal drip from allergies may also be helpful. For those having continual tonsillolith-induced bad breath, removal of the tonsils is the definitive answer.
Some people dream of getting away to Sannibel Island’s shell covered beaches, others to Bermuda’s wispy pink speckled beaches and still others to the jagged rock-strewn beaches of Maine. Do otolaryngologists (ENTs) dream of tonsillolith-covered shores?
Naline Lai, MD with Julie Kardos, MD
©2012 Two Peds in a Pod®