Two Peds in a Pod®

Who would have thought? Walking in a prewinter wonderland

If you live on the East Coast of the United States, you were bombarded today by a surprise pre-Halloween snowstorm. Now that we have our power back, we thought we’d share with you a few posts we were reminded of today:

As Dr. Lai struggled with chimney flues, she was reminded about hidden sources of carbon monoxide.

Scrambling around for a halloween costume reminded Dr. Kardos of ways to keep the candy intake down to a reasonable amount.

Squeezing children’s toes into snow boots from last year reminded us of how to dress your child appropriately for cold weather.

Looking for matching mittens reminded us of home remedies to prevent dried chapped hands.

Surely the cold, harsh weather is the fault of the retail industry- the big box stores lined their shelves with winter-holiday knick-knacks halfway through October. Mother Nature, like other mothers, was not pleased.

Naline Lai, MD and Julie Kardos, MD

October 30, 2011 by twopedsinapod

Two Pediatricians return from Boston: dispelling myths about pot, steroids and prescription drugs

We’re back from the national American Academy of Pediatrics conference in Boston and we’re galvanized to make a positive impact on youth. Just in time for Red Ribbon Week, the national campaign for halting substance abuse Oct 23-31 (www.redribboncoalition.com), we bring you facts for you to use as you talk about three drugs kids generally consider “harmless”: marijuana, anabolic steroids, and prescription medications.

Marijuana: In 2010, one out of five high school seniors and eight percent of eight graders reported using marjuana. Unlike popular belief, marijuana is addictive. Use starting in adolescence is associated with an almost 20 percent risk of dependence. It’s strong stuff. As little as five uses of pot can lead to addiction and withdrawal symptoms are similar to withdrawal symptoms from heroin. The good news is that a teen can withdraw safely at home. If your kid tells you he is not addicted and can quit at any time, challenge him to stop smoking for two weeks. If he can’t, then he is in deeper than he realizes.

Pot clouds up the brain and makes it more difficult to remember recent events. Although kids say they can drive after smoking weed, their reaction time is impaired, just as it is with alcohol use. In the past researchers thought brains did not develop much in adolescence. However, brain development does continue to the early twenties, and pot can affect that development by altering mood and executive function (planning) centers in the brain. In short, marijuana causes brain damage.

Steroids: It’s just as likely to be the kid who wants to look “buff,” and not just the athlete who wants to play better, who uses anabolic steroids. Addiction does occur… and in a lot of users. One-third of all users end up addicted. Not only do steroids affect muscles, but also they affect the brain. Adolescents are already known for emotional volatility and steroids heighten aggressiveness. Additionally, sex organs pay a price for steroid. In males, testicles can atrophy and breast development can occur. For females, non-reversible facial hair growth and deepening of voice are side effects.

Prescription medications: Throw away those unused prescription pain killers and lock up controlled substances still in use. Prescription medications seem unintimidating to kids because they are prescribed legally and they see their parents taking them. Over the last few years, reported use of Vicodin in the past year by 12^th graders ranged from about eight to ten percent. Deaths occur from overdose or from accidents from impaired driving.

Data show teens listen to advice they hear from their parents and their pediatricians, even if they sometimes take time to digest and act on that advice. We pledge to do our part when we talk to your kids about the harmful effects of drug use. We urge you to continue communicating with your children, even if they are away at college. One helpful website to assist you in talking to your kids about drugs is The National Institute on Drug Abuse: http://www.nida.nih.gov/nidahome.html.

Culled from talks given at the American Academy of Pediatrics National Convention and Exibition, 2011, by Patricia Kokotailo, MD, MPH and Greg Landry, MD, FAAP University of Wisconsin School of Medicine and Public Health, Madison, WI, John Kulig MD, MPH,FAAP, Tufts University School of Medicine, Boston. If you live in the Central Bucks area of Pennsylvania contact CBCares for more information on local Red Ribbon Week events.

Naline Lai, MD and Julie Kardos, MD

October 25, 2011 by twopedsinapod

Should I vaccinate my child?

Yes, yes, yes.

There are many deadly diseases we can’t prevent, but we do have the power to prevent a few. We now have the ability to prevent your children from getting some types of bacterial meningitis, pneumonia, and overwhelming blood infections. With vaccines we can prevent cases of mental retardation, paralysis, blindness, deafness, and brain infections. Immunizations are a safe way of boosting children’s natural immune systems. Yet some of our parents continue to doubt the benefits of vaccines and to fear harm from them.

Let’s look at another kind of prevention. You would never drive your car without putting a seat belt on your child. Even if you don’t know anyone who was in a fatal car accident, you still buckle you and your child up. You may know a kid who emerged from a car accident with only a scrape, yet you still buckle you and your child up.

You may never know a child who is paralyzed by polio or who died of whooping cough, but it does happen and can be prevented. Just like with car accidents, it’s better to prevent the injury than to play catch-up later. Dr. Kardos’s grandfather routinely rode in the front seat of his car without his seat belt because he “had a feeling” the seat belt might trap him in the car during an accident. Never mind that epidemiologists and emergency room doctors have shown people are much more likely to die in a car accident if they are not wearing a seat belts, he just “had a feeling.”

When it comes to your children, parental instinct is a powerful force. We routinely invite our patients’ parents to call us about their children if their instincts tell them something might be wrong, and we always welcome and at times rely on parents’ impressions of their children’s illnesses to help us make a diagnosis and formulate a treatment plan.

However, in the face of overwhelming evidence of safety and benefits of vaccines, we pediatricians despair when we see parents playing Russian roulette with their babies by not vaccinating or by delaying vaccinations. We hope fervently that these unprotected children do not contract a preventable debilitating or fatal disease that we all could have prevented through immunizations.

There is no conspiracy here. We both vaccinate our own children. We would never recommend any intervention where the potential for harm outweighs the potential for good. We have valid scientific data that every year vaccines save thousands of lives. One of them could be your child’s life.

Should you vaccinate your child?

YES!

Julie Kardos, MD and Naline Lai, MD
©2011 Two Peds in a Pod®

Visit these posts for more information about vaccines: How Vaccines Work, Evaluating Vaccine Sites on the Internet, and Closure: there is no link between the MMR vaccine and autism

Also, please visit the recent Institute of Medicine’s analysis of vaccine side effects.

October 19, 2011 by twopedsinapod

Ways to calm your frustrated toddler: halting the endless tantrum

Time out’s over and your 18 month old is still flailing on the floor, pig-tails flying and tears streaming down her face. “Time out is over,” you say, trying to console her, but she continues to cry, and cry and cry. She cries so long she forgets why she started.

Last week we lead a parenting seminar, “Trials and Tribulations of Toddlerhood: How to grow your child emotionally” for the Play and Learn: a Family Place series at the Pennsylvania Bensalem Bucks County Free Library. One topic of discussion was ways to help your heated up, frustrated toddler “cool off”:

–Offer a favorite stuffed animal or “blankie.” Gripping his familiar comfort toy often helps the toddler to “get a grip” on his emotions. Try to buy several of the same animals and switch off, otherwise you will soon have a pretty grubby toy. If your child’s comfort “blankie” is starting to unravel, cut it up into smaller pieces and sew the pieces onto new fabric.

-Don’t feel guilty about giving a binkie/pacifier: Otherwise known as “the magic cork,” at this age, binkies do no permanent harm to teeth and they will soothe a flustered kid. Thumb sucking is also an effective, benign self-soothing technique at this age. Please see our binkie post for more about binkies and when (and how) to wean, and listen to our earlier podcast for more about thumb sucking.

–Go outside with your toddler– a change of scenery and temperature works instantly to distract your toddler from his woes. Even bad weather works. Dr. Lai remembers many times huddling under a blanket on her porch with her children as it snowed.

–Just walk. Start walking around the house carrying your kid or holding his hand. Or marching. Or “funny-walking.” Sing a silly tune as you go. Your toddler may catch your silliness and forget his woes. If this is not enough, march outside.

–Sit down and start playing WITHOUT your toddler. Or working a puzzle. Or making toy cars drive around. Or setting up stuffed animals for a party. Or coloring. Your toddler will become curious and want to join you. Remember, “time in” is much more attractive than “time out.” Keep bubbles on hand. Blowing bubbles, not only distract, but like the breathing techniques in yoga, blowing bubbles help toddlers relax.

–Read a book. Make it a habit of reading during soothing times such as bedtime, quiet time or before nap time and your child will learn to associate this activity with feelings of peace. When your toddler is “stuck,” reading her a favorite book will return feelings of calmness. In general, reading books about emotions will also give your child a vocabulary to express himself. The inability to communicate to you her emotions will escalate frustration. After she is calm, use books to teach “what to do next time.” For instance in one of Dr. Lai’s favorite books, When Sophie Gets Angry—Really, Really Angry by Molly Bang, the main character Sophie explodes like a volcano. Ask your child when you read the book,” what can Sophie do instead of exploding? What would you do?”

Below are a list of suggested books about emotions complied by Librarian Pat Stephenson, hostess of the Bensalem Play and Learn parenting series.

Hands are not for Hitting, by Martine Agassi

Feelings, by Aliki

Squish Rabbit, by Katherine Battersby

Teach your kids to think! by Maria Chesley Fisk

Grump, Groan, Growl, by Bell Hooks

Understanding myself: a kid’s guide to intense emotions and strong feelings, by Mary C. Lamia

Any book written by Mister Rogers

Calm Down Time, by Elizabeth Verdick

Feeling Sad, by Sarah Verroken

Alexander and the Terrible, Horrible,No Good, Very Bad Day and other Alexander books, by Judith Voist

I Love my New Toy! By Mo Williams

As we discussed in Toddler Discipline “Time Out” is an effective form of discipline. But there is a difference between disciplining your child and teaching your child self calming techniques. When time out is over, it’s over. Help him move on.

Julie Kardos, MD and Naline Lai, MD

October 13, 2011 by twopedsinapod

How to check for scoliosis: as easy as 1-2-3

Ever wonder what the school nurse or your kid’s pediatrician is looking for during a scoliosis screen? Here, in three steps, you can also monitor your child. If you are concerned, see your child’s doctor.

And dat is how to check dee spine!

Naline Lai, MD and Julie Kardos, MD

October 10, 2011 by twopedsinapod

When your back “throws you a curve”: Scoliosis

I remember during my middle school days in New Jersey lining up once a year at the school nurse’s office, feeling awkward and nervous. Not only was the nurse checking our height and weight as she did every year in grade school, but now she was going to check our backs for some mysterious entity called “scoliosis.” Where I live now in Pennsylvania, many school nurses also screen students for scoliosis, a curve in the spine.

Although pediatricians check children’s spines for scoliosis throughout childhood, school based screens occur during pre-teen and teenage years. This timing is appropriate for school screens because most cases of idiopathic scoliosis, scoliosis with no known cause, occur during the rapid growth spurt of puberty. Eight times more common in girls than boys, scoliosis is painless and often detectable only to health care providers; minor curves are neither obvious nor disfiguring. Caught early, scoliosis can be ameliorated or corrected before adulthood when it can lead to back pain, difficulty breathing and disfigurement.

Unlike what some parents think, scoliosis does not cause “bad posture.” Likewise, “bad posture” does not cause scoliosis.

Depending on the degree of the curve, a child with idiopathic scoliosis might be re-examined every 4-6 months, might get an x-ray of her spine, or her health care provider might refer her to an orthopedic doctor, a specialist who cares for kids with scoliosis. Kids whose spinal curves are severe or are likely to get worse may need bracing until they stop growing. At that point the chances of the curve continuing to increase is low. Wearing a brace does not correct the curve; rather, it prevents any further curvature. Scoliosis braces are much more inconspicuous now than in the past, and can be hidden easily under clothing. Some children require surgery to correct a severe curve.

So, while it may cause an awkward middle school moment, scoliosis screening can actually have far reaching consequences for the future.

Next up: stay tuned for a “do-it-yourself “scoliosis screen.

Julie Kardos, MD and Naline Lai, MD

October 5, 2011 by twopedsinapod

“Because I said so?” – getting your kids to listen

While many good books have been written on the subject of how to get your kids to listen to you, today we boil this topic down to a few key sticky points. The goal is to make sure your child hears, “Please clean your room,” as well as,“Let’s go get ice cream.”

Here are ways to make requests which yield results:

Validate feelings, then make the request. For example, “I know you are tired. Please pick up your clothes from the floor and put them in the hamper so I can wash a load with the soccer shorts you need for tomorrow.”

Give kids a time parameter for getting a task done so they do not feel you are interrupting their fun. For example, “Dinner is in one-half hour. In the next half an hour, I expect your toys to be cleaned up.”

Make a request sandwich. Use two positive statements with the request in between. For example, “I like how creative you’re being. Remember the crayons need to be put away before bedtime. I can’t wait to see your finished picture!”

Give warnings about transitions. For example, “We are having so much fun at the playground. We will need to leave in fifteen minutes.” And then, “We will leave in five minutes. Do your last thing.” And finally, “We need to leave now.”

Use the phrase, “I expect” rather than “I want” For example, “I expect your homework to be done by dinner time,” rather than, “I want you to do your homework before dinner time.”

Stay on topic. For example, your child is trying to get out of taking out the garbage and starts giving you a multitude of reasons for not completing the task. He also starts to prattle on about his upcoming baseball game. You say, “I understand you feel it’s your brother’s turn to take out the garbage. I know you would rather continue playing your computer game. I will listen to you talk about the game later. Right now I expect you to contribute to our household by taking out the garbage.” Try to keep your own frustration out of your voice.

Don’t nag. Kids, like all people, get irked by nags. Repetitive nagging only gives them practice at ignoring you.

Remember where your child is developmentally. A thirteen year old can be told to eat after others are served at a restaurant. A thirteen month old can not.

Make eye contact when making a request. Don’t text and talk. Show your children you respect them as people.

A special note about bribes and threats: By three years old, most kids understand bribes and threats. Sounds terrible, doesn’t it? However, both can be useful when used sparingly. For example, you could offer to take your child out for ice cream, or a bike ride, or a special event, in exchange for cleaning his particularly horrendously messy room. But bribes used too often create a kid who expects to get “paid” for performing reasonable and customary personal and household tasks.

Likewise, threatening a negative consequence must also be used sparingly or else you will end up with a resentful child who will have even more motivation to not listen to you. Remember to take away “extras” rather than essentials. For example, failing to listen may result in losing a finite amount of TV/videogame time. Do NOT threaten to take away eating dinner, reading with your child before bedtime or going to her best friend’s birthday party. Remember to follow through on the consequence immediately. Giving empty threats or putting off threats put you into the “nag” category.

Most importantly, during any ice cream outing, bike ride, or special trip to the park, regardless if it was a planned event or a bribe, flip the table and take the time to listen to what your child has to say.

Julie Kardos, MD and Naline Lai, MD

Special thanks for input from Kim Ross. A first grade teacher for the past 19 years, Mrs. Ross holds a Bachlor’s degree in Early Childhood Elementary education and a Masters degree in Educational Psychology, both from Temple University. Mom of two, she also is a Certified Parenting Educator.

September 28, 2011 by twopedsinapod

Hear ye, hear ye: how can I tell if my child hears?

I just watched “The Miracle Worker” with my oldest son. This classic 1962 movie depicts Helen Keller, who was deaf and blind, struggling to understand language, with the help and supreme patience of her determined teacher Annie Sullivan.

As I watched the movie, I was reminded about how children depend on their senses to learn about the world. Starting today, Two Peds in a Pod will bring you periodic posts about the early development of senses. We start with hearing.

Unlike eyesight, which is limited at birth, babies are usually born with normal hearing. Before leaving the hospital after birth, or by two weeks of age, your newborn should receive a hearing test. Then, at every well child check, your child’s health care provider will ask you questions to confirm your child’s hearing remains the same.

Even though they are unable to localize where sound is coming from, newborns will startle to new or sudden sounds and their eyes will open wider in response to the sound of your voice. All babies babble, even deaf ones, but language progression will stop in children who cannot hear. By six months, kids usually babble one syllable at a time. By nine months, children will produce syllables that sound like whichever language they hear the most. At this point they should also respond to their name. Babies who fail to meet these milestones may do so because they cannot hear.

For older kids, hearing screening may be conducted in schools or the pediatrician’s office. The American Academy of Pediatrics recommends formal hearing screens starting at four years old. These screening tests can detect subtle hearing loss that parents did not notice. Kids who fail the screen should have a more comprehensive hearing evaluation by an audiologist. Many kinds of hearing loss are either reversible or manageable. The earlier the diagnosis the better.

Sometimes speech, behavior, or attention problems are secondary to hearing difficulties. School aged children may mispronounce words because they cannot hear sounds clearly. These children commonly do not distinguish well between the “s,” “ch,” and “sh” sounds (please click here to review language development). Symptoms attributed to Attention Deficit Hyperactivity Disorder such as difficulty focusing or inattentiveness may actually result from hearing loss. Some kids who “just don’t listen” to adults simply can’t hear well enough to follow directions.

As your child’s hearing loss progresses, you may notice your child’s language regresses, or that your child turns the volume up on the TV. Your child may accuse you of mumbling or ask you to often repeat questions. Although a common myth, a child who talks loudly is not necessarily deaf. After all, a child does not need to raise his own voice in order to understand himself.

Finally, I should mention signs of “selective hearing loss.” Many parents describe this form of “hearing loss” to me in the office. In these cases, a child does not hear her mom say “Clean your room,” yet hears her mom whisper “Let’s go out for ice cream.”

We address the topic of listening, as opposed to hearing, in our next post.

September 24, 2011 by twopedsinapod

Beware the bewitching hour

Every day across the United States, sometime between 4:00 to 5:00 PM, millions of small children are crying and whining. Welcome to the bewitching hour.

In our offices it’s bedlam during that hour. The phones start ringing off the hook: daycare called mom to report Johnny has a fever, Mildred came off the school bus bleeding from a gash from a flying lunch box, and help, the coach won’t let Mary play lacrosse until her school form is signed.

Meanwhile, you are trying to get home from work/ fix dinner/ walk a cranky baby/order new cleats for Jared, or all of the above, likely at the same time.

Resign yourself. Even if your kids are well-fed, napped and had a great play date that day, the bewitching hour can still happen. Think of it as Colic: Part Two. Some think colic is related to the difficulty of young nervous systems trying to adjust to nightfall. We’re not sure anyone ever grows out of that stage! We just hide our crankiness better as adults. When you think about it, it’s a hard point of day for adults, even childless ones. After a full day around the house or at work, you’d rather curl up on the couch and read a good book than grapple with, well, anything. Remember those ads for bath soap? “Calgon take me away.”

I remember when my oldest was a toddler. At the bewitching hour I’d stare out the window looking for my husband’s car as he drove home from work. We’d have conversations like this, “Daddy should be home any minute. Let’s go to the window and see. No Daddy? Let’s read a book on the porch and watch for him. No Daddy? Then let’s move to the lawn. I’m sure he will be in the next car.”

Your best defense against your desperation at this time: drill down to the basics: eat, sleep, drink, pee, poop. Make sure they are all going okay entering the bewitching hour- for your kids and for YOU! You may be too harried to notice that you did not drink anything for hours and a dehydrated dad will feel like he’s hallucinating during the bewitching hour.

When my oldest was three and my younger child was one, I surprised the furnace repair guy by cooking dinner at two in the afternoon. The crock pot is your friend. A crock pot dinner will cook itself. Do everything possible: cook the dinner, set the table, give the baths and make your phone calls before the hour hits.

If you are picking the kids up from daycare, make sure you have something healthy for them and yourself to munch on in case everyone is starving. Alternatively, pack a dinner for the daycare teachers to give to your children before you pick them up. These strategies will prevent your children’s hunger from fueling the bewitching hour. Additionally, having a healthy snack prevents them from becoming so full from goldfish crackers that they later refuse to eat their meal. Even if your kids eat dinner before you, they can join the adults at the dinner table and eat some fruit or veggies or have a cup of milk, allowing for some quality family time.

Several years ago during a particularly horrific bewitching hour, Dr. Kardos’s three children melted down simultaneously. In desperation, she grabbed the video camera for some footage of one five-year-old and twin two-year-olds all tantruming at the same time. Now the replay is as entertaining to her family as the funniest of America’s Funniest Videos. Sometimes you have to use humor and remind yourself that you might, one day in the not so far off future, miss this time.

And don’t forget. Just as you are questioning whether or not you will go insane… there are times when the bewitching hour will go smoothly… at least until you wake up!

Naline Lai, MD with Julie Kardos, MD

September 12, 2011 by twopedsinapod

A message to our children: Don’t be afraid to reach for the sky

If you were around the New York area ten years ago on September 11, you know it was a beautiful crystal-clear day. It was the kind of day which made you gaze admiringly at the sky as you stepped out the door. No one knew that soon the sky over New York, Pennsylvania, and Washington, DC would be marred by the dark clouds of terrorist attacks. Many of your children were too young to remember much about the day, or perhaps they were not even born yet.

As the ten year anniversary of that tragic day approaches, we remind you of previous posts which may help your children digest the images they see in the media and the raw emotions of adults around them. Above all, don’t be afraid to discuss the day and assure your children that it’s still ok to reach for the sky:

Explaining Tragedy to Children
Books for helping children through bereavement
How to explain death to a young school aged child

This link from Common Sense Media may also help: Talking to your child about 9/11: What do you need to know?

Naline Lai, MD and Julie Kardos, MD

September 10, 2011 by twopedsinapod

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