Two Peds in a Pod®

Waxing philosophically: ear wax and eew

Babies are gooey. Spew tends to dribble out of every orifice and the ear is no exception. Devin’s mother tipped her four month old baby’s head sideways in the office the other day and asked me what to do about the oily, yellow wax smeared around the opening of his ear canal.

Some say wax evolved to help keep bugs and other debris from reaching deep into our ear canals. Case in point: one of my least favorite memories during residency was when I picked out pieces of a cockroach entrapped in the wax of a child’s ear. The amount of wax you see on the outside is not indicative of the actual amount inside the ear canal. Chances are, the wax is not hard and does not block the ear drum. Even if there is a large amount of wax, it is unlikely to greatly affect a baby’s hearing. Equally normal is that some babies and children don’t seem to produce any ear wax. If you are concerned about your child’s ear wax, have your pediatrician take a peek with a light.

Despite the copious amount of wax on the outside, Devin’s ear canals were clear. “But the wax is simply disgusting,” said Devin’s mom, “Can I clean his ears? “

“Yes”, I answered. “Wipe off what you see, doesn’t matter if you use a wash cloth or cotton swab. The special shaped cotton swabs with the safety tips are unnecessary. Anything you see is fair game. Rest assured, you will not go too deeply into the ear canal if you only scrape off what is visible.” Dr. Kardos goes one step further and tells her patients: if you can get the wax with a wash cloth, it’s fair game. Otherwise, leave it alone.

Now suppose your pediatrician does say the wax should be removed. Place an over-the-counter solution such as Debrox in the ears (children and adults can use the same formulation) – three to four drops one or two times a day (during sleep is easiest for babies and toddlers) for a few days. The solution softens wax. For maintenance, mineral oil and olive oil are favorite remedies. Place one drop daily in ears. In the office some pediatricians can use a water irrigation system (like a water squirter in your ear) to wash out the wax. The worst side effect is that the child’s shirt sometimes gets wet. Irrigation is a very effective for removing wax in a school-aged or teenaged child who complains of difficulty hearing.

If you find you are constantly cleaning your baby’s waxy ears, take heart. At least there won’t be any roaches “bugging” them.

Naline Lai, MD with Julie Kardos, MD

January 20, 2011 by twopedsinapod

What? That’s not what we said: Real Simple Magazine

Take a look at the February 2011 issue of Real Simple magazine. We are two of the experts cited on page 124. The good news is that some of our thoughts on the essentials of a medicine cabinet were integrated into a photo-essay piece. The bad news is that children’s cough medicine is listed as a component of the medical cabinet. While the other contributors to the piece may encourage use of over-the-counter cold and cough medications, we discourage use.

Of concern, safety and effectiveness of cough and cold medicine has never been fully demonstrated in children. In fact, in 2007 an advisory panel including American Academy of Pediatrics physicians, Poison Control representatives, and Baltimore Department of Public Health representatives recommended to the U.S. Food and Drug Administration (FDA) to stop use of cold and cough medications under six years of age.

Thousands of children under twelve years of age go to emergency rooms each year after over dosing on cough and cold medicines according to a 2008 study in Pediatrics . Having these medicines around the house increases the chances of accidental overdosing. Cold medications do not kill germs and will not help your child get better faster. Between 1985 and 2007, six studies showed cold medications didn’t have significant effect over placebo.

So why are children’s cough and cold medicines still around? A year after the advisory panel published their recommendations, FDA advised against using these medications in children younger than two years but data about these medications in older children is still rolling in. FDA continues to advise caution with these medications. The producers of cold medicines said at that point they would launch new studies on the safety of medication for those two to twelve years of age. In the meantime pharmaceutical companies stopped manufacturing cold medicine products for those under two years of age and changed the labels to read “for four years old and above.”

Yes, watching your child suffer from a cold is tough. But why give something that doesn’t help her get better and has potential side effects? There is plenty to do besides reach for cold medicine. Give honey for her cough if she is over one year of age. Run a cool mist humidifier in her bedroom, use saline nose spray or washes, have her take a shower with you, and teach her how to blow her nose. Break up that mucous by hydrating her well- give her a bit more than she normally drinks.

If you have young children and want to make your medicine cabinet truly “real simple” then take out the over the counter cough and cold medication.

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

January 17, 2011 by twopedsinapod

Closure: there is no link between the MMR vaccine and autism

It’s confirmed. Dr. Wakefield was a fraud. Recently, on January 5, 2011, reporter Brian Deer published a report in the British Medical Journal exposing more flaws in the Wakefield study- the study which proposed a link between Measles, Mumps, and Rubella vaccine (MMR vaccine) and autism. Of note:

Lawyers who were trying to win a law suit for parents who believed that the MMR caused their children’s autism paid Wakefield to do the study.
Wakefield falsified his findings. The medical records of all 12 children in the study were inconsistent with Wakefields’s data.
Almost half of the children in the study already showed signs of developmental abnormalities before they received the MMR vaccine. Therefore, the MMR vaccine did not cause their disabilities.
Rather than randomly choosing the children for the study, Wakefield obtained most of his subjects through an anti-MMR campaign group.
Ten out of twelve other authors of Wakefield’s paper have withdrawn their support of the paper.

To read about the original study and the controversy around it, please see our earlier post, “Do vaccines cause autism?” For more information about how vaccines work, please read “How vaccines work.” To learn signs of early communication delays in your infant, please see “How do I know if my baby has autism?”

Too bad it’s too late for some children. Since Wakefield published his paper, measles cases have steadily risen in the UK. Hopefully the damage caused by Wakefield’s 1998 paper will be mitigated by more parents who vaccinate their children.

Julie Kardos, MD with Naline Lai, MD

January 11, 2011 by twopedsinapod

Teaching Kids Money Smarts

“The Great Recession has truly changed peoples’ attitudes towards money and parents are in need of help.” Thus observes award winning author John Lanza, our guest blogger today, who gives us ways to teach kids the value of money.

Just as New Years kicks off the “goal-setting season,” a powerful way to teach kids the value of money is setting goals. I’ve seen goal-setting work first hand with my kids. I’ve also seen how frivolous spending increases when a savings goal is absent. Teaching your kids to set goals, not just monetary ones, is an essential life skill.

To get started, kids must receive some type of steady stream of money – an allowance. I use David McCurrach’s Allowance Magic as a guide. David’s short workbook makes a strong case with which most money experts and I agree –- that parents should not tie chores to allowance. Because most parents were given an allowance tied to chores when they were kids, they believe that they should do the same. Times change and just as we’ve learned that a five-point harness beats a single-point one for car seats used when we were kids (see Drs. Kardos and Lai’s carseat safety post ), we money experts realize that allowance is a tool to teach kids to become comfortable with money.

It’s okay to pay your children for “above-and-beyond” chores as noted kids money expert, Karyn Hodgens, author of Raised for Richness, calls them. Clearing the table, for example, is a chore they must do because it’s a family requirement, but mowing the lawn might be an “above-and-beyond” chore for which they could be paid. For more on the allowance/chores debate, I highly recommend Karyn’s piece on Motivation Theory.

Learning to be money smart is largely about learning to make choices. Therefore, allowance distributions should be split into three parts. One of the first things parents should do when creating an allowance system is to set up a system of three jars –- one for sharing (charity), one for saving and one for spending smart. You can certainly create your own jars or simplify the process and purchase them from companies, such as my own, that provide inexpensive three-jar systems (www.themoneymammals.com).

So here’s what my wife and I do. We give our seven-year-old six dollars per week. She is required to save two dollars and to put one dollar into her share jar. She can do what she wants with the other three dollars. To encourage saving, we “match” any additional dollar put into the save jar with a quarter, a novel idea straight out of Allowance Magic. The matching program, along with pasting a picture of a specific, achievable goal on the save jar, truly helps influence the saving behavior you want to encourage in kids. To set an achievable goal, consider the horizon with which a young child can cope. Four to eight weeks for a five- or six-year-old is a good starting point.

One of the most difficult aspects of giving your kids money is relinquishing control of the money to them, within reason. Just remember that your purpose for an allowance system is to teach your kids to be money smart. They need some autonomy to make decisions and they will, inevitably, make mistakes. Learning from small mistakes now will help prevent devastating choices years down the road. Though I’m not a big fan of those $104 American Girl dolls (with tax), that’s what my oldest wanted. Saving six months for it taught her a valuable lesson that she wouldn’t have learned had I nixed the idea.

We parents have an opportunity to raise a money smart generation and I hope some of the pointers in this article are helpful.

John Lanza

John Lanza is the Chief Mammal at Snigglezoo Entertainment and is the Creator of The Money Mammals DVD that helps kids learn to “Share & Save & Spend Smart Too.” John also runs The Money Mammals Saving Money Is Fun Kids Club and blogs, tweets and writes often about youth financial literacy. His new children’s book, “Joe the Monkey Saves for a Goal” was just awarded a Dr. Toy Best Pick of 2010. Find out more at www.themoneymammals.com.

January 5, 2011 by twopedsinapod

Happy New Year 2011 from Two Peds in a Pod

We know the first time your child rides a two wheel bike or loses a tooth is a momentous occasion. In honor of January first, we’ve compiled a list of some of our favorite, lesser known, firsts. Have we missed any of your favorites? Please add to this list.

First time he tries peas

First time she walks on sand or grass in bare feet

First time he sees snow

First time she explains to you how to work your computer

First time she sleeps through the night (if ever)

First he calls grandpa on the telephone

First poop in potty- remember saving it to show your spouse?

First time she buckles herself into the car, with no help from you

First time she sleeps over someone else’s house

First time he gives you a handmade gift

First time finding the restroom by himself in a restaurant, and you allow him to “got it alone”

First time you leave her home alone to babysit herself

First time he is too old to qualify for the restaurant’s kids menu

First time she shaves her legs or first time he shaves his face

First time your teen drives herself to a sports practice

First day your youngest starts kindergarten

We wish you a year filled with many successful “firsts.”

Naline Lai, MD and Julie Kardos, MD with mommy of three Steffie MacDonald
©2010 Two Peds in a Pod℠

December 31, 2010 by twopedsinapod

Buckle up: the latest in car seat safety

I often pass a parent on her way out of my office carrying an infant in an infant car seat. As I stop to elicit a goodbye smile from the baby, I check to see that the car seat straps are buckled properly. I say to the parent, please make sure that the cross strap is across his chest, not down at his lap. And please tighten the shoulder straps; I should not be able to pinch the strap above his shoulders. These are too loose.

Car seats save many lives every year. After immunizations, they are the most effective way to prevent death in children, but car seats need to be used properly. Many families travel this time of year and that means it’s time to update your car seat safety knowledge.

Until recently, experts recommended that babies in car seats need to weigh at least 20 pounds AND be at least one year old until they could face forward. Newer recommendations say babies should stay rear facing in a car seat until two years old, or until they no longer fit facing backward. The reason for this change is that in a crash, children suffer fewer injuries when they face backward. Different car seat brands have different weight and height specifications so be sure to read the literature that comes with your car seat. If the seat fits well, the middle of the back seat is the best spot to install a car seat. Rear facing infant seats are the most difficult to install correctly. Luckily, many police stations and gas stations offer programs to check if car seats are installed properly. Check with your local police.

Children should remain in car seats as long as they correctly fit. For some kids this is age four years and for smaller kids this may be five or even six years. If your child is particularly tall or obese he may require a high-backed booster soon after age three. My friend had a tall child that unfortunately ended up in a car accident recently. Again, read the literature that comes with your car seat for the height and weight limit; this is more important than the age of your child. The more restraints, the safer the seat. Five point harnesses are safer than three point. After five years a car seat should be replaced. Usually the third born ends up with a new seat. Because of the risk of hairline cracks, also replace a car seat if it was in an accident.

When your child outgrows the car seat, he graduates to a booster. Again, remember the more restraints, the safer the seat. A high backed booster is preferable until your child outgrows it. Keep your child in his booster seat until he is tall enough for the chest strap of a car’s seatbelt to lie diagonally across his chest without hitting his neck and for the lap strap to lie straight across the bony parts of his hips, not his stomach. To provide neck support and minimize whip lash, his ears should not jut up past the top of the back of the booster or car headrest. Keep children 12 years old and younger in the back seat. The force of an air bag can harm a young child.

Parents can call 1-800-CARBELT to access the American Academy of Pediatrics car safety seat hot line for their more specific car seat questions.

To ingrain good car safety habits in your children, remember to be a role model and buckle up yourself 100 percent of the time, even if you are driving only next door. Your children are watching you.

Julie Kardos, MD with Naline Lai, MD
©2010 Two Peds in a Pod?

Addendum: Please note that the official updated car restraint policy of the American Academy of Pediatrics as of March 2011 include the above recommendations of staying rearfacing until age two years and avoiding riding in the front seat until at least age thirteen years. In addition, more specific guidelines about boosters were added: children should stay in a booster seat until the car’s seat belt fits properly, at the minimum height of 4’9″ and between 8-12 years of age.

December 24, 2010 by twopedsinapod

Recognizing potential recalls – lessons from the drop-side crib ban

Graco was founded nearly 70 years ago, and Evenflo and Child Craft have been around even longer. In fact, most of the prominent baby supply manufacturers have been in the baby business for decades, so I am always appalled when their products are recalled. Haven’t they perfected the art of manufacturing safe baby products yet? Drop-down side cribs are the latest example in faulty designs. In the past year, manufacturers announced the recall of many drop side cribs. Ultimately, last week, the Consumer Product Safety Commission completely banned drop-down side cribs because they have been implicated in the deaths of at least 32 infants since 2001.

Recalls occur slowly. Here’s an example. My husband and I discovered some of the plastic pieces which held up the mattress support for our firstborn’s crib had cracked in half when we tried to set up the crib for our second born. Thinking we had used too much force to snap the pieces into place, we simply ordered more parts and put the crib together. Not until after my third child was born, five years after my first, did a recall on this crib go out. Other families experienced some of the pieces snapping while babies were in the cribs and the mattresses fell to the ground.

Through the years, I’ve noticed most recalls are only for a handful of reasons. Look at your children’s toys and equipment for these potential dangers before the recall occurs:

Head entrapment – The most common story is that the baby slides through a leg hole of a stroller or baby carrier and his neck gets stuck. A baby also may strangle when his neck is wedged between parts of a piece of equipment. This problem occurred with drop-down side cribs. The recommended width between crib rails is 2 3/8 inches (the width of a soda can) because a child is more likely to trap his head in any larger of an opening. Make sure there are no openings or potential openings larger than 2 3/8 inches.

Choking – Any part that can be pulled off and fit into a toilet paper tube is a choking hazard.

Restraint failure – Equipment is often recalled for inadequately restraining a baby, e.g. loose swing straps.

Lead ingestion – Lead needs to be consumed to cause poisoning so anything your baby chews on, including railings, are suspect. Lead check kits are readily available; the one I use is leadcheck.com.

If your child is injured because of faulty equipment, even with an injury which seems inconsequential, remember to report the problem to the consumer product safety commission and to the manufacturers.

Forget waiting for the recall. It could be years. Don’t buy something that makes you suspicious in the first place.

For more baby proofing hints, please see our post The In’s and Out’s of Baby proofing.

Naline Lai, MD with Julie Kardos, MD

December 22, 2010 by

ADHD: what else could it be?

On Monday, your son Robby forgot his brown-bag lunch on the kitchen table.

On Tuesday, he left his second grade homework on the school bus.

On Wednesday, he jumped off a five-foot wall at recess and ended up in the nurse’s office “just because.”

On Thursday, he didn’t notice three questions on the exam and skipped them.

Every day, Robby takes over an hour to complete what the teacher claims should be ten minutes of homework.

On Friday, you are not surprised when Robby hands you a note from his teacher asking for a conference.

At the parent teacher conference you and your partner get a feeling of déjà vu. You had a similar conference with Robby’s first grade teacher. This time the principal and counselor are present. You learn that he does not follow directions, he cannot complete work unless the teacher sits next to him and redirects him, he “spaces out” during classroom activities, and he can’t keep his hands off of the extra pencils in his desk or those on his neighbor’s desk. You ask the teacher if she suggests testing Robby for Attention Deficit Hyperactivity Disorder. Everyone agrees Robby is impulsive, unfocused and constantly in motion…all hallmarks of ADHD. The counselor says the school psychologist can evaluate Robby.

“We give the go ahead,” you say. Everyone smiles and shakes hands. But as soon as you arrive home, you begin to worry. You fear “something else” may be causing ADHD symptoms. The fear of missing that “something else” brings you and Robby to my office.

Here is a list of “Something elses” that doctors think about. These all can masquerade as, or contribute to, ADHD symptoms:

Lack of good sleep – Remember how unfocused you were when your child was an infant and you were perpetually sleep deprived? In addition to just plain going to bed too late and waking too early, conditions such as sleep apnea, chronic night time cough, or itchy skin can lead to inadequate sleep at night and an inability to concentrate during the day. Hang out in his room and observe your child while he sleeps to see if you can catch anything…just when you thought you could relax at night!

Many times children with ADHD also have learning disabilities. Conditions such as dyslexia may contribute to frustration and focus difficulty.

Children with mental retardation may also appear too easily distracted when the classroom pace becomes too fast.

A child who stares off into space mid-conversation during dinner and in school may be experiencing absence seizures. A painless test where sensors are placed on a child’s head, called an electroencephalogram (EEG), can detect these seizures.

In medical school I learned, “When something goes wrong with a patient, first look and see what you did.” Some of the medications your child takes may alter his ability to concentrate. Antihistamines are common culprits.

Emotional difficulties, whether stemming from family disruptions such as divorce or from other sources such as school yard bullying, can also lead to easily-distracted children.

If your child can see the erasers in his desk better than the whiteboard, he will spend more time looking at his desk than the teacher. Make sure his vision is normal.

Likewise, if your child can’t hear perfectly, he will find other ways to amuse himself at school besides following instructions that he does not hear. Have an audiologist test his hearing.

Some medical problems that are detected in a blood test can lead to ADHD like symptoms. Specifically, an inadequate amount of thyroid hormone, a hormone which regulates a body’s metabolism, can lead to concentration issues, although other symptoms are usually present. Likewise a low level of oxygen carrying cells in the body (anemia) can lead to some ADHD symptoms. Lead poisoning may cause focus issues.Look for reasons your child may be at risk for lead exposure.

Maturity also plays a big role in a child’s ability to focus or sit still. Sometimes a child is much younger than his classmates. One family I know found one-third of their child’s first-grade class was a year or more older than their child. A study from Michigan State found the youngest children in a class are 60 percent more likely to be diagnosed with ADHD than the oldest children.

Some children have several factors leading causing attention problems. Your son Robby ultimately receives the diagnosis of ADHD as well as a new pair of glasses. You set up ADHD treatment strategies for Robby and look forward to a more successful school year.

Naline Lai, MD with Julie Kardos, MD

December 20, 2010 by twopedsinapod

Holiday travel: staying happy, healthy and wise

Dashing through the mall, having traded your one-horse open sleigh for a minivan, you have secured gifts for all creatures, including the mouse. Now you are ready to leave on a plane tomorrow to spend the holidays with forty of your closest relatives.

How will you avoid illness this holiday season? How best to travel with children? We take you to a couple posts to help you out: Traveling with Children, and A happy, healthy holiday part 2: more holiday sanity hints .

We wish you all good health this season.

December 19, 2010 by twopedsinapod

Fa-la-la-la-la, THUD: About Fainting

fainting Fa-la-la-la-la, THUD.

It’s the sound of junior high bands and choir students practicing during this holiday season. That thud is the sound of a kid fainting mid-way through a long, sweltering rehearsal. Last night Dr. Lai was on the edge of her seat wondering which child would faint during her daughter’s chorus concert. In the past couple of weeks, we had a patient who fell off the stage during a musical performance and several others falling over during choir practice. Today we discuss causes of fainting and ways you can prevent the most common reasons to faint … Just in time for pageant rehearsals.

Why do people faint? The quick answer is people faint when their brains don’t have enough blood flow. Fainting causes people to fall down. When this happens, their heads become level with their hearts, and thus the body has an easier time getting blood (and oxygen) to the brain. So then the fainted person “wakes up.”

Dehydration and anxiety are two relatively common causes of fainting. So are standing up in place for a long time, sudden pain, and underlying illness. We have had teenagers faint after they received a vaccine which they were dreading. We have seen a high school athlete play an entire soccer game, then faint while standing with her team as her coach gave information about the next practice. Another patient faints every time she suffers an injury that causes her to see her own blood, whether it is a skinned knee or a small paper cut.

Kids who faint in this way usually feel weird before they go down. They can tell that something strange is happening to their bodies. They might feel suddenly very hot and sweaty, or dizzy, or feel like their vision is blurred or sounds are coming from far away. If your child feels this way but hasn’t passed out yet, the best thing to do is have him lie down. Lying down increases blood flow to the brain and can prevent fainting.

Some fainting signals that your child has an abnormal heart or other abnormality in the body. Fainting during exercise can be caused by a heart problem. So can fainting “without warning” or without any obvious inciting event. Fainting with accompanying body shaking or rhythmic movements of arms or legs can be a seizure rather than a faint. Weakness in an arm or leg, difficulty talking or thinking after a faint are all abnormal. Staying unconscious for more than a few seconds also can be a sign of underlying problems. Vomiting, severe headache, or any persistent symptoms such as altered mental state warrant medical attention promptly. Remember that a child who faints might hit his head when he falls and may also sustain a brain injury.

If your child faints, especially if it is the first time he faints, you should call his health care provider. Some kids need a physical exam, some need an EKG (electrocardiogram), some need blood work, and some need further workup by a specialist.

Fainting should never be ignored, but it is not always a reason for panic. Again, if your child faints, lie him down so his head is level with his heart. You can even raise his legs a few inches to make blood flow to his head even easier. Make sure he is breathing (watch for chest rise and fall, watch to see that his lips stay pink and do not turn blue). When he “comes to,” try to treat the underlying problem (give fluids if your child is dehydrated). And call your child’s health care provider to see what the next step should be.

Just hydrate your child well before his choir concert and tell him not to stand with his knees locked. Then sit back and enjoy the music.

Fa-la-la-la-la!

December 16, 2010 by twopedsinapod

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Julie Kardos, MD and Naline Lai, MD ©2010 Two Peds in a Pod℠

Julie Kardos, MD and Naline Lai, MD

©2010 Two Peds in a Pod℠