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℠

The sounds of the season: Thanksgiving

Kids are noisy. A noisy child is usually a healthy child, so we pediatricians welcome noise. Today we give you Top Ten Sounds we are grateful for this Thanksgiving:

10. The sound of a six-month-old baby’s belly laugh.

9. The sound of a two year old trying to say “gobble, gobble, gobble.”

8. The sound of a three year old saying “why?” about 100 times a day.

7. The sound of a chatty first grader who tells you about her favorite part of her day in one gigantic run-on sentence.

6. The sound of a grade school orchestra concert (as heard through ear plugs).

5. The sound of a high school orchestra concert played by the same students you remember playing in their grade school concert.

4. The sound of a teenager confiding something very important during a check up and then answering “yes” to the question “Do your parents know about this?”

3. The sound of a high school senior saying he got into his first choice college.

2. The sound of children (and their pets) breathing as they sleep.

1. The sound of a child’s small voice at Thanksgiving dinner leading her family in thanks.

Wishing you all a noisy Thanksgiving.

Julie Kardos, MD and Naline Lai, MD

Beth

At this time of the Jewish High Holy Days, Dr. Kardos offers us a glimpse into lessons learned as a doctor in training. This is a true story she wrote years after meeting Beth and until now, had only shared with a few close friends.

Tonight starts Yom Kippur and my two youngest children are asleep in their beds. As my oldest sits in the rocker next to my desk reading the last book in the Lord of the Rings series, my husband relaxes playing a computer adventure game. The Jewish High Holy Days are a time for reflection about the past year. But my mind goes back to a Yom Kippur Eve when I was working as a resident in the Pediatric Intensive Care Unit (PICU) as part of my pediatric training.

Residents work through most holidays, even ones they consider important. This night, I wished I had off, but I consoled myself with knowing that I would be off on Thanksgiving. Luckily I was partnered with Amy, the lead physician in the PICU.

The sickest patient that night was twelve-year-old Beth. She had leukemia and had just started chemotherapy. Because her immune system was weak, Beth was very ill with a bacterial infection in her blood. Despite powerful antibiotics, the infection raised havoc in her body. She developed such difficulty breathing that a tube from a mechanical ventilator was placed down her throat to force air into her lungs. Even the comfort of sleep escaped her. Beth was afraid of what was happening to her body. She refused to accept medicine that could help her sleep because she was so afraid that she would never wake up.

That night, despite her incredibly ill state, she got her period. Usually when a girl’s body is stressed, the body preserves all blood and the periods stop. But hers came, and because her blood cells were so abnormal from a toxic combination of infection, chemotherapy, and leukemia, she began bleeding to death. We transfused her with bag after bag of blood to keep her alive.

In the middle of the night, Beth’s blood pressure suddenly plummeted so we added even more medication. Because my mentor Amy was not certain that Beth would survive the night, we called her family at the hotel near the hospital where they were staying and told them come to Beth’s side. And through it all, Beth refused to sleep. Her eyes always opened in terror whenever we approached her bed. Her face was gray. Her chest rose and fell to the rhythm of the mechanical ventilator, and you could smell the fear all around her.

I stood with Amy just outside Beth’s room as Amy reviewed a checklist for Beth’s care. It went something like: “Ok, we just called blood bank for more blood; we called her family; we called the lab; we called the pharmacy. We are currently attending to all of her problems, we now just have to wait for her body to respond.” She paused,” But you know what?”

“What?” I asked her.

“We need to address her spiritual needs as well. Do we know what religion her family is? They may want a clergy member with them.”

I was startled. In the midst of all the tubes and wires of technology, Amy remembered to summon the human factor in medicine. We looked in her medical chart under “religious preference” and there it was: Jewish.

“Amy,” I said, “of all nights. Tonight is Yom Kippur…the holiest night of the Jewish year.”

I knew that the hospital had a Rabbi “on call” just like they had priests, nuns, ministers, and other spiritual leaders. But that night I was sure that every rabbi in Philadelphia would be at synagogue for Kol Nidre, the declaration chanted at the beginning of the Yom Kippur evening service. We were unlikely to track down a Rabbi.

Despite this, we asked her mother if they wanted us to call a Rabbi for them. She shook her head no. I remember feeling relieved, then guilty that I felt relieved. Amy left to check on another patient. Beth’s mom, dad, and older sister stood together watching Beth. Her sister’s hand lay on her mother’s arm. Her mother’s eyes darted from me to Beth to the mechanical ventilator next to the bed. Beth’s eyes were closed and it was difficult to know if she even knew we were there.

Her family walked out into the hall to talk. Beth at that moment opened her eyes and started tapping on the bed with her foot to get my attention. She couldn’t talk because of the tube down her throat and her hands were taped down with IVs. Yet she reached out with one hand as best she could.

I walked close to her bed so she could touch me and I asked, what is it, Beth?

Her lips formed the words around the breathing tube very deliberately, her body tensing. “Am I going to die?”

All in a split second I am thinking to myself: How do I know/it could very well happen/how can I lie to her/how can I tell her the truth of what I fear could very well happen/how am I going to answer this child?

What I answered was, “Not tonight, Beth.”

She relaxed into her pillow but kept her eyes on mine. I waited to see if she would say anything else, but the effort to ask that one question had exhausted her. I stood, holding her hand, until her family came back into the room. Her eyes followed them to her bed and I left so they could be together.

Beth did survive the night and in fact survived a month in the PICU. She became well enough to be transferred to a regular hospital floor. By this time I was working in a different part of the hospital, but one of the oncologists pointed her out to me.

I don’t know what happened to her in the long term.

So now I tell my oldest child it’s time for him to stop reading and go to sleep, and I walk him to his room to say goodnight. My husband and I decide what time we’ll attend Yom Kippur services tomorrow. Part of me feels joined with Jews everywhere who will also be spending the next day reflecting, praying and celebrating a new year. But mostly, like every year at this time, I remember the sounds and the smells and the fear in the PICU where sickness doesn’t care who your God is or what your intentions are. I remember Amy caring enough to think about a dying child’s family religion, and always, I remember Beth.

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

Cry Baby- Why do infants cry?

Why do babies cry? This may seem like a silly question, but sometimes you really want to know why your infant is crying.

Remember, newborns cannot talk. They can’t even smile back at you until around six weeks of age. Why do babies cry? In short, newborns cry to communicate.

Ah, but what is it, exactly, that they try to communicate? Babies cry when they…

– Are tired.

– Are hungry.

– Feel too cold.

– Feel too hot.

– Need to be changed –I never really believed this reason before I had my twins. My firstborn couldn’t have cared less if he was wet and could nap right through a really poopy diaper. Then I had my twins. I was amazed that their crying stopped if I changed the tiniest bit of poop or a wet diaper. Go figure.

– Are bored. Perhaps she is tired of the Mozart you play and prefers some good hard rock music instead. Maybe she wants a car ride or a change of scenery. Try moving her to another room in the house.

– Feel pain. Search for a piece of hair wrapped around a finger or toe and make sure he isn’t out-growing the elastic wrist or ankle band on his clothing.

– Need to be swaddled. Remember a fetus spends the last trimester squished inside of her mom. Discovering her own randomly flailing arms and legs can be disconcerting to a newborn.

– Need to be UN-swaddled. Hey, some like the freedom to flail.

– Need to be rocked/moved. Dr. Lai’s firstborn spent hours tightly wrapped and held by her dad in a nearly upside down position nicknamed “upside-down-hotdog” while he paced all around the living room.

– Check to see if there is a burp stuck inside her belly. Lay her down for a minute and bring her up again to see if you can elicit a burp.

– Does your baby seem gassy? Bicycle his legs while he is on his back. Position him over your shoulder so that his belly presses against you. You’d be gassy too if you couldn’t move very well. The gassy baby is a topic for an entire post- talk to your doctor for other ideas.

– Are sick. Watch for fever, inability to feed normally, labored breathing, diarrhea or vomiting. Check and see if anything is swollen or not moving. Listen to his cry. Is it thin, whimper-like (sick) or is it loud and strong (not sick)? Do not hesitate to check with your pediatrician. Fever in a baby younger than eight weeks old is considered 100.4 degrees F or higher measured rectally. A feverish newborn needs immediate medical attention.

What if you’re certain that the temperature in the room is moderate, you recently changed his diaper, and he ate less than an hour ago?

– Walk outside with your baby- this can be a magic “crying be gone” trick. Fresh air seems to improve a newborn’s mood.

– Offer a pacifier. Try many different shapes of pacifiers. Marinade a pacifier in breast milk or formula to increase the chance your baby will accept it.

– Pick her up, dance with her, or walk around the house with her. You can’t spoil a newborn.

– Try vacuuming. Weird, but it can work like a charm. Place her in a baby frontal backpack or in a sling while cleaning.

– Try another feeding, maybe she’s having a growth spurt.

-When all else fails, try putting her down in her crib in a darkened room. Crying can result from overstimulation. Wait a minute or two. She may self-settle and go to sleep. If not, go get her. The act of rescuing her may stop the wailing.

-If mommy or daddy is crying at this point, call your own mom or dad or call a close friend. Your baby knows your voice and maybe hearing you speak calmly to another adult will lull her into contentment.

– Call your child’s health care provider and review signs of illness.

– If you feel anger and resentment toward your crying baby, just put her down, walk outside and count to ten. It is impossible to think rationally when you are angry and you may hurt your child in order to stop your frustration. Seek counseling if these feelings continue.

Now for the light at the end of the newborn parenting tunnel: the peak age when babies cry is six weeks old. At that point, infants can cry for up to three hours per day. Babies with colic cry MORE than three hours per day. (Can you believe people actually studied this? I am amused that Dr. Lai won a prize in medical school for a paper on the history of colic). By three months of age crying time drops dramatically.

While most crying babies are healthy babies and just need to find the perfect upside-down-hot-dog position, an inability to soothe your baby can be a sign that she is sick. Never hesitate to call your baby’s health care provider if your baby is inconsolable, and don’t listen to the people who say, “Why do babies cry?…They just do.”

———

Thanks to our Facebook friends for other ideas for what the cartoon baby is saying:

“Stop looking at me like that and please loosen this blanket and don’t hold me up here like this and where is my hat my diaper is giving me a wedgie! JUST MAKE IT ALL STOP!”

“WHY CAN”T YOU LET ME GO BACK TO SLEEP, PEOPLE!”

———

Julie Kardos, MD with Naline Lai, MD

©2010 Two Peds in a Pod℠

The Ins and Outs of Baby Proofing

A mom once told me about a time when she left their toddler in the care of her husband who worked from home.

“Are you sure you can concentrate on your work and watch him?” she asked quizzically.

“No problem,” he said reassuringly.

Hours later, the mom was delighted to come home to a quiet house. She found her husband busy working at his desk. Everything seemed calm. That is, until the mom glanced in the dining room and saw her toddler. Somehow he had scampered to the top of the table and now dangled from the chandelier.

A kid hanging from the chandelier is a parent’s baby proofing nightmare. Out there are an overwhelming number of baby proofing checklists and catalogs of safety devices. But you don’t need to read reams on how to baby proof or spend a fortune on equipment. To baby proof, just roll back to 5^th grade and remember your prepositions… those little placement words such as “IN, OUT, ON and OVER.” Remember those words? Then you are ready to baby proof. Let’s go.

Drop DOWN on your hands and knees and look at your home from your child’s perspective. Start when your child is about six months old, before he can crawl. Because baby proofing is time consuming and it’s tough to take time out of your sleep deprived life, you need to start early, or you may not be done before your child is ready for high school.

Clear play areas of anything which may go IN your baby’s mouth and choke or poison him. Anything small enough to fit inside of a toilet paper tube is a potential choking hazard. Don’t leave loose change lying around on a counter top. Lock caustic and poisonous substances UP and OUT of reach. Have the Poison Control Center’s phone number BY the phone in case of accidental ingestion (United States 1-800-222-1222). The clinicians at the Center will instruct you whether or not to go to the emergency room. Do not induce vomiting because the emergency room has more effective ways to detoxify your child and if the ingested substance is caustic, vomit will cause a chemical burn both going DOWN and coming back UP.

Brain death can occur within five minutes of oxygen deprivation, so anything a child can pull OVER or AROUND his airway passages is hazardous. Dangling drapery cords, plastic bags, crib bumpers, and loose crib sheets fall into this category. To avoid neck strangulation, bars ON cribs and on banisters should be less than 2 3/8 inches apart (the width of a soda can) to prevent a child from trapping his head between them. Do not allow more than two fingerbreadths between the crib frame and the mattress.

All standing water is a potential drowning hazard. Even a large ice bucket at a party poses a risk. Several years ago, one of my neighbor’s children toddled up to an ice bucket at a party and right UNDER my nose flipped head first INTO the icy water.

What goes UP must come DOWN. An unsteady kid who climbs UP the stairs may come tumbling DOWN. Gate the top and the bottom of the stairs. Make sure to bolt the top gate into the wall. An angry toddler can break THROUGH any pressure secured gate. Walkers are also associated with an increased injury from falls DOWN steps. Since walkers do not actually teach your baby to walk any sooner than he would have anyway, just avoid them altogether.

Look also INSIDE his crib. Too much soft bedding (crib bumpers and large blankets) are not only suffocation risks but older babies can use the material as a step ladder and climb out. Also ensure that your five month old cannot reach UP and pull the mobile OVER the crib down ON himself.

Outside the crib, your child can still fall DOWN, so cushion and move sharp edges (end tables) out of the way. Not just children fall. Furniture which is UP may tumble DOWN ONTO a child’s head. Make sure your excited child reaching for a dancing dinosaur does not pull the television DOWN.

Don’t allow children to get their hands ON a burn hazard. Secure electrical outlets and cords. Set the temperature of hot water to no more than 120 degrees and protect children from the stove and open heating units.

Beware of other people’s homes and hotels. Grandparents tend to leave pills within reach of little hands ON end tables or NEAR bathroom sinks. Once when my family stayed AT a hotel, one of my children proudly showed me a pill she found ON the floor. “Look mommy at what I found,” she said and handed me a pill of Viagra!

Sooner or later children will need to identify potential hazards on their own. Help them understand what is safe. For instance, watch and teach your two year old to “bite then chew” a grape. Practice going UP and DOWN a few steps at a time and have her always hold the rail.

Of course, nothing is a substitute for adult supervision. But not everything can be anticipated. Sometimes you just have to cross your fingers. When my oldest was 15 months old, my husband was eating an open faced toasted bagel. My daughter toddled up, looked at daddy and scraped her forehead on the hard edge of the bagel.

Maybe we should just cushion children WITH pillows and keep helmets ON their heads until they go AWAY from home.

Naline Lai, MD with Julie Kardos, MD

Top Ten Skills You Acquire as a Father

In honor of Father’s Day, we bring you our second “Top Ten” list.

Top ten skills you acquire as a father:

10. The ability to attract swarms of women if you walk in the park or the grocery store with your infant.

9. Tolerance of temperature extremes at the skating rink or on the ball field.

8. Not being completely grossed out by spit up on your nicely pressed shirt.

7. The ability to sit patiently through a 3 hour ballet recital, school music concert or graduation.

6. The ability to sit patiently through an endless one hour television show featuring some sort of dancing and singing animal and then to stand in an hour long line to buy the stuffed toy version of the animal.

5. The skill to coach teams for which you last played the sport twenty years ago.

4. The ability to swing a child, “again!”, “again!”, and “again!”

3. The ability not only to get through a day after one (or many) completely interrupted night’s sleep, but to wake up in the morning having forgotten about the interruptions.

2. An ability to seize the moment and create great memories for your child: you ignore the dishes, the garbage, and the dirty bathrooms in lieu of an impromptu wrestling match.

1. Ability to love more than you ever thought possible, and the ability (finally) to understand just how much your father loves you.

Happy Father’s Day from Two Peds in a Pod!

Julie Kardos, MD and Naline Lai, MD

I Need a Nap!

“I need a nap!”—recognize this tired parent?

OKAY, let’s take a quick survey: how many of you have ever put your over-tired young child into the car, then driven on a bumpy road on a route known for its paucity of traffic lights, looking in the rearview mirror hoping to see a sleeping child?

How many of you have ever rocked your young child until you BOTH have fallen asleep in the chair?

How many of you have purposefully keep your child AWAKE in the car in order to get home before nap time, doing anything to keep her awake? Otherwise, you predict, if your child falls asleep on the five minute car ride home, she will wake up when you try to transfer her to the crib. If that occurs you will lose the nap for the rest of the day and she will be MISERABLE (and, hence, so will you).

How precious is nap time? All parents know the answer to this question: VERY VERY PRECIOUS! Parents spend the time during a baby or toddler’s nap to pay bills, do laundry, prepare a meal, clean the house, spend time with an older sibling, and perhaps most importantly, TO TAKE A NAP OURSELVES.

Yet all children outgrow their need to nap sooner or later (at least, until they become parents themselves). The exact time this dreaded day comes can vary. The range is typically between two and five years of age. And children do not always give up their naps all at once. One day they do not nap, then they nap the rest of the week, then they don’t nap for a few days, then they nap one day, and so forth. Sometimes they fall asleep only if they happen to be in the car. Eventually your child will sleep only overnight and not at all during the day.

Naps are very important for young children. Not only do naps foster better cheer, better learning, and better behavior, but also good naps actually help improve night time sleep. Any parent can attest that an overtired toddler has a WORSE night sleep than a toddler who goes into bedtime well-rested. This is one of the great paradoxes of childhood. I like to explain to my patients: “Good sleep begets good sleep.”

Just as you invest your time and effort in taking good care of baby teeth only to have them all fall out later, you should invest your time and effort in establishing good nap habits for your young child, even though your child eventually gives up her nap. Start by making sure she can fall asleep on her own during her NIGHT bedtime routine (see our podcast on this subject) . If she can fall asleep on her own at night, she will be more apt to fall asleep in the day. Darken the room and give her other signals associated with sleep such as her favorite stuffed animal or lullaby. Have a short “nap time routine” just as you have a night time routine. Save the serious sleep training for night time- you do not have the luxury of hours to train in the day. If she does not fall asleep within half an hour, get her up and struggle through the rest of the day, or try again later.

If she still will not nap after several days of trying, go ahead and do whatever it takes to have a happy kid by dinner. Take that car ride, rock her to sleep… understand that the “fix” is temporary. Either she will give up the “nap rebellion” or she will give up the nap entirely. Continue to put your non-napper in bed at night earlier to make up for her lack of daytime sleep. When your child is mostly cheerful, not throwing an unusual number of toddler tantrums, and is at least two years old, then likely she has truly outgrown her need to nap.

In the meantime, go grab some Zzzzzs. I know some of you only have time to read this post because your child is napping. So go follow suit!!

That’s using your head! Or, how to assess your child’s knock on the noggin.

Your son’s baseball league has just upped the ante, moving from “coach pitch” to “kids pitch.” The good news is that your budding major league pitcher gets some practice. The bad news is that the pitches can be wild. Thank goodness for batting helmets!

So what if the unthinkable happens? You are cheering your child on, when suddenly the wild pitch (or the hit ball, or the wild throw to first base) wacks into your child’s head. He is knocked down and you go running.

First evaluate if your child is conscious. Passing out even momentarily is a reason to seek medical attention right away. Most likely he will not have passed out and will want to return to play. However, the safest bet is to have your child sit out the rest of the game.

Next determine if your child is bleeding inside his head. You may see a growing lump on his head which looks gruesome. However, we pediatricians are less concerned about bleeding or bruising that occurs on the outside of his skull than about possible bleeding inside his skull.

How can you tell where the bleeding is? Again, a loss of consciousness, or passing out, is a worrisome event that may signal bleeding on the inside. In addition, watch for blurry or double vision (“I see two mommies!”), inability to speak clearly or rationally, difficulty walking or loss of balance, vomiting more than once (some kids vomit once when they are scared or in pain), or headache so severe that it is not relieved by acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). Not all symptoms appear immediately.

So now your child has cheered the team on to victory, enjoyed the after-game snack, has forgotten about the trauma, and is nodding off in the back seat of your car. As you drive him home you remember some vague advice about not letting your child fall asleep after a head injury. Now what?

Go ahead and let your child sleep for a couple of hours, he probably is tired both from the game and from the injury. You have the rest of the day to observe him.

Sometimes, injuries are not conveniently timed. If a head injury occurs right before bedtime, you will not be able to watch for signs of internal head bleeding because your child will be sleeping. The best way to assess him is to wake him briefly every 2-3 hours throughout the night.

If your child makes it to 24 hours without symptoms, it is unlikely your child is bleeding inside his head. However, if your child still seems “off” he needs medical attention. Even if he is not bleeding, he may have a concussion (now termed “traumatic brain injury”).

Although it’s never easy to see your child hurt, whether it’s a scrape on the knee or a bump on the head, you can empower yourself by knowing what to watch for. Now that’s using your noggin!

Top Ten Skills You Acquire as a Mother

As Mother’s Day approaches, we give you our first Two Peds in a Pod “Top Ten List.”

Top Ten Skills You Acquire as a Mother

10) Not being completely grossed out by another person’s poop.

9) Ability to sense the “moment before the vomit” and to hustle your child to the nearest garbage can or toilet before it’s too late.

8) Ability to lick your own finger and then use it to clean a smudge completely off your child’s face.

7) Ability to get through a day (after day after day) after one (or many) completely interrupted night’s sleep.

6) Willingness to show up at work or just go out in public with dried spit-up on your shoulder.

5) Ability to use your “momometer” by touching or kissing your child’s forehead to tell if he has a fever (with fair degree of accuracy!).

4) Ability to see through walls in order to tell that your child did not wash his hands after using the bathroom.

3) Ability to see directly behind you to know that your child is getting into trouble.

2) Ability to wield the Magic Kiss that can make any and all boo-boos better.

1) Ability to love more than you ever thought possible, and the ability (finally) to understand just how much your mother loves you.

Rejoice in your abilities!

Happy Mother’s Day from Two Peds in a Pod.

When your child’s friend moves away

This sign now sits on my friend’s lawn. I still remember four years ago when I pulled my big blue minivan up in front of their house after the moving van left. A mommy sat on the stoop with her children. “How old are they? I hollered out. The ages of the children matched my children’s and I was delighted. Indeed they became good friends. And now, there’s the “For Sale” sign.

It’s nearing the end of the school year, and “For Sale” signs dot lawns all over the United States. Chances are, one of them belongs to your child’s friend. Just as the child who moves will have to adjust to a new environment, your child will have to adjust to a world without a friend who was part of his daily routine.

Much has been written about how to transition the child who moves into a new environment, but how can you help your child when his close friend moves away?

Your child may experience a sense of loss and feel that he was “left behind.” Some children perseverate over the new hole in their world. Others take the change in stride.

In the late 1960’s, psychiatrist Elisabeth Kubler-Ross described “the five stages of grief.” The stages were initially applied to people suffering from terminal illness, but later they were applied to any type of deep loss such as your child’s friend moving. The first stage is denial: “I don’t believe he moved.” Anger follows in the second stage: “Why me? That’s not fair!” Your child may then transition into the third stage and bargain: “If I’m good maybe he will hate it there and come back.” The fourth stage is sadness: “ I really miss my friend,” or, “Why make friends when they end up moving away?” The final stage is acceptance: “Everything is going to be okay. We will remain friends even if he doesn’t live here.”

Some pass through all stages quickly and some skip stages altogether. The process is personal and chastising your child to “just get over it” will not expedite the process. However, there are ways to smooth the journey:

· Reassure your child that feeling sad or angry is common. Parents need to know that sad children may not show obvious signs of sadness such as crying. Instead, rocky sleep patterns, alterations in eating, disinterest in activities or a drop in the quality of school work can be signs that a child feels sad. If feelings of depression in your child last more than a month or if your child shows a desire to hurt himself, consult your child’s health care provider.

· Set a reunion time. Plan a vacation with the family who moved or plan a trip to their new home.

· After the move, send a care package and write/ help write a letter with your child.

· Share stories about how you coped with a best friend moving when you were a child.

As for my children, when I told one of my kids that I will sign her up for soccer, she squealed with delight, “Oh, that’s the league Kelly belongs to.”

My heart sank. I said as gently as I could, “She’s moving- she won’t be here for soccer season.”

And so we begin the process…

Naline Lai, MD