Help for ear pain

girl covering ear- a child's earache
Photo by Towfiqu barbhuiya on Pexels.com

Did your child wake up in the middle of the night crying from ear pain? Fortunately, not every child with an earache has an actual ear infection. However, all children with earaches deserve to have their pain treated, no matter what is causing their pain. Here is our post about what to do for your child’s earache.

Julie Kardos, MD and Naline Lai, MD

©2023 Two Peds in a Pod®

Headaches in children

a child with a headache lying on the rug
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“Mom, Dad, my head hurts!”

Sound familiar? It’s probably not the first time ‘round this rodeo, but ever wonder if your child’s headache could be a sign of something more problematic? The good news is, while kids get headaches for many reasons, there are telltale signs every parent can look for at home to distinguish normal headaches from bad headaches in children.

Tension Headaches

For most kids with headaches, the odds are in their favor.  The most common culprit is the tension headache—the kind we have all experienced at least once in our lifetimes.  Fortunately, they are also the least scary kind of headache.

Tension headaches usually begin gradually and can last a few hours at a time.  Most children will complain of a dull, achy, or even “band-like” pain squeezing both sides of their head or across their forehead. Typical triggers include stress, inadequate sleep, excessive screen time, not drinking enough water during the day, hunger or poor diet, or a need for glasses. Targeting these triggers are key to preventing these pesky headaches.


Okay, so we know tension headaches are the most frequent, but can kids have migraines? Children can have migraines and there are key distinguishing characteristics that set these headaches apart. 

Migraines usually start in school-aged children, and for girls, often get worse with their periods. In older kids these headaches are typically throbbing or pounding, as opposed to dull, and can be one-sided.  They can also be associated with other symptoms like sensitivity to light and sound, nausea or vomiting, and strange changes in vision or smell preceding the start of a migraine (the “migraine aura”). Taking a nap almost always makes a migraine go away.

Family members will often have a history of migraines or frequent headaches.

Parents should also be aware of the occasional “abdominal migraine,” where migraine symptoms like those described above occur with stomach pain instead of headaches.

Head Trauma and Concussions

Did your child just hit their head? Or suffer a sports injury? As a parent, it’s normal to worry about headaches after head trauma. While most post-traumatic headaches are not a cause for alarm, parents need to know signs of serious injury such as bleeding inside the head. You can review these signs here.

Concussions are also caused by head trauma. Read more about concussions here.

Red Flags

While most headaches are not cause for alarm, there are warning signs to keep an eye out for. Sometimes, headaches are more sinister in nature—caused by tumors, brain bleeds, strokes, abnormal anatomy, or infection (like meningitis). And while these occurrences are fortunately rare in children, the earlier they are diagnosed, the better.

Headaches that interrupt your child’s sleep, happen first thing in the morning after waking, are becoming more frequent or severe, are associated with unsteadiness, weakness, visual changes, seizures, fever, funny eye movements, neck stiffness, early morning vomiting, changed mental state (too tired or too irritable to play) or are described by your child as as the “worst headache they’ve ever had” should all lead you to seek medical attention promptly. Finally, headaches in very young children under the age of five should not be taken lightly.

A Word on Mental Health

While headaches happen for several reasons, depression and anxiety are commonly overlooked offenders.  If you are noticing other signs like sadness, worry, poor appetite, weight change, or less interest in prior activities, talk to your pediatrician about further evaluation.

Still not sure what’s causing your child’s headache? 

It’s okay!  Headaches are complicated, and keeping track of your child’s symptoms can be hard. Maintaining a headache diary to track headache features can help both you and your pediatrician figure out the next best steps for your child.

Nitya Rajeshuni, MD MS

©2023 Two Peds in a Pod®

Guest blogger Dr. Nitya Rajeshuni completed her pediatric residency at the Children’s Hospital of Philadelphia. She attended medical school at Stanford University, and is a contributing writer to ABC News and the health humanities journal Synapsis.

How to Talk to Kids About Hard Topics: a panel discussion

a young woman using a laptop beside her mother
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Death, politics, mental illness, and sex- all difficult topics for parents to talk about with their kids. Your Two Peds joined a social worker, school guidance counselor, and former teacher in a lively panel discussion at the Haverford Township Library in Haverford PA on how to normalize conversations on difficult topics between parents and their children. Watch as we talk about on ways parents can give kids give information while limiting their anxiety .

Past posts about ways to share difficult information with your children include the topics of suicide, stillbirth/miscarriage, death of a person, and death of a pet.


Julie Kardos, MD and Naline Lai, MD

©2023 Two Peds in a Pod®

Strep throat: Sore throat “dragon” your child down?

sore throats and strep throat can feel like a fire-breathing dragon in your throat

Is your child’s sore throat “dragon” them down? This month we contributed to The Children’s Hospital of Philadelphia’s Health Tip of the Week on the subjects of sore throats and strep throat. We hope you find our tips helpul if your your child’s throat feels like it’s on fire.

Julie Kardos, MD and Naline Lai, MD

©2023 Two Peds in a Pod®

Which is it: the flu, RSV, or COVID?

Photo by Leeloo, Prexel

Parents ask us every day the difference between the flu (influenza), RSV (respiratory syncytial virus), or COVID (coronavirus disease 2019). While no method is fool proof, here are some typical differences among these viruses:

The flu, caused by influenza virus, comes on suddenly and makes you feel as if you’ve been hit by a truck.

Flu almost always causes fever of 101°F or higher and some respiratory symptoms such as runny nose, cough, or sore throat (many times, all three). In addition to the usual respiratory symptoms, the flu causes

body aches, headaches, and often the sensation of your eyes burning. Fever can last 5-7 days. Children, more often than adults, can vomit and have diarrhea along with their respiratory symptoms, but contrary to popular belief, there is no such thing as “stomach flu.” All symptoms come on at once; there is nothing gradual about coming down with the flu.

COVID can cause the same symptoms. Since home COVID tests are readily available, you can answer the question of “Flu or COVID?” at home.

Colds, even really yucky ones from RSV, come on more gradually.

RSV, a common cause of the common cold, is notorious for causing very thick mucus. The mucous is why some babies and young children have more severe coughing and breathing difficulties with this particular cold virus. Our immune systems are not good at mounting a lasting immunity to RSV so kids and adults tend to get this virus again and again. The first time someone is hit with RSV is usually their worst episode.

Symptoms usually start out with a sore throat or mild runny nose. Gradually, the nose runs more and a cough starts. Sometimes RSV can cause fevers for a couple of days and some hoarseness. Children are often tired from interrupted sleep because of cough or nasal congestion. This tiredness leads to extra crankiness. To further complicate things, Covid can cause identical symptoms.

Usually kids still feel well enough to play and attend school with colds like RSV.

The average length of a cold is 7-10 days although sometimes it takes two weeks or more for all coughing and nasal congestion to resolve.

Wondering about the color of mucus?

The mucus from a cold can be thick, thin, clear, yellow, green, or white, and can change from one to the other, all in the same cold. The color of mucus in the first few days does NOT tell you if your child needs an antibiotic and will not help you differentiate between a cold and the flu.

So, is it the flu, RSV, or COVID?

  • Flu = sudden and miserable
  • Colds, including RSV = gradual and annoying
  • COVID = either

If your child has several days of runny nose and cough, but is drinking well, playing well, sleeping well and does not have a fever, the illness is unlikely to “turn into the flu.” A home test can help tease out COVID from a cold or the flu.

And yes, a kid can have multiple respiratory viruses at the same time. Let’s hope that does not happen this winter.

Julie Kardos, MD and Naline Lai, MD

©2022 Two Peds in a Pod®

What to do if you suspect RSV


Cold and flu season is upon us earlier than usual. Click here for our contribution to Children’s Hospital of Philadelphia’s Health Tip on What to do if you suspect RSV (Respiratory syncytial virus). Click here for an example of a sign labored breathing called retractions– when a child is breathing in very deeply.

Yes, we all deserve a break! But with the COVID pandemic, now our kids are experts at hand-washing and know not to rub noses, so hopefully this cold and flu season will leave as early as it came.

Drs. Lai and Kardos

©2022 Two Peds in a Pod®

How to help your gassy baby

How to help your gassy baby, photo of a momma car and her baby car who is gassy

Do you have a gassy newborn? Please read our tips on how to help your gassy baby in the Children’s Hospital of Philadelphia’s Health Tip of the Week.

Trust us, it’s a gas!

Julie Kardos, MD and Naline Lai, MD

© 2022 Two Peds in a Pod®

Is your college kid homesick?

Now that the excitement of the first weeks of college have gone by, your first year college student may be homesick. What can a parent do? We point you to last year’s timeless post which is still relevant today.

©2022 Two Peds in a Pod®


positive school year
change your mindset (attribution unknown)

As the lazy, hazy days of summer wound down in August, the “Back to School” commercials began in full force. TV and print advertisements from major retailers showed smiling students and adults buying colorful backpacks and school supplies . This is in contrast to the past two years when TV brought no shortage of bad news about the global pandemic, its impact on education, and news about horrific school shootings. It’s not just a commercial, we do have the ability to help our kids move through this school year with a positive mindset.

Now that we are into September and the school year is underway, one of the most important things we can do with our students is talk with them. Engage in dialogue about what they are excited about, what concerns they have, and their overall thoughts and feelings about the upcoming year. Nervousness, excitement, anxiety, and anticipation can make up a child’s emotional mix at the start of the year. Open conversations will help identify and address any negative thoughts or feelings that our kids may harbor. Conversations will help our students focus on strengths and internal and external resources .

Remind them of times when they showed grit, recovered from a poor grade, navigated a tricky peer situation, or made a new friend. Revisiting the past will reinforce that those skills are still present inside of them and ready to be used when needed. For teens, often you will help them by simply lending an ear and listening to their concerns.

I also believe in teaching children the two P’s: plan and prepare. This can apply to different parts of school – the practical and concrete, such as establishing new routines, using a new planner for time management, or designating a space to complete homework; or the conceptual, such as sitting with a different group at lunch or knowing and talking about the importance of the junior year of high school. When we feel prepared, we feel more confident.

We constantly communicate with our children, both verbally and non-verbally

As parents, it is also important to have an awareness of how our own feelings affect our children. We constantly communicate with our children, both verbally and non-verbally. Called emotional contagion, we transfer not only words, but feelings to our children. If we feel anxious about the school year, our children will pick up on that; conversely, if we portray confidence, our students will feel confident.

Recognize that kids are by nature resilient, although some more than others. Thanks to neuroplasticity – our brain’s fascinating ability to reorganize itself – we can continue to dust off the residue of COVID, navigate through all of the negativity, and keep things optimistic, constructive, and encouraging over the next nine months.

Here’s to a positive school year!

Dina Ricciardi, LCSW, ACSW

We thank guest blogger Dina Ricciardi for her continued contributions to Two Peds in a Pod on the mental health aspects of parenting. Drs. Kardos and Lai

Ricciardi, LCSW, ACSW is a psychotherapist in private practice in Doylestown, PA who works with children, teens, and adults. Her areas of expertise include anxiety, depression, disordered eating, and ADHD. She has studied at the Family and Play Therapy Center in Mt. Airy and is a graduate of the Philadelphia Psychotherapy Study Center. Her full profile is available on the Psychology Today Therapist Finder and on LinkedIn.

©2022 Two Peds in a Pod®

All about lice

lice party
Lice- unpleasant guests at the sleepover party

Itching to learn about lice? Check out our recent contribution to The Children’s Hospital of Philadelphia’s Health Tip of the Week!

Julie Kardos, MD and Naline Lai, MD

©2022 Two Peds in a Pod®