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Haiti, one of the poorest countries in theWestern Hemisphere, was struck by a devastating earthquake last week.

If you are looking for a way to help the children, consider donating to the American Academy of Pediatrics Friends of Children Disaster Relief Fund. The American Academy of Pediatrics has used this fund in the past to respond to disasters that affect children in the US, such as hurricanes Katrina and Ike, and worldwide, such as recent earthquakes in China.

 The fund provides emergency relief to pediatricians and the children they treat by:

• Addressing primary health care needs of children;

• Supporting medical services (example: power generators for medical facilities, replacement of medical equipment damaged by the disaster);

• Supporting future disaster preparedness and response programs with a special focus on children.

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

For families with young children, holiday time can be magical yet stressful. Often families travel great distances to be together and parties tend to run late. Fancy food and fancy dress are common.  And winter holidays, well, they occur in the winter, usually during flu season, stomach virus season, and in general multi-illness season. Here are some suggestions about how to keep your kids healthy and happy during this time.

We preface by referring you to suggestions # 1, 2, and 3 of Part 1of A Happy, Healthy Holiday. HANDWASHING, HANDWASHING, AND HANDWASHING will prevent spread of germs. In addition:

1.      Traveling 400 miles away from home to spend the week with close family and/or friends is not the time to solve your child’s chronic problems. Let’s say you have a child who is a poor sleeper and tries to climb into your bed every night at home and you have chronic fatigue from arguing with her/walking her back to bed. Knowing that even the best of sleepers will often have difficulty with sleeping in a new environment, just take your “bad sleeper” into your bed at bedtime and avoid your usual exhausting home routine of waking up every hour to walk her back into her room. That way everyone gets better sleep. Similarly, if you have a very picky eater, pack up her favorite portable meals and have them available during the fancy dinners. (But when you return home, please refer to our podcast and blog posts on helping your child to establish good sleep habits and on feeding picky eaters.) Good sleep and good nutrition keep children and their parents healthy and happy.

 

2.      Think of giving your children a wholesome, healthy meal at home before a holiday party which you know will be filled with junk food and food that may seem “foreign” to your children. Hunger fuels tantrums, so eliminate that meltdown source by taking them to the party with full bellies. Also you won’t feel guilty letting them have some of the sweets because they already ate a healthy meal.

 

3.      Speaking of sweets, ginger-bread house vomit is DISGUSTING.   Dr. Kardos found this out first-hand with one of her children after a holiday party where the hostess served the kids a beautiful (and generous sized) ginger bread house for dessert. While Dr. Kardos was engrossed in conversation with a long lost friend, one of her boys over-ate. Make sure you supervise what your child is eating at parties. 

 

4.      If you have a young baby, be careful not to put yourself in a situation where you lose control of your ability to protect the baby from germs.  Well-meaning family members love passing infants from person to person, smothering them with kisses along the way. Unfortunately, kisses can spread cold and flu germs, as well as stomach virus germs.

 

5.      On the flip side, there are some family events, such as having your 95-year-old grandfather meet your baby for the first time, that are once in a lifetime. While you should be cautious on behalf of your child, you can balance caution while looking at the whole context of a situation before deciding whether or not to attend a gathering.

6.      Once you have children, their needs come before yours. (Of course there is a healthy balance-but that is a talk for another day.) Although you have anticipated a holiday reunion, your child may be too young to remember it.  An ill, overtired child makes everyone miserable.  If your child has a cold, is tired, won’t use the unfamiliar bathroom, has eaten too many cookies and has a belly ache, and is in general crying, clingy, and miserable, just leave the party. You can console yourself that when your child is older his actions at that gathering may be the stuff of legends, or at least will make for a funny story. 

 

7.      For the allergic families- think twice before you drag in a live Christmas tree into your house.  The trees are often covered in dust and mud.  Washing the tree off with a hose in the driveway will keep the sneezing down to a minimum.  Every year Dr. Lai tells families about rinsing off the tree in the driveway. Most parents dismiss the idea as too time consuming.  However, she is pleased to report that a family recently told her they did rinse the tree and it did help keep the allergens at bay.

 

8.      No one else baby proofs.  Remember this when you are on the road. We worry less in our own homes.  But with their medication pills lying on the end tables and their menorah candles within a toddler’s reach, other people’s homes should make us more cautious.  One year at holiday time Dr. Lai’s family was in a hotel room and her six year old came running up saying “look what I found”…It was a pill of Viagra. 

 

We wish you all the best this holiday season.

Julie Kardos, MD and Naline Lai, MD
©2009 Two Peds in a Pod®

“Three things we know for certain: a child is a gift, being a good parent is a blessing, and being a pediatrician is a privilege.” –author unknown

This Thanksgiving, we want to thank you, our readers, for allowing us to help you help your children. We are grateful to you for telling other families about Two Peds In A Pod because when you get right down to it, our information is only good if it reaches people. Thank you for your comments and questions. Keep them coming!

From both of our families, we wish you all a Happy Thanksgiving.

Julie Kardos, MD and Naline Lai, MD
©2009 Two Peds in a Pod®

Emma’s dad and I both peered at the filamentous growth dangling from his nine year old’s right nostril.  “Yes,” I said, “it’s definitely a wart.”

 

Emma’s dad replied, “When I was a kid, I heard the way to get rid of a wart was to cut a potato in half, rub it on the wart, and bury it in the backyard.Legend had it, by the time the potato disintegrates, the wart will begone.”

“I wish it were so easy,” I replied.

Warts are caused by skin-dwelling viruses. On the feet, warts can sometimes be mistaken for calluses.  One distinguishing feature is that warts sit in the skin like this:

 

 

Fine “feeder” blood vessels extend from the wart into the skin. Therefore, if you scrape off the top layer of a wart, a dotted pattern usually appears from above. The dots will not appear in a callus. View from above:

There are simply no glamorous ways to get rid of warts. Most treatment modalities destroy warts by pulverizing the home they live in, a.k.a. your skin. Your doctor maybe armed with various agents such as liquid nitrogen, or dimethyl ether propane,which produces a chemical “freeze” and dries up the wart. Another agent called cantharidin (otherwise known as “beetle juice”) is a caustic liquid derived from the blister beetle (pictured here.)

Application of beetle juice causes the warts to blister.  Some doctors will even manually take a scalpel and cut out the warts. Like I said, there are no glamorous treatments. However, more gentle creams which stimulate the immune system, such as Imiquimod (Aldara) are showing promise.  

 

 

Over the counter remedies exist in a milder form.  Commonly used wart removers such as Compound W, Dr Scholl’s Clear Away Wart and Duofilm all contain salicylic acid.  The acid slowly dries up the warts.  When applying salicylic acid, after a few applications make sure you peel the dead crusty top layer off  the wart. Without peeling, future medicine will not reach the wart.  These methods can take weeks to months to work, but they do work.

 

And don’t forget the duct tape.  Duct tape, the great all-purpose household item, has also been shown to speed up the resolution of warts.Scientists hypothesize the constant presence of the adhesive somehow stimulates a natural immune response.  If you try duct tape, have your child wear the duct tape over the wart for several days in a row and then give a day off. Effects should be seen within a couple of months if not sooner.

           

 The prevention of warts is tricky.  Some people just seem genetically predisposed.  However, your best bet for keeping warts away is to keep your child’s skin as healthy as possible.  Warts tend to gravitate towards areas of skin broken down by friction such as feet or fingers. Liberally apply moisturizing creams daily to prone areas.  After a summer of wearing flip-flops and walking on the rough cement by the side of a swimming pool in bare feet, many children end up with warts on the bottom of their feet.  I know a teen whose warts on the tips of her fingers stemmed from months of guitar strumming.

 

Turns out that even without treatment, 60% percent or more of all warts will disappear spontaneously within two years.

Coincidentally, I think that’s also the time it takes for a potato half to disintegrate.

Naline Lai , MD

 

© 2009 TwoPeds in a Pod

Addendum, January 14, 2010

We noticed Atom 1.0 readers did not pick up the podcast. Try the RSS 2 feed instead.

Let us know about any technical glitches.  We are still very new to cyberspace and appreciate your feedback.  We say in our podcasts, “Right now our recording studio is our kitchen table”…. you should see our computer help desk

Naline Lai, MD and Julie Kardos, MD

Boo (boo-hoo)

A lot of Halloween festivities in our area have been dampened by H1N1 flu.  For all the parents of the boys and ghouls in a similar situation, this picture will make you smile.  It was sent to me by Ben’s mom.  It is flu from the perspective of a kindergarten boy.  The arrow points to Ben’s nose.  Note the huge boogie to nose ratio.  The red represents “boss germs” and the purple ones are the “just plain mean” ones. 

Don’t let the “Boogie” man get your family this Halloween

Naline Lai, MD

© 2009 Two Peds In a Pod

If your child’s health care provider prescribes the liquid form of Oseltamivir, brand name Tamiflu, to treat your child’s flu, pay particular attention to how you dose the medication.

The dosing syringe that comes with the manufacturer’s liquid formulation is marked in milligrams (mg), not in the customary milliliters (ml) or teaspoons (tsp).

Also, be aware that if your pharmacist makes up a liquid version from the tablets (because the liquid formulation is in short supply), the concentration (amount of medicine per amount of liquid volume) is different than what the manufacturer makes. The manufacturer makes 12mg/ml and the commonly used recipe your pharmacist will use for making a liquid formulation makes a 15mg/ml formulation.

Confused? Before you leave the pharmacy with Tamiflu, just make sure you clarify the proper amount to give with your pharmacist.

Naline Lai, MD and Julie Kardos, MD

©2009 Two Peds in a Pod®

We just returned from this year’s American Academy of Pediatrics National Conference and Exhibition in Washington D.C. It  was heartening and motivating to meet with thousands of pediatricians from across the country all dedicated to improving the health and welfare of children locally and globally.  We attended numerous seminars, workshops, and lectures and even ran a 7 a.m. 5K race to benefit the American Academy of Pediatrics Friends of Children Fund.  We plan to incorporate what we’ve learned these past few days both in our offices and in future blog posts.

We were fortunate to find other pediatricians who promote pediatric education outside of the office setting.  We enjoyed exchanging ideas with fellow pediatric blogger Dr. Roy Benaroch. In addition to writing his blog, Dr. Benaroch has authored two books for parents: A Guide to Getting the Best Health care for Your Child and Solving Health Behavioral Problems from Birth Through Preschool: A Parent’s Guide.  Also, we spent time with Dr Kardos’s medical school friend Dr. Laura Jana, author of Heading Home with your Newborn, from Birth to Reality and Food Fights. She is also a pediatric media spokesperson.

It was also nice to meet Dr David Hill from North Carolina whose work can be found as well on the internet.  

With pediatricians like these, the health of our nation’s children is in good hands.

Julie Kardos, MD and Naline Lai, MD

©2009 Two Peds in a Pod®

As the first batches of the H1N1 vaccine are distributed, is my pleasure to introduce our first  guest blogger Kimberly Lafferty.  A mom and well respected scientist, she brings us information on the H1N1 vaccine.  Dr. Lafferty holds a doctorate in pharmacology from University of North Carolina at Chapel Hill and a masters of business administration from Pennsylvania State University.  She completed a fellowship in clinical research and drug development  and  is a mom to a young child and an infant.

Naline Lai, MD

* * * * * *

As a mother of two young children, I am always concerned about their health and well-being.  So, naturally, I am especially concerned about the novel influenza A/H1N1 strain that has led to the current global pandemic.  But, as a pharmacist with over ten years experience in the pharmaceutical industry (mostly in research & development), I also know the importance of good research and making decisions based on the best available scientific evidence. Therefore, I have spent quite a bit of time researching the novel H1N1 virus and the soon-to-be available vaccine.  Below is a summary of my findings:
 
1.  While most people infected with H1N1 have had only mild to moderate symptoms, there have been deaths associated with this virus.  Many of these have been in people with underlying chronic health conditions, but some deaths have occurred in otherwise healthy, young people.
 
2.  According to the CDC (US Center for Disease Control and Prevention) on 10/1/2009, 100 pregnant women in the U.S. have required treatment for H1N1 influenza in intensive care units; 28 of these have died.  Pregnant women are especially vulnerable to infections (due to a weakened immune system) and are at especially high risk of complications from the H1N1 strain.
 
3.  The H1N1 vaccine is made by the same companies and by the same processes as the seasonal flu vaccine.  It is also undergoing the same lot testing and release procedures as the seasonal flu vaccine.  The only difference between the seasonal vaccine and the H1N1 vaccine is that the H1N1 vaccine contains only one strain of influenza while the seasonal vaccine contains three. While the strain in the H1N1 vaccine is different from the strains in the seasonal vaccine, the seasonal flu vaccine has been safely admininstered to millions of people over many years, including children.
 
4.  Because the H1N1 vaccine is made the same way as the seasonal flu vaccine, clinical trials were officially not necessary for this vaccine. However, the NIH (National Institute of Health) and the manufacturers are separately conducting clinical trials, not only to verify the safety of the vaccine, but also to determine the optimal dose and dosing schedule needed to ensure that people who are vaccinated become immune to the H1N1 strain of flu.
 
5.  The H1N1 vaccines currently approved in the U.S. do NOT contain adjuvant (or “immune boosters”).  Adjuvants are used in European seasonal flu vaccines and the European H1N1 vaccine.
 
6.  As with the seasonal influenza vaccine, the H1N1 vaccine will be available in preservative-free formulations.  These will most likely be targeted to young children and pregnant women.
 
Since there are a lot of myths and misinformation out there regarding the H1N1 vaccine, focus your own research on independent, credible sources such as the World Health Organization (WHO), the US Centers for Disease Control and Prevention(CDC), the Food and Drug Administration (FDA), and your state/local health departments.  One important resource is www.flu.gov. 

Kimberly Lafferty, Pharm D, MBA