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Does your baby have a white tongue? Think Thrush

thrush
White curds that don’t wipe off can be indicative of thrush.

You find cottage cheese like curds coating the inside of your baby’s tongue and inner cheeks and try to wipe them off to no avail. It’s not breast milk, not formula. It’s thrush.

Thrush, fancy medical name Oral Candidiasis, is caused by an overgrowth of yeast, called Candida. Although not painful, it may cause discomfort akin to having a film of cotton coating the inside the mouth. 

We ALL have yeast, which is a type of fungus, on our bodies. Usually we have enough bacteria on our bodies to suppress the growth of yeast, but in cases when there is less than usual bacteria present such as in young babies or in kids who are on antibiotics, Candida can emerge. For older kids using inhaled steroids for asthma, failure  to rinse out the mouth after medication use also promotes an environment conducive to thrush. 



Treatment

To treat thrush, doctors usually prescribe oral Nystatin, an anti-fungal/anti-yeast medication, which works topically. Parents apply the medicine to the inside of the baby’s mouth after feedings four times per day. Use Nystatin until thrush is no longer visible for 48 hours. A course usually takes one to two weeks to complete. An oral medication called fluconazole (brand name Diflucan) may also be prescribed. 

Watch out. Candida may also be thriving on mom’s breasts or on pacifiers or bottle nipples. Mothers can apply the same medicine to their breasts after breast feeding. Scrub pacifiers, bottle nipples, and any other object that goes in to a baby’s mouth extra well with hot water and soap. Or, you can use the dishwasher to wash away the Candida.

Thrush that persists despite proper treatment can signal an immune system problem.  So if your child’s thrush is not resolving in the expected time, let your child’s health care provider know.

Does yeast cause infections elsewhere?

If you are a female who is familiar with vaginal yeast infections, you may wonder if the same organism causes both thrush and yeast infections. Yes, it is the same organism. But don’t have any mom-guilt. You did not cause the thrush. Yeast tends to thrive in wet moist areas such as the diaper area, mouth and even the neck folds of drooling babies.

A newborn’s tongue may always look slightly white. This “coated tongue” in young babies could be residual breast milk or formula and does not need treatment. Even if there is a little residual yeast, remember that yeast is just a part of our microbiome along with all the other wonderful microscopic organisms that call human bodies their home. If you are unsure, your baby’s health care provider’s door is always open. They will be happy to take a peek.

Julie Kardos, MD and Naline Lai, MD
©2021 Two Peds in a Pod® (rev. from 2012)




High calorie foods for underweight children

High calorie food for underweight children

Your child’s pediatrician charts your child’s height and weight in order to determine whether he is growing appropriately.  Some kids are underweight. These kids use more calories than they take in.

Here are ways to increase calories. Remember, it’s not as simple as demanding that your child eat more of her noodles. Instead of trying to stuff more food into your child, increase the caloric umph behind each meal.

Make every bite count:  



  • Mix baby cereal with breast milk or formula, not juice or water.
  • After weaning from formula or breast milk at a year of age, give whole milk until two years, longer if your pediatrician recommends this. Cow’s milk has more calories than rice, oat, or nut milks.
  • Add Carnation Breakfast Essentials to milk.  
  • Add Smart Balance, butter, or olive oil to cooked vegetables, pasta, rice, and hot cereal.
  • Dip fruit into whole milk yogurt
  • Dip vegetables into cheese sauce or ranch dressing
  • Offer avocado and banana over less caloric fruits such as grapes (which contain only one calorie per grape).
  • Cream cheese is full of calories and flavor: smear some on raw veggies, whole wheat crackers, or add some to a jelly sandwich.
  • Peanut butter and other nut-butters are great ways to add calories as well as protein to crackers, sandwiches, and cereal.
  • If your child is old enough to eat nuts without choking (as least 3 years), a snack of nuts provides more calories and nutrition than crackers.
  • For your older child, feed hardy “home style foods.” Give mac ‘n cheese instead of pasta with tomato sauce.
  • In general, any form of meat (chicken, fish, or other meat) is more calorically dense than most other foods.
  • Mix granola into yogurt.
  • Give a hard boiled egg or pieces of cheese as a snack.
  • For those who don’t like plain egg, try French toast!
  • Give milkshakes in place of milk (no raw eggs!).
  • Choose a muffin over a piece of toast.
  • Butter their waffles and pancakes before serving.

Have your child’s pediatrician exclude medical reasons of poor weight gain with a thorough history and physical exam before you assume poor weight gain is from low caloric intake.

Julie Kardos, MD and Naline Lai, MD
©2021 Two Peds in a Pod®




Vaccinate your children during the COVID-19 pandemic

vaccinate your children during the covid-19 pandemic

Social distancing? Take the time to immunize

Parents are calling us and asking to cancel their well baby visits to the pediatrician. Tempted to cancel? Think again. If families allow their babies to get behind on their vaccines, we will risk other epidemics. It is important to vaccinate your children during the COVID-19 pandemic.

Before vaccines, babies died of polio, bacterial meningitis, pneumonia, blood infections, measles, and whooping cough. All of these infections are contagious. Babies need to stay on track to get immunized against these potentially lethal illnesses.

Vaccine preventable illnesses such as polio are still alive in the memories of those now experiencing the COVID-19 pandemic. Pictured to the right is a photo of members of Dr. Lai’s family. Great-Uncle Holloway, with the broken arm, and his cousin Billy were slated to go swimming soon after the photo was taken. Cousin Billy went, was exposed to polio at the pool, and died shortly after. In a twist of luck, Great-Uncle Holloway was spared because he had broken his arm and thus did not go to the crowded swimming pool that day.

Billy (L) and Holloway (R) in the 1930’s

We understand your fear of leaving home with your baby. We know that some families have difficulty obtaining transportation. But we know also that vaccine preventable illnesses are MUCH more dangerous than COVID-19 for our youngest children.

One day socially distancing will end, and on that day, babies will be more vulnerable to vaccine preventable illness. We cannot possibly catch up every single baby on our first day out of isolation. It is far better to keep your babies up to date on vaccines all along. 

In the US, our American Academy of Pediatrics strongly urges pediatricians to continue to vaccinate our infants and younger children on time. 

Pediatricians across the country, and the world, are adjusting how they see patients in their offices in order to protect their patients, as well as themselves, from acquiring COVID-19 in their offices. Ask what steps your baby’s doctor is taking to provide extra protection for your family.

Vaccines not only protect your own children, but they also protect everyone around them. Remember that some babies with immune system disease or other underlying medical reasons cannot receive some vaccines. Immunizing your child can protect these children as well as themselves. 

We cannot stress more how important it is to vaccinate your children during the COVID-19 pandemic. Please share this post with anyone you know that has young children, especially babies, who are due for vaccines.

Julie Kardos, MD and Naline Lai, MD
©2020 Two Peds in a Pod®




Afraid of a tantrum? How to set limits for your child

set limits for your child and don't fear the tantrumHas your toddler ever pulled off your glasses and thrown them? Slapped another toddler at the playground? Bitten their brother? Run off in a store and ignored you when you called? Are you afraid to set limits for your child because you fear the tantrum that may result?

Yes, toddlers are cute, but left to their own devices, they grow into the school bully, the family bully, or worse yet, they don’t listen to an adult and run into the street in front of a car.

Unbeknownst to you, you probably started to set limits for your child as early as 6 months of age.

If you breastfed, you may remember this scenario: you were breastfeeding your 6-month-old when they suddenly bit you very hard with their new tooth. 

Did you continue to breastfeed calmly and ignore the mind numbing agony? Did you say in a sweet sing-song voice, “Honey, biting hurts Mommy. Mommy does not like being hurt. Please do not do that again?” 

If you are like Dr. Kardos and Dr. Lai, you did not have time to say any of the above, because you were suddenly in PAIN. You likely removed your baby from your breast immediately and yelled, “OW!” Your baby (like each of ours) may have cried (howled) from surprise. However, your baby probably never bit you again while breast feeding!

Fast forward to the present and imagine you are holding your 16 month old and they hit, bite, pinch, pull your hair, or pull off your glasses. Maybe they were angry, but equally possible they may have been simply excited. Even though you know they are not purposefully hurting you, it is important to stop this behavior. Say in a firm voice: “No hitting!” and put them down. 

This is time-out.

Time-out does not have to be spent on a chair in the corner of the room. Time-out is not a terrible punishment. Just like in sports, it is a pause in the play. By giving a time-out, your child learns that they do not get more attention for mean or aggressive behaviors, but less attention. As a variation, you can time-out a toy.

What if your baby starts crying on the floor? Give them a minute to recover. Remember that time-out lasts one minute per year of age. For your 16 month old, time-out will last one minute. At  two years, time out will last two minutes. When time-out is complete, offer comfort. If they repeat the behavior, put them back down again. 

Your goal, when you set limits for your child, is to stop a behavior that can hurt them or hurt others. 

More tips on how to set limits:

Praise them specifically at every opportunity.

For example, “Good job putting your toys back into the box,” or “I like how you remembered to take my hand when we cross the street,” or “I like how you sit in your chair at dinner instead of standing up.” You will be amazed at how often children repeat desired behaviors that you point out to them. 

Follow through on your requests.

If your toddler got a hold of a pair of scissors, you would take those scissors away immediately, without thought or fear about their feelings. You would put your child’s immediate safety ahead of their desire to play with scissors, and you would not stop to explain why they should give up this new-found plaything. Likewise, if you tell your child to come to you for any reason, be ready to physically go and lead them if they choose to ignore you. For instance, at a party, wait to tell them to come until you are ready to go. Otherwise they will learn that you “cry wolf” and will ignore you.

Make consequences logical and immediate for undesirable behaviors.

If your child throws a toy train at his friend’s house, say “No throwing trains!” and take the train away for a time-out. Telling them that “you are in trouble when we get home” means nothing to a toddler.

Refrain from explaining too much.

Toddlers have a TINY attention span. Just give them a command or an explanation that is 3-4 words or less. For example, “No hitting, it hurts!” is enough. Telling them that hitting hurts others, asking how would they like to be hit and telling them about the need to be kind, is wasted effort. The time for longer explanations is when they are developmentally capable of putting themselves in another’s shoes, around age six years for most children. 

Label the behavior as bad, not the child.

Say “No throwing sand!” not “You are bad for throwing sand!”

Remember to set expectations and teach which behaviors are not acceptable.

Toddlers are not mind-readers. You need to tell them not to open the trash can and rummage through it, otherwise they will not know any better.

Seize the opportunity to turn a negative behavior into a positive behavior.

For instance, as you see your child raise their hand to hit you, firmly hold their wrist and say “Don’t hit. Soft touches,” and simultaneously bring their hand to pat your cheek. This will give you a chance to praise your child.

Do not fear the tantrum.

Toddler tantrums are NORMAL reactions to feeling angry or frustrated. Many toddlers throw tantrums in response to your telling them “no” or “stop.” It is not fair to expect toddlers not to throw tantrums. Just put on your bored face (and some ear plugs) and wait for it to be over.

If  a tantrum immediately occurs, remind yourself that at least you stopped your child from hurting themselves or others.  Tantrums don’t hurt anyone. You can read more about how to manage tantrums here

Set limits for your child.

When you set limits for your child, you teach them to behave in ways that will keep them and others safe. Act confidently when you set limits, and your child will learn to interact appropriately with others and gain self-control.

Julie Kardos, MD and Naline Lai, MD
©2019 Two Peds in a Pod®




How to treat eczema or atopic dermatitis

eczemaIt’s pretty annoying to be itchy. Dr. Lai fondly called her itchy oldest child with eczema “itchy, bitty, spider,”or some variant of that, for much of her daughter’s childhood. Fortunately, for your kids with sensitive skin, dermatologist Teresa S. Wright, MD  joins us today with tips for how to treat eczema or atopic dermatitis—Drs. Kardos and Lai

Has your child been diagnosed with eczema? Eczema is a general term that refers to a group of skin conditions characterized by itchy red rashes. The term “eczema” often refers to a skin condition known as atopic dermatitis. Atopic dermatitis may occur in association with allergies and/or asthma and the rash tends to come and go. Common triggers include illness, stress, and changes in the weather or temperature. The cause of atopic dermatitis is not well understood. However, most children with atopic dermatitis tend to have very dry, sensitive skin. Atopic dermatitis cannot be cured, but it can be controlled. Most children with atopic dermatitis gradually improve and many will outgrow it over time. In order to control the rash, a proper daily skin care regimen is extremely important.

Skin care regimen to treat eczema

A daily bath or shower is recommended. It is a common myth that daily bathing “dries out” the skin. This is not true. Bathing puts moisture in the skin and removes irritants and germs. However, the bath or shower should be short (less than 10 minutes) and not too hot. Cleanser should be gentle, fragrance-free, and dye-free. Dove™ for Sensitive Skin or Aveeno™ fragrance-free cleanser are good choices. After bathing, pat the skin dry with a soft cotton towel and apply a  heavy bland moisturizer to all skin to seal in the moisture.

cow with dry itchy skinThe type of moisturizer you select is very important. It is best to use an ointment (like plain unscented Vaseline™ or Aquaphor™) or a heavy cream (like Vanicream™, CeraVe™ cream, Cetaphil™ cream, or Aveeno™ Baby Eczema Therapy Moisturizing cream, to name a few). Lotions are poor choices because they tend to contain more preservatives and ingredients that can sting open skin or cause irritation.

Maybe this stork has eczemaApply moisturizer  to the skin at least twice daily, but more often if the child’s skin is unusually dry or the eczema is severe. Apply topical medications sparingly to the affected areas prior to the application of moisturizer. I recommend applying topical medications twice daily, but you should follow the instructions given by your child’s doctor. It is very important that medications are applied only to areas of active eczema and never to normal skin. Apply moisturizer to all skin, including over the areas where you already applied medication.

This time of year, parents ask if swimming is okay for children with atopic dermatitis. In general, swimming should not be a problem for children with atopic dermatitis. In fact, some children improve dramatically with regular swimming. Improvement may be due to the effect of chlorine. Chlorine causes a decrease in the skin residing germs that can play a role in triggering eczema flares. However, chlorinated water can be very drying to the skin, so rinse the skin thoroughly and apply a generous layer of a heavy moisturizer as soon as possible after swimming. For most children, taking these steps prevents significant flares of swimming related atopic dermatitis.

In my practice, I see many children with eczema every day. I understand how challenging and frustrating this condition can be for parents. The recommendations I outlined here are often very helpful and I sincerely hope they will help you control your child’s eczema.

Teresa S. Wright, MD
©2019 Two Peds in a Pod®

Dr. Teresa S. Wright is a board-certified pediatric dermatologist in Memphis, TN, and is Division Chief of Pediatric Dermatology at LeBonheur Children’s Hospital and Associate Professor of Dermatology at the University of Tennessee Health Science Center. She has particular interests in atopic dermatitis, vascular birthmarks, and pigmented skin lesions.

 




New national guidelines for water safety, and free swim lessons in Bucks County

 

water safety guidelines apply on beaches as well as pools

When one of Dr. Lai’s kids was around two years old, she deliberately let go of Dr. Lai’s hand when wading in waist high water. She exclaimed, “Look mommy, I can swim!” But she couldn’t, and as she started to sink, Dr. Lai scooped her up. What if she had taken swim lessons? Would that have been enough to prevent drowning? It may have helped, but that’s not enough. Kids need layers of protection to prevent tragedy in water.

Just in time for summer, we have new evidence about drowning prevention for both young kids and teens. Read on for updated swimming and water safety tips and an offer for free swim competency lessons for older kids.

 

Who is most at risk for drowning?

Children age 4 years and younger.

Most of these kids drown when parents do not realize kids have access to water. Think bathtubs, buckets, and toilets as well as ponds, puddles, and pools. Drowning is silent. Parents need to always watch their children around any body of water.

Adolescents aged 15-19.

Several factors contribute, including under-estimating risk (strong tides, swimming out too far), overestimation of skills, and substance use. Be sure to discuss rules of swimming with all of your children even if they are strong swimmers, and instruct them never to swim alone or without a lifeguard. Set an example yourself by wearing life jackets while boating and abstain from alcohol consumption. Alcohol contributes to half of all boating accidents in the United States.

Kids with autism.

Like children with other behavioral disabilities, they often wander away from adults without warning.

Children with seizure disorders.

Drowning is the leading cause of accidental death in children with epilepsy. Like ALL children, kids who have seizures should never be left alone for even a second in pools or baths.

Kids with a predisposition to cardiac arrhythmias.

If your family has a history of heart arrhythmias (eg. Long QT, Brugada syndrome, Ventricular tachycardia), unexplained sudden death at a young age, or an unexplained drowning, bring it to your pediatrician’s attention. In your child, let your pediatrician know about any fainting/near fainting episodes, “funny” heart beats, or chest pain.

 

When should I start swim lessons for my child?

There is no standard recommended age, but evidence suggests that swim lessons, even for kids as young as 1-4 years, can add a level of protection against drowning. Goals of swim lessons include the ability to enter the water, surface, turn around, swim for 25 yards, tread water or float, and to exit the water safely.

Swim lessons should also include real life “what to do in case of an accident” scenarios, such as swimming with clothes on, how to recognize a swimmer in trouble, and how to call for help. They should learn never to swim without adult supervision. Older children, and all adults for that matter, should learn CPR.

There is lack of evidence that swim lessons for babies under one year protects babies. Babies this young have relatively large heads compared to their body size and are incapable of picking up their heads out of the water to breathe if they are submerged. Think of swim “lessons” for babies as a fun, social activity instead of a potentially life-saving class.

Even if your children take swim lessons, THEY ARE NOT DROWN PROOF. Stay within arm’s length of all young children and non-swimmers.

 

How can I make kids in my backyard pool safer?

Install a fence that is at least 4 feet high around the pool.

The fence should be self-closing and self-latching, and isolates the pool completely from the rest of the yard and the house.

Pool covers and barrier alarms may add another level of protection, but there is no data that demonstrates definitively that they prevent drowning.

The Consumer Product Safety Commission has detailed instructions and information on the latest safety products recommended for home pools.

Always supervise your swimming children.

Adults should be very clear with each other about who is watching the swimmers. Stay at arm’s length of non-swimmers and young swimmers, and refrain from texting, drinking alcohol, reading, socializing, or any other activity that takes your eyes off of your child or could shift attention away from kids in the water. When kids drown, they drown silently, so you will likely not hear trouble.

Non-swimmers and small children should wear life jackets, even in your own pool, for maximum water safety. Inflatables are not substitutes. Look for US Coast Guard approved jackets.

 

It bears repeating: most drownings occur when parents had no idea that their child had access to water.

A few years ago, Dr. Lai’s toddler-aged neighbor waddled over to the ice bucket at a Fourth of July party. Toddlers have big pumpkin shaped heads and before Dr. Lai could blink an eye, her neighbor tumbled into the water head first. Luckily Dr. Lai’s husband was standing next to the bucket and pulled the toddler out.

As this case shows, you can’t let your guard down, even if no pool or large body of water is in sight.

Small, blow-up backyard pools are the same as bath tubs in terms of drowning risk, so never leave kids unattended around these pools. Stay at arm’s length of your babies and toddlers when they play in these pools.

Additionally, never leave kids unattended, even briefly, in the bathtub.

 

We’re going to the beach- can my baby go swimming in the ocean? How about a pool?

Most pools, oceans, and lakes are much colder than bath water. Babies feel colder more quickly than adults. Remember your own parent telling you to come out of a pool because your lips were blue? Limit a baby’s exposure to cold water accordingly.

Chlorine will not hurt babies, but it can dry out skin. Apply moisturizer after swimming if your child’s skin gets dry.

Salt water is safe for babies and kids to swim in.

Young kids try to drink the water they swim in. Don’t let them. It’s not just your nephew who pees through his swim diaper that you need to worry about. Unfortunately, chlorine and salt fail to kill all viruses, bacteria, and parasites that might lurk in swimming water.

If your child swims outside, remember that sunburns occur more easily because sunlight reflects off the water. Apply sunscreen liberally before and after swimming, even if the sunscreen label says “waterproof.” Better yet, try to keep that baby hat on and have your child wear a sun protective shirt.

 

Can you suggest more ways my kids can play with water?

Water tables (which can double as sand tables in the spring, leaf tables in the fall and indoor snow tables in the winter) allow young toddlers to stand and play with toys in very shallow water.

Fill a bunch of different sized stacking cups with water for kids to pour, dump, or perhaps to mix with rocks, dirt, or leaves.

Simple squirt bottles are great fun. When Dr. Kardos’s twins were little they spent large amounts of time “watering” every plant, bush, flower, and blade of grass in the yard.

Transform chalk drawings into masterpieces by adding water.

Wet down your walkway and blow bubbles onto the cement – they will cling onto the walkway for a long period of time.

 

Local Parents: Do you live in Bucks County, PA? Has your child graduated from first grade? Do they know how to swim? The Y of Bucks County, in conjunction with the Children’s Hospital of Philadelphia, is offering free swim lessons for kids past first grade to achieve basic water skills competency. For more information on obtaining a voucher, email us at twopedsinapod@gmail.com.

Julie Kardos, MD and Naline Lai, MD
©2019 Two Peds in a Pod®

 

 

 

 




What do Rock ‘n Play and socks have in common? They’ve both been recalled this year. Predicting what’s up next:

child product recall

Whenever we look at the child product recall lists from The Consumer Protection Safety Commission (CPSC), it never fails to amaze us that even big brand names crop up in product recalls for children. Ironically, most are not new-fangled products. Bouncer seats, high chairs, rattles, and bicycle helmets are often amongst the recalls. We figure after decades of baby product manufacturing, designers and production managers would understand what constitutes a potential hazard for kids.

We urge you to scrutinize the kid merchandise in your house and identify the potential hazards before your child ends up as the reason a product is on the CPSC list. In fact, you might have already missed a recall on your older products. According to kidsindanger.org, child product recalls occur a couple of times a week, but when a baby product is recalled, only 10-30 percent are ever retrieved. Because recalls occur AFTER injury or death occurs, it is better if parents assess the safety of child products before a recall.

Here are some common reasons for recalls:

Products fail to adhere to the American Academy of Pediatrics safe sleep guidelines. We know parents of crying young infants are often desperate to get some sleep themselves, but many sleep products are not studied. If it seems too good to be true, it probably isn’t. Infants are not ready developmentally to sleep through the night, so any product that promises to help your infant sleep through the night is, by definition, problematic. An example is the Rock ‘n Play sleeper which was recently recalled. The soft squishy inclined cradles clearly did not adhere to the safe sleep guidelines, but often we heard a parent say, ”But that’s the only place they will sleep.” Unfortunately, this recall does not undo the deaths of the 32 reported babies who died in the sleeper. In the wake of the recall, other companies who make similar sleepers are also recalling their products.

We cringe every time a family tells us they are using a new fangled piece of wrap-around-baby sleep gear or sleeping contraption, because
most involve soft surfaces (not advised), inclined surfaces (not advised) or things-in-the-crib-other-than-your-baby (also not advised).

Choking hazards: Babies and toddlers explore the world by mouthing objects. So drop on your hands and knees and see the world from their perspective. And don’t assume your kid has reached an age when “they should know better.” Ever wonder why many Monopoly game pieces go missing? Or why so many kids visit Emergency Departments after swallowing coins? In the past twenty years, the number of children visiting U.S. emergency rooms for swallowing objects doubled. Anything that can fit into a toilet paper tube (2.5 inches in diameter) is considered a choking hazard. Be aware that the toy may be too large to choke on, but a piece that breaks off may be small enough to choke on. Some great example of poorly thought-out products are teething necklaces made of beads strung together and decorative buttons on baby socks.

Ingestion hazards:

  • Magnets might be a fun toy, yet they can stick together after a kid swallows them and erode through any piece of gut trapped between them. In fact, even when a parent is fairly certain that their child ate only one single magnet, we pediatricians know that because magnets can be so dangerous, we will check an X-ray, just in case there are more. After all, even an older kid is sometimes too embarrassed to fess up on the number swallowed.
  • Batteries can corrode through the lining of the intestines, constituting an emergency. Check to make sure all battery backings are secure. Particularly problematic are button batteries. They are tiny and easily swallowed.
  • Brightly painted wooden toys are beautiful, but they may contain lead paint. So can kid jewelry. Lead poisoning occurs usually through eating or drinking contaminated objects such as lead containing paint or paint chips. Be aware of old toys (think antique doll houses) made prior to 1978 (when lead was taken out of paint in the US), toys manufactured in China or other Pacific Rim countries, or imported candies from Mexico. If you are wondering about possible lead exposure, ask your child’s doctor to test your child for lead exposure with a simple blood test. Avoid purchasing home lead kits because they can be inaccurate.

Head entrapment hazards: Infant heads and toddler heads can get wedged. Be aware that slates on a crib need to be no more than 2 ⅜ inches apart, or no bigger than the diameter of a soda can. Beware of baby carriers or high chairs that could allow babies to slip through.

Fall hazard: Check to see all buckles are secure and unlikely to catapult your child out of the restraint. Baby carriers and strollers, especially the jogging ones, seem to crop up often in recalls.

For general guidelines for baby proofing click here.

Sign up for child product recall alerts through the CPSC, the American Academy of Pediatrics,  or kidsindanger.org. Help other families by reporting product concerns to CPSC.

Dr. Lai tells this tale: Years ago, my first child’s crib came with plastic clips which held up her mattress. As my husband and I assembled the crib, a few of the clips snapped and broke. By my second child, even more clips broke apart. By my third child, the crib clips were recalled.

Perhaps we should have been suspicious the first time.

Naline Lai, MD and Julie Kardos, MD
©2019 Two Peds in a Pod®




What to do when your child has an earache

earacheDoes your child have an earache?

In the aftermath of flu and croup season, we are diagnosing a fair share of ear infections. But not all earaches are due to ear infections.

Read our post about ear pain and what to do about it.

Julie Kardos, MD and Naline Lai, MD
©2019 Two Peds in a Pod®




How to burp a baby

Wondering how to burp a baby? We decided that words just didn’t convey what to do. So we introduce baby Emma in her first, and our first, how-to-video.

Any other video requests, send them our way.

Julie Kardos, MD and Naline Lai, MD
©2019 Two Peds in a Pod®




Four month sleep regression

Tired parents, four month sleep regression“I think we just hit the four month sleep regression. My baby used to sleep better, and now at four months, she is waking up every hour! What happened?”

Sound familiar?

The term “four month sleep regression” did not appear on Google searches in the United States until 2006 and has been on the rise ever since.
It is not clear how the term came about. After all, babies existed well before 2006. Oddly, most of the search requests come from the state of California. Unfortunately, the term sleep regression has put many a parent into a panic. Do not worry. Sleep is not a developmental milestone, you do not need to move from California, and your baby is not regressing. Rather, your baby is changing. Just like eating and poop patterns change, sleep patterns also change.

Sleep in the beginning

In the beginning… there is newborn sleep. Newborns can fall asleep anywhere at any time: while feeding, in a stroller, on your chest, in your arms, in the car or on the floor. Sometimes they sleep for minutes, sometimes they sleep for a few hours.

For the first three months, babies are in a feeding frenzy mode. Babies this age gain about one ounce per day (a huge feat) so therefore they eat to sustain growth. So they eat, and eat, at a pace of every one and one-half to three hours. They are hungry buttheir bellies are small, so they must eat frequently. Sometimes they cluster feed every hour. Because they spend so much time feeding, chances are they often fall asleep while sucking either a breast or a bottle. Some babies, by the end of the third month, are sleeping longer at night and making up for missed feedings during the day.

The plot thickens…

Between three and four months, babies slow in the pace of their growth. From three to six months they gain only about one-half an ounce per day. Because they are not quite so ravenous and because their bellies are bigger now, they can wait longer between feedings. You will notice that a more discernible pattern to their day emerges and you can now tell the difference between “hungry” and “tired” cries.

Another change occurs around four months. You will notice that when your baby is hungry, they get excited when they either hear or see you preparing a bottle or positioning to breastfeed. They become AWARE that a feeding is about to happen and recognize events that immediately precede a meal.

That same awareness occurs around sleep. When she feels sleepy, your baby becomes aware of events that lead up to sleep. If that event is eating, then she will believe that EATING precedes SLEEPING. If that event is rocking with a parent to sleep or laying in a parent’s arms, then they learn that rocking or being held is the key to falling asleep.

The final piece of the puzzle

This increased awareness of sleep associations is likely the origin of the four month sleep regression. You see that the 4 month sleep regression actually is not a regression, but rather an AWARENESS of how to fall asleep. If you always put your baby down in the crib when tired, they will learn that resting in a crib is how to fall asleep. If you play music and put the baby in the crib, the baby will expect music and a crib to fall asleep. And if you always feed your baby to sleep, then feeding becomes the key to falling asleep.

Unlike when they were newborns, if you always put your four-month-old baby in the crib AFTER they fall asleep, they will eventually sense that something is different, and they will wake up. Imagine if you fall asleep in your bed and then wake up to find yourself on the front lawn. You will think to yourself, “WHAT ON EARTH JUST HAPPENED?” Then you will stomp back into the house and find your bed in order to go back to sleep.

If your baby falls asleep breastfeeding, and then you put them down in a crib, your baby may realize that the breast is no longer there. The realization will jolt them out of sleep (WHAT ON EARTH JUST HAPPENED?) and they will cry until you comply with your baby’s demand to breastfeed in order to fall back asleep. All understandable.

The solution: how to overcome the four month sleep regression

Herein lies the key to overcoming the four month sleep regression. Teach your baby that she wants to be in the CRIB to fall asleep. Now is the time to change up the bedtime routine so it ends with your baby in the crib AWAKE and then your baby will fall asleep on her own in the crib. Then, if she wakes up later in the night, she will think to herself: “Ok, I am in the crib, just where I was before. I am still tired and will go back to sleep now.” Same at nap time. When your baby gets drowsy, put her in her crib. It is not necessary to feed her first.

We do not advocate letting your baby “cry it out” yet— four months is too young. Developmentally, a four-month-old does not understand cause and effect. Anytime you show up, it’s a happy surprise. They do not realize that they have the power to “make you come.” However, you can allow for a bit of crying (say, five minutes maximum) because some babies need to unwind before they fall asleep. Remember, if you last fed your four-month-old within the hour, they are not hungry. They are just fussy. Do you remember stomping your foot as a child, rubbing your eyes and crying to your parents, “I am not tired! I do not want to go to bed now.”

If, however, your baby is not showing signs of self-soothing after a couple minutes, then go to them and pat them gently or pick them up for a cuddle. But, as soon as they calm down, put them back into the crib so they can learn to fall asleep in the crib, not on you. Allow them to learn that their crib is coming when they are tired, just as they learn that a breast or bottle is coming when they are hungry.

Once babies learn to fall asleep in the crib, many night time awakenings just stop happening. Keep in mind, most four-month-olds do not sleep for eight hour stretches overnight. Many still wake up once or twice to feed. Keep the feedings brief, and put your baby back into the crib BEFORE they drift off to sleep. Also, many babies are ready for additional solid food at this point. Discuss with your pediatrician if it’s time to give solid sustenance during the day along with liquids.

A parenting truth

The bottom line? The four month sleep regression is not a regression. Rather, it’s a sign of your baby’s emerging awareness of her environment and her readiness to learn how to fall asleep.

Julie Kardos, MD and Naline Lai, MD
©2019 Two Peds in a Pod®