Elementary school kids Archives - Page 17 of 40

Cold weather is here: time to start an organic produce garden with your kids

We welcome pediatrician Dr. Marion Mass to talk about starting a garden from a piece of suburban lawn. — Drs. Kardos and Lai

A few years back, my family was getting ready for my parents to come for dinner and I was peeling the skins off the roasted beets we had grown for my mother. One of her favorites…but not mine. My five-year-old Brian had picked the beets and was eager to try them. As Brian brought a sliver of beet up to his mouth I braced myself for a “ yucky face”. Instead, I was shocked to see him gobble the beets up. He loved them. To this day, beets are one of his favorite veggies.

Hands down, the best activity I have ever done with my family is planting and nurturing an organic garden for 11 years. Along the path to growing delectable vegetables, we have discovered together gardening’s health, intellectual and social benefits.

Actively tied to the process of supplying their own food, gardening kids will naturally want to eat more and more produce. Kids develop a sense of pride (truly, a basketful of beans, lettuce and cucumbers is so attractive) and eventually they develop a positive association with the outdoors and vegetables. In addition to eating more quantity, what your kids eat will be healthier than store bought veggies. Produce closer to harvest contains more nutrients and you don’t get closer than your own yard to table. If you garden organically, you will also avoid potentially harmful chemicals. Lastly, there is a sense of relaxation upon stepping into a garden. It is a balm for anxiety, for depression, for anger; in short, one of the best adjuvants to mental health therapy that I know.

If you want to harvest a crop next year, and you live in a cold weather area of the northern hemisphere, NOW is the best time to start. The most cumbersome task of starting a garden is to dig up the sod (existing lawn), but a few tricks in the fall can prevent this disc-slipping chore.

Chose a spot in your yard that gets at least 6 and preferably 8 hours of sunlight a day.
If possible, stay away from edges, tree lines and spots where large garden parasites (such as deer, rabbit and groundhogs) lurk.
If you live next to a pesticide happy neighbor, you will want to locate your garden away from a spray zone and will want to think about runoff. A helpful site to determine runoff capabilities of specific pesticides is: http://www.pw.ucr.edu/
Remember you may need to water your organic garden bed once in awhile, so keep it close to a water source (or at least someplace to which you don’t mind lugging a hose).
Start small: a 3 x 10 foot plot can grow a good bit if you plan well. Lay out a 12 layer thick plot of newspaper over the grass where you want your garden to grow and dump 4 inches of composted manure, manure and hummus mix or mushroom soil over top of the newspaper. You can purchase in bulk from a garden center (I would do 2 cubic yards for a 3 x 10 spot) or in bags (about 15 40 lb bags).

That’s it. Now go away and leave the garden alone until spring. During the fall and winter, the grass will die and the newspaper will rot. Both will become a source of composted nutrients for your garden veggies. While you hibernate this winter, start your wheels turning and think about what crops you will grow. Buy a few packs of discounted seeds now; they will still germinate next year.

When the ground is ready in the spring, rent a tiller or get a sturdy pitchfork (trust me, the tiller is SO much easier!!) and turn over the soil mixing the composted manure, rotted newspaper and dead sod into the rocky soil we have around here. The result will be a much richer garden soil that your vegetables will love.

What are you waiting for?? Get cracking now and start your produce garden. Hopefully, by next spring your kids will be eating and enjoying organic beets that they grew !!!!

Marion Mass MD, FAAP

In practice for 17 years, Marion Mass MD, FAAP graduated from Penn State and Duke University Medical School. She completed her pediatric residency at Northwestern University’s Children’s Memorial Hospital in Chicago. Currently Dr. Mass works at Jellinek Pediatrics in Doylestown, PA and serves on the Wellness Council of the Central Bucks School District, PA. Produce from her kids’ garden garnishes the plates of many local families as well as the plates of the restaurant Puck. All garden profits benefit Relay for Life. When she is not in her home garden, you can find her also tending to her son’s middle school garden.

Why is my potty trained child’s underwear occassionally damp?

A mom of a six-year-old patient asked recently, “Why is my daughter’s underwear damp?”

—She’s been potty trained for 3 years.

—She is dry overnight.

—She urinates about 6 times in the daytime.

—She doesn’t complain of pain during urination.

Yet, her underwear is occasionally slightly wet.

We don’t know if anyone has ever tracked the statistics, but this girl’s cause of damp underwear is common in little girls. Called vaginal voiding, vaginal voiding occurs when a girl urinates on the toilet with her legs tightly pushed together. She pulls her pants down minimally, to about mid-thighs so urine gets trapped in the vagina as it comes out the urethra. When she stands up and pulls up her pants, the drop of urine that was trapped in the vagina will drip out into her underwear.

The treatment of vaginal voiding is simple. Make sure your daughter pulls her pants all the way down to her ankles when sitting on the toilet. Encourage her to spread her knees apart while urinating. You could even have her sit on the toilet seat BACKWARDS, facing the back of the toilet. This position forces the knees apart and prevents any urine from becoming trapped. In turn, her underwear will remain dry.

A reason both girls and boys occasionally have damp underwear is giggle incontinence or cough incontinence, which is exactly what it sounds like—a bit of urine gets leaked during laughing or coughing.

To help kids who leak during coughing or laughing, first make sure that they are not holding in their urine for too long. Have your child do a potty check, as in “go sit on the potty,” every 2-3 hours throughout the day. Try setting an alarm on her iPod or on your cell phone. Often, merely providing enough opportunities during the day to empty the bladder cures the problem of leaking during laughing or coughing.

After trying these simple measures, if your child’s underwear is still wet or your child tells you that she still leaks during coughing or laughing, discuss this problem with your child’s doctor. In addition, please know that while laughing daily is wonderful, daily coughing is not normal. Your child may need further evaluation for the source of a daily cough.

Damp or wet underwear may not be the most glamorous pediatric topic, but it is important for the kids who suffer from it. Hopefully this post offered a quick fix for some of your kids. You and your laundry machine will be happier.

Julie Kardos, MD and Naline Lai,MD
©2014 Two Peds in a Pod®

Enterovirus D-68 put into perspective

No doubt, there has been an uptick in respiratory illness in our area, but the news media is causing panic specifically over one of them: enterovirus D-68.
The name “enterovirus” does not imply “deadly.” Many of you are well familiar with hand-foot-mouth disease, aka “Coxsackie virus.” Guess what? This extremely common, benign but annoying virus is also an enterovirus!

Let’s put into perspective how this “new” respiratory virus compares with an “old” well-known respiratory virus, influenza (The Flu). Remember that both flu and enterovirus D-68 are tracked by REPORTED cases. Most of the time doctors do not test children with mild disease so most reported cases are hospitalized patients.

Enterovirus D-68, the numbers: From mid-August through the first week in October (peak enterovirus season)- 664 people are known to have been infected in the USA, most of whom are children. You can track these numbers on this Centers for Disease Control website.
Influenza, the numbers: Each year in the US, approximately 200,000 people (children and adults) are hospitalized from complications of the flu. This year’s flu season in the northern hemisphere is just starting. Generally peak flu season is in the winter months. Large numbers of people contract the flu but they are not sick enough to be hospitalized- they suffer a week of fever, cough, sore throat and body aches at home but recover uneventfully. Up to 20% of the population are infected with flu each season.

Death from enterovirus D-68: 1 child. Four other children died who tested positive for this virus but it is unknown if the virus caused their deaths.
Death from influenza during the 2013-2014 flu season: 108 children

Symptoms of enterovirus D-68: range from mild cold symptoms to high fever and severe respiratory symptoms
Symptoms of flu: usually abrupt at the onset: fever, body aches, cough, and runny nose. Please see our prior post for more information.

Prevent enterovirus D-68: same as for all “cold” viruses- wash hands, sneeze/cough into elbow, not hands.
Prevent flu: Same as for enterovirus D-68, AND we have an Influenza vaccine for all children aged 6 months and above, with a few exceptions-see our article for more information. Last year the flu vaccine was about 60% effective: it’s not perfect, but it is certainly better than not vaccinating.

Overall, remember that enterovirus D-68 is one of many cold viruses that circulate the country. We are all familiar with back-to-school viruses. My teen-aged son told me, amid his sniffles and nose-blowing last week, that “more than half my school has a cold now.”
Certainly some of those colds could be enterovirus-D-68. But please don’t panic. All respiratory illnesses, including colds, have the potential to travel into your child’s lungs. It is more important to practice good illness prevention techniques and to recognize the signs of difficulty breathing. As we have said before, if we parents could worry all illnesses away, no one would ever be sick.

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®

Enterovirus D68, RSV, The flu! How do I know my kid’s having trouble breathing?

Mid-west respiratory virus, RSV, The Flu! Lots of respiratory-distress-causing- germs. Although Enterovirus D68 is in the news these days, a slew of infections can hit the lungs hard. So even if you think your child has a simple cold, it’s important to recognize when your child is having difficulty breathing. Share this information with all of your child’s caretakers, including teachers. As this cartoon illustrates, many people wear medical hats. Too often we get a child in our office with labored breathing which started during school hours but was not recognized until parent pick up time.

Signs of difficulty breathing:

Your child is breathing faster than normal.
Your child’s nostrils flare with each breath in an effort to extract more oxygen from the air.
Your child’s chest or her belly move dramatically while breathing—lift up her shirt to appreciate this.
Your child’s ribs stick out with every breath she takes because she is using extra muscles to help her breathe—again, lift up her shirt to appreciate this. We call these movements “retractions.”
You hear a grunting sound (a slight pause followed by a forced grunt/whimper) or a wheeze sound at the end of each exhalation.
A baby may refuse to breast feed or bottle feed because the effort required to breathe inhibits her ability to eat.
An older child might experience difficulty talking.
Your child may appear anxious as she becomes “air hungry” or alternatively she might seem very tired, exhausted from the effort to breathe.
Your child is pale or blue at the lips.

In this video, the child uses extra chest muscles in order to breath. He tries so hard to pull air into his lungs that his ribs stick out with each inhalation.

For those with sensitive asthma lungs, review our earlier asthma posts. Understanding Asthma Part I explains asthma and lists common symptoms of asthma and Understanding Asthma Part II tells how to treat asthma, summarizes commonly used asthma medicine, and offers environmental changes to help control asthma symptoms.

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®

updated from our previous 2012 post

Flu vaccines: what you need to know for the 2014-2015 flu season

We gave our kids their back-to-school haircuts, donated their pants that fit like floods, and bought them new folders and notebooks. As shown on our back-to-school supply list photo, back-to-school also means the start of hand sanitizer and tissue season. Yes, it’s time for your child’s yearly flu vaccine. Even if you gave your child a flu vaccine last year, she’ll need another one this season. Not only does the flu or influenza virus (not to be confused with “the stomach bug/stomach flu”) usually come back every season in a slightly different form, but your child’s immunity has waned over the past year. With every flu season, the Centers for Disease Control comes out with new recommendations. Here is a snap shot:

Who needs the flu vaccine?
All children aged 6 months or older, with a few exceptions discussed below, should receive a flu vaccine every year.

How many doses of flu vaccine does my child need this year?

If your child is nine years or older, your child only needs one dose this season.

If your child is younger than nine, your child only needs one dose this season UNLESS:

This year will be the first time your child receives the flu vaccine. Then, she will need a second (booster) dose at least 4 weeks later.
Your child skipped last year’s flu vaccine. Then, she may need a booster dose this year. Check with your child’s doctor.

Which type of flu vaccine is better, a shot or the mist (squirt in the nose)?

This year, the Centers for Disease Control suggests, if available, to give children aged 2-8 years the squirt in the nose. However, if the mist is unavailable, do not delay the vaccine. Give your child a flu shot instead. For older kids, the data is not as clear cut as to which vaccine works better to prevent the flu. Give your child either form of the vaccine.

Who cannot receive the mist?
Kids younger than 2 years; kids with certain medical conditions such as ongoing asthma (wheezing in the past year, or 2 through 4 years of age with asthma) and diabetes; kids undergoing aspirin therapy; kids who have had influenza antiviral therapy in the last 48 hours; kids with immune deficiencies; and kids around immunosupressed people who require a protective environment (e.g. around people hospitalized in a bone marrow transplant unit), should not receive the mist. These kids should receive the injectable form of flu vaccine. Your child’s doctor can provide the complete list of contraindications.

Who should NOT receive any flu vaccine?
Babies younger than 6 months old and children with severe egg allergy (anaphylaxis) should not receive the flu vaccine.

Our office is slotted to receive our annual supply of flu vaccine in the next few weeks. Our own families have learned to expect the annual flu vaccine with the start of each school year. Now we just need to convince them that they needed the haircuts.

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®

The return of measles- What to look for in your child

Yet another reminder about the signs and symptoms of measles from a health agency landed in our email inbox the other day. The reason? According to the Centers for Disease Control, as of this point, the United States has seen more measles cases this year (almost 600 reported) than in the past decade (typically 60 cases per year). Organizations are reminding physicians about the symptoms of measles because thanks to vaccinations, many pediatricians have not seen a case of the measles in decades. In this post, we pass the information on to you. After all, you will be the first to recognize that your child is ill.

Measles typically starts out looking like almost every other respiratory virus— kids develop cough, runny nose, runny bloodshot eyes, fever, fatigue, and muscle aches.

Around the fourth day of illness, the fever spikes to 104 F or more and a red rash starts at the hairline and face and works its way down the body and out to arms and legs, as shown here at the Immunization Coalition site. Many kids also develop Koplik spots on the inside of the mouth (small, slightly raised, bluish-white spots on a red base) 1-2 days before rash.

In the US, one in 10 kids with measles will develop an ear infection and one in 20 will develop pneumonia. Roughly one in 1000 kids develop permanent brain damage, and up to two in 1000 who get measles die from measles complications. Kids under age 5 years are the most vulnerable to complications. These statistics are found here. For global stats on measles, please see this World Health Organization page.

There is no cure for measles and there no way to predict if your child will have a mild or severe case. Fortunately, one dose of the MMR (Measles, Mumps, Rubella) vaccine is 92% effective at preventing measles, and two doses are 97% effective at preventing measles. That’s the best we can do, but this 97% protection rate works great when everyone is vaccinated. The American Academy of Pediatrics recommends giving the first dose of MMR vaccine at 12-15 months and the second dose at school entry, between 4-6 years of age.

If parents refuse the MMR vaccination for their children, then more people are left susceptible to measles. This leads to more people who can spread the disease when it hits a community. Measles is one of the most contagious diseases known: 9 out of 10 unvaccinated people exposed to measles will become sick, and infected people are contagious even before symptoms appear. One of the reasons behind the increase in measles cases is the increase in unvaccinated children. One patient of Dr. Kardos’s was a four-year-old boy who was behind on his vaccines and hospitalized for measles pneumonia. Before he was diagnosed he exposed an entire Emergency Department to measles.

In our global world, another reason for the spike in measles cases is the increase in travel between countries. In fact, young children traveling internationally often need to get the MMR vaccine outside of the routine schedule. If you plan on traveling, check here to see if you need to give your child the MMR vaccine on an early schedule.

With increased vigilance and vaccination, hopefully measles will once again become a disease few doctors have ever encountered. After all, vaccines did eradicate small pox. The last case of smallpox in the United States was in 1949, and the last case in the world was in 1977. In the meantime, you’ll know how to “spot” a case of measles too.

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®

On letting go and coming back

I have been musing ever since our hosting site told us they were switching blog platforms. In a blink of an eye, our blog was slated to disappear. The dynamic Two Peds in a Pod community would be plunged into silence. At first, disbelief gave away to intrigue. Was this a sign to change personal paths? As I started to think of all the things I could do with the time that I would have spent writing the blog, my to-do list grew and grew. I could hear my son’s closet, overflowing with outgrown clothing, crying out to be re-organized.

When I told friends of the opportunity to dissolve the blog, I heard time and time again “I think you should save it.” Even friends without children were aghast. When I told my own children that the blog was on the verge of imploding they looked at me blankly and said, “Why would you stop writing for Two Peds?”

Then I remembered the mom who read our article on croup seven times in one night. I remembered Dr. Kardos’s patient whose dad said our strep throat article helped him decide not to cut his family’s vacation short. I thought of the many times parents thanked me for posts which allayed their fears of fever.

The blog did eventually stop when the old hosting site went down. But as my friends and family reminded me, the goal of the blog is to positively impact children globally by guiding their caretakers; and by the time the blog went down, we had reached nearly three million views. Two Peds in a Pod is “Practical pediatrics for parents on the go.” After more thought, I decided it would be difficult to accomplish this goal from the back of one of my kid’s closets.

So today, I am happy to post that the stop was just a temporary suspension. I credit my friends and family for reminding me of the original goal of the blog. In particular, thanks to Dr. Kardos. While I was mulling, Dr. Kardos was busy staying up past midnight valiantly importing posts from the rapidly fading old site.

We’re back, albeit a little rough around the edges as we construct the new site. And it’s just in time for our 5th birthday!

Thanks, my friend, Dr. Kardos. I wouldn’t be able to blow those candles out without you.

Happy 5th Birthday Two Peds in a Pod- may there be many more.

Dr. Lai

Naline Lai, MD and Julie Kardos, MD
©2014 Two Peds in a Pod^®

Hand-foot-mouth Disease

We’re seeing a lot of this stuff around the office. It’s “hand-foot-mouth” disease, a common, self-limited illness caused by the Coxsackie virus, and it strikes most often in the spring and summer. Named for rashes which can affect the hands, feet, or mouth, this illness can cause fever for the first few days as well as some loose stools.

What does it look like?

If you look carefully at the photos, you will see faint red bumps on this child’s feet. The rash may also look like tiny blisters and will always blanch (if you press on it and lift up your finger, the redness will briefly disappear- just as if you pressed on a sunburn). The same rash may appear on the hands and is not itchy. The child’s throat above is red in the back and has several ulcers, or canker sores. The hands, feet and mouth are not always simultaneously affected, and although we don’t call the illness “hand-foot-mouth-tush” disease, sometimes kids also get a red bumpy rash on their buttocks.

Is hand-foot-mouth disease painful?

The throat ulcers can be quite painful and the rash on the feet may be slightly tender. Usually the rash on the hands is not felt by the child. You can alleviate your child’s throat pain with acetaminophen (brand name Tylenol) or ibuprofen (brand names Advil or Motrin). For toddlers and older, Magic Mouthwash, a mix of 1/4 tsp diphenhydramine (plain liquid Benadryl) and 1/4 tsp Maalox (the regular adult stuff) squirted over mouth ulcers prior to eating a meal (three times a day) is an age-old way to sooth sores.

How is it spread?

This virus is contagious through saliva. Prevent kids from sharing cups, eating utensils, and tooth brushes, and clean up toddler drool. This vigilance can help prevent the virus from spreading to family members and friends. Children with this virus can still attend daycare as long as they are not feeling ill. Typically after the first few days of illness, fever and pain subside. Most commonly the rash and mouth ulcers last about a week or two.

What is the treatment?

Unfortunately there is no treatment for hand-foot-mouth disease, but fortunately your child’s body is fully capable of fighting off the virus. Your role is to help soothe pain. Otherwise, kids may refuse to drink and end up dehydrated. When my son had this illness at age two, he liked sucking on a washcloth soaked in very cold water. I also gave him lots of sherbet, ice cream, milk shakes, and noodles. These foods were easier for him to swallow while his throat was sore.

When should I call my kid’s doctor?

Kids can get this virus more than once, and many strains of this virus circulate. Even parents are not always immune. So now add Coxsackie virus, or hand-foot-mouth disease, to your Dr. Mom and Dr. Dad list of manageable diseases. Knowledge is power. However, if your child’s fever lasts more than three days, if he does not drink enough to urinate his baseline amount, if he is inconsolable, seems disoriented, or if your parent gut-instinct tells you something more might be wrong, do get your child to medical attention.

Originally posted June, 2011, and right on cue, Coxsackie is back again this summer.

Father’s Day 2014: real words from real dads

This year we asked our dad readers to help us write our Father’s Day post. They completed this thought: “Before I became a dad, I never thought I’d…”

…Learn to curl hair for cheerleading competitions

…BE RESPONSIBLE

…Become a stay at home dad AND love it so much after everything I’ve been through!!

…Learn all of the names of Thomas The Tank Engine’s friends and the many songs associated with them.

…Have a toys r us in my house.

…Go food shopping at midnight.

…Make so many pancakes on Sunday mornings.

…Volunteer in a dunk tank and have pie thrown at me.

One of our readers summed up his thoughts on becoming a dad:

Since I’ve become a father, nearly seven years and two beautiful daughters later, my life has become a series of jobs that I never thought I would have to tackle. These include:

Beautician: I never thought in a million years that I would be learning how to do pony tails, side pony’s, braids (not that I can braid yet), and painting little finger and toe nails.

Disney Princess Aficionado: At one point in my life I thought I was cool because I knew a lot about beer, how it was made, where it was from, where the best IPA’s were being poured. Now I am “cool” because I know where Mulan lived, and because I know the story about Ariel falling in love with Prince Eric.

Doctor: I am well versed here and can cover almost everything from the simple band-aid application and boo-boo kissing, to the complex answering of why daddy is different and why he gets to go to the bathroom standing up.

Cheerleader: Both of my daughters enjoy participating in sports. It’s been such a great experience to cheer them both on from the side line. I enjoy watching them grow with the sport and gain confidence game after game.

Becoming a father was one of the best choices I have made with my life. I love being a dad, and I look forward to the future dad challenges, good and bad, and beingthe best mentor I can be.

Thank you to our readers for contributing to this post.

Happy Father’s Day!

Julie Kardos, MD and Naline Lai, MD

Pediatric photo puzzler: What caused this skin discoloration?

Every child with a lemonade stand hopes for hot sunny days to drive in customers. But if your kids squeeze fresh lemons for their stand, make sure they wash their hands after squeezing the lemons. Otherwise, after a sunny day, your child’s hands may turn out looking like the kid’s feet pictured to the left.The juice of some fruits or plants will cause a dark discoloration of the skin if exposed to sunlight. The reaction, called phytophotodermatitis, usually starts a day after the juice comes into contact with the skin. Redness and mild blistering eventually leads into a discoloration which can that can last for months. Citrus fruits are the most common culprits, but wild parsnip, wild dill, wild parsley and buttercups also cause the photosensitivity. Often the initial redness and blistering is missed. The kid in the photo was walking in bare feet on leaves near an apple tree. Makes you almost want to only use powdered lemonade mix…almost.

Naline Lai, MD and Julie Kardos, MD