Elementary school kids Archives - Page 22 of 40

Doctor Dad Kris Taylor- A Father’s Day Story

Dr. Kardos’s dad is a pediatrician and during our long grueling hours of residency training he’d always serve as a source of encouragement. One of my favorite memories will always be the proud look in his eyes years later as he watched his daughter present at a physician conference.

Today we honor all Dr. Dads- dads or father figures- who help their children in times of crisis, illness, or injury. Following is a tribute sent by one of our readers, Jennifer Taylor.

Happy Father’s Day!

Dr. Lai with Dr. Kardos
_________________________

Kris taylor father's day We are parents to three boys so needless to say, our house is always full of cuts, bruises or injuries of some sort. Band-Aids and “feel better” kisses are a regular part of our daily activity. And while my husband is a great “Doctor Dad” to all three boys, it is his every day involvement in my youngest son’s medical care that makes him a truly amazing father.

My son Luke is 4 years old. At the age of 6 months, he was diagnosed with an in-utero stroke. We were told at the time of his diagnosis that he may never talk or walk based on where the stroke hit. We’ve had several years of therapy, doctor’s appointments and testing. Throughout it all, Kris has been an amazing supporter- both for Luke and me.

While I tend to see the glass half-empty, Kris is perpetually positive. He always says “When Luke can” instead of “If”. He does research on therapies that might shake things up in Luke’s progress and is certainly a very active participator in all the therapies we receive. Kris stops in to chat with all the therapists so that they know he is Luke’s Dad. He is at every medical appointment: driving us to CHOP at 7:00 in the morning because he knows I hate driving on Route 76 by myself; heading up to Lehigh Valley Hospital for a speech consult; sitting by me while Luke has some sort of test done, holding my hand and telling me it will be okay. He is compassionate throughout it all and yet he still pushes Luke to succeed, knowing that our little boy can accomplish anything. When Luke gets frustrated, it is my husband who can calmly get him to try, try again. And they say laughter is the best medicine so my husband pulls out all the jokes and silly behavior he knows to get Luke to go “one more time.”

I really could go on and on about what a wonderful Dad my husband is but the true testament to him is sitting on the floor next to me singing and playing. Luke wouldn’t be where he is now without Kris.

And for that, I am eternally grateful.

Jennifer Taylor
©2013 Two Peds in a Pod®

Seeing is not always believing

summer pediatric hints Yesterday morning we were aghast to read medical misinformation in the print edition of our local newspaper. Aghast, because we were the pediatricians interviewed for the content of a summer time tips article.

Although a more accurate online version appeared, the print version contained several inaccuracies.

How can you tell if the medical article you are reading is accurate?

Readers should always question what they read, and cross check to see if the information is consistent when compared with other credible sources. In this instance, we served as the “expert” sources of two articles for the same publication (print and online), yet the articles contain conflicting medical information. Cross reference our information with other experts in our field, such as the American Academy of Pediatrics, the Centers for Disease Control, and of course your own pediatrician.
Look twice if the interpretation of the information is coming from a secondary source. The information we give on Two Peds in a Pod is “straight from the horse’s mouth.” We edit and publish our own material. In our office, we talk to patients directly. Remember that “telephone” game you played at birthday parties? The message changes the more intervening people are involved in relaying information.
Medical information changes as new discoveries occur and more studies are conducted. There is a saying in medical school, “Even though half of what you learn in medical school will be inaccurate in ten years, learn it all, because you don’t know which half will be disproven.” We keep up with evolving knowledge in pediatrics by reading journals, taking courses, reviewing cases with our colleagues, and retaking our medical boards on a scheduled rotation. Be sure you read information that is current as well as backed by credible sources.

Despite our dismay at the inaccuracies in the print version, you will find the online article helpful. In addition, please check our prior summertime posts about bee stings, Lyme disease, tick removal, poison ivy, splinter removal, and stay tuned for near-future articles about swimming and sunscreen.

Whoever said, “You can’t believe everything you read on the internet,” was right… except perhaps this time.

Julie Kardos, MD and Naline Lai, MD
©2013 Two Peds in a Pod®

“What you forgot to tell the babysitter” and “When is my child old enough to babysit?”

babysitting cartoon

What you forgot to tell the babysitter

The first time my husband and I went out to dinner after our daughter was born, we walked out the door, got into the car, and sat in the driveway as my husband fretted over how our daughter was doing with the babysitter. “Did you see?” he said. “She looked sad when we left.” After a few minutes elapsed, he still had not started the car engine. Finally, to allay his fears, I told him to sneak back to the house and peek into the window. He came back amazed. “She’s fine,” he said with relief.

Finding someone to appropriately look after your child can be a difficult task. Even if you resist the urge to run back and check on your child when you leave the house, you may wonder as you pull away if there is anything you forgot to tell the babysitter. Chances are, you didn’t think of much beyond leaving your cell phone number and the name of your destination. Linda Miller, a nurse who taught a babysitting course for years for Child, Home, and Community (a United Way agency serving Bucks and Montgomery Country, Pennsylvania), shares with us the information she leaves her own babysitters:

Parents’ cell numbers

Kids’ names, ages and birthdays

House address (chances are, if your sitter lives down the street, she or he doesn’t know your house number)

The full name of the town you live in (is it Borough or Township?) In Nurse Miller’s case, there is a street of the same name in the neighboring township. Ever since the pizza delivery guy went to the wrong house one hungry night, her family is careful to be very clear as to where they live.

The nearest cross street. This important piece of information helps emergency responders confirm they are heading to the correct address. (It could also be helpful if your sitter is old enough to order pizza!)

Where you are going – name and address and phone number.

Phone number to call in an emergency: For most it is 911

Poison control center phone number : 1-800-222-1222

Height and weight of each child – for emergency medication administration

Allergies – to Foods and Medications

Since seconds count in an emergency, even if your sitter is a regular fixture in your home, it doesn’t hurt to point out the safety information each time, should he or she need it.

Remember to bring your sitter’s cell phone number with you so you can reach her, in case you cannot get through on your own house phone.

When is my child old enough to babysit?

Somehow the years passed quickly, and the tables have turned. My daughter herself is a babysitter. How will you know when your own child is old enough to babysit? First ask yourself whether he will be too scared to stay home without an adult. Then ask yourself if he can solve problems on his own. The age that kids start to babysit themselves or younger siblings varies. Ultimately parents need to judge their child’s maturity for themselves. Tweens can be mature enough to babysit themselves and a younger sibling for short period of time. In fact, the American Red Cross babysitting training course (which can be taken online) is offered to kids 11 years and older. Even if your child is not babysitting anyone else, but staying by himself at home, a course will give your child valuable self-care tips.

Outline specific Do’s and Don’ts for your child. Walk them through what to do if the doorbell rings or if the phone rings. What activities are they allowed to do? Are they allowed to eat? Cook? Can friends come over? What will they do in a power outage? What if someone gets injured or sick while you are out? Familiarize him with basic first aid.

Keep anything which is potentially harmful such as medications, guns, and alcohol inaccessible. Make sure you are comfortable with parental controls for computers and the television.

And of course…give them Nurse Miller’s list from above.

Naline Lai, MD with Julie Kardos, MD
©2013 Two Peds in a Pod®

Calling Dr. Dads

father's day In honor of Father’s Day, we would love to hear your anecdotes of any “Doctor Dad” moments your children have experienced. Tell us about how your child’s dad or any father figure in your child’s life helped your child through a tough time, an illness, or an injury. Send us your anecdotes to twopedsinapod@gmail.com by June 4 and we will include the top stories in our Father’s Day post.

Thank you in advance,

Drs. Kardos and Lai

Getting a leg up on growing pains

You tuck your child into bed and five minutes later he cries for you. You bolt back in to find him moaning that his legs hurt. You rub his legs, he feels better, and drifts back off to sleep. Later you can’t put yourself to sleep. “What was that all about?” you wonder.

Growing pains cause recurring leg pain at night that sometimes awakens children from sleep. They usually affect boys and girls in two age groups: three to five years old and eight to twelve. We don’t really know what causes growing pains. We do know that massaging the legs, one dose of pain reliever (acetaminophen or ibuprofen), and warmth can help. The kids are always fine in the morning. Often growing pains occur after a particularly active day. Fortunately, growing pains do not cause any long term problems, just temporary discomfort and some disturbed family sleep.

Before you chalk up leg pain to growing pains, you need to be sure that some other ominous source of pain is not waking your child. If you see any of these symptoms, schedule an office visit with your child’s doctor:

Leg swelling

Leg redness

The pain is always in the same spot on the same leg

Your child is limping

Your child stops participating in her usual activities because of the pain

The pain comes on during exercise

Fever is present with the pain

Simple massage or Tylenol fails to relieve the pain.

Your child is losing weight or seems otherwise sick

Leg pain is accompanied by night sweats: your child’s pajamas and sheets are soaking wet

The pains seem to be getting more frequent or worse

Pain in the daytime

Even without the above symptoms, if your parent intuition is telling you to get your child checked, then please do.

Julie Kardos, MD and Naline Lai, MD
©2013 Two Peds in a Pod®

The definition of happy: Mother’s Day 2013!

mother's day cartoon This Mother’s Day we bring you definitions inspired by our children and our patients. Don’t think we’ll out-hip Urban Dictionary, but we’re moms…. by definition we are not hip. Enjoy your day.

Sleep walker: the daytime state of a new mom.

Sweater: a garment worn by a child when his mother feels cold.

Displacement: a vacation with toddlers.

Sick: something moms are not allowed to become.

WOW: MOM upside-down.

Mommometer: a mom’s hand on a feverish forehead.

One zillion: number of times a mom says “wash your hands” to her children over the course of their childhoods.

Yesterday: when the sports/camp/school field trip form was due.
Today: when the child hands the mom the sports/camp/school field trip form.

Working mother: Every Mom

Water torture: a grade-school son’s interpretation of a mom’s announcement of “shower night.”

Boomerang: a mom’s realization that her child is acting like she did at the same age.

Happy Mother’s Day from your two Pediatrician Moms,

Julie Kardos, MD and Naline Lai, MD

The effects of sugar on children … not so sweet

Today’s guest blogger, teacher and health coach Mary McDonald, teaches us how to understand the amount of sugar reported on nutrition labels and gives ideas for low sugar snacks —Drs. Lai and Kardos

Can you imagine packing lunch for your child and throwing a cigarette into the bottom of the brown paper bag? Well, many Americans may not be packing cigarettes in their kids’ lunches, but they are packing something addicting: sugar. As a family and consumer sciences teacher, I see what the students eat and their food choices are alarming.

In the past, my colleagues and our students worked together to bring awareness to drug prevention in a campaign called “Red Ribbon Week.” This campaign asks individuals to take a stand against drugs and live a drug free life. I now challenge the organizers of Red Ribbon Week to include excess sugar to their list of drugs. In 2008, Professor Bart Hoebel and his team in the Department of Psychology at Princeton University determined that mice given excess sugar demonstrated three qualities indicative of addiction: increased intake, withdrawal, and cravings. The subject of excess sugar has gained a lot of popularity over the past few years. A recent article in the NY Times, “Is Sugar Toxic?” highlights the negative health effects of excessive sugar consumption.

If you don’t trust the reports coming in day after day from physicians and researchers, then test it out at home. Tell your kids that you are going to skip dessert tonight after dinner. I can almost hear the blood-curdling screams from here. The image may be funny, but the reality of what we are doing to our children is not. Excess sugar causes weight gain, obesity, diabetes, heart disease, and many other deleterious conditions. The President of the American Diabetes Association and a Pediatric Endocrinologist, Dr. Frances Ratner Kaufman, MD, reported in the fall 2012 Clinical Diabetes Journal that diabetes is no longer a disease of our grandparents, but instead it is a disease of our children. Type 2 diabetes is now considered an epidemic in the American pediatric population, up 33% in the past decade alone. Epidemic. If that doesn’t scare you, then think about the fact that our children’s generation is not expected to live as long as our generation.

Okay, enough about the depressing news. What can we do to stop these trends? My advice is something so simple, but not so easy. Turn over each and every label of your food and read the ingredient list and nutrition label. For this activity, focus in on the number of grams of sugar in each product. But what does a gram really represent? Well, here’s an easy conversion:

4.2 grams sugar= 1 teaspoon of sugar

So keep your life simple when you are reading labels and divide the number of grams of sugar by 4 to understand how much sugar you and your children are consuming. Take a look at a bag of Skittles®. Each 2.17 oz bag of original Skittles® contains 44 grams of sugar, or 11 teaspoons of sugar. Instead of reaching for that bag of candy, reach for something equally as sweet that contains far less sugar: an apple!

Here are some suggestions for snacks to substitute for sugar-filled junk food:

Banana and Natural Peanut Butter Circles– great snack for energy too!
Healthy Yogurt Parfait– a new twist on the “build your own” dessert.
Cheerios n’ Fruit- grab the old fashioned yellow box of plain Cheerios and top it with fruit of your choice. This is a great way to start your day or a great snack at anytime.
Trail Mix – it’s a satisfying treat with many health benefits.
Fruit Kabobs–who doesn’t like a kabob?
Homemade snack bars-this is a tried and true favorite in our house.
Apple and Cinnamon– you cut the apples and let the kids sprinkle on the cinnamon.
Fruit Smoothie– my favorite snack of 2013!

Mary McDonald holds a Masters of Education from Arcadia University and a health coach certification from Institute of Integrative Nutrition. A mom of four daughters, she teaches family and consumer sciences in Central Bucks School District, Pennsylvania. For more information on her health counseling services, please contact her at nutrition101withmary@gmail.com or visit her website at nutrition101withmary.com.

Allergy medicine: the quest for the best antihistamine

The antihistamine quandry
Junior’s nose is starting to twitch
His nose and his eyes are starting to itch.
As those boogies flow You ask oh why, oh why can’t he learn to blow?
It’s nice to finally see the sun
But the influx of pollen is no fun.
Up at night, he’s had no rest,
But which antihistamine is the best?

It’s a riddle with a straight forward answer. The best antihistamine, or “allergy medicine” is the one which works best for your child with the fewest side effects. Overall, I don’t find much of a difference between how well one antihistamine works versus another for my patients. However, I do find a big difference in side effects.

Oral antihistamines differ mostly by how long they last, how well they help the itchiness, and their side effect profile. During an allergic reaction, antihistamines block one of the agents responsible for producing swelling and secretions in your child’s body, called histamine. Prescription antihistamines are not necessarily “stronger.” In fact, at this point there are very few prescription antihistamines. Most of what you see over-the-counter was by prescription only just a few years ago. And unlike some medications, the recommended dosage over-the-counter is the same as what we used to give when we wrote prescriptions for them.

The oldest category, the first generation antihistamines work well at drying up nasal secretions and stopping itchiness but don’t tend to last as long and often make kids very sleepy. Diphendydramine (brand name Benadryl) is the best known medicine in this category. It lasts only about six hours and can make people so tired that it is the main ingredient for many over-the-counter adult sleep aids. Occasionally, kids become “hyper” and are unable to sleep after taking this medicine. Other first generation antihistamines include Brompheniramine (eg. brand names Bromfed and Dimetapp) and Clemastine (eg.brand name Tavist).

The newer second generation antihistamines cause less sedation and are conveniently dosed only once a day. Loratadine (eg. brand name Alavert, Claritin) is biochemically more removed from diphenhydramine than Cetirizine (eg. brand Zyrtec) and runs a slightly less risk of sleepiness. However, Cetirizine tends to be a better at stopping itchiness.
Now over-the-counter, fexofenadine (eg brand name Allegra) is a third generation antihistamine. Theoretically, because a third generation antihistamine is chemically the farthest removed from a first generation antihistamine, it causes the least amount of sedation. The jury is still out.

If you find your child’s allergies are breaking through oral antihistamines, discuss adding a different category of oral allergy medication, eye drops or nasal sprays with your pediatrician.
Because of decongestant side effects in children, avoid using an antihistamine and decongestant mix.

Back to our antihistamine poem:
Too many choices, some make kids tired,
While some, paradoxically, make them wired.
Maybe while watering flowers with a hose,
Just turn the nozzle onto his runny nose.

Naline Lai, MD with Julie Kardos, MD

Updated from the original post April 10, 2011

Confused omnivore? How to feed your vegetarian kid

vegetarian cartoon After reading Charlotte’s Web, by E.B. White, when I was eight, I became a vegetarian. It was the first time in my life I thought seriously about the source of my food. My vegetarian diet only lasted only a week in my carnivorous family, but other kids stick to their convictions for much longer. Let’s say that your child is one of those kids. Below is a general guide on how to fulfill your child’s nutritional needs with a vegetarian diet:

Meat provides protein. “If you give up meat, choose at least two other protein sources,” says Dr. Lai.

Consider alternative protein sources such as:

Dairy products

Beans

Soy products

Nuts and nut butters

Seeds

Eggs

Iron is another important nutrient found in meat, but can be found in other foods as well. Menstruating females are particularly at risk for iron deficiency. Intake guidelines can be found on the Centers for Disease Control website.

Iron-containing foods include:

Iron fortified cereals

Beans

Dark green leafy vegetables

Eggs

Enriched breads, rice, and pastas

Soybeans

Dried fruit

If your child also stops eating dairy, he will also need to find additional sources of calcium and vitamin D. The American Academy of Pediatrics and the Institute of Medicine
recommend a daily intake of 400 IU per day of vitamin D during the first
year of life, and 600 IU for everyone
over age one. Older kids should get 700 to 1,300 milligrams of calcium daily.

Sources of calcium (other than cow’s milk):

Soy, almond, or rice milk

Soy yogurt

Calcium-set tofu

Fortified breakfast cereals

Leafy green vegetables

Broccoli

Almonds, sesame seeds, and soy nuts

Foods containing vitamin D :

Fortified soy, rice, or almond milk, or items made with these products

Some brands of orange juice

Eggs

Direct sunlight on the skin also stimulates vitamin D production, but because of the risk of skin cancer and skin damage, obtaining vitamin D through sun exposure is not recommended. Consider giving your child a daily vitamin D supplement.

Kids on a vegan diet take ALL animal products out of their diet—no meat, no dairy, and no eggs. In addition to the above recommendations, these kids need an alternative source of vitamin B12, which is found naturally only in animal products. One good alternative is to eat B12 fortified breakfast cereals—read the labels and look for those that contain 100% of the RDA (Recommended Daily Allowance) for B12. The other way is to take a B12 vitamin (cobalamin). According to the National Institute of Health, the RDA of Vitamin B12 for kids is:

Ages 4-8 years: 1.2 micrograms (mcg)

Ages 9-13 years: 2.4 micrograms (mcg)

Ages 14 years to adult: 2.8 micrograms (mcg).

While vegetarian diets are fads for some kids and teens, they become a way of life for others. Encourage your vegetarian child to help you shop and cook, and to experiment with preparation methods and flavors. In a Vegetarian Kitchen with Nava Atlas has numerous vegetarian recipes.

For vegetarian meal and snack guidelines as well as general information about nutrition, please visit the American Dietetic Association’s site.

The truth about lying: what to do when your child lies to you

lying Stunned, you find your child’s third quarter report card under his bed. Your child told you he got an A, but the teacher’s report shows a lower grade. A much lower grade. You are horrified, not about the grade, but about the lying. Refrain from running straight to school and yanking him out of class to confront him.

Lying is not uncommon in childhood. For very young children, “lying” is a normal part of developmental. Preschool children are at the developmental stage where they exaggerate and tell tall tales. Preschoolers rarely have a hidden agenda and truly believe in their fantasies.

Beyond the preschool age, there often is a hidden agenda. “There is a reason behind their lies,” says Pennsylvania based Buckingham Friends School teacher of over 25 years, Nancy Sandberg. Try to figure out your child’s underlying reason for lying. During elementary school, children develope a sense of right and wrong. They begin to lie to avoid disappointing a parent, to avoid a perceived punishment, or for attention. In their teens, kids protect their privacy and begin to separate their identity from their parents. Teens may lie because they are afraid of losing face with peers or in order to get something they want. A lying teen may also be covering up underlying problems such as alcoholism.

Before talking to your child about his lying, clear your head of anger. An emotionally charged confrontation will end up in a blow-up rather than a rational discussion. If he lies when you talk to him, state that you are not sure that he is telling the truth and plan a later time to discuss the issue. Also, do not ask your child questions to which you already know the answer and avoid giving him a reason to lie further. In the report card example, when your child comes home, do not ask him where his report card is or if he had seen his grades. Instead, start the conversation with facts: “I found your report card. I see that your grades are not what you said they would be. I am concerned because you hid the truth from me. Let’s talk about it.”

Sometimes anger may impede your ability or your child’s ability to have a rational discussion. Wait until things cool down or have an objective third party present during your conversation. In your discussion, give your child an alternative to lying. For instance, if she is concerned about your reaction to a grade, tell her to go to another adult first, such as a teacher, if the situation reoccurs and they can approach you together. Talk about how your child would feel if someone lied to her. Discussing a book with a protagonist who lied can give your child a way to indirectly discuss her own situation. And reassure, reassure, reassure her that in no way does the incident diminish your love for her.

Keep in mind, most episodes of lying are isolated incidents. However, a child who chronically lies and also shows negativity and hostility or defiance towards adults should be evaluated by a health care professional. For more information, click on the American Academy of Child and Adolescent Psychiatry’s site www.aacap.org.

Sandberg proudly recalls a child whom she worked with years ago. At the beginning of the school year, the child lied about his school work. Later, the child went on to play Hercules in the school play. Sandberg and the child talked about how like Hercules, he had struggled, but because he faced his challenges head-on, he turned into a hero.

Originally published April 18, 2011