Frustrated that your young child is not listening? This in-person talk gives some basics on ways to set limits and self-calming techniques. Your two peds, Dr. Lai will be on hand to moderate!
Naline Lai, MD and Julie Kardos, MD
©2024 Two Peds in a Pod®
We know how it’s easy to spend money on the kids- just wait until they are old enough to get Venmo. Here are some money saving tips for parents to save a little dough and put that saving towards the next family vacation and orthodontia!
Julie Kardos, MD and Naline Lai, MD
©2024 Two Peds in a Pod®
Everything has a season, incluing seasonal allergies.
In our area near Philadelphia, we associate spring with the Phillies opener and also with the onset of spring allergies.
Here is a nice summary of how to treat allergies, from The Children’s Hospital of Philadelphia (note that one of your Two Peds was a contributor). And following are some of our prior posts that can help you treat your child’s seasonal allergies this spring:
The Best Allergy Medicine for Kids
The Best Allergy Medicine for Kids aged 2-5 years old
Allergy Eyes: when spring rubs you the wrong way
How to tell the difference between Covid (or any viral cold) and allergies
We hope this post answers all that you are itching to know about seasonal allergies.
Julie Kardos, MD and Naline Lai, MD
©2023 Two Peds in a Pod®
Death, politics, mental illness, and sex- all difficult topics for parents to talk about with their kids. Your Two Peds joined a social worker, school guidance counselor, and former teacher in a lively panel discussion at the Haverford Township Library in Haverford PA on how to normalize conversations on difficult topics between parents and their children. Watch as we talk about on ways parents can give kids give information while limiting their anxiety .
Past posts about ways to share difficult information with your children include the topics of suicide, stillbirth/miscarriage, death of a person, and death of a pet.
Warmly,
Julie Kardos, MD and Naline Lai, MD
©2023 Two Peds in a Pod®
Croup is an often-suprising middle-of-the-night malady that produces a barky seal-like cough in children who seemed just fine at bedtime.
Any virus that causes cold-like symptoms of runny nose, cough, runny eyes, and sometimes fever, can also cause croup. Think parainfluenza, influenza (flu), RSV, adenovirus, rhinovirus, and now Covid-19. Any of these viruses can land in a child’s larynx, or voice box, and cause hoarseness, barky cough, and a weird gutteral sound on breathing inward, called “stridor.” Croup is the name we give the constellation of symptoms, not the name of the virus that causes it.
An adult with the same exact illness would sound hoarse, but would likely not have the strange barky cough or noisy breathing.
We have a great podcast on this subject, but for those who prefer to read medical advice, please read on.
Stay calm. Children are frightened when they wake up coughing and find it hard to take in a deep breath. Parents are often frightened too. Even if you are worried, exude calmness in order to help your child settle down.
Create a rain-forest like environment. Go into the bathroom, run a hot shower, and hunker down with a book to read to your child. The steam helps shrink the uncomfortable swelling in the voice box. Wait for about 15 minutes for the barky cough and the harsh gutteral breathing to subside.
You can also recreate a misty environment by cranking a humidifier in your child’s bedroom. To avoid the risk of burns, we recommend a cool mist humidifier, not a hot water vaporizer. The temperature of the mist does not matter; it is the mist itself that children with croup find soothing.
Go outside with your child. Wrap them in a blanket and head into the cool night air. This trick works as well as the steamy environment trick. Each winter we hear of our patients with croup who’s parents put them into the car to drive to the nearest Emergency Department, only to find that by the time they arrive, their child’s croupy cough and noisy breathing have resolved.
Treat any sore throat pain. Offer your child acetaminophen (brand name Tylenol) or ibuprofen (brand names Motrin, Advil) because easing the pain calms your child with croup and helps them to breathe easier.
Most children with croup can be managed at home, but some need extra medical care. Head to the nearest emergency department or call 911 if your child has these symptoms:
Strangely, a scary night of croup can be followed by a calmer day. Your markedly improved child may show merely some mild hoarseness or mild stuffy nose. Be aware that your child might have another night or two of croup symptoms, even after they barely cough during the day. So make sure your child and you take a nap in preparation for another possible rough night.
Most children with croup improve after two or three nights. Then, they develop more classic “cold” symptoms of runny nose and more “normal” sounding cough. Because Covid-19 virus is becoming a more common cause of croup, have your child tested so you know how long they need to stay home from school or daycare.
Talk to your child’s pediatrician if your child’s seal-like barky cough or cold symptoms last more than a week without improvement. Call sooner if your child seems to worsen or you have further concerns about your child. Know that some children are “Croupers” and tend to get the same croup symptoms with almost any cold virus. But take heart, even the croupers will be less croupy over time. It’s fairly uncommon to see a grade-school aged child with croup. Until then, you never know when you’ll hear a little seal in the middle of the night.
Julie Kardos, MD and Naline Lai, MD
©2022 Two Peds in a Pod®
Emma’s parents were hopeful that Emma could start preschool this winter, but with the slow COVID-19 vaccine roll out, Emma’s parents chose to keep her home just a little longer. Grandparents come over every day, but three-year-old Emma does not have interaction with other children. Her parents are confident that they can teach Emma shapes and numbers, but are concerned about her social and emotional development. For those in the same shoes as Emma’s parents, we share ways to socialize your preschooler without preschool.
Preschool has not changed much since you were three or four years old. There is still circle time, show-and-tell, and cubbies to hang little coats in. And games, lots of fun and games. But as early childhood educators will tell you, there is a method to their madness. In particular, the fun and games encourage social and emotional growth.
Unlike a two year old, three and four-year-old children are capable of turn-taking and rule-following. These skills help preschoolers form friendships and learn to get along with others. At home, parents can teach their preschoolers simple games that involve turn-taking. Don’t be tempted to bend the rules to allow your child to win every game of Candy Land®. Whether you lose or win, you will model “good winning” and “good losing.” For instance, if you win, say “Good game!” If you lose, say “Oh, I lost, but I had fun playing!” Fast forward a few years and you can avoid having the kid who is a poor sport and can’t move on from a loss.
Whenever you teach a new life skill, take turns. For example, as you teach them to set the table, say “I put the fork next to this plate, now you can put the fork next to THIS plate,” Or, as you teach them to brush their teeth, take turns brushing. This will teach taking turns as well as also ensure shiny bright teeth.
Children who say “Yes, please!” and “No, thank-you” endear themselves to others. When you teach your child manners, say “thank you” to your child. By saying “Thank you for putting your cup on the table and not the floor,” and “Thank you for putting your clothes in the hamper” and “Thank you for helping me clean up this game,” you build their confidence, and you model how to speak to others politely. Since children this age like to please their parents, your praise will motivate them to repeat the behavior.
Teach them to use their manners even with family members. When you teach that even family members deserve gratitude, fast forward to the teen years and you will have a teenager thanking you for waking up early to make them pancakes in the morning.
To help them with emotional development, label their negative emotions as you see them arise. For example: “You are so frustrated that the toy is not working correctly,” or “You are sad because I said we cannot play outside right now.” This allows them to feel what they feel and legitimizes them by giving their feelings a name. In the example above, if they lose the game of Candy Land® and start to tantrum, you can say, “You are disappointed that you lost this game, but we had such fun together. You might win the next game! Thank you for playing with me.”
Resist the temptation at home to soothe emotions with food or cups of liquid. In times of calm, be sure to read books about emotions, or talk about the emotions of characters in books. Talk about how to display anger and frustration in acceptable ways. Except for the binkie suggestion, this post applies to preschoolers as well as toddlers who find cooling down after a tantrum difficult.
Show and tell gives kids the confidence to express themselves in front of others. Virtually connect with a cousin or other relatives and have your child talk about what they brought. Have your child reciprocate by listening and asking one or two questions to the others in the group. The internet is full of themes and suggestions for items.
Fast forward to elementary school, middle school or high school and your kid will be breezing through their powerpoint slide deck in front of an entire classroom of kids.
The purpose of circle time, a hallmark of the young child classroom experience, is to give order to the day. Circle time organizes kids, and relieves anxiety. Just as teachers do, at the start of the day, review the day’s plan. Keep in mind that children who are 3 and 4 cannot keep more than 3 or 4 items in mind at one time.
Circle time organizes kids, and relieves anxiety
For example, say during breakfast, “After breakfast, you can play with your puzzles while daddy cleans up, then we will play out in the yard, and then we will read books.” Then after you read books, say, “Now that we are done reading, you can have time for free play while daddy does (some other task they need to do), then we will do laundry together and then have lunch.” Side note: young children can empty a hamper into a basket, they can sort and fold clothes, and they can turn on and off the washer and dryer under your guidance. They enjoy mimicking you and like to spend time with you. Take advantage of that!
Other useful tools are the color alarm clocks (google to find a large assortment) which use colors to mark the passage of time. Do-it-yourself felt boards have pictures of weather or activities. While your child will not understand a full calendar, they will be happy to populate a “today” felt board and “tomorrow” felt board with activities.
Continue to pause throughout the day to remind your child what they just did and then a couple of things that come next. You will find that your child’s day runs smoother than days without a plan.
If you can find one other family with a child the same age as your preschooler who is quarantining the same way your family is, consider setting up playdates for the two children. In the age of this pandemic, it is best for playdates to occur outside while wearing masks. Be sure to cancel if anyone has any illness symptoms or was exposed to anyone with COVID-19.
Unstructured play with one other child is just as valuable as a classroom full of others for your child to practice and enjoy socializing. Eventually the pandemic will end and you will feel safer sending your child to school. In the meantime, use these tips to help socialize your preschooler even when they are not in the classroom.
For more on three year olds, check out our post “Three’s the magic number” and this one that highlights four-year old development.
Julie Kardos, MD and Naline Lai, MD
©2021 Two Peds in a Pod®
A family asked, “My toddler figured out how to climb out of the crib! How do I transition him into a bed?”
Some kids never climb out of their cribs, but sometimes families need the crib for a new sibling. If this is the case, consider if you really need the crib right away. Using a bassinet for the new baby allows the big brother/sister to get used to having a baby around. Many older siblings regress after the birth of a sibling and it can be useful to keep the older one in a crib for just a little bit longer, then use the new bed as a reward for “helping” or as a token of increased status.
So if your child is NOT yet climbing out of the crib, do not rush to transition him out. You first need to childproof the bedroom. Crawl on your hands and knees to see what you can reach. For his safety, gate him into his room or keep the door closed. You may also need to gate the steps or gate a hallway to prevent him from wandering into more dangerous rooms, such as the kitchen, in the middle of the night. We know one family who found their child crawling around on the kitchen counters one morning. Know that open or closed bedroom doors likely do not impact potential fire safety. It is far more important make sure your smoke detectors work.
If you have no reason to break down the crib and your child goes to sleep easily in it, there is no harm in keeping him in his crib. However, once a child is able to climb out, a child is able to fall out. So….time to get out. For many toddlers, the ability to throw a leg over the side of the crib occurs around two years of age or when the toddler reaches three feet tall.
If your child is potty trained at this point, he will find it easier to get to the bathroom at night if he is in a bed rather than a crib. On the other hand, many kids who are fully potty trained during the day continue to wet the bed for years, so don’t wait for dry overnight diapers to put your child into a bed. Just protect the bed mattress with a water-proof liner until your child masters night time dryness.
You can talk up sleeping in a big boy/big girl bed “just like Mommy and Daddy.” Let your toddler pick out sheets or buy him ones you know he will love. For example, choose sheets in a favorite color, or with favorite characters. Supply a pillow and blanket. But if he is used to a crib without bedding, expect the blanket or pillow to end up off the bed. You might want to continue warm pajamas until a blanket stays on. Sometimes kids want a small “kid’s sized” blanket, but sometimes a larger blanket is more apt to stay on the bed.
Their excitement might lead them to nap enthusiastically in the bed but then they may want their crib at night. Or they might fight their naps now- remember that many children give up napping between the ages of 2-5 years. If space allows, consider leaving the crib set up for the first week of sleeping in the new bed, then break down the crib once you have several successful naps and overnights in the bed.
Some sleep with stuffed animals, a pacifier, or in the case of one of Dr. Kardos’s kids, a soft Philadelphia Eagles football. Many kids fall asleep with toy cars clutched in their hands. If these friends help your child sleep better, then allow the slumber party.
Falling out of bed is common. For his first week in a bed, Dr Kardos’s first son was always found sleeping peacefully in the middle of his room on the carpet after they tucked him into his bed for the night. You can place a carpet or pillow next to the bed so when the inevitable falling overboard occurs, your child has a softer landing.
Then when your child has gone for a few weeks without falling off the mattress, “build up the bed” onto the standard bedframe.
Alternatively, your child can sleep in a bed with side rails. Note that portable side rails are made for use only on adult beds, NOT for toddler beds or bunk beds. You can find guidelines for preventing injury from side rails here. Rails are designed for children aged two to five years who are capable of getting in and out of an adult bed by themselves. According to safety guidelines published by Consumer Reports in 2010, “Be sure they (the rails) fit tightly with no gaps between the mattress and the rail, so that your child can’t get stuck. Leave at least 9 inches between the bed rail and the footboard and headboard of the bed.” The wall is not a bed rail substitute because a child can get trapped between the wall and the mattress.
For everyone’s safety, be sure no clothes or clutter between his bed and yours can cause tripping in the dark. A night light in the bathroom helps as well.
If your child pops out of bed immediately after tucking him in, teach him how to self-calm and fall asleep in his own bed. Continue to walk him back to bed in a caring manner with minimal conversation besides: “I love you, good night.”
Now your child’s bedtime story will really include a bed! (For instance click here)
Julie Kardos, MD and Naline Lai, MD
Ⓒ2021 Two Peds in a PodⓇ
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.
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®
Physical therapist Dr. Deborah Stack brings us quick exercises for kids and teens – Dr. Lai and Kardos
After six months of COVID; yes, it really has been that long already, your family has probably found some favorite outdoor hiking spots or bike routes. But what can you do when it’s too cold or wet outside? How can you combat literally HOURS of kids sitting at computers especially if they only have 30-45 minutes until their next class? Here are quick exercises for kids and teens and a table of caloric expenditure for common activities.
Schedule active movement breaks into their day. Take advantage of that lunch and recess “break” and be an example yourself.
Here are some short burst ideas:
Don’t forget the teenagers; they still need activity too especially if their teams are not practicing or competing. Staff from the Mayo Clinic recommend kids ages 6-17 should have one hour of moderate exercise each day. Exercise can help improve mood (through the release of endorphins), improve sleep and therefore attention (critical with all the online learning), and improve cardiovascular endurance. Here are some numbers to get the kids moving:
All activities are based on 20 minutes and a teen who weighs 110 pounds. The number of calories burned depends on weight. If your child weighs more, he will burn a few more calories, if he weighs less, he’ll burn a few less. Below the table are links to some free and quick calorie calculators on the web so your kids can check it out for themselves. For those attached to their phones, there are web apps too.
| ACTIVITY | CALORIES USED |
| Shooting Basketballs | 75 |
| Pickup Basketball game/practice | 100 |
| Biking on stationary bike | 116 |
| Dancing | 75 |
| Hopscotch | 67 |
| Ice Skating | 116 |
| Jogging in place | 133 |
| Juggling | 67 |
| Jumping Rope | 166 |
| Ping Pong | 67 |
| Rock Climbing | 183 |
| Running at 5 mph | 133 |
| Sledding | 116 |
| Treadmill at 4 mph | 67 |
| Vacuuming | 58 |
Try these activity calculators:
http://www.caloriecontrol.org/healthy-weight-tool-kit/lighten-up-and-get-moving
https://www.webmd.com/fitness-exercise/healthtool-exercise-calculator
Keep ’em moving- you’ll have more fit, better rested, and happier kids!
Deborah Stack, PT DPT PCS
©2020 Two Peds in a Pod®
Dr. Stack is a board certified specialist in pediatric physical therapy and the owner of the Pediatric Therapy Center of Bucks County, LLC in Doylestown, PA. In addition to treating children ages 0-21 for conditions such as torticollis, coordination, neurologic and orthopedic disorders, she also instructs physical therapists across the country in pediatric development and postural control and is a Certified Theratogs fitter.
#homeschooling #computer ergonomics #COVID #admireteachers
Oh my aching back…
Right now, with schools closed, kids of all ages are doing schoolwork at home. Technology has allowed continuation of learning and even face-to-face check in with teachers. But it also poses some challenges. School classrooms are designed for children; our kitchen tables are not. How to sit at the computer? Just as we require ergonomic workstations for our jobs; we need to consider proper fit and alignment for our children as they learn virtually. The following are basic ergonomics for kids doing schoolwork from home that can prevent muscle aches and fatigue.
Place the computer screen directly in front of your child with the eyes level with a spot about 2-3” below the top of the screen. In addition, place the keyboard so that the upper arms and shoulders are relaxed. The forearms should be parallel to the floor and the elbow bent less than 90 degrees. The chair should have back support and allow the thighs to be supported parallel with the floor. Knees should also be bent to 90 degrees or a bit less with feet supported. This can be a challenge for our elementary school kids who are trying to work at home. The Canadian Safety Council suggests: “choose a chair that places the child at the proper height in relation to the equipment. If that means a higher chair, provide a footrest to support the feet and a pillow to support the back.”
Chairs with adjustable seat and footrest heights are great for this. If you don’t have an adjustable chair, you may need to create a footrest out of a box, block or storage crate. Also, since many children are using laptops, it is difficult to position both the screen and keyboard appropriately; it may be best to attach a separate monitor at the right height once the keyboard is set for proper arm and body position.
If children are using an iPad or reading a textbook, an angled book holder may help with proper positioning to avoid back and neck pain. We have cookbook holders for a reason!
An angled writing surface will help with fatigue and proper support. There are quite a few child sized desks available with a surface that raises to an angle. If you child is a wiggler; consider a ball chair with an appropriate height table that allows for that 90-90-90 ankle, knee, hip alignment, or consider using a standing desk. In each case, the keyboard, mouse and screen still need to be adjusted for alignment as above.
The most important thing you can do is make sure your kids take a break and MOVE every 30 minutes according to both the Cornell University Ergonomics Web and Canada Safety Council. Active breaks are necessary not just for the body, but for the eyes as well. The best ergonomics for kids doing schoolwork at home cannot substitute for these breaks.
Stay home. Stay safe… and keep moving.
Deborah Stack, PT DPT PCS
©2020 Two Peds in a Pod®
We thank Dr. Stack for contributing to twopedsinapod.org— Drs. Lai and Kardos
Dr. Stack is a board certified specialist in pediatric physical therapy and the owner of the Pediatric Therapy Center of Bucks County, LLC in Doylestown, PA. In addition to treating children ages 0-21 for conditions such as torticollis, coordination, neurologic and orthopedic disorders, she also instructs physical therapists across the country in pediatric development and postural control and is a Certified Theratogs fitter.