Preschoolers Archives - Page 33 of 39

Understanding Asthma, part 1

\
Last week a nurse in my office rushed a one year old girl back to one of my exam rooms. She was sitting in her mom’s lap, anxious and breathing hard. Her nostrils flared with every breath she took, and when I had her mom pull up the child’s shirt, I could see her ribs every time she inhaled because she was using extra muscles in her chest to breathe. Her belly was moving in and out as well. Her breathing had just become labored an hour before the office visit. The child had similar experiences in the past and now carries the diagnosis of asthma.

Asthma. Parents initially cringe at the diagnosis. But what is it? Most children with asthma never show up in the office with an attack as severe as the child I described above.

Asthma is a condition where the millions of airway tubes (called bronchioles) throughout the lungs get clogged with mucus (inflammation) and also get narrower (constrict) and thus become harder to breathe through. Medicine reverses the effects of asthma. Think of asthma as sensitive airways. A nasty cold virus or the billowing dust cloud from cleaning the garage makes everyone’s airway spasm. In kids with asthma, the spasm may be more severe, resulting in more cough or airway tightening.

Asthma is the most common on-going illness in children. Many babies and toddlers who have asthma have a good likelihood of outgrowing it by age three. Another subset of children, again especially below age three, have ONE episode that looks for all the world like asthma, but then they never have another episode. Other kids have asthma that stays and these kids and their families must proactively manage their asthma long term.

Asthma symptoms can start at any point, from infancy through the teen years. Adults can be diagnosed with asthma for the first time at age fifty. Dr. Lai has had symptoms of asthma since childhood but Dr. Kardos first had symptoms of asthma when she turned thirty.

The tendency to develop asthma is genetic, but there are environmental triggers in kids who carry the asthma gene. The most common triggers of asthma flares are cold viruses, cigarette smoke, and environmental allergies (animals, pollen, etc). Also, air pollution, exercise, and very strong scents (new house paint or perfume, for example) can trigger an asthma attack. It is also common for someone with asthma to have allergies and/or eczema (excessively dry, irritated skin).

How do you know your child has asthma? No one test can definitively identify asthma. Chest x-rays cannot show asthma. Sometimes Pulmonary Function Testing in older children helps doctors diagnose asthma, but younger kids often have a hard time performing the test.

Pediatricians diagnose asthma by studying the past experiences of the child. Not every child is out of breath like the patient I saw in the office. The most common symptom of asthma is cough. Watch for the following symptoms:

Night time cough most nights of the week, usually starting somewhere after midnight. The child may or may not wake up because of the cough.
Cough that shows up with exercise, usually after several minutes of running, swimming, jumping, even laughing.
Cough with a common cold virus that lasts much longer than what is typical—longer than two weeks after the onset of a cold when most other kids or siblings with the same cold are better.
Cough that is accompanied by increased work of breathing. Your child’s nostrils may flare in and out with each breath, or her ribs might stick out with each breath, or her breathing rate is much higher than baseline as if she were just running hard even when she is just resting. She might not be able to talk in complete sentences, drink, or eat because she is too short of breath.
A wheeze— a high pitched sound heard during exhalation. The sound is not the strange, hoarse sound heard during inhalation (e.g. in a child with croup) nor is it the mucus/rumble you hear from the back of the throat of most kids with a cold.
Cough triggered by cold: eating an ice pop or breathing cold, winter air, for example.

Don’t worry about labeling your child with the diagnosis of asthma. Gone is the stereotype of a child with asthma as a sickly kid who sits in the corner and is told not to participate in sports. A large percentage of Olympic athletes have asthma. The diagnosis of asthma will open up a world of medication and lifestyles which can soothe your child’s irritated airways.

Stay tuned for Understanding Asthma, part 2: the treatment of asthma.

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

A Sand Mandala Kind of Christmas: thoughts from last year’s holidays

Panic.

Off to the mall today with my children. Everyone was strapped in the minivan ready to go. But where were the gift certificates the kids just got for Christmas from the relatives? I was perplexed and scuttled back into the house. Inside, I recreated in my head the scene at grandma and grandpa’s where I had last seen the gift certificates. At their house, after the children had properly said their thank yous, I remembered carefully folding the certificates in tissue paper and tucking them into the sparkly blue gift bag which was to go to my parents on behalf of my in-laws. As an added guarantee that they would not be forgotten, I deliberately placed the blue bag with the other presents we had received. Where could they be? After all, they were safely in the big black trash bag with all of the other presents.

The trash bag? Oh dear.

Suddenly I remembered arriving home from my in-laws to a family room cluttered with gifts from Santa. I told the kids to clear everything out. When the dust settled I saw a big black trash bag in the center of the room. I grabbed it and threw it in the garage. Then a Christmas miracle happened. In the midst of holiday hub-bub, my husband remembered that it was trash pickup day and took out the trash.

Gone were the gift certificates. Gone were my in-law’s presents to my parents. Gone was the plug in Star Wars game module. Gone was the “last copy” of a book of Chinese folk tales lovingly picked out for my daughter. And gone was the silly Bop- it game, a crazy game of Simon Says where one of the commands is to “bop” the toy against your tummy.

For a brief moment I contemplated running down to the dump and trolling through the garbage. After all, there were probably only a couple thousand black garbage bags. If I started now, I could be done by next Christmas.

Laughing (what else could I do?), I made my way back to the car where I broke the news to my kids. I too was disappointed, but I couldn’t go back and undo the event. I had no choice but to laugh.

Together, between the tears, we stepped through lessons learned.

Lesson #1 Be more careful with our things

Lesson #2 Forgiveness is hard but essential for moving forward

Lesson #3 We were happy two days ago and that was before the presents arrived

Lesson #4 Let your kids play with their new toys the moment they get them- you never know when they will disappear

And the most important lesson #5 Use clear trash bags

My oldest smiled slowly and pointed out that I had declared to the kids, “Any presents not cleared out of the family room and put away in your own rooms will be thrown out.” I had unknowingly carried out my threat. Gradually, murmurs of disappointment gave way to laughter as we all imagined a scruffy bearded hobo going through the garbage picking up gift certificates from the girly stores Justice and Abercrombie. Somewhere there is a stylin’ hobo with a scruffy beard in a fur trimmed hooded puffy coat and tank top, hopping up and down, playing Bop-it.

The minivan shook with laughter.”Oh, mommy, I’m laughing so hard my stomach hurts,” my daughter said. “Mine too,” my other two moaned between giggles.

The cost of “the stuff”:

A lot.

Making kids laugh so hard that their stomachs hurt:

Priceless.

Naline Lai, MD
©Two Peds in a Pod℠

The sounds of the season: Thanksgiving

Kids are noisy. A noisy child is usually a healthy child, so we pediatricians welcome noise. Today we give you Top Ten Sounds we are grateful for this Thanksgiving:

10. The sound of a six-month-old baby’s belly laugh.

9. The sound of a two year old trying to say “gobble, gobble, gobble.”

8. The sound of a three year old saying “why?” about 100 times a day.

7. The sound of a chatty first grader who tells you about her favorite part of her day in one gigantic run-on sentence.

6. The sound of a grade school orchestra concert (as heard through ear plugs).

5. The sound of a high school orchestra concert played by the same students you remember playing in their grade school concert.

4. The sound of a teenager confiding something very important during a check up and then answering “yes” to the question “Do your parents know about this?”

3. The sound of a high school senior saying he got into his first choice college.

2. The sound of children (and their pets) breathing as they sleep.

1. The sound of a child’s small voice at Thanksgiving dinner leading her family in thanks.

Wishing you all a noisy Thanksgiving.

Julie Kardos, MD and Naline Lai, MD

When to keep your child home from school

Your child wakes up hot with fever but no other symptoms. She seems hungry, eats a great breakfast, and after a dose of Tylenol, she is no longer feverish and is now jumping off the couch. Are you a mean mommy or an unethical daddy if you send her off to school? Maybe not. Last month we had the privilege to address an audience of early childhood educators at the Bucks County Association for the Education of Young Children’s annual conference about when a child should leave school for medical reasons. In our podcast, When to keep your child home from school, we share some of the medical scenarios we discussed with the teachers: fever, vomiting, diarrhea, head lice, and pink eye.

Guidelines are based on Managing Infectious Diseases in Child Care and Schools, 2^nd edition, Editors: Susan S. Aronson, MD, FAAP and Timothy R. Shope, MD, MPH, FAAP published by tThe American Academy of Pediatrics.

Happy listening. Some of the answers may surprise you…

Julie Kardos, MD and Naline Lai, MD

Not small talk: how to explain big topics to young children

Whether you are discussing after dinner cleanup or explaining a complex issue such as an impending divorce, keep in mind talking to a young child is not the same as talking to a “little adult.” Our guest blogger, child psychologist Dr. Barry Ginsberg, a child and family psychologist since 1969 and the originator of the Parent-Adolescent Relationship Development Program (PARD), illustrates how to communicate with preschool and young school aged children.

Julie Kardos, MD and Naline Lai, MD

Children’s Questions

It’s important to be receptive to what we call teachable moments. Be prepared to

respond when you perceive that your child is ready and then follow your child’s lead.

Here’s such a moment: Johnny, age three, asks Sam, his dad, “Why do I have to go to day care?”

Sam could explain that it’s important to be with other children, or that he has to go to work. But instead, he realizes that he first needs to respond to Johnny’s feelings. So he says, “You’re not happy about going.”

Johnny says, “Yes, I want to be with you.”

“It makes me feel good that you want to be with me,” Sam says, going to a positive feeling first. Then, he refers to his own feelings by saying, “That’s important to me, too.”

Only after Sam says this does he become specific and answer Johnny’s question with facts: “It’s important to go to day care because I feel better knowing where you are and that you are safe when I’m at work.”

This was a teachable moment. Sam paid attention to Johnny’s feelings, acknowledged both their feelings, and offered a reasonable explanation. This demonstrates Sam’s respect for his son. As a result, Johnny truly “heard” his father.

When talking with young children, keep the following in mind:

Young children express themselves mostly through play.
Play is how they go about understanding their world and experiences.
Letting a young child lead you in play helps you understand the child better.
It may be hard to get a young child to let you know that she understands you. Forcing her to respond may be threatening to her and frustrating for you.
Even though children may not seem to be showing you that they understand, they probably do.
Keep your comments short and simple. As much as possible, try to phrase things in children’s terms, let them know you understand their feelings and use your feelings when you want to let them know what you want. For example, “You’d like to keep playing but I’m unhappy that the toys aren’t picked up,” and “The rule is that toys are put away before dinner.”
If you want children to understand or do something, you need to be patient; repeat it a few times; gently convey through your movements what you want; and try not to act out of your frustration.
Try to be consistent, and have clear rules and expectations.
Pay attention to children’s feelings when talking to them.

Read these nine suggestions over a few times. It takes a little practice to use them consistently. Be patient with yourself. You’ll get it after a while.

Barry G. Ginsberg, PhD, ABPP, CFLE
The Center of Relationship Enhancement (CORE)

215-348-2424
www.relationshipenhancement.com

Reprinted with permission from 50 Wonderful ways to be a Single-Parent Family.

photo credit: Lexi Logan www.lexilogan.com

Don’t let carbon monoxide creep up on your family

This monstrosity arrived at my house last week. It’s the neighborhood snow blower my husband and several neighbors purchased together to share. As I stared at the machine, I thought about all the little arms and legs that could potentially be churned up as the monster chugs through the snow. Paranoid? Perhaps. Although, I console myself, it would be hard to ignore a snow blower coming at you.

Unfortunately, one of the biggest winter hazards is not so loud and obvious. As the temperature drops, deaths rise from this insidious poisonous gas: carbon monoxide.

According to the Centers for Disease Control, about 400 unintentional deaths occur a year from carbon monoxide poisoning. Carbon monoxide results from the incomplete combustion of fuel. The gas causes a chemical suffocation by competing with oxygen in your body. The colorless, odorless gas is impossible for human senses to detect, and unfortunately, loss of consciousness usually occurs before any symptoms appear. Those lucky enough to have warning symptoms before passing out may experience headaches, nausea or confusion.

Because carbon monoxide is a by-product of incomplete combustion, sources are related to energy use. Poisoning occurs more during the winter months when fuel is used to heat closed spaces and ventilation from exhausts is poor. My sister, toxicologist and Harvard medical school instructor, Dr. Melisa Lai, tells the story of a snowplow operator a few years ago who left the house early in the morning to plow snow, only to return and find his family dead. The reason—snow blocked the exhaust pipe from the furnace and caused lethal levels of carbon monoxide to accumulate in his home.

Carbon monoxide also occurs in warm weather. To avoid carbon monoxide buildup in all climates:

–Install carbon monoxide detectors. My sister says a $20 detector such as Kidde works as well as the $150 models. Put them on every level of your home and check that the batteries work. Smoke detectors are not the same as carbon monoxide detectors. However, combination detectors are available.

–Ventilate all appliances, heating units, and your chimney adequately. Have them serviced yearly.

–Be wary of the exhaust from of any vehicle.

Parents have put their infants in running cars while they shovel snow, unaware that the car’s tailpipe is covered in snow. By the time they return to the car, the infant, who is extremely susceptible to carbon monoxide poisoning because of his size, is dead. Even opening the garage door when you run your car is not enough ventilation to prevent poisoning.

Like cars, boats also produce carbon monoxide. Since boats are less energy efficient than cars, they spew more of the gas. While your teen boogie boards behind a motor boat, the carbon monoxide can knock her tumbling unconscious into the water.

–Keep anything meant to burn fuel outdoors, OUTDOORS. Even an innocent barbeque can turn into a nightmare if you decide to grill inside your garage. Emissions from any type of grill, charcoal or gas, can send carbon monoxide levels skyrocketing. Additionally, hurricane season in the southern United States is known by toxicologists as “Carbon Monoxide Season.” During hurricanes, people buy outdoor generators and auxiliary heating units. They work so well that people then bring them indoors, trapping fumes in their homes.

My sister says she has hundreds of stories about carbon monoxide poisoning, all which end tragically. Maybe I’ll let my husband store that larger-than-life-take-up-car-space neighborhood snow blower here this winter. Then, at least I know I’ll be able to make sure no one starts up the blower in a garage.

For more details please visit http://www.cdc.gov/co/faqs.htm.

Naline Lai, MD with Julie Kardos, MD
©2010 Two Peds in a Pod℠

Thinking hard about the stages of child development? Look to SillyBandz

Lately my office staff has taken to giving out Sillybandz as rewards for kids who bravely endure the sting of vaccines , cooperate during exams, or just behave well while along for the ride at a sibling’s doctor visit. The kids LOVE them. Better than stickers. Healthier than lollipops.

From an educational perspective, these glorified rubber bands can help demonstrate normal child behavior and development:

Toddlers explore their world by using all their senses. They will touch and pull on SillyBandz in imitation of their older siblings. But watch out, they also explore by mouthing objects…don’t let them choke on a band.

Preschool and young school aged children try to impose order to their world, learn rules, and then often follow rules to the extreme. This tendency explaines why primary school-aged kids count and sort their SillyBandz by color or category. They understand trading and bartering, and they apply their knowledge to SillyBandz. Starting now, they understand number value and assume that whoever has the most of something also has the most power. This explains their desire for more and more SillyBandz. Kids this age respond to the “here and now” in their environment. They have a poor concept of time. If you use the bracelets as positive incentives, give them one immediately as a reward. If you tell your four year old you will buy him SillyBandz next week as a reward, he will forget why you are rewarding him and he won’t be motivated to repeat the good behavior you desire.

Middle school kids love to form clubs. Peers become more important than family. Wearing a particular set of SillyBandz makes them feel as if they belong to a club. This mentality is also the reason kids may wear unmatching socks- it puts them in the same club as their friends who also follow the identical fad. Other kids this age may balk entirely at the notion of SillyBandz (“they’re stupid” or “they’re for babies”) in an effort to avoid being like their younger siblings who are obsessed with SillyBandz.

Teenagers wear them when they believe that everyone else does. They are not so concerned about counting, ordering, or obtaining the most of something. Like the middle school kids, they are concerned about fitting in. Because this is an implusive age as well as an age of moral development, the same teen may buy a hundred SillyBandz but then give them all away. With teens, choose your battles. Put your foot down about things such as drugs and poor school performance. However, if your teen feels like wearing SillyBandz to the prom, express your displeasure, if you must, but let her go.

We grown-ups simply take advantage of the popularity of SillyBandz and use them to reward our children for good behavior, for completing homework in a timely manner and without arguments, for getting a good grade, for remembering to brush teeth every day for a week without parental reminders, and on and on.

Or we can just wear them too. Wonder if that would kill their appeal for kids.

Julie Kardos, MD with Naline Lai, MD
©2010 Two Peds in a Pod

Tricks to stop continual treats— how to avoid Halloween candy overload

You poured out all of your two liter soda bottles, replaced all the potato chip snacks with fruit and signed all your children up for winter sports. Just when you thought your family’s activity and diet balance was perfect, along comes Halloween, that fabulous candy-filled holiday to thwart your efforts. Ways to keep the candy deluge down to a trickle:

-Let your children know Halloween (and most holidays) lasts only one day. Live it up on Halloween then dump the extra sweets into the trashcan the next day.

-Buy back the candy with toys or money. Alternatively, have the sweet tooth fairy come overnight, pick up the candy and leave a present behind.

-If you decide to keep a small bag of candy around, watch out, your children will be tempted to eat some daily. Candy becomes an ongoing “must have.” Instead, designate a day to eat candy during the week such as Sweet Saturday or Candy Friday. If the kids whine for candy on any other day of the week, you can say, ”Sorry, it’s not Sweet Saturday.”

-One parent told me she discourages her kids from eating Halloween candy by making their dental appointments on November 1—the day after Halloween.

According to an article published in the New England Journal of Medicine in 2000, the average American adult gains about a pound over the winter holidays. Unfortunately, the weight is not shed during the rest of the year.

Hope your kids don’t grow into that kind of adult. Now, that’s a scary Halloween thought.

Naline Lai, MD with Julie Kardos, MD

Childhood Anxiety: What happens during Cognitive Behavioral Therapy?

Parents can become frustrated when searching for effective therapeutic treatment for childhood anxiety. Parents want to know what works and what their child will experience. Cognitive behavioral therapy is one type of therapy for children which directly addresses the behaviors kids exhibit. When anxiety starts, CBT gives kids concrete strategies to employ. Today psychologist and mom, Dr. Leah Murphy gives us an example of cognitive behavioral therapy treatment and how it involves the patient’s family and community.

Naline Lai, MD and Julie Kardos, MD

We all experience anxiety at times; anxiety can help us get things done (e.g., study for a test, finish a project, complete things in time for deadlines) and inform us that something is wrong. However, frequent, moderate to high levels of childhood anxiety both prevent, and interfere with, enjoyment and success in the school, home, and social arenas, resulting in a poorer quality of life. Wanting to improve your child’s anxiety and stress without “pushing them” much? You could have a look about at what summer activities for kids might be able to help manage their anxieties.

The experience of Connor, an 11 year-old boy, is a good example of how children can experience and show social and separation anxiety, as well as of how psychologists help children with anxiety.

Connor constantly worried. When he came to school Connor clung to his mother. At bedtime, Connor was unable to fall asleep without a parent staying with him, and he would often wake up and go into his parents’ room in the middle of the night. He even felt uncomfortable talking to other children. He constantly worried that kids would not like him and that he would “do something” that would cause the other children to tease him. He would avoid other children, and as a result, he had very few friends. He felt sad and lonely. Connor’s social and separation anxiety also manifested in physical symptoms. He felt nauseous, tired, suffered headaches and stomach aches, and experienced panic attacks in social situations. At school, Connor failed to concentrate on his work. Anger ensued when he felt pressure to perform anxiety provoking acts.

To help Conner, his pediatrician determined Conner had anxiety but no other medical condition and referred Conner to us for therapy. Our initial therapy sessions focused on teaching him how to to identify and express his feelings. During these sessions he created a feelings dictionary book and a feelings collage.

During the next set of sessions, Connor learned relaxation skills (deep breathing and muscle relaxation), positive coping thinking (“I can do this, the chance of something bad happening is very small, the chance of something good happening is very big”), and problem solving skills to help him to identify and implement solutions to the problems that made him nervous. Most sessions were conducted individually, but his parents participated in these sessions at times to learn the skills and to establish a plan for practicing and using these skills outside of our sessions. Also, I conducted parent-only and family meetings helped his parents cope with their own stress and anxiety about Connor’s difficulties.

During the last part of the skills based therapy, Connor used his skills in the situations which made him anxious. Starting with the least anxiety provoking situations, he gradually worked into more anxiety provoking situations. He practiced asking a teacher for a pencil, asking a waiter for a napkin/straw, introducing himself to a new peer, giving answers in class, asking a teacher for help, and going to swim lessons/baseball. We made a list of coping strategies (think positive, deep breathing, muscle relaxation, use problem solving steps, ask an adult for support/help) that he could use when overcoming anxiety provoking situations. He hung this list in his room and sometimes took it with him in his pocket or backpack. Apparently it was a lot of help to him.

Connor’s parents and school/camp staff prompted and reinforced his use of these skills in anxiety provoking situations. Connor had a point chart in which he earned points for using his skills and doing anxiety provoking activities. When he earned a sufficient number of points, he would pick a privilege from the privilege list that he created with his parents. Parent-only meetings during this time further assisted his parents cope with the discomfort and distress that they experienced when Connor began engaging in situations that caused him anxiety.

Additionally, Connor participated in a social skills group for children experiencing anxiety. Therapy groups are a great way for children to practice social skills while in a small group setting under supervision. The group practiced relaxation skills, as well as introduction/greeting and conversation skills. The group also learned skills to make friends.

In response to the therapy, all of Connor’s anxiety symptoms stopped over the course of 9-12 months, and his mood changed from anxious and fearful to calm and happy much of the time. He successfully attended school, participated in camp and after school programs, participated in social and recreational activities with children, and established friendships.

Sometimes, other strategies are needed to alleviate anxiety, including medication. Your pediatrician is able to provide information about medication options.

Leah Murphy, Psy.D.

Center for Psychology and Counseling www.psychologyandcounseling.com

(introduction modified 10:48a.m. October 13, 2010)

Organic fruit and veggies: health or hype?

Two Peds in a Pod turns today to guest blogger Dr. Alan Woolf, Director of the Pediatric Environmental Health Center at Children’s Hospital Boston and president-elect of the American Academy of Clinical Toxicology, to tackle the question, “Should you feed your kids organic fruits and vegetables?”

Nutritionists are urging parents to feed kids one and one-half cups of fruit and two and one-half cups of vegetables daily and the American Academy of Pediatrics suggests whole fruit rather than juice to meet most of the daily fruit requirements.

OK, so that’s fine, but why spend a lot more money to buy those fruits and veggies labed organic? Are they worth it? Will non-organic produce harm your kid? No easy answers here. American consumers demand a bountiful supply of blemish-free, perfect fruits and vegetables. We want unspotted shiny red apples, brightly colored large oranges and arrow-straight asparagus. Farmers want to give us just that. Since pests attack crops causing blemishes, worms, blight, and other forms of costly crop damage, farmers have been using pesticides for years to increase crop yield, profit, and visual marketability.

The US Dept of Agriculture (USDA) regulates the agricultural procedures and labeling that use the buzz word organic. Obviously every business wants to put that word on their product if it means consumers will run out and buy it. The USDA will certify farms that use organic methods. But even the USDA’s definition of organic allows a percentage of synthetic chemicals to be added to products labeled organic. Also organic does not mean that the food contains increased amounts of essential minerals and vitamins or is more nutritious for you. And remember that organic produce doesn’t necessarily come from small, cuddly, local, family-run farms. Most large, international agribusinesses are touting organic foods for sale these days.

Well over one billion pounds of pesticides, according to the Department of Agriculture, are used on American crops annually. And pesticides tend to be nasty chemicals—otherwise they wouldn’t kill bugs. In large amounts, some types can cause seizures or coma in people. However, all foods , whether organic or non-organic, must contain pesticide residues well below the standard that the government considers safe. Not every piece of non organic fruit even contains a residue; it’s hit and miss.

But what about the long-term safety of pesticides in trace amounts, the amounts barely present as micro-grams or nano-grams? The fact is that no one knows the safety for sure. The science just isn’t there yet. Some dispute the government’s definitions; arguing that children don’t eat the same market basket as adults (they eat more fruit). They reason that using adult pesticide residue standards may not protect children. Recently some scientists did a study where they measured pesticide residue in the urine of school-aged children who were fed regular, market-basket produce, and then measured again after they switched them to organic-only fruits and vegetables. Guess what—kids fed organic foods excreted less pesticide residues in their urine. There’s a powerful argument for organic.

One thing that everyone agrees with—wash all of your fruits and vegetables after you buy them and before anybody in your family eats them. And that means soap and water, not just a quick rinse. Also keep in mind that infants and children are resilient even in this modern age filled with all sorts of hazards. Kids and adults are armed with marvelous defense mechanisms that prevent chemicals from doing bodily harm. Even if a chemical does cause some injury, the body has remarkable mechanisms that repair the damage in a hurry. No need to be “chemical phobic;” you can’t keep your kids in a bubble.

That being said, you still need to be cautious. In pediatrics we often invoke the “precautionary principle.” The idea is that if you don’t exactly know what a chemical will do to a child’s health because there aren’t enough scientific studies out there, then you assume that what it is capable of is bad and so, if possible, try not to expose them, just as a precaution.

When you can, buy from local farms or stands where you can ask them their growing practices, or else just grow your own. If you decide to buy organic foods, you should eat them right away. They may not stay edible as long without preservatives. Again, no matter what type of food you buy, wash, wash, wash.

Finally, alternative “greener” farming techniques, integrated pest management (IPM), and more resistant varieties of plants have increased crop yields, in many cases without using as much pesticide. That’s good news for all of us. Breeding of genetically-engineered plants require less use of pesticides, but they may not be acceptable to most consumers. That’s a whole column in itself!

The bottom line: My wife and I will try to buy organic foods when we think of it, but we don’t obsess over it when we forget.

Alan Woolf, MD, MPH, FAACT, FAAP

Director, Pediatric Environmental Health Center, Children’s Hospital Boston