A few days ago, I spoke with the faculty of a local early childhood education center about flu vaccine myths. See how you do on the true and false quiz I gave them:

I can tell when I am getting the flu and will leave work before I infect anyone.

False. According to the CDC (US Center for Disease Control), you are infectious the day before symptoms show up.

I never get the flu so it’s not necessary to get the vaccine. 

False. Saying I’ve never had the flu is like saying, “I’ve never a car accident so I won’t wear my seat belt.”

I hate shots. I hear I can get a flu vaccine in a different form.

True.  One flu vaccine, brand name Flu Mist, provides immunity when squirted in the nose. Non-pregnant, healthy people aged 2-49 years of age qualify for this type of vaccine.

I got the flu shot so I was healthy all year.

False. Perhaps it was the half-hour a day you added to your workout, or the surgical mask you wore to birthday parties, but your entirely healthy winter was not secondary just to the flu vaccine.  The United States flu vaccine protects against several strains of flu predicted to cause illness this winter. This year’s vaccine contain both seasonal and the 2009 H1N1 strains. Your body builds up a defense (immunity) only against the strains covered in the vaccine. Immunity will not be conferred to the thousands of other viruses which exist. On the other hand, the vaccine probably did protect you from some forms of the flu, and two fewer weeks of illness feels great.

My friend got the flu shot last year, therefore, she was sick all winter.

My condolences. True, your friend was sick. But the answer is False, because the illnesses were not caused by the flu vaccine.  Vaccines are not real germs, so you can’t “get” a disease from the vaccine. But to your body, vaccine proteins appear very similar to real germs and your immune system will respond by making protection against the fake vaccine germ. When the real germ comes along, pow, your body already has the protection to fend off the real disease. Please know, however, there is a chance that for a couple days after a vaccine, you will ache and have a mild fever. The reason? Your immune system is simply revving up. But no, the flu vaccine does not give you an illness.

I got the flu vaccine every year for the past decade. I will still need to get one this year.

True. Unfortunately, the flu strains change from year to year. Previous vaccines may not protect you against current germs.

I am a healthy adult and not at high risk for complications from the flu, so I will forgo the flu vaccine this year.

False. The flu vaccine is now recommended for everyone greater than 6 months of age. When supply is limited, targeted groups at risk for flu complications include all children aged 6 months–18 years, all persons aged ≥50 years, and persons with medical conditions that put them at risk for medical complications.   These persons, people living in their home, their close contacts, and their CARETAKERS are the focus of vaccination. 

Even if I get the flu, I’ll just wash my hands a lot to keep the germ from spreading. I have to come back to work because I don’t have much time off.

False, According to the American Academy of Pediatrics Report of the Committee on Infectious Diseases, the influenza virus can spread from an infected person for about a week after infection.

Yes, kids get sick from others kids, but as a parent who comes in contact with two children, an early childhood educator who comes in contact with ten children, an elementary school teacher who comes in contact with twenty children or a high school teacher who comes into contact with one-hundred children daily, you may end up the one who seeds your community with a potentially deadly illness.  Right now, flu vaccine clinics are as plentiful as Starbucks. Hit that CVS or Walgreens on the way home, wander into your doctor’s or grab a shot while you get groceries.  By protecting yourself from the flu, you protect the children you care for.

Naline Lai, MD with Julie Kardos, MD

© 2010 Two Peds in a Pod℠

Move over liveStrong bracelets, move over Silly Bandz. Just when you thought you threw away the your last Oriental Trading Company gadget, here come “I Love Boobies” bracelets.  As I see the newest overpriced piece of fashionable rubber dangle from my daughter’s wrist, I sigh at the cost, but console myself that at least the money goes towards breast cancer research.  Use the bracelets as a reminder to teach your girls to do monthly breast exams. The American Cancer Society recommends monthly self-breast exams starting at age twenty. However, most pediatricians recommend starting exams earlier. Breasts are full of normal lumps and bumps and your teen or young adult should know her baseline. For directions on conducting a breast exam refer to American College of Obstetrics and Gynecology’s online pamphlet . Yes, even a fashion accessory can turn into a parental teaching point. Now what do jeggings teach kids?

Naline Lai, MD with Julie Kardos, MD

©2010 Two Peds in a Pod℠

Can you identify your child in any of these scenarios?

-Your second grader comes off the school bus crying because another student was teasing him the entire ride home about his new glasses.

-Your fifth grader was punched on the school yard by a sixth grader and none of the playground teachers saw it happen. Your child’s friend shoved the older child off your child before more damage was done.

-Your ninth grader keeps missing the school bus so you have to drive her to school.  When she comes home from school she uses the bathroom immediately. You find out she avoids the bus and the school bathroom because verbal abuse occurs in both places.

Whatever your child’s age, when you realize he or she is being bullied you will be outraged. In fact you might be tempted to retaliate against the bully yourself. However, here are more appropriate ways to help your child.

Bullying should never be tolerated. Teach your child how to directly deal with a bully, but be quick to talk also to the adult supervising your child when the bullying occurs. Your child should always feel safe in school, day camp, on a sports team, or any other adult-supervised activity.

Bullies are always in a position of power over their victims; either they are physically larger, older, or more socially popular. Teach your child first to try a strong verbal response (talk) such as “STOP talking to me that way!” or “Don’t DO that to me!” Speaking strongly and looking the bully in the eye may take away some of the bully’s power as well as attract attention of nearby peers or adults who can help your child.

Teach your child to walk away from a fight. Tell him to keep on walking toward a teacher, a classroom, a peer, or anyone else who can offer safety from a bully. Train him to breathe deeply/ignore/de-escalate situations to diffuse a bully’s anger.

Have your child tell a teacher, camp counselor, coach, or other supervising adult about the abuse (squawk) as soon as it occurs. Always encourage your children to talk to you as well. Remember at home to ask your child questions such as “How is school,” “How are your friends,” “Do you know any kids who are being bullied?,” and “Are YOU being bullied?”

If your child says he is angry at a friend or a classmate, be sure to ask questions that encourage your child to elaborate, such as “Oh, what happened?” or “Did something happen between you?” Listen carefully to his response. He may be taking out his anger at a bully on his own friends. This response is in retaliation for his friend’s failure to protect him from a bully. Also, is your child becoming more reluctant to attend school, “missing” the bus more often and thus requiring a ride, or acting angry or sad more often? Kids who are victims of bullying can act like this.

In school, once you are aware that your child is a victim, talk not only to your child about how she should handle a bully but also alert your child’s teacher and/or school principal about the situation (support). You should tell them in your child’s words what happened, what was said, and be clear that you are asking for more supervision so that the bully has less access to your child. Ask for more supervision during times when there is usually less adult presence such as in the lunchroom or on the schoolyard. Your school may already have a “no bullying” policy. Often, the aggressor gets the heavier consequence in the event of a conflict.  Again, children have a right to feel safe in school.

Restore your child’s self-confidence. Bullies pick on kids who are smaller and weaker than they are, physically as well as psychologically. So your child has more positive experiences with kids who do not bully, encourage your child to invite friends over to your home or host a fun group activity (kickball game in your backyard, show a movie/supply popcorn, etc.). Do family activities and show your child that you enjoy spending time with him. Enroll your child in activities that increase his self esteem such as karate, sports, or music lessons.  A child who feels good about himself “walks taller” and is less likely to attract a bully.

As a parent, you might read this post and think, “Yes, but I’d rather just teach my child to take revenge.” Unfortunately, escalating the situation only breeds anger and in fact may get your child into trouble. Rather than “hate” the bully, help your child see that a bully deep down feels insecure. A bully resorts to making himself feel better by making others feel bad. Teach your child to pity the bully. With your guidance, your child will project self-confidence and a bully will never, ever, be able to touch him.

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

A concerned parent wrote to us:

Eeew! Pictured is the raw chicken I left sitting out in a pot for a day (inadvertently, of course).  The putrid mess was teaming with germs and amongst them was probably salmonella. This bacteria is in the news because of the thousands of eggs recently recalled for contamination (Centers for Disease Control , New York Times, National Public Radio.)

Non-typhoidal Salmonella usually causes fever and crampy diarrhea.  This stomach bug mainly lurks in raw poultry, raw eggs, raw beef, and unpasturized dairy products. Luckily, salmonella does not jump up and attack humans. People are safe from disease as long as they do not eat salmonella-infested food.

In the case of my pot of rotten chicken, the obvious stench warned me that it was inedible.  However, salmonella often hides in food and it is difficult to tell what is or is not contaminated.  A perfectly fine looking egg may harbor the germ. Even before this outbreak, the Centers for Disease Control estimates in the United States as many as 1 in 50 people are exposed to a contaminated egg each year.

Luckily salmonella is killed by heat and bleach.  Even if an egg has salmonella, adequate cooking will destroy the bacteria. Gone are the days when parents can feed kids soft boiled eggs in a silver cup, have kids wipe up with toast the yolk from a sunny-side up egg, or add a raw egg to a milkshake.  Instead, cook your hardboiled eggs until the yolks are green and crumble, and tolerate a little crispness to your scrambled eggs.  Wash all utensils well. The disinfecting solution used in childcare centers of ¼ cup bleach to 1 gallon water works well to sanitize counters. Do not keep perishable food, even if it is cooked, out at room temperature for more than two hours.

A mom once called me frantic because her child had just happily eaten a half-cooked chicken nugget. What if this happens to your child? Don’t panic. Watch for symptoms — the onset of diarrhea from salmonella is usually between 12 to 36 hours after exposure but can occur up to three days later.  The diarrhea can last up to 5-7 days. If symptoms occur, the general recommendation is to ride it out. Prevent dehydration by giving plenty of fluids. My simple rule to prevent dehydration is that more must go in than comes out. 

According to the American Academy of Pediatric’s 2009 infectious diseases report, antibiotic treatment may be considered for unusually severe symptoms or if your child is at risk for overwhelming infection. People at high risk for overwhelming disease include infants younger than three months old and those with abnormal immune systems (cancer, HIV, Sickle Cell disease, kids taking daily steroids for other illnesses). Using antibiotics in a typical case of salmonella not only promotes general antibiotic resistance, but in fact does not shorten the time frame for the illness. Also, the medication can prolong how long your child carries the germ in his stool.

I ended up tying the chicken up, pot and all, in a plastic grocery bag and throwing out the whole mess.  Don’t tell my husband, he is the kind of guy who gets annoyed because I throw out germy sponges on a frequent basis. If he knew, he’d probably want me to at least keep the pot. Yuck.

Naline Lai, MD with Julie Kardos, MD

©2010 Two Peds in a Pod℠

Ah…you’ve tucked in your tired kids, now kick back and take out your Kleenex while you read Dr. Lai’s personal letter to her own child as she started school. The post is meant for all parents with a child who is approaching a major milestone. Then, come back to reality and read Dr. Kardos’s post on how to help kids get back to a healthy school year sleep pattern.

Best wishes for a smooth transition to school.

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

As summer dwindles, unfortunately so do the summer romances. Psychologist John Gannon guest blogs today on how to help your teen when a first love goes sour…

It happens to almost every adolescent. At some point or another, we all experienced our first love. In the early stages, it was the greatest feeling we had ever felt. When it ended, it was the largest and most powerful feeling of hurt that we had ever experienced. Each moment felt like 10 years. Days went by and life went on for everyone else. Yet, for us, life stopped and we felt lost and paralyzed.

Your child will not be the exception either. They will feel their feelings the same way we felt ours. Your response to their heart break might offer them comfort. It may also infuriate them. They might claim that you just don’t understand. They might sob inconsolably. In practicality, your life will also suffer! Nothing can take their pain away except the passage of time. I always speak about the scar that occurs from first love. I believe it is a necessary scar, so that we do not become lost without emotional boundaries.  The price of the scar though, is the loss of emotional love with another person.

There are things you may want to consider when this occurs for your child. For instance, some teenagers have more than just a traditional break up syndrome. They enter a state of significant sadness or anxiety. It can be difficult to distinguish what is a break up and what is something else. Sometimes, they will try to self medicate with drugs or alcohol. They may be more likely to have poorer judgment than they typically would have. It’s good to try and be as emotionally available as they will let you. Don’t take it personally if they shut you away.

Fortunately, time does heal most of these feelings. One day, you will see they look brighter. They may start to smile. Luckily, first love happens only once in a lifetime for most of us. (Some people live life with every relationship as a first love.) Keep in touch with your kids during this time. Even if it appears they are being overly dramatic, they are inexperienced when it comes to affairs of the heart. The pain is real for them. First love can teach how to balance love. Sometimes, they may need to have several breakups to figure this out. Most of the time, we ultimately learn how love is kept in perspective and by doing so we do not lose our emotional well-being.

Finally, this is a passage of your child’s becoming an adult. Enjoy the ride!

John Gannon, MS, licensed psychologist

Gannon has over 25 years experience as a marriage and family therapist in the Philadelphia area. He has spoken both locally and nationally on family matters. He has addressed numerous teacher and parent groups, given advice on radio, and has appeared on The Montel Williams Show.

© 2010 Two Peds in a Pod℠

Just in time for the fall sales,  physical therapist Dr. Deborah Stack returns to give us the low-down on backpacks.

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Believe it or not, there are only a few weeks left before school starts for the fall.  As I look at last year’s first day of school photo, I notice my not-quite-100-pound child bending in half under the weight of a backpack, trombone, lunchbox and art portfolio. This year, I quietly decree, that scenario will not happen again.  To make sure it does not happen at your house either, consider a few tidbits as you plan your back-to-school purchases:

-A traditional backpack with two shoulder straps distributes the weight more evenly than a pack or messenger bag with a single strap.

-Look for wide, padded straps.  Narrow straps can dig in and limit circulation.

-A chest or waist strap can distribute weight more evenly.

-Look for a padded back to protect your child from pointy pencils etc.

-Look for a lightweight pack that does not add much overall weight.

–Multiple compartments can help distribute weight.

–Compression straps on the sides or bottom of a backpack can compress and stabilize the contents.

–Reflective material allows your child to be more visible on those rainy mornings.

–A well fitting backpack should match the size of the child. Shoulder straps should fit comfortably on the shoulder and under the arms, so that the arms can move freely. The bottom of the pack should rest in the contour of the lower back. The pack should “sit” evenly in the middle of the back, not “sag down” toward the buttocks.

How much should your tike tote? Experts, including the American Academy of Pediatrics and the American Physical Therapy Association, recommend kids should not carry backpacks weighing more than 15-20% of the kid’s weight.

Here’s a chart to give you an idea of the absolute maximum a child should carry in a properly worn backpack:

Here are some ideas to help lighten the load, especially for those middle school kids who have a plethora of textbooks:

-Find out if your child’s textbook can be accessed on the internet.  Many schools are purchasing access so the students can log on rather than lug home.

-Consider buying an extra set of books for home.  Used textbooks are available inexpensively online.

-Limit the “extras” in the backpack such as one free reading book instead of five.  I am not exaggerating; one day I found five free reading books in my child’s backpack!

-Encourage your child to use free periods to actually study, and leave the extra books in his locker.

-Remind your child to stop by her locker between classes to switch books rather than carrying them all at once.

-Consider individual folders or pockets for each class rather than a bulky 3-ring notebook that holds every subject.

 

You may need to limit the load even further if your child is still:

-Struggling to get the backpack on by herself

-Complaining of back, neck or shoulder pain

-Leaning forward to carry the backpack

If your child complains of back pain or numbness or weakness in the arms or legs, talk to your doctor or physical therapist.

When used correctly, backpacks are supported by some of the strongest muscles in the body: the back and abdominal muscles. These muscle groups work together to stabilize the trunk and hold the body in proper postural alignment.  However, backpacks that are worn incorrectly or are too heavy can lead to neck, shoulder and back pain as well as postural problems.  So choose wisely and lighten the load.  Happy shopping!

Deborah Stack, PT, DPT, PCS

Dr. Stack has been a physical therapist for over 15 years and heads The Pediatric Therapy Center of Bucks County in Pennsylvania www.buckscountypeds.com. She holds both masters and doctoral degrees in physical therapy from Thomas Jefferson University.

© 2010 Two Peds in a Pod℠

Debunking myths about soy, our guest blogger today is esteemed pediatrician Dr. Roy Benaroch. In practice near Atlanta, Georgia, he is an assistant clinical professor of pediatrics at Emory University, a father of three, and the author  of The Guide to Getting the Best Health Care for your Child  and Solving Health and Behavioral Problems from Birth through Preschool . We enjoy his blog The Pediatric Insider  and we think you will enjoy the except below.

Drs. Lai and Kardos

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From LeeAnn: “Are soybeans (edamame) safe for my 11 year old daughter to eat? I have heard that they can ‘mess with’ her hormones?”

You want to see a freakshow? Try googling this topic. I found one essay, on a “news” site, that blamed soy products for everything from stroke to vision loss to homosexuality. On the other hand, other authors love soy: it will apparently prevent heart attacks, improve the symptoms of menopause, and help flush the toxins out of your body while improving your sex drive (women) and fracture healing (men.) On one site, in two adjacent paragraphs, I found a breathless author worrying that soy could cause breast cancer, followed by a second paragraph extolling its virtues in preventing breast cancer.

Please.

Soybeans contain a group of chemicals called “phytoestrogens” (sometimes called “isoflavones”) that are chemically somewhat similar to human estrogen hormones. In the 1970’s and 1980’s, some research showed that in the laboratory, these compounds could activate human estrogen receptors, presumably causing estrogen-like effects. So that’s the germ of truth.

But these phytoestrogens activate human estrogen receptors very, very weakly. They’re also easily broken down by cooking and processing, and by enzymes in the human body. It would take a tremendous amount of soy, eaten every day, to have anything close to a genuine hormonal effect. No human study has shown anything close to a measurable effect of consuming soy, at least not in ordinary amounts.

So: enjoy your edamame, tofu, and soy burgers. If you want to be super-careful, just don’t do all of this on the same day.

The Pediatric Insider

© 2010 Roy Benaroch, MD
Printed with permission in Two Peds in a Pod

Why does that big pimple always appear the night before prom, picture day, her sweet sixteenth birthday party or any other important event in your teen’s life?

A rite of passage, acne is caused by a combination of genetics and bad luck. The perception of acne as a problem depends on the eye of the beholder. When I see a teenaged patient in my office for acne, the first question I ask is, “Who is more concerned about the acne? The parent or the patient?” Some kids have very mild acne, yet those kids perceive their pimples are the size of golf balls. Other kids are oblivious, and the parents are more upset than the teen. 

Even if your teen starts to break out with what she perceives are huge blemishes but are really the size of pin pricks, do take her seriously. Many effective, safe products can diminish mild acne and thus greatly help self-esteem in a self conscious teen. Also, make sure to probe to see if a negative perception of her appearance extends to an overall poor body image. Sometimes distress over minimal acne can be an early sign of body image disorders such as anorexia nervosa or bulimia.

The categories of acne medicines are:

-Topical antibiotics such as benzoyl peroxide or clindamycin, applied directly to skin- works to kill the bacteria that lead to acne

-Other topical medications such as tretinoin (Retin A) and adapalene (Differin) stop acne formation mainly by penetrating into the deep layers of the skin to loosen acne causing pores

-Oral antibiotics, such as minocin, clindamycin or erythromycin also kill the bacteria that lead to acne formation

-Accutane, an oral medical reserved for severe, scarring acne. Can cause significant birth defects and so girls who take it must also take birth control pills and have periodic pregnancy tests. Chemical imbalances may occur, so blood work is required for both sexes.

-Hormonal therapy (birth control pills)- works best for females who break out near their periods, smooths out the hormonal fluctuations which fire up acne.

I always remind my patients that most treatments take six weeks to work. For kids who experience dry skin with the topical medications, use noncomedogenic (non acne forming) moisturizer liberally.Dermatologists and pediatricians schedule follow up visits for acne at 4-6 week intervals. If your teen has mild acne but truly doesn’t want to bother with treatment, just encourage washing with a mild cleanser (for example Dove soap) once daily. Tell him also to use a clean washcloth or soft paper towel to dry off after each washing. Applaud his self-confidence and lack of obsession with a skin condition which almost always improves with time.

Myth buster: eating chocolate does not cause acne. The chocoholic in me is greatly relieved by this knowledge.

Truth: arranging hair to hide the face tends to make acne worse. Avoid oily hair gels and sprays. In addition, touching and picking at the skin also causes irritation in an already irritated area.

Finally, what to do on prom night? Cosmetics work wonders, and parental reassurance, even if your teen waves it aside, can take care of the rest.

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