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
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
©2013 Two Peds in a Pod®
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:
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.
©2013 Two Peds in a Pod®
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
©2013 Two Peds in a Pod®
Updated from the original post April 10, 2011
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.
Julie Kardos, MD with Naline Lai, MD
©2013 Two Peds in a Pod®
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.
Naline Lai, MD and Julie Kardos, MD
©2013 Two Peds in a Pod®
Originally published April 18, 2011
Last week we all sat on the couch watching the Super Bowl. If your kids are still on the couch, this post on indoor exercises by Dr. Deborah Stack is for you:
Let’s face it, it’s hard to move when it’s cold and it’s freezing at my home. I believe today’s high is 20 degrees Fahrenheit. Now while this may not deter younger children from bundling up and going sledding, teen couch potatoes are busy whining that it’s “too cold.” So there they sit.
What’s the secret to keeping them active in the winter months? Have them schedule an activity, and be an example yourself. Ideas for teens (and you) to do when it’s cold outside:
Have a 15-minute dance party
Have a Wii contest
Try swimming (indoors please!)
Dust off the treadmill or stationary bike in the basement and GET ON IT
Play ping-pong
Do a few chores
Jump rope
Jog during T.V. commercials
Pull out some “little kid games” such as hopscotch, hula-hoop or Twister
Let each child in your house choose an activity for everyone to try
Teens, like everyone else, need exercise to stay healthy. Staff from the Mayo Clinic recommend kids ages 6-17 years 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 finals coming up), and improve cardiovascular endurance. Those spring sports really ARE just around the corner.
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 teen 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 teen can check it out for him self. 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 |
What’s the worst that can happen? You’ll have a more fit, better rested, and happier teen! Or at least you’ll have a cleaner home!
Try these activity calculators:
http://primusweb.com/fitnesspartner/calculat.htm
www.caloriesperhour.com/index_burn.php
http://www.caloriecontrol.org/healthy-weight-tool-kit/lighten-up-and-get-moving
References:
www.mayoclinic.com/health/fitness/FL00030.
www.caloriesperhour.com/index.burn.php
Deborah Stack, PT, DPT, PCS
With over 15 years of experience as a physical therapist, guest blogger Dr. Stack 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.
modified from the original Jan 26, 2011 post
© 2013 Two Peds in a Pod®
“Mommy, I throwed up.”
Few words are more dreadful for parents to hear, especially at 2:00am (my children’s usual time to start with a stomach bug).
In my house, I am the parent who comforts, changes pajamas and sheets, washes hands and face, and sprays the disinfectant. My husband scrubs (and scrubs, and scrubs) the rug. Little kids never throw up neatly into a toilet or into the garbage can. Sometimes even big kids can’t seem to manage to throw up conveniently.
What should you do when your child vomits?
After you finish cleaning up her and her immediate environment, I suggest that you CHANGE YOUR OWN CLOTHES AND WASH YOUR HANDS! The most common cause of vomiting in kids is a stomach virus, and there are so many strains, we do not develop immunity to all of them. And trust me, stomach viruses are extremely contagious and often spread through entire households in a matter of hours. Rotavirus, a particularly nasty strain of stomach virus, is preventable by vaccine, but only young babies can get the vaccine. The rest of us are left to fend for ourselves.
Stomach viruses usually cause several episodes of vomiting and conclude within 6-8 hours. Concurrently or very soon thereafter, the virus makes an exit out the other end in the form of diarrhea, which can last a week or so.
The biggest problem children face when they vomit is dehydration. Kids need to replace fluids lost from vomiting. Pedialyte® or other oral rehydration solutions (ORS) such as Kaolectrolyte® or CeraLyte® are useful and well tolerated beverages for rehydrating kids. They contain salt, sugar, electrolytes and water, all substances that kids need when they throw up and have diarrhea. For babies however, try to “feed through” with breast milk or formula unless otherwise directed by your child’s doctor. Most oral rehydration guidelines are based on diarrheal illnesses such as cholera, so you will find slight variations on how to rehydrate. Basically, they all say to offer small frequent amounts of liquid. I council parents to wait until no throwing up occurs for 45 minutes to an hour and then start offering very small amounts of an ORS (we’re talking spoonfuls rather than ounces) until it seems that the vomiting has subsided. In her house, Dr. Lai uses the two vomit rule: her kids go back to bed after the first vomit and she hopes it doesn’t occur again. If vomiting occurs a second time, she starts to rehydrate. Continue to offer more fluids until your child urinates- this is a sign that her body is not dangerously dehydrated.
Can’t immediately get out to the store? The World Health Organization has recommended home based oral rehydration solutions for years in third world countries. Also, while the oral rehydration solutions are ideal, any fluid is better than none for the first hours of a stomach bug. You can give older kids watered down clear juices, broth or flat ginger-ale with lots of ice. Now, some kids hate the taste of Pedialyte®. Plain, unflavored Pedialyte® splashed with juice often goes down better than the flavored varieties. For some reason, plain water tends to increase nausea in sick kids and copious amounts of plain water can lower the salt in a child’s bloodstream. So, offer a fluid other than plain water while your child is vomiting.
Even if your child drinks the Pedialyte®, once the stomach symptoms have subsided, don’t forget that Pedialyte®, while excellent at “filling the tank,” has no nutrition. The gut needs nutrition to overcome illness. Start to offer small amounts of food at this point. Easy-to-digest foods include complex carbohydrates such as rice, noodles, toast with jelly, dry cereal, crackers, and pretzels. Additionally, give protein such as bits of turkey or baked chicken. Thicker fluids such as milk and orange juice do not sit as well in upset bellies, nor do large quantities of anything, food or drink. So offer small bits of nutrition fairly frequently and let kids eat as their appetite dictates. Warning- just when everything blows over, toddlers in particular, may go a day without vomiting and vomit one more time as a last hurrah.
Vomiting from stomach viruses typically does not cause severe pain. A child curled up whimpering (or yelling) on the floor with belly pain might have something more serious such as appendicitis, kidney stones, or a urinary tract infection. Call your child’s doctor about your child’s vomiting if you see any of the following:
Of course, when in doubt, call your child’s doctor .
Hope this post wasn’t too much to stomach!
Julie Kardos, MD with Naline Lai, MD
©2013 Two Peds in a Pod®
Breathless after a stint on the treadmill at the gym, I burst out of the building yesterday into the bitter cold. Startled by the frigid air, I reached into my winter coat pocket and pulled out… a pair of stinky socks. One of my kids handed them to me after swimming the other day and I had stuffed them into my pocket. Instantly all my visions of myself as a wonder-workout -woman dissipated as I scurried towards my car with my new sock-mittens. What would have happened if I hadn’t thrown on the socks? Probably not much beyond dry chapped hands. But if you live in a cold area of the world, and your kids refuse to wear mittens (or socks) on their hands in this chilly weather… this post is for you:
Three little kittens, they lost their mittens, and they began to cry.
Oh, mother dear, we sadly fear
That we have lost our mittens.
What! Lost your mittens, you naughty kittens!
Then you shall have no Xbox today.
-the modern version of a traditional poem
It’s only January and already my kids’ mittens are missing some mates.
Prolonged exposure to cold can lead to injury in body parts with relatively less blood flow such as the ears, fingers and toes. In frostbite, injury occurs secondary to ice crystals which form within or between the cells in your body. Injury can be so severe that the tissue dies and infection sets in.
Early signs of frostbite include tingling or aching. Without treatment, the area will become pale and lose all sensation.
If you suspect your child’s hands are frostbitten, first remove all wet clothing. Rewarm the area by placing immediately in warm water. Think opposite of a burn- where you use cold water. Do not massage the hand as this may cause further injury, but do encourage your child to move his hands. As very cold hands warm up, they will become blotchy and painful or itchy. Ibuprofen (brand names Motrin and Advil)or acetaminophen (Tylenol) will be helpful. Warm for at least half an hour even if it is painful.
Signs of actual frostbite are blistering, numbness, or color changes. As my sister, an emergency room doctor says, red is good. Black and white are not.
Head over to the emergency room if you think your child has frostbite. To avoid the risk of over-heating and to manage the pain of treating frost bite, thawing for frost bite should be medically supervised. Just as you would seek care for a burn, seek medical care for a cold induced injury. To rewarm properly, the frostbitten part of the body should be submerged in warm 37-to-40 C (98 -to-104 F) water. No higher because then it’s like trying to defrost a chicken. You will end up cooking rather than thawing the tissue, says my sister. Also a big no-no: starting to thaw but then not completing the thaw. Thaw-refreeze-thaw will injure tissue, same as it ruins a defrosting chicken. So again, seek medical attention for your child if you suspect frost bite has set in.
For an interesting but somewhat technical article with photographs on a case of frostbite, check out this New England Journal of Medicine article.
Naline Lai, MD with Julie Kardos, MD
© 2013 Two Peds in a Pod®
modified from original post on 1/20/2010
A mom recently asked me: My child seems angry more often than not. He snaps at the slightest frustration and cries more often. If I didn’t know any better, I’d wonder if he’s depressed. But young kids don’t get depressed, do they?
The signs of depression in younger children can look different than depression in teens and young adults. Younger children are less likely to tell you that they feel sad- often because they can not pinpoint what is wrong. Of course everyone is allowed periodic “bad days”, but when there are more “bad days” than “good days” action must be taken. Below are some warning signs that your child may be depressed:
-Feels down or sad much of the time
-Acts angry much of the time
-Acts “out of control” or has new behavior problems that seem resistant to your usual discipline measures.
-Loses interest in activities which normally bring pleasure, withdraws from friends
-Exhibits changes in sleep patterns-difficulty falling asleep, numerous awakenings, or excess sleeping
-Has feelings of worthlessness (feelings she let a family member or teacher down, etc.)
-Finds it difficult to concentrate
-Performs worse in school, grades slip, or tries to avoid going to school
-Shows low energy or fatigue or conversely seems restless or “hyper”
-Alcohol or drug use (attempts at “self-medicating”)
-Expresses thoughts of being better off dead or desires to hurt himself.
If you suspect your child is depressed, ask him the hard questions. Ask him if he is thinking of hurting himself or others. Ask if he wants to commit suicide. You will not be “planting an idea.” Asking will allow you to find the medical help he needs immediately. Not asking may lead to death. We always tell patients and their parents not to hesitate to call “911” or go to the emergency room if the patient is suicidal. After all, it is an emergency– a life is at stake.
Sometimes it’s not your child who is depressed.Your child’s friend may confide that he or she is extremely sad and may tell your child to keep the information a secret. Let your child know that her friend is giving a “cry for help” and that it is appropriate to share information with adults.
Children and teens can have “real” depression just like adults and they need treatment from an experienced health care professional just like adults do. Consequences of untreated depression, just like adults, can include loss of enjoyment in life, estrangement from friends, school or job failure, and untimely death from suicide.
Naline Lai, MD and Julie Kardos, MD
© 2013 Two Peds in a Pod®
modified from original post from June 3,2010
