Ever wonder what the school nurse or your kid’s pediatrician is looking for during a scoliosis screen? Here, in three steps, you can also monitor your child. If you are concerned, see your child’s doctor.
And dat is how to check dee spine!
Naline Lai, MD and Julie Kardos, MD
©2011 Two Peds in a Pod®
Although pediatricians check children’s spines for scoliosis throughout childhood, school based screens occur during pre-teen and teenage years. This timing is appropriate for school screens because most cases of idiopathic scoliosis, scoliosis with no known cause, occur during the rapid growth spurt of puberty. Eight times more common in girls than boys, scoliosis is painless and often detectable only to health care providers; minor curves are neither obvious nor disfiguring. Caught early, scoliosis can be ameliorated or corrected before adulthood when it can lead to back pain, difficulty breathing and disfigurement. Unlike what some parents think, scoliosis does not cause “bad posture.” Likewise, “bad posture” does not cause scoliosis. So, while it may cause an awkward middle school moment, scoliosis screening can actually have far reaching consequences for the future. Next up: stay tuned for a “do-it-yourself “scoliosis screen. ©2011 Two Peds in a Pod®
I remember during my middle school days in New Jersey lining up once a year at the school nurse’s office, feeling awkward and nervous. Not only was the nurse checking our height and weight as she did every year in grade school, but now she was going to check our backs for some mysterious entity called “scoliosis.” Where I live now in Pennsylvania, many school nurses also screen students for scoliosis, a curve in the spine.
Depending on the degree of the curve, a child with idiopathic scoliosis might be re-examined every 4-6 months, might get an x-ray of her spine, or her health care provider might refer her to an orthopedic doctor, a specialist who cares for kids with scoliosis. Kids whose spinal curves are severe or are likely to get worse may need bracing until they stop growing. At that point the chances of the curve continuing to increase is low. Wearing a brace does not correct the curve; rather, it prevents any further curvature. Scoliosis braces are much more inconspicuous now than in the past, and can be hidden easily under clothing. Some children require surgery to correct a severe curve.
Julie Kardos, MD and Naline Lai, MD
While many good books have been written on the subject of how to get your kids to listen to you, today we boil this topic down to a few key sticky points. The goal is to make sure your child hears, “Please clean your room,” as well as,“Let’s go get ice cream.” Here are ways to make requests which yield results: A special note about bribes and threats: By three years old, most kids understand bribes and threats. Sounds terrible, doesn’t it? However, both can be useful when used sparingly. For example, you could offer to take your child out for ice cream, or a bike ride, or a special event, in exchange for cleaning his particularly horrendously messy room. But bribes used too often create a kid who expects to get “paid” for performing reasonable and customary personal and household tasks. Likewise, threatening a negative consequence must also be used sparingly or else you will end up with a resentful child who will have even more motivation to not listen to you. Remember to take away “extras” rather than essentials. For example, failing to listen may result in losing a finite amount of TV/videogame time. Do NOT threaten to take away eating dinner, reading with your child before bedtime or going to her best friend’s birthday party. Remember to follow through on the consequence immediately. Giving empty threats or putting off threats put you into the “nag” category. Most importantly, during any ice cream outing, bike ride, or special trip to the park, regardless if it was a planned event or a bribe, flip the table and take the time to listen to what your child has to say. Julie Kardos, MD and Naline Lai, MD Special thanks for input from Kim Ross. A first grade teacher for the past 19 years, Mrs. Ross holds a Bachlor’s degree in Early Childhood Elementary education and a Masters degree in Educational Psychology, both from Temple University. Mom of two, she also is a Certified Parenting Educator. ©2011 Two Peds in a Pod®
©2011 Two Peds in a Pod®
If you were around the New York area ten years ago on September 11, you know it was a beautiful crystal-clear day. It was the kind of day which made you gaze admiringly at the sky as you stepped out the door. No one knew that soon the sky over New York, Pennsylvania, and Washington, DC would be marred by the dark clouds of terrorist attacks. Many of your children were too young to remember much about the day, or perhaps they were not even born yet.
As the ten year anniversary of that tragic day approaches, we remind you of previous posts which may help your children digest the images they see in the media and the raw emotions of adults around them. Above all, don’t be afraid to discuss the day and assure your children that it’s still ok to reach for the sky:
Explaining Tragedy to Children
Books for helping children through bereavement
How to explain death to a young school aged child
This link from Common Sense Media may also help: Talking to your child about 9/11: What do you need to know?
Naline Lai, MD and Julie Kardos, MD
Wondering what crawled into your child’s room and bit her in the middle of the night? If you see two little pinpricks side by side, it’s probably a spider. Spider fangs make two little bite marks. Unfortunately, by the time you examine it in the morning, the bite may be so puffy and red that the two marks are no longer visible. With the exception of the Black widow spider and the Brown recluse spider, most spider bites are harmless and cause only a little bit of irritation. Over-the-counter hydrocortisone 1% ointment, ice, and an analgesic such as acetaminophen or ibuprofen can take the edge off of the itch and/or pain.
Naline Lai, MD and Julie Kardos, MD
©2011 Two Peds in a Pod®
Happy Start of School Year 2011! In case you missed these school related posts earlier, here are guides to packing a healthy school lunch, backpack weight guidelines, and deciding when to keep your children home for medical reasons. We wish your children a rewarding, educational, and healthy year. Julie Kardos, MD and Naline Lai, MD
©2011 Two Peds in a Pod®
We love it! With MyPlate, the United States Department of Agriculture’s new depiction of “a good diet” is easier to understand than the food pyramid. Mentally cut your kid’s plate in half. On one side are fruits and veggies, on the other side are grains and protein. The dairy is represented by a cup. Check out choosemyplate.gov for all sorts of hints including a personal plan which calculates the amount of each food group kids (and adults) above two years old need daily.
We’re wondering when people will start hearing about the “new pyramid”. We think the food pyramid gained prominence partially because of it’s visibility on cereal boxes. After all, we all stare groggily at the back of cereal boxes while eating breakfast. In the food pyramid days, grains were a large part of the pyramid base. Will the cereal companies have as much incentive to post MyPlate if grains have been relegated to a quarter of the plate?
We’ll find out.
Naline Lai, MD and Julie Kardos, MD
©2011 Two Peds in a Pod®
I love French fries, I mean really, who doesn’t? They’re probably one of the most delicious treats on the planet, but unfortunately they’re also one of the worst treats when it comes to our health. You’ll likely want to opt for baked “fries.”
It’s about overall diet. Ideally we should enjoy a diet that includes lots of fresh fruits and vegetables, fish, grains, and legumes, and one that is devoid of processed foods and sugary sodas. Even diet sodas may be harmful as they are laden with sweeteners made from chemicals.
Also very important, according to doctors, is maintaining a healthy weight. If you’ve had the pleasure of eating baked “fries,” you know what a tasty option they are; if not, please give the baked variety a chance.
You can cut some russet potatoes a bit thick and coat them and coat them with a little extra-virgin olive oil, some rosemary, a little salt and pepper and bake them until golden at 350 degrees, usually between 30-35 minutes. You can do the same with sweet potatoes, but use a little cracked black pepper instead of the rosemary. I normally boil my sweet potatoes first for about 15 minutes. They are a lot easier to peel that way. The recipe is in my book, My Italian Kitchen on amazon.com.
There is no reason to give up the foods you love, just find healthier ways to make them. This way of thinking has become my mantra. It could well become yours too, if it isn’t already.
Buona Salute! To Your Health~
Janet
Returning guest blogger Janet Zappala is a certified nutritional consultant and author of My Italian Kitchen — Home-Style Recipes Made Lighter & Healthier. She is also a six-time emmy award winning television journalist and the host of Wealth of Health at www.janetzappala.tv. Janet is a busy mom as well and is always creating ways to offer up delicious, nutritious foods that are quick and easy to make.
©2011 Two Peds in a Pod®
Medical mystery: What is that lump?
Hint: Your basketball star now is taller than you and works out daily.
Hint: He talks about pain at this spot.
Answer: Your kid’s tibial tuberosity when affected by Osgood Schlatter disease
First, some knee anatomy. The knee cap (patella) is anchored into place by tendons and ligaments. One called the patellar tendon attaches to the shin bone (tibia) below the knee at a point called the tibial tuberosity .
Repetitive bending movements of the knee, such as running and jumping, cause the patella tendon to pull on the bone where it attaches at the tibial tuberosity. Strain can result in a large tender lump which forms as the body tries to repair this area. This condition called Osgood Schlatter disease is associated with puberty, so most kids eventually “grow out of it.”
Ice, rest, and ibuprofen will alleviate pain. Your child’s health care provider may recommend gentle stretching of the quadriceps muscles or a knee brace. Beware of increased pain because rarely the muscle tears away from the bone and causes stress fractures.
Never know when you will “kneed” this information.
Naline Lai, MD and Julie Kardos, MD
© 2011 Two Peds in a Pod®
Many of our patients have dogs in their homes, and many choose to add a dog to their family during summer. Unfortunately, dog bite rates are also highest in summer, and occur most often in five to nine year olds, according to the Centers for Disease Control. Our guest expert today, veterinarian Dr. Sharin Skolnik, provides tips on how to introduce a dog into a home with children and how to best avoid dog bites. Interestingly, we noticed similar behavioral management strategies work for dogs and kids.
–Julie Kardos, MD and Naline Lai, MD
Two Peds: Are some breeds of dogs better for children?
Dr. Skolnik: Breed recommendations are tough, because there are such different personalities within every breed. Breeds bred to protect will tend to guard their family, but may not be friendly with other kids. I have had to euthanize golden retrievers and labs for severe aggression, and know some truly stellar pit bulls. I would like every family bringing a dog into their home to think about how much time and energy they can devote to the following: exercise/walks/play dates/ mental stimulation, grooming, feeding, veterinary care and arranging travel concerns/contingency plans. If I had to pick a good family breed, I would suggest a Cavalier King Charles spaniel, but only if you forced me to pick one!
Two Peds: Any suggestions for screening a dog before bringing it into the family?
Dr. Skolnik: Many rescue groups use experienced foster homes to really get an idea of where a dog is at before placement, which is wonderful. Look for a puppy or dog that is not too hyper or timid, unless you have the time and energy to devote to modifying these behaviors. An inquisitive but not pushy dog is ideal. Having said that, dogs are incredibly trainable in the right hands. Use care when bathing, feeding, or taking things away from a newly adopted dog. Trust is a two-way deal, and positive and gentle first interactions will set the stage for the relationship.
Two Peds: Why are young kids prone to dog bites by the family dog?
Dr. Skolnik: Many factors: kids are usually very bad at reading dog body language. For that matter, many adults I meet think that a wagging tail indicates a friendly dog, when in fact it means the dog is willing to interact, positively or negatively. Kids are usually loud and move unpredictably and quickly. Never leave kids and dogs unsupervised, because the kids may not understand how to be gentle and respectful of the dog. It is important to set clear and consistent expectations for both kids and dogs on what counts as acceptable behavior
Two Peds: What should parents teach their children about approaching a dog?
Dr. Skolnik: Teach them to always ask an owner’s permission with unknown dogs. Look for “soft” features like relaxed ears, floppy wagging tail, wiggling body. Tense body, rigid tail (wagging or not), backing up, dilated pupils– leave that dog alone. Supervision by responsible adults is key.
Two Peds: How can a dog be taught to “respect” a child?
Dr. Skolnik: Same way dogs learn to leave people’s houses and other pets alone. “Claim” items as yours, and not the dog’s, while meeting their needs. When I adopt a new dog: Guinea pigs/cats/shoes/etc. are mine. Every time the dog shows an interest in one of these things, he is told firmly “No.” The dog is given plenty of walks through the woods, praise for desired behaviors, some one-on-one time, and a few weeks later and we usually are on the same page. Consistency in training is key. The dog can’t be allowed to chase the cat when you are not home, so keep them separated! Set the dog up for praise, gently but firmly correct missteps, don’t overcorrect or correct after the fact. The latter only increase anxiety and the likelihood of future behavior problems
A common mistake in dog discipline is relying too much on punishment/ negative corrections and ignoring “good” behavior. For example; yelling at the dog for grabbing at the kids’ clothes, hands, whatever and ignoring the dog when it is chewing one of its own toys. Dogs are pack creatures; they rarely will play by themselves. Single-dog homes especially need to budget enough time each day to meet the dog’s mental and physical needs.
Two Peds: Should a dog that bites a kid be given a second chance? Can dogs be rehabilitated?
Dr. Skolnik: Depends on the scenario. A very forward dog with a history of unprovoked aggression towards kids is going to require a huge commitment to prevent injury and likely needs to go where there are no children, or humanely put to sleep. Most vets are pretty intolerant of dog aggression towards children. Now if an adult dog unfamiliar with kids snaps when a kid grabs an ear, or tries to take something away, or if the dog gave some warning that the kid should back off– I would blame the adults that put those two in the situation. Dogs (and people) can be rehabilitated, but there will always be the possibility of relapse. There are no guarantees with behavior modification.
Sharin Skolnik, DVM, holds a Bachelor’s degree from Cornell University School of Agriculture and Life Science and a veterinary degree from University of Pennsylvania School of Veterinary Medicine. She has been practicing veterinary medicine for 17 years and is a member of the AVMA and the NJVMA. She currently works at Chesterfield Veterinary Clinic in Bordentown, New Jersey.
Her “children” include five horses, eight dogs, eight cats, nine guinea pigs, nine hamsters, six sheep, 40 chickens, and 50 rabbits. She is also a long time friend of Dr. Kardos’s. Their children play well together under close supervision.
©2011 Two Peds in a Pod®
