It’s time for another Two Peds in a Pod photo quiz.

The question: What’s depicted in this photo?

If you answered: a pen, a thumb nail drive, or an asthma inhaler, you would be wrong.

Kids use these devices, which purposely look like common innocuous objects, to inhale electronic cigarettes (e-cigarettes). Vaping, also called “Juuling” and an even more concentrated form of vaping, called “dripping,” is unfortunately popular among teens. It’s unhealthy: the stuff that the kids are inhaling contains nicotine and other chemicals.

Ask your middle schooler or high schooler. They most likely have seen these devices if they have not actually used one.

Parents need to know kids are vaping in school as well as outside of school. Unlike conventional cigarettes, it’s easy for the kids to hide: no smoky smell, no cigarette cartons. The vaping liquid or “e-juice” comes in all kinds of “kid friendly” flavors such as gummy bear, fruit, or chocolate, and the devices needed to inhale them look like items in every kid’s pencil case or backpack.

It’s easy for kids to get the e-juice on the internet because online stores don’t always ask for proof of age (legal age to buy is 18 years in the US). Most e-juices contain nicotine, which is addictive. Emerging data show that kids who vape are more likely to go on to use regular cigarettes than kids who do not vape.

Bottom line: Vaping, or using electronic cigarettes, is unhealthy and addictive, and startlingly easy for kids to hide.

Julie Kardos, MD and Naline Lai, MD
©2018 Two Peds in a Pod®

Nope, warthogs don’t actually have warts. But kids often do!

Emma’s dad and I both peered at the filamentous growth dangling from his nine year old’s right nostril.  “Yes,” I said, “it’s definitely a wart.”

Emma’s dad offered, “When I was a kid, I heard the way to get rid of a wart was to cut a potato in half, rub it on the wart, and bury the potato in the backyard. Legend had it, by the time the potato disintegrates, the wart will be gone.”

“I wish it were so easy,” I replied.

Warts are caused by skin-dwelling viruses. On the feet, warts can sometimes be mistaken for calluses.  One distinguishing feature is that warts sit in the skin like this:

Fine “feeder” blood vessels extend from the wart into the skin. Therefore, if you scrape off the top layer of a wart, a dotted pattern usually appears from above. The dots will not appear in a callus. View from above:

There are simply no glamorous ways to get rid of warts. Most treatment modalities destroy warts by pulverizing the home they live in, a.k.a. your skin. Your doctor may be armed with various agents such as liquid nitrogen or dimethyl ether propane, which produces a chemical “freeze” and dries up the wart. Another agent called cantharidin (otherwise known as “beetle juice”) is a caustic liquid derived from the blister beetle. Application of beetle juice causes the warts to blister.

Some doctors will even manually take a scalpel and cut out the warts.

Like I said, there are no glamorous treatments. However, more gentle creams which stimulate the immune system, such as Imiquimod (Aldara) show some promise in children. Other compounds such as 5-fluorouracil can be topically applied or injected and treatments such as pulsed dye laser therapy have mixed reviews.

Over-the-counter remedies exist in a milder form.  Commonly used wart removers such as Compound W, Dr Scholl’s Clear Away Wart, and Duofilm all contain salicylic acid.  The acid slowly dries up the warts.  When applying salicylic acid, after a few applications make sure you peel the dead crusty top layer off  the wart. Without peeling, future medicine will not reach the wart.  These methods can take weeks to months to work, but they do work.

And don’t forget the duct tape.  Duct tape, the great all-purpose household item, has also been shown to speed up the resolution of warts. Scientists hypothesize the constant presence of the adhesive somehow stimulates a natural immune response.  If you try duct tape, have your child wear the duct tape over the wart for several days in a row and then give a day off. If the wart is on a hand or foot, the tape tends to fall off during the day: just re-apply some tape at bedtime. Effects should be seen within a couple of months if not sooner. Now, the original study that showed duct tape was helpful, was followed by a study which showed duct tape was not helpful. Some hypothesize that the results differ because silver sticky duct tape was used in the initial study, while the later study used less sticky duct tape. So be sure to use the old-fashioned silver duct tape.

The prevention of warts is tricky.  Some people just seem genetically predisposed.  However, your best bet for keeping warts away is to keep your child’s skin as healthy as possible.  Warts tend to gravitate towards areas of skin broken down by friction such as feet or fingers. Liberally apply moisturizing creams daily to prone areas.  After a summer of wearing flip-flops and walking on the rough cement by the side of a swimming pool in bare feet, many children end up with warts on the bottom of their feet.  I know a teen whose warts on the tips of her fingers stemmed from months of guitar strumming.

Turns out that even without treatment, 60% percent or more of all warts will disappear spontaneously within two years.

Coincidentally, I think that’s also the time it takes for a potato half to disintegrate.

Naline Lai , MD and Julie Kardos, MD

© 2009, 2018 TwoPeds in a Pod®

Conversation hearts murmuring

When the Tin Man was a child in Oz, I’m sure his pediatrician never told his parents, “Has anyone ever said your child has a heart murmur? I hear one today.”

I know that when I tell parents about a heart murmur in their child, their hearts skip and jump. But not all heart murmurs are bad.

What is a heart murmur?

A heart murmur is an extra sound that we pediatricians hear when we listen to a child’s heart with a stethoscope. A normal heart beat sounds like this:  “lub, dub.  lub, dub.  lub, dub.”  A heart murmur adds a whooshing sound.  So what we hear instead is “lub, whoosh, dub” or “lub, dub, whoosh.”

The “whoosh” is usually caused by blood flowing through a relatively narrow opening somewhere in or around the heart. Think of your blood vessels and heart like a garden hose.  If you run the water (blood) very hard, or put a kink or cut a hole in the hose, the whoosh of the water grows louder in those locations.

Heart murmurs signal different issues at different ages.

In a newborn, some types of heart murmurs are expected. Normal newborn hearts contain extra holes that close up after the first hours or days of birth. One type of murmur occurs as the infant draws in his first breath and holes in the heart, present inside the womb, begin to seal. As the holes get narrower, we sometimes hear the “whoosh” of blood as it flows through the narrowing opening. Then these holes close completely and the murmur goes away.

However, some murmurs in infancy signal “extra holes” in the heart. As pediatricians, we experience our own heart palpitations when moms want to leave the hospital early with their infants who are less than 48 hours old. We worry because many infants who have abnormal hearts may not develop their abnormal heart murmurs and other signs of heart failure until the day or two after birth.

Preschool and early school-age children often develop “innocent” heart murmurs. “Innocent” implies that extra blood flows through their hearts, but the hearts are structurally normal. These murmurs are fairly common and can run in families. However, there are some significant heart problems which do not surface until this age. For this reason, remember to schedule those yearly well child checkups.

For teens, during the pre-participation sports physical, pediatricians listen carefully for a murmur that may indicate that an over grown heart muscle has developed.

What else can cause a heart murmur?

Holes are not the only culprit behind a murmur. The whoosh sound can also arise when a person is anemic and blood flows faster than normal. In anemic kids, the blood flows faster because it lacks enough oxygen-carrying red blood cells and the heart needs to move blood faster in order to supply oxygen to the body. The most common cause for anemia is a lack of eating enough iron-containing foods. Subsequently, we hear these flow murmurs in children whose diets lack iron, in teenagers who grow rapidly and quickly use up their iron stores, and in girls who bleed too much at each period. Replenishing the iron level makes a heart murmur from anemia go away.

Even a simple fever can cause a heart murmur on physical exam. The murmur goes away when the fever goes away.

Pediatric health care providers can often distinguish between “innocent” heart murmurs and not-so- innocent heart murmurs by the sound of the murmur itself (not all “whooshes” sound alike). If any question exists, your child will be referred for more testing, which could include a chest x-ray, an EKG (electrocardiogram), an ECHO (echocardiogram, or ultrasound of the heart), or evaluation by a pediatric cardiologist.

If your child’s pediatrician tells you that your child has a heart murmur, “take heart.”

Many times a murmur comes and goes or just becomes part of your child’s baseline physical exam. Even if your child has a serious heart problem, most cases respond well to medication, surgery, or both. While not all heart problems cause heart murmurs, and while not all murmurs signal heart problems, the presence of a heart murmur in a child can signal that your child needs further testing.

Unless, of course, your child is the Tin Man. In this case, extra sounds indicate that your child needs more oil!

Julie Kardos, MD and Naline Lai, MD
©2010, 2018 Two Peds in a Pod®

photo by Lexi Logan, www.lexilogan.com

The recent Parkland shooting in Florida is causing many to wonder how to support the emotional health of boys in their families and communities. We welcome therapist Dina Ricciardo’s words of wisdom— Drs. Kardos and Lai

Your son is crying.  A mad dash across the playground has led to a spectacular trip and fall, complete with a bloody knee and hands full of dirt.  Part of you wants to hold him on your lap and console him until he stops crying.  The other part of you wants to firmly wipe away his tears and tell him to be brave.  Which part of you is right?

In a world where there is a great deal of emphasis placed on the emotional health of girls, our boys are frequently overlooked.  While girls are typically encouraged to develop and express a broad range of emotions, boys are socialized from a young age to suppress their feelings. As a result, many boys and men struggle to express fear or sadness and are unable to ask for help.  It is time for us adults to stop perpetuating stereotypes and myths about manhood, and help each other raise emotionally healthy boys. Here are five ways for us to do so:

Make his living environment a safe space to express emotions. Give your son permission to express all of his feelings. Boys typically do not have the freedom to show the full range of their emotions in school and out in the world, so it is essential that they have that freedom at home.  Nothing should be off limits, as long as feelings are expressed in a manner that is not destructive.

Expose him to positive male role models. Boys need to be exposed to positive male figures who can to indoctrinate them into their culture and teach them how to be men. It is an important rite of passage in a boy’s development.  Take a look around your social ecosystem and ask yourself, “Who would be good for my son?”  Other parents, coaches, teachers, and pastors are examples of individuals who can play a positive role in his life.

Understand your unique role.  Each parent plays a unique role in the development of a son, and that role changes over time. A mother is a son’s first teacher about love and what it looks like, and this dynamic can breed a particular kind of closeness.  As a boy grows and begins to develop his sexuality, however, it is natural for him to pull away a bit from his mother and turn more towards his father for guidance. While this distance can be unsettling for mom, it marks a new phase in a son’s relationship with his father, who typically provides a sense of security and authority in a family as well as support for a boy’s developing identity. Mothers still play an important role, but that role may look different. As parents, it is important to re-evaluate what our sons need from us at each stage of their development.

Look at the world with a critical eye. Our culture not only glorifies violence, it equates vulnerability in males with weakness and attempts to crush it. That does not mean we have to accept this paradigm.  Talk honestly with your son about how and when to be gentle and compassionate, educate him on how the world view softness in men, and never tolerate anyone shaming him when he exhibits these traits. There is no shame in showing vulnerability, it is actually an act of courage.

Take a look in the mirror. Whether you are a mother or a father (or both), be honest with yourself: what are your beliefs about manhood? Do you feel safe expressing all of your feelings, or are some of them off-limits? If you are perpetuating negative stereotypes about men or are not comfortable with a full range of emotions, then your son will follow in your footsteps. Regardless of our own gender, we cannot expect our children to be comfortable with their feelings if we are not comfortable with our own.

There are times when insuring the emotional health of your son will feel like an uphill battle.  Keep the conversation open, and do not be afraid to talk with others about the dilemmas of boyhood and manhood.  And if you are looking for an answer to the playground dilemma, then I will tell you that both parts of you are right.  Sometimes our sons need loving compassion, and sometimes they need a firm nudge over the hump.  You know your child better than anyone else, so it is up to you to decide which approach to use and when.

Dina Ricciardi, LSW, ACSW

©2016, 2018 Two Peds in a Pod®

Dina Ricciardi is a psychotherapist in private practice treating children, adolescents, and adults in Doylestown, PA. She specializes in disordered eating and pediatric and adult anxiety, and is also trained in Sandtray Therapy. Ricciardi is a Licensed Social Worker and a member of the Academy of Certified Social Workers. She can be reached at dina@nourishcounseling.com.

Photo by Lexi Logan

We welcome Bereavement Counselor Amy Keiper-Shaw who shares with us how to discuss the death of a pet with your child.
–Drs. Lai and Kardos

When I first graduated from college I worked as a nanny. One day the mom shared with me that their family goldfish recently died. As this was her daughter’s first experience with death, we schemed for nearly 20 minutes to find the best way to talk to her child. The mom and I thought it could be an excellent teaching moment.

We pulled the girl away from her playing to explain that the fish had died. We told the girl we’d help her have a funeral if she wanted, and we would find a box (casket) to bury the fish so she could say her goodbyes. We explained what a casket was and what a funeral was in minute detail. After our monologue we stopped, we asked if she had any questions.

After a slight pause she asked, “Can’t we just flush it?”

The lesson I learned from that experience, and still use to this day, is to keep things simple, and know my audience. Sometimes as parents we overcompensate for our own fears and make situations more challenging than they need to be.

Here are some tips on how to talk to your children about pet loss:

Tell your child about the death, and then pause. Ask her what she thinks death means before moving on with further explanations. This will help you know if she has questions or if she has enough information for the moment. Children often need a small amount of information initially and will later come back to you several times later to ask more questions after they process the information.

Remember to express your own grief, and reassure your child that many different feelings are ok. Be sure to allow children to express their feelings. If your child is too young to express herself verbally, give her crayons and paper or modeling clay too help express grief.

Avoid using clichés such as: Fluffy “went to sleep.” Children may develop fears of going to bed and waking up. The phrase “God has taken” the pet could create conflicts in a child and she may become angry at a higher power for making the pet sick, die, or for “taking” the pet from them.

Be honest. Hiding a death from a child can cause increased anxiety. Children are intuitive and can sense is something is wrong. When the death isn’t explained they make up their own explanation of the truth, and this is often much worse than the reality of what occurred.
Children are capable of understanding that life must end for all living things. Support their grief by acknowledging their pain. The death of a pet can be an opportunity for a child to learn that adult caretakers can be relied upon to extend comfort and reassurance through honest communication.

Developmental Understanding of Death

Two and three-year-olds
Often consider death as sleeping, therefore tell them the pet has died and will not return.

Reassure children that the pet’s failure to return is unrelated to anything the child may have said or done (magical thinking).

A child at this age will readily accept another pet in the place of a loved one that died.

Four, five, and six-year-olds
These children have some understanding of death but also a hope for continued living (a pet may continue to eat, play & breathe although deceased).

They can feel that any anger that they had towards the pet may make them responsible for the pet’s death (“I hated feeding him everyday”).

Some children may fear that death is contagious and could begin to fear their own death or worry about the safety of their parents.

Parents may see temporary changes in their child’s bladder/bowels, eating, and sleeping.

Several brief discussions about the death are more productive than one or two prolonged discussions.

Seven, eight, and nine-year-olds
These children have an understanding that death is real and irreversible.

Although, to a lesser degree than a four, five, or six-year-old, these children may still possibly fear their own death or the death of their parents.

May ask about death and its implications (Will we be able to get another pet?).

Expressions of grief may include: somatic concerns, learning challenges, aggression, and antisocial behavior. Expression may take place weeks or months after the loss.

Adolescents
Reactions are similar to an adult’s reaction.

May experience denial which can take the form of lack of emotional display so they could be experiencing the grief without outwards manifestations.

Resources:
Petloss.com– a gentle and compassionate website for pet lovers who are grieving the death or an illness of a pet- they have a Pet Loss Candle Ceremony every week

Your local veterinarian- often your veterinarian has or knows of a local pet loss group

Handsholdinghearts.org– our group of counselors offer grief support to children, teens, and their families centered in Bucks County Pennsylvania.

Books on pet loss for children:

Badger’s Parting Gifts (children) by Susan Varley
Lifetimes by Brian Mellonie & Robert Ingpen
The Tenth Good Thing About Barney (children) by Judith Viorst

Amy Keiper-Shaw, LCSW, QCSW, GC-C
©2013, 2018 Two Peds in a Pod®
Amy Keiper-Shaw is a licensed grief counselor who holds a Masters Degree in clinical social work from the University of Pennsylvania. For over a decade she has served as a bereavement counselor to a hospice program and facilitates a bereavement camp for children. She directs Handsholdinghearts, a resource for children who have experienced a significant death in their lives.

Raw hands- recognize your kid?

Even when it isn’t flu season, we pediatricians wash our hands about sixty times a day, maybe more. This frequent washing, in combination with cold winter air, leads to dry, chapped hands. Here are the hands of a patient. Do your children’s hands look like these?

To prevent dry, chapped hands:

• Don’t stop washing your hands, but do use a moisturizer afterwards. Also use warm but not hot water. Hot water removes protective oils from skin.
• According to the American Academy of Dermatology, hand sanitizer can prevent the drying that accompanies frequent hand washing. However, we can tell you from experience that once your hands are already chapped and cracked, the alcohol content in the sanitizers stings sensitive skin. So if your child’s hands are already chapped, stick with water and soap.
• Wear gloves or mittens as much as possible outside even if the temperature is above freezing. Remember chemistry class—cold air holds less moisture than warm air and therefore is unkind to skin. Gloves will prevent some moisture loss. Having difficulty convincing your child to wear gloves? Point out that refrigerators are kept around 40 degrees Fahrenheit or below. Tell your kids that if they wouldn’t sit inside a refrigerator without layers, then it would be wise to wear gloves.
• Before exposure to any possible irritants such as the chlorine in a swimming pool, protect the hands by layering heavy lotion (e.g. Eucerin cream) or petroleum based product (e.g. Vaseline or Aquaphor) over the skin.

To rescue dry, chapped hands:

• Prior to bedtime, smother hands in 1% hydrocortisone ointment. Avoid the cream formulation. Creams tend to sting if there are any open cracks. Take old socks, cut out thumb holes and have your child sleep at night with the sock on his hands. Repeat nightly for up to a week. Alternatively, for mildly chapped hands, use a petroleum oil based product such as Vaseline or Aquaphor in place of the hydrocortisone.
• If your child has underlying eczema, prevent your child from scratching his hands. An antihistamine taken orally such as diphenhydramine (Benadryl) or cetirizine (Zyrtec) will take the edge off the itch. Keep his nails trimmed to avoid further damage from scratching.
• For extremely raw hands, your child’s doctor may prescribe a stronger cream and if there are signs of a bacterial skin infection, your child’s doctor may prescribe an antibiotic.

Happy moisturizing. Remember smearing glue on your hands and then peeling off the dried glue? It’s not so fun when your skin really is peeling.

Naline Lai, MD and Julie Kardos, MD
© 2009, updated 2019, Two Peds in a Pod®

In light of the recent school shooting in Parkland, Florida, you may be left wondering if, and how, to explain this or other tragedies to your children.

Understand that kids sense your emotions even if you don’t tell them. Not telling them about an event may make them concerned that they are the cause for your worried hushed conversations. Break away from your discussion with adults to say, “ Do you know what we are talking about? We are not talking about you.”

Even though an event may be far away, media makes it seem as if it happened next door, and sooner or later your children will see or hear about it. Tell the facts in a straight forward, age appropriate manner. Answer questions and don’t be afraid to answer with an “I don’t know.” Preschoolers are concrete in their thinking—dragons are real and live under their bed, so don’t put any there that do not exist. For a preschooler a simple “Mom is sad because a lot of people got hurt,” will suffice. Young school age kids will want to know more details. And be prepared to grapple with more high level questions from teens.

Look for the helpers. Mr. Rogers who hosted Mister Roger’s Neighborhood for 30 years, tells this story about seeing scary things on the news: “My mother would say to me, ‘Look for the helpers. You will always find people who are helping.’ To this day, especially in times of ‘disaster,’ I remember my mother’s words, and I am always comforted by realizing that there are still so many helpers-so many caring people in this world.”

What if the kids ask, “Will that happen here?” or “Why did that happen?” Again, reassure in a simple straight forward manner. For instance you can say, “Many people are working hard to prevent something like that here.” Consider answering the question with a question. Asking “What do you think?” will give you an idea of exactly what your child fears. You can also reach out to other family supports for help with answers. Say to your child, ”I wonder what our minister or school counselor has to say about this, let’s ask.”

Routine is reassuring to children, so turn off the background 24 hour television and internet coverage and make dinner, take them to sports activities, and get the homework done.

Give your kids something tangible to do to be helpful. Help them set up a coin donation jar at school or put aside part of their allowance for a donation.

If your child seems overly anxious and fearful, and her worries are interfering with her ability to conduct her daily activities, such as performing at school, sleeping, eating, and maintaining strong relationships with family and friends, then seek professional help.

For more advice on this topic, please see this American Academy of Pediatrics recommendation for parents. Also, the following is a firearms safety message for parents, from the AAP:

• Young children are curious. They are often unable to remember or follow safety rules. Teens are impulsive, and naturally tend to be moody. When combined with access to firearms, the consequences can be tragic and permanent.

• Many homes have guns – which is why you have to ask about guns when your child visits another home. Depending on location, 18 percent to 64 percent of U.S. homes have firearms.

• If there is a gun in the home, there’s a good chance a child living there will know where it is. In a recent study, 39 percent of parents erroneously believed their children did not know where their gun is stored, and 22 percent wrongly believed their child never handled a gun.

• The safest home for children and teens is one without guns. If you do have a gun, you can greatly reduce the risk of a child being injured or killed by storing the gun unloaded and locked, with the ammunition locked in a separate place.

Parent your children so they feel secure in themselves and secure in the world around them. You may not hold the answers to why a tragedy strikes, but you do hold the ability to comfort and reassure your children.

Naline Lai, MD and Julie Kardos, MD
© 2018 Two Peds in a Pod®, adapted from our 2015 post

So you just read our post “Does my child have the flu or a cold” and you’ve decided that your child likely has the flu (short for influenza). Now what do you do? When do you call the pediatrician? Does your child need medication?

First take a deep breath. Then, make sure your child is breathing easily. She may be coughing a lot but as long as her breathing is unlabored, and you see no retractions (see 6 second video in our coughing post), her lungs are most likely OK. Kids who are short of breath can become agitated or lethargic. A little tiredness from illness is normal, but extreme lethargy is not.

Think about it. Is your child’s mental state OK? Is she thinking clearly, walking well, talking normally, and consolable? She may be more sleepy than usual but when awake she should be rational and easily engaged.

Hydrate!  A high fever and cough increases a child’s hydration needs.  Make up for lost fluids by aiming to give her at least one and one-half times the amount she usually drinks in a day. For example, if she typically drinks 24 ounces of water or milk per day, try to give at least 36 ounces of fluid per day. Offer your child ANYTHING she wants to drink, including soup, juice, lemonade, electrolyte replenishers (e.g. Gatorade or Pedialyte), decaffeinated tea or a little flat decaffeinated soda.

If your child is not eating, avoid hydrating solely with plain water. Kids need salt to keep their blood pressure up and sugar to keep their energy levels up. And yes, milk is great to offer. If milk doesn’t cause your child to make more mucus when she is healthy, then it won’t affect her nose or lungs when she is sick. Even chocolate milk is fine! For infants, give breastmilk or formula—no need to switch. The goal is to produce PEE. Well hydrated kids pee at least every 6-8 hours. Other signs of dehydration include dark urine, dry mouths/lips, the inability to produce tears, sunken eyes, and sunken soft spot (in an infant).

Offer food as well. My grandmother used to say, “Feed a cold, starve a fever.” I loved my grandmother, but she was incorrect about this advice. Food = nutrition = improved germ fighting ability. However, don’t argue with your sick kid about eating if she is not hungry. Just know that drinking extra is a MUST.

Placate pain. She may have muscle aches, a headache, or a sore throat. Relieve her discomfort with ibuprofen (Motrin, Advil) or acetaminophen (Tylenol). Offer some ice pops and a movie on the couch. If she is in severe pain, is unable to move normally, or is inconsolable, call your child’s doctor. Unable to move or inconsolable = very bad.

It’s OK to play and move about. Your child with flu might spend a large portion of her day on the couch or in bed but it’s fine to let her play and have some activity. Some walking around and playtime helps her exercise her lungs. “Moving” her lungs with a cough actually prevents pneumonia by preventing germy mucus from lodging in the lungs. Also, seeing that your child can walk around, despite her aches and discomfort, will reassure you that she is handing her illness.

Does every kid with flu need to see a doctor? No. Some kids have medical problems that predispose them to complications of illness and doctors will want to see those kids more often. Most otherwise healthy kids get through the flu, as long as they drink enough and can be kept comfortable. The fever from flu usually lasts from 4-7 days and can go quite high, but you know from reading our fever post that the number alone is not what you fear. What matters is how your child is acting.

Some reasons your child should see a doctor:
-difficulty breathing
-change in mental state or you cannot console her
-your child is dehydrated
-a new symptom that concerns you
-the fever goes away for a day or two and then returns with a vengeance
-fever goes on more than 4-7 days, but you can certainly call the doctor to check in by day 3-5
-a rash appears during the flu illness (this can be a sign of overwhelming bacterial infection, not the flu)
-new pain (eg. ear pain from an ear infection) or severe pain
-your gut instinct tells you that your child needs to see a doctor

What about Tamiflu (brand name for oseltamivir) ? Some areas of the United States are experiencing a shortage of this anti-flu medicine. Oseltamivir can lesson the severity of flu symptoms and perhaps shorten how long the flu lasts by about a day. Since most people recover in about the same amount of time without the medication, the CDC (Centers for Disease Control) and the AAP (American Academy of Pediatrics) issued treatment guidelines. Kids with certain lung, heart, neurologic, or immune system diseases, kids with diabetes, and kids under the age of two years may be medication candidates.  You can check the exhaustive list here. The other two medications that cover the two main types of flu are not available in oral form.

Better than Tamiflu is the flu vaccine. Remember the saying, “An ounce of prevention is worth a pound of cure?” A 2017 study showed that the flu vaccine prevented kids from dying of the flu. Vaccinated kids who do end up with the flu tend to have less severe illness. The vaccine prevents several types of the flu, so even if your child gets flu and did not receive the flu shot this season, it’s not too late. Take her to get it after her fever is gone. Also put in a reminder to yourself to schedule a flu vaccine appointment for your child next September, in advance of next winter’s flu season.  

Over-the-counter flu medications  do not treat the flu, but they can give side effects. In fact, cough and cold medicines should not be given to children younger than four years, according to the American Academy of Pediatrics. Instead, try these natural remedies:

-If older than one year, you can give honey for her cough and to soothe her throat.
-Run a cool mist humidifier in her bedroom, use saline nose spray or washes, have her take a soothing, steamy shower, and teach her how to blow her nose.
-For infants, help them blow their noses by using a bulb suction. However, be careful, over-zealous suctioning can lead to a torn-up nose and an overlying bacterial infection. Use a bulb suction only a few times a day.

What about black elderberry (sambucus)? Articles abound on social media about the benefits of black elderberry in fighting flu symptoms. However, if you read a credible source such as the National Institute of Health information site about complementary and alternative medicine, you will find, “Although some preliminary research indicates that elderberry may relieve flu symptoms, the evidence is not strong enough to support its use for this purpose.” The research was not conducted with kids, so unfortunately we cannot recommend this unproven treatment for flu.

Take heart. While the groundhog predicted 6 more weeks of winter this year, history shows that the groundhog is usually wrong.

Julie Kardos, MD and Naline Lai, MD
©2018 Two Peds in a Pod®

photo by Lexi Logan

We are seeing a lot of coughing kids in the office these days. In general we like coughs. Coughs keep nasty germs from lodging in the lungs. It is hard for parents to tell if a cough is from a cold, an asthma flare, pneumonia, allergies, or something else. Regardless of what is causing your child to cough,  even if you think your child has a simple cold, it’s important to recognize when your child is having difficulty breathing. Share this information with all of your child’s caretakers, including teachers. Too often we get a child in our office with labored breathing which started during school hours but was not recognized until parent pick-up time.

photo from pixabay

Dr. Lai’s son practices his saxophone with headphones on, while Dr. Kardos’s son rarely remembers to protect his ears while practicing drums. While admirable that they both practice their instruments, guess which one is more at risk for teen hearing loss?

Sound is described by decibels (loudness) and by frequency (pitch) measured in hertz. An example of a high frequency sound is a person whispering. A very high frequency noise is the sound of a dog whistle. By thirty years old, almost everyone experiences some hearing loss at frequencies above 15 hertz. If you are this age, this is why everyone now seems to mumble at parties. A few years ago, teens capitalized on this natural hearing loss phenomenon with “mosquito” ringtones– high frequency cell phone rings heard only by younger ears but not by prying adult ears. For kicks, check out your ability to hear high frequencies at this non-scientific site.

Exposure to loud sounds at high decibels hastens the natural progression of high frequency hearing loss. The ringing in the ears after a loud concert or a day of weed-wacking is the “sound” of hearing loss occurring. Damage to the hearing nerve (cochlear nerve) in an ear can occur from a one time exposure to dangerously high decibels or from repetitive exposure over time.

What is the margin of safety?

• Sounds above 85 decibels cause damage.
• Those below 75 decibels rarely cause problems.
• The humming of a refrigerator is 40 decibels.
• Ordinary conversations are 60 decibels.
• City traffic registers at 80 decibels.
• Lawn mowers and hair dryers are around 90 decibels.
• Firecrackers explode at 120-140 decibels.
• After two minutes, exposure to rock concerts (which usually register at 110 decibels) may cause damage.
• For lawn mowing, the permissible exposure time of exposure is some time between 2-4 hours.

This site gives maximum recommended lengths of time for exposure to loud sounds.

When we last published a post on teen hearing loss five years ago, there was concern that amongst teens, high frequency hearing loss was on the rise. Turns out this may not be the case, however, there is still concern that teens are putting themselves at risk for hearing loss from their frequent use of headsets and earbuds. Because of differences in ear buds and how music is recorded, there is no uniform way to regulate the volume reaching your teen’s ears. However, as a general rule of thumb, if you can hear your teen’s music playing when he has ear buds in, it’s too loud. Kids should be able to hear normal conversations even when their devices are on. Frequently asked questions about sound settings for Apple devices can be found at the Apple site. Encourage your kids to protect hearing by turning down the sound, and by using ear plugs or sound blocking headphones when appropriate.

Finally, we should mention signs of “selective hearing loss.” Many parents describe this form of “hearing loss” in the office. In these cases, a child does not hear her mom admonish “Clean your room,” yet hears her mom whisper “Let’s go out for ice cream.”

Even if your teen can hear, he may not listen!

Julie Kardos, MD and Naline Lai, MD
©2018 Two Peds in a Pod®