“I need a nap!”—recognize this tired parent?

OKAY, let’s take a quick survey: how many of you have ever put your over-tired young child into the car, then driven on a bumpy road on a route known for its paucity of traffic lights, looking in the rearview mirror hoping to see a sleeping child?

How many of you have ever rocked your young child until you BOTH have fallen asleep in the chair?

How many of you have purposefully keep your child AWAKE in the car in order to get home before nap time, doing anything to keep her awake? Otherwise, you predict, if  your child falls asleep on the five minute car ride home, she will wake up when you try to transfer her to the crib. If that occurs you will lose the nap for the rest of the day and she will be MISERABLE (and, hence, so will you).

How precious is nap time? All parents know the answer to this question: VERY VERY PRECIOUS! Parents spend the time during a baby or toddler’s nap to pay bills, do laundry, prepare a meal, clean the house, spend time with an older sibling, and perhaps most importantly, TO TAKE A NAP OURSELVES.

Yet all children outgrow their need to nap sooner or later (at least, until they become parents themselves). The exact time this dreaded day comes can vary. The range is typically between two and five years of age. And children do not always give up their naps all at once. One day they do not nap, then they nap the rest of the week, then they don’t nap for a few days, then they nap one day, and so forth. Sometimes they fall asleep only if they happen to be in the car. Eventually your child will sleep only overnight and not at all during the day.

Naps are very important for young children. Not only do naps foster better cheer, better learning, and better behavior, but also good naps actually help improve night time sleep. Any parent can attest that an overtired toddler has a WORSE night sleep than a toddler who goes into bedtime well-rested. This is one of the great paradoxes of childhood. I like to explain to my patients: “Good sleep begets good sleep.”

Just as you invest your time and effort in taking good care of baby teeth only to have them all fall out later, you should invest your time and effort in establishing good nap habits for your young child, even though your child eventually gives up her nap. Start by making sure she can fall asleep on her own during her NIGHT bedtime routine (see our podcast on this subject) . If she can fall asleep on her own at night, she will be more apt to fall asleep in the day.  Darken the room and give her other signals associated with sleep such as her favorite stuffed animal or lullaby. Have a short “nap time routine” just as you have a night time routine. Save the serious sleep training for night time- you do not have the luxury of hours to train in the day.  If she does not fall asleep within half an hour, get her up and struggle through the rest of the day, or try again later.

If she still will not nap after several days of trying, go ahead and do whatever it takes to have a happy kid by dinner. Take that car ride, rock her to sleep… understand that the “fix” is temporary. Either she will give up the “nap rebellion” or she will give up the nap entirely. Continue to put your non-napper in bed at night earlier to make up for her lack of daytime sleep.  When your child is mostly cheerful, not throwing an unusual number of toddler tantrums, and is at least two years old, then likely she has truly outgrown her need to nap.

In the meantime, go grab some Zzzzzs. I know some of you only have time to read this post because your child is napping. So go follow suit!!

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

Your son’s baseball league has just upped the ante, moving from “coach pitch” to “kids pitch.” The good news is that your budding major league pitcher gets some practice. The bad news is that the pitches can be wild. Thank goodness for batting helmets!

So what if the unthinkable happens? You are cheering your child on, when suddenly the wild pitch (or the hit ball, or the wild throw to first base) wacks into your child’s head. He is knocked down and you go running.

First evaluate if your child is conscious. Passing out even momentarily is a reason to seek medical attention right away. Most likely he will not have passed out and will want to return to play. However, the safest bet is to have your child sit out the rest of the game.

Next determine if your child is bleeding inside his head. You may see a growing lump on his head which looks gruesome. However, we pediatricians are less concerned about bleeding or bruising that occurs on the outside of his skull than about possible bleeding inside his skull.

How can you tell where the bleeding is? Again, a loss of consciousness, or passing out, is a worrisome event that may signal bleeding on the inside. In addition, watch for blurry or double vision (“I see two mommies!”), inability to speak clearly or rationally, difficulty walking or loss of balance, vomiting more than once (some kids vomit once when they are scared or in pain), or headache so severe that it is not relieved by acetaminophen (Tylenol) or ibuprofen (Motrin, Advil).  Not all symptoms appear immediately.

So now your child has cheered the team on to victory, enjoyed the after-game snack, has forgotten about the trauma, and is nodding off in the back seat of your car. As you drive him home you remember some vague advice about not letting your child fall asleep after a head injury. Now what?

Go ahead and let your child sleep for a couple of hours, he probably is tired both from the game and from the injury.  You have the rest of the day to observe him.

Sometimes, injuries are not conveniently timed. If a head injury occurs right before bedtime, you will not be able to watch for signs of internal head bleeding because your child will be sleeping. The best way to assess him is to wake him briefly every 2-3 hours throughout the night. 

If your child makes it to 24 hours without symptoms, it is unlikely your child is bleeding inside his head. However, if your child still seems “off” he needs medical attention. Even if he is not bleeding, he may have a concussion (now termed “traumatic brain injury”).

Although it’s never easy to see your child hurt, whether it’s a scrape on the knee or a bump on the head, you can empower yourself by knowing what to watch for. Now that’s using your noggin!

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

As Mother’s Day approaches, we give you our first Two Peds in a Pod “Top Ten List.” 

Top Ten Skills You Acquire as a Mother

     10)  Not being completely grossed out by another person’s poop.

 9)  Ability to sense the “moment before the vomit” and to hustle your child to the nearest garbage can or toilet before it’s too late.

 8)  Ability to lick your own finger and then use it to clean a smudge completely off your child’s face.

 7)  Ability to get through a day (after day after day) after one (or many) completely interrupted night’s sleep.

 6)  Willingness to show up at work or just go out in public with dried spit-up on your shoulder.

 5)  Ability to use your “momometer” by touching or kissing your child’s forehead to tell if he has a fever (with fair degree of accuracy!).

 4)  Ability to see through walls in order to tell that your child did not wash his hands after using the bathroom.

 3)  Ability to see directly behind you to know that your child is getting into trouble.

 2)  Ability to wield the Magic Kiss that can make any and all boo-boos better.

 1)  Ability to love more than you ever thought possible, and the ability (finally) to understand just how much your mother loves you.

Rejoice in your abilities!

Happy Mother’s Day from Two Peds in a Pod.

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

This sign now sits on my friend’s lawn. I still remember four years ago when I pulled my big blue minivan up in front of their house after the moving van left. A mommy sat on the stoop with her children. “How old are they? I hollered out. The ages of the children matched my children’s and I was delighted. Indeed they became good friends. And now, there’s the “For Sale” sign.

It’s nearing the end of the school year, and “For Sale” signs dot lawns all over the United States. Chances are, one of them belongs to your child’s friend. Just as the child who moves will have to adjust to a new environment, your child will have to adjust to a world without a friend who was part of his daily routine.

Much has been written about how to transition the child who moves into a new environment, but how can you help your child when his close friend moves away? 

Your child may experience a sense of loss and feel that he was “left behind.” Some children perseverate over the new hole in their world. Others take the change in stride.

In the late 1960’s, psychiatrist Elisabeth Kubler-Ross described “the five stages of grief.” The stages were initially applied to people suffering from terminal illness, but later they were applied to any type of deep loss such as your child’s friend moving. The first stage is denial: “I don’t believe he moved.” Anger follows in the second stage: “Why me? That’s not fair!” Your child may then transition into the third stage and bargain: “If I’m good maybe he will hate it there and come back.” The fourth stage is sadness: “ I really miss my friend,” or, “Why make friends when they end up moving away?” The final stage is acceptance: “Everything is going to be okay. We will remain friends even if he doesn’t live here.”

Some pass through all stages quickly and some skip stages altogether. The process is personal and chastising your child to “just get over it” will not expedite the process. However, there are ways to smooth the journey:

· Reassure your child that feeling sad or angry is common. Parents need to know that sad children may not show obvious signs of sadness such as crying. Instead, rocky sleep patterns, alterations in eating, disinterest in activities or a drop in the quality of school work can be signs that a child feels sad. If feelings of depression in your child last more than a month or if your child shows a desire to hurt himself, consult your child’s health care provider.

· When you discuss the move with your child, keep in mind your child’s developmental stage. For instance, preschool children are concrete and tend to be okay with things being “out of sight, out of mind.” Talking endlessly about the move only conveys to the child that something is wrong. Children around third or fourth grade can take the move hard. They are old enough to feel loss, yet not old enough to understand that friendships can transcend distance. For teens, who are heavily influenced by their peers, a friend’s moving away can cause a great deal of disruption. Acknowledge the negative emotions and reassure your child that each day will get better. Reassure him that despite the distance, he is still friends with the child who moved.

· Prior to the move, don’t be surprised if arguments break out between the friends. Anger can be a self defense mechanism employed subconsciously to substitute for sadness.

· Set a reunion time. Plan a vacation with the family who moved or plan a trip to their new home.

· After the move, send a care package and write/ help write a letter with your child.

· Answer a question with a question when you are not sure what a child wants to know. For example if he asks,” Will we always be friends?” Counter with “What do you think will happen?”

· Share stories about how you coped with a best friend moving when you were a child.

As for my children, when I told one of my kids that I will sign her up for soccer, she squealed with delight, “Oh, that’s the league Kelly belongs to.”

My heart sank. I said as gently as I could, “She’s moving- she won’t be here for soccer season.”

And so we begin the process…

Naline Lai, MD

© 2010 Two Peds in a Pod

My sister-in-law was startled when brown spots began to appear on her preschooler’s teeth. A trip to the dentist revealed that my nephew had eleven cavities, the result of constantly drinking juice as an infant and toddler. Unfortunately, time in the operating room was required to fill all the rotten spots. Today our guest blogger, Dr. Paria Hassouri, answers frequently asked questions on infant dental care. Starting care as an infant can prevent your child from ending up like my nephew with a mouthful of cavities. Dr. Hassouri is a board certified pediatrician who completed her training at the Cleveland Clinic Foundation. She has been in practice for seven years and is with Cedars Sinai Medical Group in Beverly Hills, California. She is currently writing abook about the experience of pediatrician moms across the United States. – Dr. Lai

When do I need to start brushing my baby’s teeth?

You should start brushing your baby’s teeth as soon as they come out. You can either use a clean moist washcloth or a soft baby toothbrush to do this. Before this point, many pediatricians advocate wiping your infant’s gums with a washcloth a couple times a day.

While plain water is enough to clean the teeth and gums, you can also use a small amount of fluoride-free toothpaste. Flossing should begin anytime there is tight contact between the teeth, particularly when the molars come in.

When will my baby get his/her first tooth?

While most babies will get their first tooth between 6 to 10 months, your baby may not get his/her first tooth until 15 to 18 months.

What is “baby bottle tooth decay” and how do I prevent it?

Baby bottle tooth decay is caused by frequent and long exposure of an infant’s teeth to liquids that contain sugar. The sugar penetrates the gums and affects the teeth even while they are below the surface. Sugar-containing drinks include milk and formula (even breastmilk), fruit juice, and other sweetened drinks. Putting a baby to bed for naps or at night with a bottle increases the risk. And again, remember that your baby does not need any juice.

When does my baby need to first see a dentist?

While the American Academy of Pediatric Dentistry recommends dental visits starting at age one, you can ask your pediatrician when he/she thinks that your baby should first see the dentist. If you are already following a good dental care regimen which includes brushing your baby’s teeth regularly and not letting your baby fall asleep with a bottle, your pediatrician may say that you can wait longer for the first dental visit.

What to I do if my baby dislikes or refuses to let me brush his/her teeth?

Even if your child resists brushing, it is still very important to brush the teeth twice a day. You can try brushing in front of a mirror or taking turns with your child. You can also try having your child hold a larger, thicker handled toothbrush while you use a thinner handled toothbrush to brush the teeth. In this way, the thicker toothbrush acts as a “door stop” that your child can bite on to keep his mouth open while you follow through with the thinner toothbrush. Finally, you can try blowing bubbles or singing a special song while you are brushing your child’s teeth. That way your child associates this special activity with tooth brushing; but keep in mind that this only works if you reserve the blowing bubbles or other special song for tooth brushing.

What should we do if we don’t have fluoride in our water ?

If your water does not contain fluoride, ask your pediatrician or dentist about fluoride supplements starting at six months old.

Paria Hassouri, MD

© 2010 Two Peds in a Pod

Unless your child is getting the flu mist, your child may receive not only the seasonal flu vaccine as an injection this year, but also the H1N1 vaccine as an injection. Here’s how you can take away the sting of any needle:

Set the stage. Your child looks to you for clues on how to act. If mommy and daddy are trembling in the corner of the room, it will be difficult to convince your child that the immunization is “no big deal.”  Do not tell your child days in advance that she will be immunized. The more you perseverate, the more your child will perceive that something terrible is about to happen. Simply announce to your child right before you leave to get the immunization, “We are going to get an immunization to protect you from getting sick.”

Do not say “I’m sorry.” Say instead,”Even if this is tough, I am happy that this will protect you.”  

Never lie.  If your kid asks “will it hurt?”say “less than if I pinched you.”

Watch your word choice. Calling an immunization “a shot” or “a needle” conjures up negative images. In general, avoid negative statements about injected vaccines. I cringe when parents in the office threaten children with,” If you don’t behave, then Dr. Lai will give you a shot.”

Remember the mantra, if all is well in the basic areas of eat, sleep, drink, pee, and poop, then any stressor is easier to handle. 

Kids talk. Be aware that kids, especially those in kindergarten, like to scare each other with tall tales. Ask your child what they have heard about vaccines. Let children know that Johnny’s experience will not be their experience.

The moment is here.

You may have heard about a topical cream which numbs up an area of skin. Unfortunately, because the creams anesthetize the surface of the skin and most vaccines go into muscle, I do not find the creams very effective at taking the pain away. 

Instead, practice blowing the worries away. Have your child practice breathing slowly in through her nose and blowing out worries through her mouth. For the younger children, bring bubbles or a pin wheel for your child to blow during the immunization. In a pinch, take a piece of the exam paper in the room and have your child blow the paper.

The cold pack: holding something very cold can distract your child’s brain from feeling the pain of an injection.

“Transfer” the immunization to mommy or daddy.  Have your child squeeze your hand and “take the immunization” for him.

Tell your child to count backwards from 10 and it will be over. In reality, it will be over before your child says the number seven.

Have as much direct contact with your child as possible. The more surfaces of his body you touch, the less your child’s brain will focus on the injection. Again, this is the distraction principle at work. By touching your child, you are also sending reassuring signals to him. For the younger child, if he is on the table, stay close to his head and hug his arms, or have him on your lap. For the older child and teen, hold their hand. I sometimes see parents of older teens and college students leave the room. Even the big kids may need someone to keep them company.

Help hold your child firmly. Holding him will make him feel safe and will  prevent him from  moving during the injection. Movement causes more pain or even injury.

After the drama is over. 

Have your older child sit quietly for a moment. As the anxiety and tension suddenly falls away, the body sometimes relaxes too suddenly and a child will start to faint.  This phenomenon seems to happen most often with the six foot tall stoic teenage boys.  We have a saying in my office- The bigger they are, the more likely they are to fall.

Compliment your child. Remind them that you will never let anyone really hurt them.

Now a story:

When my middle daughter was two years old, my family trouped into my office for the flu vaccine injection. We all sat calmly in a circle and smiled. 

First, the nurse gave me my immunization. I smiled. My middle daughter smiled.

Second, the nurse gave my husband his immunization. He smiled. My middle daughter smiled.

Then the nurse gave my oldest daughter her immunization. She smiled. My middle daughter smiled.

Then the nurse gave my middle daughter her immunization. She did not smile. She did not cry. Instead, she slugged the nurse with her little fist.  I think the nurse felt more pain than my child.

Someday all immunizations will be beamed painlessly into children via telepathy. Until then, I have no advice on how to take the sting away from the punch of a two year old. 

Naline Lai, MD

© 2009 Two Peds In a Pod

Why the recent American media hub-bub over “the flu” and “the swine flu”?  Both are forms of the same virus called influenza.  Usually known as “the flu,” this year, “the flu” is called the seasonal flu in order to distinguish it from “the swine flu,” properly known as the 2009 H1N1 flu.  Getting hit by any form of influenza can feel like being hit by a ton of bricks.  Just ask my husband.  Last winter, the same man who ran his first Marathon in the fall, couldn’t run 500 feet for nearly a month after his bout with the seasonal flu.   Complications from either form of influenza include sinus infections, pneumonia and even death.  Influenza   infections in the States occur mainly from October to April each year.  Usually, only the  seasonal strain is of concern, but this season there is the added concern that the 2009 H1N1 strain, which first leaped into the spotlight this past spring, will also add to the total number of people affected by influenza.

Both influenza forms are viral illnesses which predominantly cause airway symptoms.  Classic flu symptoms are sudden onset of nasal discharge, cough, high fever, headache and achiness.  A virus is a category of germs which are named for the way they reproduce.  Examples of viruses vary wildly.  Chicken pox, the common cold, and Human Immunodeficiency Virus (HIV) are all caused by viruses.  Whether an illness is caused by either a virus or a bacterial germ does not necessarily reflect the severity of an illness.  To add to the confusion, people sometimes call any viral illness which causes stomach upset “the stomach flu.”  “The Stomach flu” is not caused by an influenza virus.  If your child has diarrhea and vomiting alone with no stuffy nose or cough, they are not likely to have a form of influenza.

How do I protect my kids against either the Seasonal Flu or H1N1?

Wash, wash, wash. 

Hand washing with soap and water for 15 seconds has been proven to decrease germs.  For young (or impatient) children , have them sing the Happy Birthday Song until they are done.  One note- alcohol containing hand sanitizers do kill germs; however, most brands contain a greater percentage of ethylene alcohol than distilled drinks. Hand sanitizers contain over 60 percent alcohol versus 30-40 percent alcohol in liquor. According to my sister, Melisa Lai, MD, a Boston area toxicologist, toddlers have ended up in comas from alcohol poisoning after drinking hand sanitizer.

No nose-to-nose. 

Both forms of influenza are spread through air via coughing and sneezing. Tell your kids that they don’t want boogies from other kid’s noses to go into their nose.  If their noses can touch the noses of other children, then they are too close.  Cough away from other kid’s faces.  If we use national standards for spacing between sleeping cots in daycares (Caring For Our Children Health and Safety Standards, 2nd edition), children are ideally kept two feet apart.

Keep ‘em away from crowded places.

Any parent knows, keeping playing children two feet apart from each other is near impossible.  If your child is sick, keep them away from crowded places such as birthday parties, school and daycare.  If your child is already ill, you do not want them to catch a secondary illness on top of their current illness.  For the protection of your child and others, keep your child at home until  he/she is 24 hours fever free.  This school and daycare exclusion criteria is already recommended not only for influenza by the American Academy of Pediatrics, but for all illnesses (www.AAP.org).  A few days ago, the Centers for Disease Control http://www.cdc.gov/h1n1flu/schools/  published the same guidelines for influenza.

Immunize.

There are two types of immunizations against the seasonal flu.  Because the seasonal influenza strains change from year to year, the vaccine changes and need to be given yearly.  One is a nasal spray for children two years old and up.  The other type is injected into muscle and is approved for those six months and above.  Because the vaccines are made up in eggs, children with egg allergies cannot receive the vaccine.   Under nine years of age, the first year a child receives the seasonal flu vaccine, two doses are required.  If only one immunization was given the first year, the child will require two the second year.  If your child is ill or had a reaction to the seasonal vaccine in the past, ask your doctor about administration of the vaccine.

 As of this writing, vaccines for the H1N1 flu are still not available.  Vaccines are expected to be available in the late fall.  Uncertainties about the H1N1 formulations, side effects and distribution still persist.

 The priority groups for the seasonal flu immunization and the 2009 H1N1 flu immunization are slightly different.  The main difference between the set of recommendations is that those over 65 years of age are not a target groups for the 2009 HINI vaccine but a target for the seasonal flu vaccine.  Also, college aged (19-24 years) adults are part of the 2009 H1N1 target group but not of the seasonal flu vaccine target group.

 According to the Advisory Committee on Immunization Practices, a working group of the Centers for Disease Control which meets to review infectious disease  data and recommends national guidelines for immunizations, the following groups are the priority groups for influenza vaccination:

Priority groups for the seasonal influenza vaccine:

1.       Children aged 6 months up to their 19th birthday

2.       People 50 years of age and older

3.       People of any age with certain chronic medical conditions

4.       People who live in nursing homes and other long-term care facilities

5.       People who live with or care for those at high risk for complications from flu, – includes Health care workers, Household contacts of persons at high risk for complications from the flu, Household contacts and out of home caregivers of children less than 6 months of age (children too young to be vaccinated)

6.       Pregnant women

Priority groups for the 2009 H1N1 influenza vaccine:

1. All people from 6 months through 24 years of age
2. Household contacts and caregivers for children younger than 6 months of age
3. People aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.
4. Healthcare and emergency medical services personnel
5. Pregnant women

Is there treatment?

Treatment is generally supportive.  Have your child drink plenty of fluids and get as much rest as possible.  Fever reducers such as ibuprofen (i.e. Morin, Advil) and acetaminophen (i.e. Tylenol) may help keep children comfortable enough to do the things such as drink and sleep that will make them better.  Outpatient antiviral does exist but the strains of flu can morph, thus rendering them sometimes ineffective.   Antiviral medications are for children whose illness is moderate or severe or if they are at high risk of complications.  Generally antivirals work best within the first 48 hours after onset of symptoms.  Antibiotics such as Amoxicillin and a “Z-pack “will not kill influenza viruses.  Antibiotics are prescribed if there is bacterial infection overlying the influenza infection.

This winter, although your family may escape both strains of influenza, remember, there are plenty of “flu-like” illnesses out there which can also wreck havoc on your child’s health.  Hopefully, if the threat of the seasonal and 2009 H1N1 flu forces us to pay attention to good hygiene habits, we may overall end up with a healthier winter.

For the most up to date information on influenza: www.CDC.gov

Naline Lai, MD and Julie Kardos, MD

©2009 Two Peds in a Pod®

Ouch! Stung on the scalp.

Ouch! Stung on the hand.

Ouch! Stung on the leg.

Ouch! Ouch! Stung TWICE on the lips.

Those nasty, nasty hornets.  During the hot days of August, they become more and more territorial and attack anything near their nests.  Today, in my yard, hornets mercilessly chased and attacked a fourth grader named Dan.  As everyone knows, you’d rather have something happen to yourself than have something negative happen to a child who is under “your watch.” As I rolled out the Slip and Slide, I was relieved not to see any wasps hovering above nests buried in the lawn.  I was also falsely reassured by the fact that our lawn had been recently mowed.  I reasoned that anything lurking would have already attacked a lawn mower.  Unfortunately, I failed to see the basketball sized grey wasp nest dangling insidiously above our heads in a tree.  So, when a wayward ball shook the tree, the hornets found Dan.

What will you do in the same  situation?

Assess the airway- signs of impending airway compromise include hoarseness, wheezing (whistle like sounds on inhalation or expiration), difficulty swallowing, and inability to talk.  Ask if the child feels swelling, itchiness or burning (like hot peppers) in his or her mouth/throat.  Watch for labored breathing.  If you see the child’s ribs jut out with each breath, the child is struggling to pull air into his/her body.    If you have Epinephrine (Epi-Pen or Twin Jet)  inject  immediately- if you have to, you can inject  through clothing.  Call 911 immediately. 

Calm the panic- being chased by a hornet is frightening and the child is more agitated  over the disruption to his/her sense of security than over the pain of the sting.  Use pain control /self calming techniques such as having the child breath slowly in through the nose and out through the mouth.  Distract the child by having them “squeeze out” the pain out by squeezing your hand.

If the child was stung by a honey bee, if seen, scrape the stinger out with your fingernail or a credit card.  Do not squeeze or pull with tweezers to avoid injecting any remaining venom into the site.   Hornets, and other kinds of wasps, do not leave their stingers behind.  Hence the reason they can sting multiple times.

Relieve pain by administering Ibuprofen (Motrin,Advil) or Acetaminophen (Tylenol).

As  you would with any break in the skin, to prevent infection, wash the affected areas with mild soap and water.

Decrease the swelling.  Histamine produces redness, swelling and itch.  Counter any histamine release with an antihistamine such as Diphenhydramine (Benadryl).  Any antihistamine will be helpful, but generally the older ones like Diphenhydramine, tend to work the best in these instances.  Unfortunately, sleepiness is common side effect.

To decrease overall swelling elevate the affected area.

A topical steroid like hydrocortisone 1% will also help the itch and counter some of the swelling. 

And don’t forget, ice, ice and more ice.  Fifteen minutes of indirect ice on and fifteen minutes off.

Even if the child’s airway is okay, if the child is particularly swollen, or has numerous bites, a pediatrician may elect to add oral steroids to the child’s treatment.

It is almost midnight as I write this blog post.  Now that I know all of my kids are safely tucked in their beds, and I know that Dan is fine, I turn my mind to one final matter:  Hornets beware – I know that at night you return to your nest.  My husband is going outside now with a can of insecticide.   Never, never mess with the mother bear…at least on my watch.

Naline Lai, MD and Julie Kardos, MD

©2009 Two Peds in a Pod®

Recently we’ve had a parade of itchy children troop through our office.  The culprit: poison ivy.

Myth buster: Fortunately, poison ivy is NOT contagious. You can catch poison ivy ONLY from the plant, not from another person.

Also, contrary to popular belief, you can not spread poison ivy on yourself through scratching.  However, where  the poison (oil) has touched  your skin, your skin can show a delayed reaction- sometimes up to two weeks later.  Different  areas of skin can react at different times, thus giving the illusion of a spreading rash.

Some home remedies for the itch :

• Hopping into the shower and rinsing off within fifteen minutes of exposure can curtail the reaction.  Warning, a bath immediately after exposure may cause the oils to simply swirl around the bathtub and touch new places on your child.
• Hydrocortisone 1%.  This is a mild topical steroid which decreases inflammation.  I suggest the ointment- more staying power and unlike the cream will not sting on open areas, use up to four times a day
• Calamine lotion – a.k.a. the pink stuff. this is an active ingredient in many of the combination creams.  Apply as many times as you like.
• Diphenhydramine (brand name Benadryl)- take orally up to every six hours. If this makes your child too sleepy, once a day Cetirizine (brand name Zyrtec) also has very good anti itch properties.
• Oatmeal baths – Crush oatmeal, place in old hosiery, tie it off and float in the bathtub- this will prevent oat meal from clogging up your bath tub.
• Do not use alcohol or bleach- these items will irritate the rash more than help

The biggest worry with poison ivy rashes is not the itch, but the chance of super-infection.  With each scratch, your child is possibly introducing  infection into an open wound.  Unfortunately, it is sometimes difficult to tell the difference between an allergic reaction to poison ivy and an infection.  Both are red, both can be warm, both can be swollen.  However, a hallmark of infection is tenderness- if there is pain associated with a poison ivy rash, think infection.  A hallmark of an allergic reaction is itchiness- if there is itchiness associated with a rash, think allergic reaction.  Because it usually takes time for an infection to “settle in,” an infection will not occur immediately after an exposure.  Infection usually occurs on the 2nd or 3rd days.  If you have any concerns take your child to her doctor.

Generally, any poison ivy rash which is in the area of the eye or genitals (difficult to apply topical remedies), appears infected, or is just plain making your child miserable needs medical attention.

When all else fails, comfort yourself with this statistic: up to 85% of people are allergic to poison ivy.  If misery loves company, your child certainly has company.

Naline Lai, MD and Julie Kardos, MD

2012 Two Peds in a Pod®