High calorie foods for underweight children

High calorie food for underweight children

Your child’s pediatrician charts your child’s height and weight in order to determine whether he is growing appropriately.  Some kids are underweight. These kids use more calories than they take in.

Here are ways to increase calories. Remember, it’s not as simple as demanding that your child eat more of her noodles. Instead of trying to stuff more food into your child, increase the caloric umph behind each meal.

Make every bite count:  

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When will kids get a COVID-19 vaccine?

As the year 2020 comes to a close, we are grateful, as pediatricians caring for your children, that we received our first doses of COVID-19 vaccine.

There is hope!  COVID-19 vaccines have arrived and more than two million adults have safely received a vaccine. Now that vaccinations are reaching adults, many families wonder when COVID-19 vaccines will be available for their children.

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Dry, cracked hands are for lizards

Dry, cracked hands: treatment and prevention

In addition to pocket-sized hand sanitizer, I recently got my kids pocket-sized moisturizer to help their dry, cracked hands. 

Between diligent handwashing and falling temperatures in Pennsylvania, we are experiencing annoying, itchy skin changes. We’ve blogged about this before-Dr. Lai and I are used to washing our hands twice for every patient we see in the office-once before examining them and once again afterward. I have a jar of moisturizer on my desk that I frequently dip into between patients. Now I remind my kids to do the same between hand washings.

Here are some remedies to help treat dry, cracked hands: 

  • Petroleum jelly, such as Vasoline or Aquaphor, works great to moisturize and heal cracks in the skin. Apply at bedtime. Ointments are greasy, so during the day your kids might prefer using a fragrance-free moisturizing cream such as CeraVe or Aveeno.
  • If itchy, add hydrocortisone 1% ointment to your kids’ daily or twice daily hand-care regime. Sometimes, for kids with underlying eczema, pediatricians prescribe a stronger type of hydrocortisone to help with more severe skin cracking and itching from dryness. Ointment tends to sting less than cream.
  • Mix equal parts of moisturizing ointment and hydrocortisone ointment, smear, and put socks over hands to lock in moisture. This works best as a bedtime routine to help decrease the subconscious scratching and picking that occurs during sleep.
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Holiday Gifts for school-age kids 2020

2020 gift ideas for kids
Holidays 2020 style: Oops. I must have been wearing my mask when I told your grandmother that you wanted a “new fur cat.” I think she heard “new fur hat.”

We’re bringing back our popular holiday gift guide based on ages and developmental stages. As always, we will concentrate on non electronic options, as well as pandemic-friendly ideas.


What’s happening: Kids at this age can hop up and down on one foot and they start having a better sense of time. They tell simple stories, can tell real from make-believe and can swing and climb.

Ideas: Clocks, calendars, and games that require some balance like Twister® are all hits. Games with simple rules such as checkers and puzzles with large pieces are developmentally within reach. They may enjoy reading books with very simple sentences on their own. Foster creativity with colored papers, crayons, markers, stickers, and water-color paints.

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Is it COVID or a cold?

COVID or cold
Viral lamentations: imagine an elephant’s woes when a cold ends up in their nose

In the age of the COVID-19 pandemic, we can no longer say easily that your child with cold symptoms has a simple cold. Pre-pandemic, it was so easy to say, “Of course they can go to school with a cold. Most kids can participate and be perfectly happy despite their stuffy nose or mild cough.” We pediatricians often spent time reassuring parents about colds.

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Quick exercises for kids and teens

couch potato

Physical therapist Dr. Deborah Stack brings us quick exercises for kids and teens – Dr. Lai and Kardos

After six months of COVID; yes, it really has been that long already, your family has probably found some favorite outdoor hiking spots or bike routes.  But what can you do when it’s too cold or wet outside?  How can you combat literally HOURS of kids sitting at computers especially if they only have 30-45 minutes until their next class? Here are quick exercises for kids and teens and a table of caloric expenditure for common activities.

Schedule active movement breaks into their day.  Take advantage of that lunch and recess “break” and be an example yourself. 

Here are some short burst ideas:

  • Have a 15-minute dance party
  • Use your body to make all the letters of the alphabet
  • Shadow box to some music
  • Dust off the treadmill or stationary bike in the basement
  • Play ping-pong
  • Do a few chores (carrying laundry baskets up and down is great exercise)
  • Jump rope
  • Jog in place
  • Do jumping jacks
  • Pull out some “little kid games” such as hopscotch or hulahoop
  • Let each child in your house choose an activity for everyone to try
  • Do a family yoga video
  • Walk or “run” stairs…kids can try to beat their prior score for a minute of stairs
  • Take walking/wheeling/even wheelbarrow laps around the house
  • Stretch out calves, quadriceps, arms and back…see ergonomics post for counteracting all the sitting
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Online school tips

Going back to school online? Here’s what pediatricians want you to know

Chances are, because of COVID 19, this school year will look different for your children. Here are your Two Peds’ tips for helping your children if they are learning online this fall.

Start with basics such as setting a sleep schedule. Think about how many hours your child slept during the spring quarantine and over the summer. If they woke up refreshed, that is the optimal amount of sleep they need to be alert during class. Incorporate this into your school year expectations.  Falling asleep too late and sleeping too late? Check here on how to get your child’s late schedule under control. 

Set up an eating routine. Healthy eating habits have not changed from when you were a child. Stick to the school year schedule of breakfast, lunch, dinner and a morning and afternoon snack – just like at school. Don’t allow the  kids to graze. Without structure, children tend to throw off their weight- in fact, kids tend to gain weight more quickly  in the summer than during the school year

Rehearse mask wearing. Even though they attend school at home, your kids will go to the grocery store, see a good friend or get a haircut. Teach them to wear a mask properly so you don’t need to spend time readjusting their masks outside of the house.  

Keep up the hand hygiene at home: Washing hands always limits germ spread. WHEN–before and after eating, after using the bathroom, after playing outside, and before and after school, the HOW–soap and water preferred for the duration of time it takes to sing the Happy Birthday song twice, or hand sanitizer if a sink is not available, and the WHY–avoid germ spread. See our post on handwashing.

Prevent neck and back strain from continual computer use: Read these posts on ergonomics and proper computer positioning to prevent your children from feeling like pretzels  at the end of the day. Likewise, prevent eye strain.

If you are worried about the amount of additional time your children will spend in front of the computer for entertainment in addition to schoolwork, use the American Academy of Pediatrics’ Family Media Plan tool to create a customized screen time contract.

Create a home learning space that your child can call their own. This will be where your child will complete schoolwork and homework. This is especially important if you child usually spends time doing homework on their bed. You want your child to associate their bed with relaxation and sleep rather than activities that rev up their mind. 

Get your child the flu vaccine this fall. Even if you never immunized in the past, this is the year you should. Please see our post on the benefits of the flu vaccine

Help your child to “roll with the punches.” Change, even happy change, can be stressful for adults. After all, we all know how adults often run around frantically during the winter holidays. If you feel frustrated, angry, or fearful about the pandemic, try to keep the brunt of your own negativity from your children. Kids are often more adaptable than you might give them credit for, but they tend to mimic their parents and look to parents about how to respond to new situations. Seek adult help to prevent your own negative feelings from flowing over and smothering your children.

You can do this. Who taught your children their first words? How to walk? The color of an apple? How to organize their homework? You will still have teachers who will teach the content of a class. Your role, as it always has been, is to provide the best possible  learning environment.

No matter how it looks, we wish your family a great start to the school year!

Naline Lai, MD and Julie Kardos, MD

©2020 Two Peds in a Pod®


How superheroes wear masks

how to get your kid to wear masks

Superheroes don’t wear masks just over their eyes when they fight germs.

Every child, long before COVID, was taught to prevent germs from entering their bodies by washing their hands and making sure their nose did not get too close to other kids’ noses. As we’ve always said, “You don’t want someone’s boogers to jump into your nose.” Besides distancing, wearing a mask is just another way to prevent those boogers from jumping in or out of noses. But most people are unfamiliar with wearing masks and are not sure how to teach their kids to wear them. 

Enter superheroes. As we know, superheroes wear masks. Above is a photo of one of Dr. Lai’s favorite superheroes, along side other mask-wearing superheroes. Her superhero sister is an ER doctor. She wears layers to keep herself from bringing home COVID to her own kids. She works in this garb for hours and hours. We borrow from her hints for helping your kids do the same with their masks:

  • Cover both your child’s nose and mouth with the mask. The path for a germ to enter and exit the lungs is through BOTH the mouth and nose…it’s all connected. If the mask has a wire at the top part of the mask, pinch it over your child’s nose and press gently over the tops of their cheeks. This helps prevent glasses from fogging and also limits germs from coming and going through leaky areas of the mask.
  • Have your child talk, sing, and jump up and down in their mask before leaving the house. We have seen many a mask wiggle down a kid’s (or parent’s) face as they start to talk. It’s like watching a game of chutes and ladder…the mask goes up a little, and down and little, and sometimes it slides right off.
  • If the mask seems too big, try tying the loop with a small knot. The secret is to fold the mask in half (lengthwise) with the outsides facing each other and tie a knot close to where the strings meet the paper/fabric. Then pop it back open and tuck the corners in. This works best with a paper mask. Note, masks are not recommended by the American Academy of Pediatrics for those under two years old. Check out other kids who should not wear masks here
  • Some kids will complain about the mask. It can be a comfort issue, a fashion issue, or a habit issue.  They are just not accustomed to wearing a mask and over time they will get used to it. If comfort were the only goal of kid fashion, gel light-up princess shoes would not exist! Practice having all of your family members wear a mask around the house before venturing out. Also, try your child’s mask on yourself. Maybe the material really is “stinky” or “pinchy” and it’s time for a different mask. 
  • Once a mask is on, teach kids to pull up a mask from the sides or near their cheeks, not near their nose. Again, you want them to avoid touching their boogers.
  • Taking off a mask correctly is as important as putting one on. When taking off a mask have them wash their hands with soap and water and then gently take their mask off at the ears. If their hands are not washed and they touch their mask around their nose, there is the potential for germy droplets on their hands to jump into their nose.
  • If you find that ear loops are chafing your child behind the ears or over the cheeks, moisturize an hour before wearing. If you moisturize right before putting on the mask, there is the risk that the mask will slide around. There are all sorts of methods to hook the loops to places other than behind the ears. You can sew buttons on a headband and secure the loops to the buttons or secure the loops to glasses. There are also mask extenders available. Use non-comedogenic (non-acne-producing) lotions such as Cervave®,  Cetaphil®, or moisturizers meant for faces only. 
  • If cloth, wash the mask in soap and water when they get home. There is no need to torch the mask with high heat or douse in a special chemical.  A good wash with soap and air drying for a day will kill off germs- COVID and other germs as well.  
  • Paper masks need to breathe. Most are technically one time use, but let’s get real, we know that you will use them more than once. Store them in paper lunch bags-fold the masks so the outside (germy side) is touching together. 
  • One final tip: COMPLIMENT your child’s proper mask wearing! Dr. Kardos is often overheard exclaiming to her patients: “I LOVE your mask! It is so COOL! Do you like MINE? See how I wear it LIKE A SUPERHERO?” It is fun to watch the kids immediately put on their masks if they were initially off, and to pull it up over their noses correctly to mirror Dr. Kardos if they had been wearing the mask improperly.

What better barrier against nose spew than wearing a mask? Have your kids wear them in superhero style. Until this pandemic is under control, mask wearing will play a huge role in keeping your children safer from disease spread.

Naline Lai, MD and Julie Kardos, MD
©2020 Two Peds in a Pod®


Conversations: Talking with kids about race

talking with kids about race

Does the adult looking through the camera at these children see what a child sees? — photo courtesy of Pixabay

No matter your skin coloration, you will have the first opportunity to teach your kids about racism in the United States. To help you approach the topic, therapist Dina Ricciardi culled through the internet to pick out resources to start a dialogue. — Drs. Lai and Kardos

Lately, conversations and news coverage about racism surround us. Images of unrest and violence have covered our news screens, affecting our country, our communities, and sometimes our own homes. On top of the global pandemic of COVID-19, navigating the topic of race and race relations with your family can feel downright overwhelming. Adults may be experiencing a whole range of feelings. Emotions may range from anger to sadness to fear and beyond. While us parents want to teach our kids, we also want to protect them. We wonder, do we talk with them about what they see on television and social media? Or do we shield them from serious problems? 

Our understanding and beliefs about race, whether our own race or others’, is deeply personal and rooted in our own unique experiences. As parents, we may feel unprepared and not know how to address our children’s questions and concerns. Therefore, we may avoid conversations about race. 

Fortunately, there are many available resources. Many educators, mental health experts, and medical professionals are sharing information to equip us with knowledge and confidence. Below is a handful of the offerings.

Resources on talking with kids about race:

The Child Mind Institute

The American Psychological Association

Embrace Race www.embracerace.org 

Book Recommendations: 

Books about a variety of races

Books with Characters of Color

Books for Asian-American Children and Young Adults

Book Recommendations for Adults:

The Schomburg Center for Research in Black Culture of the New York Public Library

Well Read Black Girl

Links to issues of racism, police violence and discrimination (says COVID, but not about COVID):


These are just a few of the resources available to help you wade into challenging conversations about race. As stated by Dr. Howard Stevenson from the Penn Graduate School of Education, “The more you listen for what your child already knows, what they are concerned about, what they are afraid of, the more you’ll be able to help them speak and feel confident…and keep listening, because your child will need you to keep that conversation going.” 

Dina Ricciardi, LCSW, ACSW

Ricciardi is a licensed clinical social worker and psychotherapist in private practice treating children, adolescents, and adults in Doylestown, PA. She can be reached at dina@nourishcounseling.com.

©2020 Two Peds in a Pod®