Two Peds in a Pod®

FAQs about swimming

baby sand sculpture Babies and children love bath time and are drawn to water play. Today we bring you the splash on swimming.

We’re going to the beach- can my baby go swimming? How about a pool?

Most pools, oceans, and lakes are much colder than bath water. Babies feel colder more quickly than adults. Remember your own parent telling you to come out of a pool because your lips were blue? Limit a baby’s exposure to cold water accordingly.
Chlorine will not hurt babies, but it can dry out skin. Apply moisturizer after swimming if your child’s skin gets dry. Kids with eczema can be particularly sensitive to chlorinated water.
Salt water is safe for babies and kids to swim in.
Young kids try to drink the water they swim in. Don’t let them. It’s not just your nephew who pees through his swim diaper that you need to worry about. Unfortunately chlorine and salt fail to kill all viruses, bacteria, and parasites that might lurk in swimming water.
If your child swims outside, remember that sunburns occur more easily because sunlight reflects off the water. Apply sunscreen liberally before and after swimming. Better yet, try to keep that baby hat on and have your child wear a sun protective shirt.

When should I start swim lessons for my child?

Start swim lessons as early as toddlerhood — it is a great life skill. However, swim lessons will not make your child “drown proof.” You can find more data in this drowning prevention article from The American Academy of Pediatrics. Unfortunately, even under adult supervision, drownings occur. When an adult’s attention is briefly diverted to answer the phone, their meal, etc, a drowning can take place. The bottom line:

Always stay arm’s length of babies and toddlers in the water. Also stay at arm’s length of your older children who have not yet learned to swim.
Even if your child can swim well, never let your child or teen swim alone or without a life guard.

A note about Baby Swim Lessons:

Babies can take “swim lessons,” meaning “spend quality time with a parent in the pool.” Despite the claims of some swim instructors, no studies have shown that infant swim lessons make infants “drown proof.”

Any other water safety tips?

A few years ago, Dr. Lai’s toddler-aged neighbor waddled over to the ice bucket at a Fourth of July party. Toddlers have big pumpkin shaped heads and before Dr. Lai could blink an eye, her neighbor tumbled into the water head first. Luckily Dr. Lai’s husband was standing next to the bucket and pulled the toddler out.

As this case shows, you can’t let your guard down, even if no pool or large body of water is in sight.
Small blow-up backyard pools are the same as bath tubs in terms of drowning risk, so never leave kids unattended around these pools. Stay at arm’s length of your babies and toddlers when they play in these pools.
Additionally, never leave kids unattended, even briefly, in the bathtub.

Ideas on how to play with water?

Water tables (which can double as sand tables in the spring, leaf tables in the fall and indoor snow tables in the winter) allow young toddlers to stand and play with toys in very shallow water.
Fill a bunch of different sized stacking cups with water for kids to pour, dump, or perhaps to mix with rocks, dirt, or leaves.
Simple squirt bottles are great fun. When Dr. Kardos’s twins were little they spent large amounts of time “watering” every plant, bush, flower, and blade of grass in the yard.
Fill small cupcake tins with water and supply your kids with water-color paint to decorate the sidewalk or walkway of your house. Kids become entranced by the colors created as they rinse off the brushes. Warning— make sure the paint is water soluble. Dr. Lai still has the name of one of her children in fluorescent orange written on her driveway.
Wet down your walkway and blow bubbles onto the cement – they will cling onto the walkway for a long period of time.

Grab a towel and enjoy the summer with your children.

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®
originally published June 2013, updated May 2019

May 28, 2014 by twopedsinapod

On our minds: Concussions

concussions in kids Dr. Lai will be up at Brown University this weekend giving a primary care pediatrician’s perspective on concussions (traumatic brain injuries) at a parent forum. A lot has changed since you were a kid. As she prepared, we mulled over questions we commonly encounter and thought we’d pass them on to our parents:

What is a concussion? A concussion is an injury to the brain which does not show up on head scans such as CT Scans and MRIs. Think of a concussion like a sprained ankle, but instead of an injury to the ankle, it’s an injury to the brain. Just like an ankle sprain, it may not show up on X-ray, but your child is affected by the injury.

What are the signs of a concussion? Immediately after a head injury, we first look for signs of bleeding in the head. After we know there is not any bleeding, we look for signs of a concussion. Concussions affect kids physically, cognitively, and emotionally. Common symptoms include persistent head ache, nausea, fatigue, sleep disturbances, light and noise sensitivity, balance problems, difficulty with memory, difficulty with concentration, and emotional lability. Parents often describe their children as moving or thinking slowly- as if they were in a fog. Teens and young adults tend to belittle any injury, so if your kid tells you that she hit her head when you weren’t around, scrutinize your child very closely. If you “just know” your kid is not 100 percent his baseline, then she probably has a concussion.

How long is recovery?

In the not-so-old days we would clear kids for athletics 2 weeks after a teen had a normal neurological exam and symptoms disappeared. But the prescription for recovery has changed. Now there is a new emphasis on brain rest and returning a kid to school before returning to sports. Just like you rest a sprained ankle, doctors now recommend resting the brain. For the brain, that means no thinking or concentrating. Examples of prohibited activities include texting, video games, and homework. Interestingly TV watching is considered mindless enough to be permitted during the period of brain rest. Once there are no symptoms we allow a little more brain activity in a stepwise fashion until a kid can return to school. Only then can a kid consider starting a stepwise program to return to playing sports. For most kids, recovery takes about a month. Kids with baseline neurological issues such as migraines or attention deficit hyperactivity disorder tend to take longer to recover fully.

I’ve heard it’s dangerous to hit your head again before you have fully recovered from a concussion- is that true? YES! The scary stuff you hear about possible brain swelling and death if a concussion occurs on top of a concussion is not just internet mumbo-jumbo. Called second-impact syndrome, these secondary concussions occur during a window of vulnerability while the brain is healing from an initial concussion.

How many concussions can you have before there is permanent brain damage? There is still a lot of research that still needs to be done on concussions and this is one area where people are actively seeking answers. So far, studies in youth are unclear on the impact of repetitive concussions and the development of long term neurodegenerative diseases.

My kid wears a helmet or mouth guard to prevent concussions-right? While helmets and mouth guards help prevent skull fractures and jaw dislocations, current designs do little to prevent concussions.

I’m not going to keep my kid wrapped in bubble wrap, but do some activities pose a greater concussion risk than others? While there is still a paucity of sports data at the grade school and middle school level, we do know that according to the Centers for Disease Control (CDC), over half of concussions in those under 14 years old are caused by falls. Boys’ football followed by girls’ soccer lead the injury rate amongst high school athletes according to a 2010 paper published in Pediatrics .

I have seen kids receive concussions from standing too close to swing sets, concussions from sudden stops on school busses, and from jumping off beds. Once, a parent came into my office dazed after hitting her head on her trunk door in my parking lot. So, concussions can occur in any activity. The most important “take-away” is to take head injuries seriously and learn to recognize and report concussions.

For more information on concussions the pathway to recovery, please visit the CDC website and the Children’s Hospital of Philadelphia webite.

See you up at Brown.

Naline Lai, MD with Julie Kardos, MD

May 22, 2014 by twopedsinapod

Sunscreens and sunburns: your burning questions answered

Just in time for Field Day and pool openings, today we provide sunburn protection information.

Hot!

Pictured is a kid with a second degree burn. No, this burn wasn’t caused by hot water or by touching the stove, but by the sun. A sunburn is still a burn, even if it was caused by sunlight.

Treat sunburn the same as you would any burn:

Apply a cool compress or soak in cool water.
Do NOT break any blister that forms- the skin under the blister is clean and germ free. Once the blister breaks on its own, prevent infection by carefully trimming away the dead skin (this is not painful because dead skin has no working nerves) and clean with mild soap and water 2 times per day.
You can apply antibiotic ointment to the raw skin twice daily for a week or two.
Signs of infection include increased pain, pus, and increased redness around the burn site.
A September 2010 Annals of Emergency Medicine review article found no best method for dressing a burn. In general, try to minimize pain and prevent skin from sticking to dressings by applying generous amounts of antibiotic ointment. Look for non adherent dressings in the store (e.g. Telfa™). The dressings look like big versions of the plastic covered pad in the middle of a Band aid®.
At first, the new skin may be lighter or darker than the surrounding skin. You will not know what the scar ultimately will look like for 6-12 months.
If the skin peels and becomes itchy after a few days, you can apply moisturizer and/or hydrocortisone cream to soothe the itch.
Treat the initial pain with oral pain reliever such as acetaminophen or ibuprofen.

Preventing sunburn is much easier, more effective, and less painful than treating sunburn.

What is SPF? Which one should be applied to children?

SPF stands for Sun Protection Factor. SPF gives you an idea of how long it may take you to burn. SPF of 15 means you will take 15 times longer to burn… if you would burn after one minute in the sun, that’s only 15 minutes of protection!

The American Academy of Pediatrics recommends applying a minimum of SPF 15 to children, while the American Academy of Dermatology recommends a minimum of SPF 30. Dr. Lai and I both apply sunscreen with SPF 30 to our own kids.

Apply all sunscreen liberally and often– at least every two hours. More important than the SPF is how often you reapply the sunscreen. All sunscreen will slide off of a sweaty, wet kid. Even if the label says “waterproof,” reapply after swimming.

Why does the bottle of sunscreen say to ask the doctor about applying sunscreen to babies under 6 months of age?

Sunscreens were not safety-tested in babies younger than 6 months of age, so the old advice was not to use sunscreen under this age. The latest American Academy of Pediatrics recommendation is that it is more prudent to avoid sunburn in this young age group than to worry about possible problems from sunscreen. While shade and clothing are the best defenses against sun damage, you can also use sunscreen to exposed body areas.
Some clothes are more effective than others in blocking out sunlight. Tighter weaves protect better than loose weaves. Cotton t-shirts are horrible for sun protection. Clothing uses a UPF rating. UPF measures the amount of UV light that reaches your skin. Higher numbers are better. For example, a rating of 100 means that 1/100, or one percent of UV rays reach your skin.
Hats help prevent burns as well.
Remember that babies burn more easily than older kids because their skin is thinner.

Which brand of sunscreen is best for babies and kids?

For babies and kids, no one brand of sun screen is better than another. Dr. Lai and I tell our patients to apply a “test patch” the size of a quarter to an arm or leg of your baby and wait a few hours. If no rash appears, then use the sunscreen on whatever body parts you can’t keep covered by clothing.

Remember when we used to call sun screen lotion “suntan lotion,” and tolerating red, blistering shoulders was considered a small price to pay for a tan? Live and learn.

Julie Kardos, MD with Naline Lai, MD
©2014 Two Peds in a Pod®
Originally posted 6/19/2013

May 18, 2014 by twopedsinapod

Until I became a mother I never thought…

mother hen cartoon Until I became a mother I never thought…

I’d care if a birthday party was cancelled

I’d obsess about bowel movements and gas

I’d remember to reapply sunscreen

I’d bake zucchini muffins and count them as a vegetable serving

I’d wipe someone else’s nose

I’d relearn my most dreaded school subject in order to help my child with homework

I’d feel compelled to ask if anyone needs to go to the bathroom before I go anywhere in a car

I’d go on nauseating upside-down amusement park rides because my kid needed to be accompanied by an adult

I’d spend my Friday night driving and picking up kids from parties and then spend my Saturday morning driving and picking up kids from the ice hockey rink starting at 5:00am.

I’d get to play Tooth Fairy

I’d (try to) answer questions such as “What does God look like?” and “Who was the mom of the first man?”

I’d willingly read the same book out loud night after night after night

And finally-

Until I became a mother I never thought… I’d wipe away tears when reading sappy Mother’s Day cards.

Happy Mother’s Day from your two Peds

Naline Lai, MD and Julie Kardos, MD

May 11, 2014 by twopedsinapod

Warn your kids: it’s not smart to inhale Smarties

Where do these tween/teen games come from?

Warn your kids about a game that Dr. Kardos learned about from some tweens recently: inhale Smarties ®. Young teens at a party took intact packages of Smarties® candy and used their cell phones (!) to smash the candies into a fine dust inside their cellophane wrappers. Then they peeled off the end of the roll and sucked the dust into their mouths (imagine a “Smarties®” cigarette), and exhaled, causing Smarties® smoke to spew from their mouths. They spit out any candy that was left in their mouths. The thrill came from creating Smarties® smoke.

I was glad that the kids who told me about this game saw that this was a not-so-smart game to play (click here for another example of a not-so smart game). No, this does not count as “smoking” and is likely not addictive, but this story begs several teaching points for parents of tweens/teens:

1- Tweens and teens need supervision at parties.

2- Teach your kids never to inhale anything except AIR. Anything else can cause coughing, irritation to the lungs, and possible infection. Do not inhale Smarties ®!

3- Young teens especially are prone to “mob mentality.” Teach them if their friends do something that they have never done before, to think long and hard about possible consequences before following the crowd. Ask them to think, “What’s the worst that can happen if I do this?”

4- Know your children’s friends. If you know they are thrill seekers, attention grabbers, or prone to engage in questionable behaviors, make sure you have frequent talks with your kid about smart choices. Sign your child up for activities that allow opportunities to become friendly with an alternative crowd.

If you see kids engaged in risky behaviors, even if they are not your own children, stop them. Someone has to care. Hopefully someone else is watching out for your kids, too.

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®

May 7, 2014 by twopedsinapod

Bring out the splat mat—cook with your kids.

cartoon family dinner

When my kids were younger, I realized one way to avoid the pre-dinner time meltdowns was to enlist their help in cooking. In addition, baking muffins or cookies with kids is a great rainy day activity with a built-in reward at the end. Much has been written about the nutritional and psychological merits of a shared family meal. Instead, this post is about sharing the mealtime prep. For those of you who do not love to cook yourselves, here are reasons to find your inner cook and encourage your child’s development at the same time:

1-Toddlers LOVE pouring, mixing, and measuring, and when you teach toddlers these skills, you are strengthening their fine motor skills. Why else are toy kitchens and Play-doh so popular? Nothing beats “playing” with REAL ingredients in a REAL kitchen.

2-Teach young kids to count measurements, let older kids do the measuring themselves.

3-Kids who are learning to read now see WHY they need this skill- as you follow a recipe kids see how to read with a purpose. You can let your budding reader read the directions to you.

4- Time spent with a parent in the kitchen fosters more shared attention which can build self-esteem.

5-You will build good memories for your child.

6-For the picky eaters: kids are more likely to taste what they cook themselves.

7-Kids love water play, so even the clean-up is fun.

8- Kids as young as 7 or 8 can learn to cut with a knife. Teach them this life skill while cooking instead of when they are hungry and trying to eat dinner-it causes less frustration.

9-Kids take pride in what they help create. They can also take pride in completing a project. Pride in accomplishments develops self-esteem.

10- Cooking with you teaches your child how to help others as well as how to receive help graciously.

Finally, cooking is one of those life skills needed for when kids grow up and live on their own. Just as you teach them to use the potty, brush their own teeth, dress themselves and tie their own shoes, you should teach them how to cook.

Are you parents who don’t cook? Call Grandma or Grandpa for some tutoring, or take a cooking class with your child!

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®

April 30, 2014 by twopedsinapod

Save money: how to penny pinch without hurting your young child

keeping up with the neighbors When it comes to our children, we want the best that money can buy. But the best is not necessarily the most expensive. Today we offer our pediatrician perspective on ways you can save money without compromising your child’s health or safety.

Buy generic infant formula: Common store brands of iron-containing Food and Drug Administration regulated infant formulas cost less than big name brands and have equal nutritional value.

Do not buy toddler formula. This is a marketing coup. Children over one year of age can drink milk.

No need to buy only organic milk and food. Read here for more information about organic vs conventional foods.

Make your own baby food- from the start you can grind up part of your breakfast, lunch or dinner in a blender for your baby. Grind up cooked chicken or cooked vegetables, pasta or soft fruits, mix with a little formula or breast milk if you need to get the pureed consistency just right, and commence spoon feeding! You will save tons of money from not buying bad-for-the-environment plastic containers of baby food. When your babies advance to finger foods, simply cut up pieces of your foods.

Do NOT spend money on “toddler junk food” such as Puffs for portable finger food practice. Instead buy “toasted oats” (brand name = Cheerios) which are low in sugar, contain iron, and are much less expensive. One exception: do buy the baby cereals (rice, oatmeal, barley, or mixed grains) because they contain more iron than “grown-up” oatmeal and babies need the extra iron for their development.

Buy generic medicine: acetaminophen (brand name Tylenol), ibuprofen (brand name Motrin, Advil), diphenhydramine (brand name Benadryl), loratadine (Claritin), ceterizine (Zyrtec). If your child’s doctor prescribes amoxicillin (for ear infection, Strep throat, sinusitis), ask the pharmacist how much the medication would cost if you paid cash. The cost for this commonly prescribed antibiotic may be less than your insurance co-pay.

Accept hand-me-down clothes, shoes, etc. The purpose of shoes is to protect feet. Contrary to what the shoe sales-people tell you, cheap shoes or already-worn shoes will protect feet just as well as expensive, new ones. Just make sure they fit properly.

Don’t buy “sleep positioners” for the crib. Place your newborn to sleep on his back and he will not/cannot roll over. If you need to elevate your baby’s upper body to prevent spit-up or to provide comfort from gas, don’t buy a “wedge” but instead put a book under each of the 2 crib legs so the entire head of the crib is elevated. There is NO evidence that wedges or sleep positioners prevent SIDS (Sudden Infant Death Syndrome) and these products are NOT endorsed by the American Academy of Pediatrics. Dr. Kardos advises her patients to return any sleep positioners that they received at the baby shower and use the money for diapers instead.

The best toys are ones that can be reconfigured and used again and again. Legos, blocks, crayons/markers/chalk, small cars, dolls, balls come to mind. Avoid one-time only assembly type items, breakables, etc. Have a “toy recycle” party or a pre-Halloween costume recycle party: everyone brings an old costume/toy they would like to trade and everyone leaves with a “new” item (kids don’t care if things are brand new or not, they care only if you teach them to care). Along the same lines, inexpensive paint can turn a pink “girl’s bike” into her younger brother’s blue “boy bike.” Read our article on gift ideas for kids for more ideas that do not “break the bank.”

Borrow books from libraries instead of buying them new or look for previously owned ones at yard sales, thrift shops and online.

Don’t buy “Sippy cups.” Teach your child to drink out of regular open cups. Sippy cups are for parents who don’t like mess-they are not a developmental stage. They are actually bad for teeth when they contain juice or milk and they do not aid in child development. They can also cause harm to children who run and fall while drinking out of them.

Skip over potty training pants. Go straight to underwear.

April 17, 2014 by twopedsinapod

Avoid Allergy Eyes

Arrggh, sitting on top of kid’s items that need to be returned to Target are the allergy eye drops that need to go back to the pharmacy. With growing kids, it’s an endless cycle of buy-return-buy-return. I suppose I was duped by the sale price, but the drops which contain “red out” ingredients are not appropriate for long term use. Hoping the post below doesn’t have you running back and forth from the store this allergy season:

allergy eyes

“I see green stuff all over my car and I park in the garage,” a mom said to me today.

It’s finally spring on the east coast and with it comes green cars and itchy eyes. Eighty percent of the older kids I saw today, including those seen for routine check-ups, had red irritated eyes.

So what to do? Pollen directly irritates eyes, so start with washing the pollen off. One parent told me he applied cool compresses to his child’s eyes. This is not enough- get the pollen off. Plain tap water works as well as a saline rinse. Have your child take a shower. Filter the pollen out of your house by running the air conditioning. Pollen counts tend to be higher in the morning, so plan outdoor activities for later in the day. Some people will leave shoes outside the house and wipe the paws of their dogs in order to keep the green stuff from tracking into the house.

Oral medications do not help the eyes as much as topical eye drops. Over-the-counter antihistamine drops include ketotifen fumarate (eg. Zatidor and Alaway). Prescription drops such as Pataday or Optivar add a second ingredient called a mast cell stabilizer. Avoid use of a product which contains a vasoconstictor (look on the label or ask the pharmacist) for more than two to three days to avoid rebound redness. Contacts can be worn with some eye drops– first check the package insert. Place drops in a few minutes before putting in contacts and avoid wearing contacts when the eyes are red.

Hopefully allergy season will blow through soon. After all, as a couple teens pointed out-prom is around the corner and allergies can make even the young look haggard. One teen male told his mom that he shaved today because having a beard and blood shot eyes made him look THIRTY years old. Miserable allergies!

April 8, 2014 by twopedsinapod

I have Autism.

According to the latest CDC report, 1 in 68 children have some form of autism. April 2 is World Autism Awareness Day, and today we post, with permission, a speech that a 15-year-old friend of mine with autism gave to his classmates when school started last year.
—Dr. Kardos

Good morning everybody. Today, I wanted to talk to you about Autism. I have Autism. Don’t worry, it’s not something you can catch from me… it’s not a like a virus or anything like that. When I was very young, a doctor diagnosed me with Autism. My parents took me to the doctor because I didn’t talk much – I talked a lot less than kids were supposed to. Actually, I still talk a lot less than other kids.

A lot of people think things about Autism that just aren’t true. They really shouldn’t because everybody is different and has different things they do well. Actually, I am pretty smart. So are a lot of my friends with Autism. I just have a hard time with words. So reading, writing, and speaking are kind of hard, but I’m very good at math, science and stuff like that.

Every person with Autism has different things that they do well and other things that they have trouble with. For me, like I said, I have a hard time with words, I have a hard time remembering people’s names, and sometimes, I may have trouble knowing if someone is joking with me. You may see me walking around by myself – sometimes I pace back and forth when I’m thinking. I also sometimes flap my hands when I get excited or frustrated. So, if you see me doing that, just come over and say “Hey, Rob!” or something like that to me. That usually helps me stop right away. It may look funny, but really everybody does this a little bit. Other people may jump up and down when they are excited or clench up when they get angry. Unfortunately, I flap. But don’t worry, I’m OK.

Other than that stuff, I am just like everybody else. I really like movies and music. I go to concerts all the time… the next concert I’m going to is Bruno Mars. By the way, if anyone likes Bruno Mars, let me know – my sister doesn’t want to go… so we have a free ticket!

That’s really all I have to say. Just remember that you shouldn’t judge anyone without getting to know him or her. I’m just a normal kid that happens to have Autism. I don’t mind if you don’t mind.

Thanks for letting me tell you about myself. Does anyone have any questions?

Robbie

2014 Two Peds in a Pod®

April 1, 2014 by twopedsinapod

My tummy hurts! Stomach pain in children

stomach pain It’s 24 hours after your teenager finished up a competition for National History Day. Now she’s curled up in a ball whimpering with belly pain. Post adrenaline let down? Ate something wrong for breakfast? Appendicitis? Just as a mom’s mind goes berserk thinking of all the possible causes, a doctor’s does too. There are many organs that live inside a belly, including the stomach, the intestines, the liver, and the bladder, that cause pain. Then there are the organs next to the belly which can cause pain including the lungs and the female reproductive organs. On top of it all, chemical imbalances and emotional issues can cause or exacerbate pain. So, how can one tell if your teen should ignore the pain and go to the showing of Divergent or consult with her pediatrician?

Here are some “Red Flags” of belly pain. Pay close attention to pain associated with any of the following:

Pain which wakes your child out of sleep
Severe pain – prevents walking, moving, makes kids not want to be touched. Severe pain makes kids unable to jump up and down easily.
Diarrhea or constipation
Vomiting
Blood in the stools
Refusal to eat/not hungry—We do not mean the refusal to eat brussel sprouts, but rather refusal to eat any food
Change in behavior. To gauge severity, it helps to stand back and observe your kid. Block out what he is saying. Instead, watch how she acts. Your child may play with friends, run by you, say “My belly hurts,” and then continue to play. This is not as worrisome as the child who stops playing with friends and goes to lie down by herself on the couch. School avoidance is also a sign that something is not right.
Pain with a pattern– Perhaps you notice that your child experiences pain after downing milk or ice cream (dairy intolerance), or pain only on school mornings and not weekends (possible bullying at school).

Be aware, young kids often use the phrase “my tummy hurts” for any type of belly discomfort. A child whose belly pain disappears after he eats may mean, “I’m hungry.” New potty trainers may mean,” I need to go potty.” Young kids also use the phrase to mean, “I am nauseous.”

Finally, the most important “red flag” is if your child’s belly pain makes YOUR belly hurt; that is, if your gut tells you that something is wrong with your child, consult with your child’s doctor immediately.

Julie Kardos, MD and Naline Lai, MD

March 26, 2014 by twopedsinapod

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