Two Peds in a Pod®

Got milk? myths about milk

milk does not cause congestion We’ve heard some interesting things about cow’s milk over the years. I am going to share with you four myths about milk that I continue to hear from my patients’ parents. Spoiler: reading myth #4 can save you lots of money.

Myth #1: Don’t give milk to a child with a fever, the milk will curdle (or some other variant).

Truth: As long as your child is not vomiting, milk is a perfectly acceptable fluid to give your febrile child. In fact it is superior to plain water if your child is refusing to eat, which is very typical of a child with a fever. Fevers take away appetites. So if your child stops eating while she is sick, at least she can drink some nutrition. Milk has energy and nutrition, which help fight infection (germs). Take milk, add a banana and a little honey (if your child is older than one year), and maybe some peanut butter for added protein, pour it into a blender, and make a nourishing milk shake for your febrile child. Children with fevers need extra hydration anyway. Even febrile infants need formula or breast milk, NOT plain water. The milk will not curdle or upset them in any way. If, on the other hand, your child is vomiting, then stick to clear fluids until her stomach settles.

Myth #2: Don’t give children milk when they have a cold because the milk will give them more mucus.

Truth: There is NOTHING mucus-inducing about milk. Milk will not make your child’s nose run thicker or make his chest more congested. Let your runny-nosed child have his milk! Yet my own mother cringes when I give my children milk when they have colds. Never mind my medical degree; my mom is simply passing on the wisdom of HER mother which is that you should not give your child milk with a cold. Then again, my grandmother also believed that your body only digests vitamin C in the morning which is why you have to drink your orange juice at breakfast time. But that’s a myth I’ll tackle in the future.

Myth #3: You can’t over- dose a child on milk.

Truth: Actually, while milk is healthy and provides necessary calcium and vitamin D, too much milk CAN be a bad thing. To get enough calcium from milk, your child’s body needs somewhere between 16 to 24 ounces of milk per day. Of course, if your child eats cheese, yogurt, and other calcium-containing foods, she does not need this much milk. New recommendations for healthy Vitamin D requirements have been increased recently to 400 IU (international units) daily which translates into 32 ounces of milk daily. BUT we pediatricians know from experience that over 24 ounces of milk daily leads to iron-deficiency anemia: calcium competes with iron absorption. You’re better off giving an over-the-counter vitamin such as Tri-Vi-Sol or letting older children chew a multivitamin that contains 400 IU of vitamin D. In addition to iron-deficiency anemia, drinking all that extra milk is bad for teeth (all milk contains sugar) and can also lead to obesity from excessive calories or can in fact lead to poor weight gain in children who are picky eaters to begin with: the milk fills them up too much for them to have any appetite left for food.

Myth #4: Organic milk is healthier than non-organic milk.

Truth: If you compare organic milk to non-organic milk, the nutrients on the label of the milk carton are the SAME. “But what about the growth hormones in milk,” you may wonder. First of all, cows may be supplemented with growth hormone, but their milk is not. In addition, let me explain about growth hormone. Some children are actually born without growth hormone, and other kids develop growth hormone deficiency because of kidney failure, or cancer treatment, or other medical problems. These children need supplemental growth hormone. Unfortunately for these kids, the only way that we have to give growth hormone to these kids is by injection (a shot) every day. Do you know why? Growth hormone gets DIGESTED in the stomach and is not active if a child eats/drinks it. SO, even if non-organic milk contained growth hormone (which it doesn’t) then your child would have no effects of it anyway because their guts would break it down before it could act on their bodies. WHEW! So unless you just like the taste better, you do NOT have to spend twice as much money on organic milk. Just buy regular milk. Put that extra money away in your college funds.

In summary, you can safely continue serving your children milk in sickness and in health, in moderation, at a lower cost than organic, every day. Now, all this talk about milk really puts me in the mood to bake cookies…

Julie Kardos, MD with Naline Lai, MD
©2013 Two Peds in a Pod®

Update: Please read this article , by the American Academy of Pediatrics in 2012, for a comprehensive, unbiased review of the data comparing health benefits of conventional vs organic milk and other foods–Drs. Kardos and Lai, October 6, 2013.

Revised from the original post from 10/5/2009

September 26, 2013 by twopedsinapod

Flu vaccine 2013-2014: what’s new?

flu Pediatricians associate Back to School with “Time to get your flu vaccine.” At least this pediatrician mom does. As I try to figure out when I can get my own three children over to my office to get their flu vaccines, we want to give you a flu vaccine update.

This year, the squirt-in-the-nose flu vaccine protects against FOUR flu strains of flu, not three as in past years. Most of the injectable form of the flu vaccine this year still protects against three flu strains as in years past but some injectable flu vaccines also offer protection against a fourth strain as well (this is called QUADravalent, as opposed to the traditional TRIvalent form).

Because of supply issues, not all offices will be stocked with the newer quadravalent form of the injectable vaccine. The American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC) recommend that your children receive which ever kind of flu vaccine is available in your pediatrician’s office. We imagine that if the new quadravalent vaccine prevents more flu complications than the traditional trivalent vaccine this year, then next year manufacturers will make more of the quadravalent form.

It is not too soon to get your flu vaccines. Immunize now to help keep flu out of your homes this year. Your child’s immunity will last the entire season. As in past years, all children aged 6 months and older should receive flu vaccine. If this is the first time your child ever receives the flu vaccine and if she is under age nine years, she will need two doses spaced at least one month apart this season to receive maximum protection.

As a refresher, please see our post on how to tell the difference between the flu and the common cold, and also our flu and flu vaccine myth buster post.

You may recognize the illustration from last year. Even though school just started, the holidays and flu season are right around the corner. Today we bring the drawing back again as a symbolic gesture. After all, the flu keeps coming back too.

Julie Kardos, MD and Naline Lai, MD
©2013 Two Peds in a Pod®

September 17, 2013 by twopedsinapod

Arsenic in your food: an update

arsenic in rice Good News.

Last year we responded to your concerns about arsenic in food, particularly rice, and shared with you the FDA’s recommendation at that time.

We are relieved that after considerable research which included analyzing over 1300 samples of rice products, the FDA scientists determined that “… the levels of inorganic arsenic found in the samples are too low to cause immediate health damage.” Please see this link for the details of the investigation and recommendations.

Bottom line: continue to offer a well-balanced diet to your children and vary the types of grains that you serve to your families.

Julie Kardos, MD and Naline Lai, MD
©2013 Two Peds in a Pod®

September 12, 2013 by twopedsinapod

Bring on the basics: for kids who don’t like team sports

Some kids simply don’t like team sports. Today, childhood obesity specialist Dr. Patricia Cantrell and Youth Fitness Expert Anna Renderer, share a piece from their fitness site on activities which encourage kids to move without signing them up on a roster. Enjoy—and join in!
Drs. Lai and Kardos

hopscotch Running around the yard or playing kickball with friends is the essence of what it means to be a kid. They are gaining aerobic fitness, strength, social skills and much more just by PLAYING!

Getting kids on the right path towards a long healthy lifestyle all starts with basic fundamental movement skills (FMS) that are learned by participating in basically any activity that teaches body awareness, balance and coordination such as catching, kicking, jumping, balancing, throwing, etc. The easiest way to help kids improve these skills is to simply PLAY. A game of tag, Simon says, kickball, or 4-square is a great way to gain basic FMS.

What about the kids that don’t naturally feel motivated or confident to participate in school yard games or after school sports? It’s important to build their confidence and skills with similar movements that are simple and fun that can be done at home or with a friend after school.

Check out these great beginner moves/games to develop aerobic fitness, strength, balance and coordination.

Pick 4-5 of these moves per day (starting with 1-2 is a great way to begin).

Set small goals by trying to complete 1 set of each move and then progressing to the full recommendations.

FUNdamental Exercises!

1. Skipping: Perform in place or moving. In place skip for 30 seconds and then rest for 30 seconds. Try and repeat this 5-10 times (sets). Skipping improves coordination, rhythm, and strength.

2. Single Legged Hops: Perform in place or moving. In place hop for 15 seconds on each leg and then rest for 30 seconds. Try and repeat this 5-10 times. It’s also fun to use a line and hop down the line and back for 30 seconds to add variety of movement. Try hopping backwards for an added challenge!

3. Jumping Jacks: Perform in place for 10 reps and then rest for 30 seconds. Add 5 reps to your number (15,20, 25, 30) and rest for 30 seconds in between each set. Try to reach 30 reps in a row for your last set.

4. Hop Scotch: Use chalk to draw the ladder and number each step of the ladder 1-10. Every time they complete the ladder they get 1 point and their goal is 10! If performing in place: Hop Scotch for 30 seconds and then rest for 30 seconds. Try and repeat this 5-10 times.

5. Card Catch: Use a deck of playing cards for this. Throw up one card at a time and see if they can catch it before it hits the ground. This is a great way to interact with kids and encourage them one on one. It’s also fun to play with multiple kids who can cheer each other on. If playing with more than 1 kid, give them each 5 tries and have them alternate turns. Go through the entire deck as many times as desired!

6. Tennis Ball Bounce Pass: Perform with a partner or against a wall. With a partner, bounce the tennis ball between you and your partner so they can catch it. Alternate bounce passes back and forth. To progress, try and catch it with one hand versus two. To set an added challenge, set up goals about 10 feet wide and try to score with a bounce pass through your partners goal.

7. Jump Rope: Perform in place or moving. Jump rope for 30 seconds and then rest for 30 seconds. Add an extra 10 seconds to your next set (40, 50, 60) and rest for 30 seconds only between each set. Try and get to 60 seconds on your last set.

Remember that the more you move, you more you improve! Now GET READY, GET SET & GET FIT!

Anna Renderer, MS

Anna Renderer holds Bachelor and Master degrees in Clinical Exercise Physiology, is a certified Youth Fitness Specialist with the International Youth and Conditioning Association (IYCA), and is a certified Personal Trainer with the American Council on Exercise (ACE).

Dr. Pat Cantrell, mother of two young boys has practiced pediatrics at Southern California Permanente Medical Group for over 15 years. She has a special interest in pediatric obesity and is the President of KFIT Health, LLC (www.kidfitnessandhealth.com) which creates fitness and nutrition DVDs and products for children.

KFIT Health, LLC

September 8, 2013 by twopedsinapod

Acne: an unwelcome bump on the road to adulthood

acne treatments Why does that big pimple always appear the first week of school, the night before prom, picture day, her sweet sixteenth birthday party, or any other important event in your teen’s life?

A rite of passage, acne is caused by a combination of genetics and bad luck. The perception of acne as a problem depends on the eye of the beholder. When I see a teenaged patient in my office for acne, the first question I ask is, “Who is more concerned about the acne? The parent or the patient?” Some kids have very mild acne, yet those kids perceive their pimples are the size of golf balls. Other kids are oblivious, and the parents are more upset than the teen. When you’re a teenager, everything to you seems bigger than it actually is.

Even if your teen starts to break out with what she perceives are huge blemishes but are really the size of pin pricks, do take her seriously. For anyone dealing with acne, to them one spot can seem like many.

Many effective, safe products can diminish mild acne and thus greatly help self-esteem in a self-conscious teen. Also, make sure to probe to see if a negative perception of her appearance extends to an overall poor body image. Sometimes distress over minimal acne can be an early sign of body image disorders such as anorexia nervosa or bulimia.

The categories of acne medicines are:

-Topical antibiotics such as benzoyl peroxide or clindamycin, applied directly to skin- works to kill the bacteria that lead to acne

-Topical medications called retenoids such as tretinoin (Retin A) and adapalene (Differin) stop acne formation mainly by penetrating into the deep layers of the skin to loosen acne causing pores

-Topical creams which combine both a retenoid and an antibiotic also exist such as the adapalene and benzoyl peroxide product called Epiduo.

-Oral antibiotics, such as minocin, clindamycin, or erythromycin also kill the bacteria that lead to acne formation

-Accutane, an oral medical reserved for severe, scarring acne. Can cause significant birth defects and so girls who take it must also take birth control pills and have periodic pregnancy tests. Chemical imbalances may occur, so blood work is required for both sexes.

-Hormonal therapy (birth control pills)- works best for females who break out near their periods, smooths out the hormonal fluctuations which fire up acne.

I always remind my patients that most treatments take six weeks to work. For kids who experience dry skin from the topical medications, use noncomedogenic (non acne forming) moisturizer liberally. Pediatricians usually schedule follow up visits for acne at 4-6 week intervals. If your teen has mild acne but truly doesn’t want to bother with treatment, just encourage washing with a mild cleanser (for example Dove or Cetaphil soap) once or twice a day. No scrubbing, and stay away from alcohol containing astringents. You don’t want him irritating already irritated skin. Also ask him not to use the same smelly germy cloth after every wash. Instead dry off with a clean washcloth or soft paper towel . Applaud his self-confidence and lack of obsession with a skin condition which almost always improves with time.

Myth buster: eating chocolate does not cause acne. The chocoholic in me is greatly relieved by this knowledge.

Truth: arranging hair to hide the face tends to make acne worse. Avoid oily hair gels and sprays. In addition, touching and picking at the skin also causes irritation in an already irritated area.

Finally, what to do on prom night? Cosmetics work wonders, and parental reassurance, even if your teen waves it aside, can take care of the rest.

Julie Kardos, MD with Naline Lai, MD
©2013 Two Peds in a Pod®
Updated from the original post of July 22, 2010

August 29, 2013 by twopedsinapod

Feeding picky eaters

“You just don’t appreciate a picky eater until you have one. ”
—Overheard at Dr. Lai’s dinner table.

Picky eaters come in two major varieties. One kind is the child who eats the same foods every day and will not vary her diet; for example, cereal, milk, and a banana for breakfast, peanut butter and jelly with milk or juice for lunch, and chicken, rice, and peas for dinner. This diet is nutritionally complete (has fruit, vegetable, protein, dairy, carbohydrate) but is quite “boring” to the parent.

The other kind of picky eater is the child who either leaves out entire food groups, most commonly vegetables or meat, or leaves out meals, such as always eats breakfast but never eats dinner.

My own children range from the One Who Tries Anything to the One Who Refuses Everything (these are my twins!). My oldest child lived on cheerios and peanut butter and jelly for about two years and now eats crab legs and bulgur wheat and other various foods. My point: I know where you’re coming from, I feel your frustration, and I will give you advice that works as well as optimism and a new way of thinking about feeding your children.

Fortunately, from a medical point of view, toddler/child nutrition needs to be complete as you look over several days, not just one meal. For example, if every 3 days your child has eaten some fruit, some vegetables, some protein, some dairy, and some complex carbohydrates, then nutritional needs are met and your child will thrive!

Twelve ways to outwit, outplay, and outlast picky eaters

1) Never let them know you care about what they eat. If you struggle with your child about eating, she will not eat and you will continue to feel bad about her not eating. Talk about the day, not about the food on the table. You want your child to eat for the simple reason that she feels hungry, not to please you or anyone else, and not because she feels glad or mad or sad or because of what you the parent will feel if she eats or doesn’t eat. Along these lines, NEVER cook a “special meal” for your toddler. I can guarantee that when she knows how desperately you want her to eat your cooking, she will refuse it.

2) Let them help cook. Even young children can wash vegetables and fruit, arrange food on platters, and mix, pour, and sprinkle ingredients. Older kids can read recipes out loud for you and measure ingredients. Kids are more apt to taste what they help create.

3) Let them dip their food into salad dressing, apple sauce, ketchup etc., which can make their food more appealing or interesting to eat.

4) Let them pick their own food. Whether you grow your own foods, visit a farm or just let your kids help you in the supermarket, kids often get a kick out of tasting what they pick.

5) Hide more nutritious food in the foods they already like (without them knowing). For example, carefully mix vegetables into meatballs or meatloaf or into macaroni and cheese. Let me know if you want my recipe for zucchini chocolate chip muffins or Magic Soup.

6) Offer them foods that you don’t like—THEY might like it. Here’s an example: a few years ago, my children were decorating Easter eggs with Dr. Lai’s children. My kids asked if they could eat their decorated hard boiled eggs. Now, hard boiled eggs are one of the few foods that I do NOT like. I don’t like their smell, their texture, and I really don’t like the way they taste. Yet, all three of my kids, including my pickiest, loved those hard boiled eggs dipped in a little bit of salt. Go figure. Now I have an inexpensive, easy, healthy protein source to offer even though I can’t stand the way my kitchen smells when I cook them… but hey, if my kids actually will EAT them…

7) Continue to offer foods even if they are refused. Don’t force feed; just have them on the table. It could take 20 -30 exposures before your kids might try them so don’t despair. It took eight years of exposure to brocoli until two of my three kids decided they loved it.

8) Hunger is the best sauce. Do not offer junk food as snacks. Pretzels, crackers, cookies, candy, and chips have NO nutritional value yet fill up small bellies quickly. Do not waste precious stomach space with junk because your insightful child will HOLD OUT for the junk and refuse good nutrition if they know they can fill up on snacks later. Along these lines, never bribe food for food. Chances are, if you bribe eating vegetables with dessert, all the focus will be on the dessert and a tantrum will follow. You and your child will have belly aches from stress, not full bellies.

9) It is okay to repeat similar meals day after day as long as they are nutritious. We might like variety as grownups but most toddlers and young kids prefer sameness and predictability.

10) Turn off the TV. Trust me and trust numerous scientific behavioral studies on this, while it sometimes works in the short term, it never works in the long term. In addition, watching TV during meals is antisocial and promotes obesity.

11) Do not become a “short order” chef. If you do, your child will take advantage of you and likely will not end up eating anyway. When your child says, I don’t want this dinner/lunch/breakfast, I want something else,” you say “The meal is on the table.”
One variation of this that works in some families is to have one back-up meal that is the same every day and for every meal and must be completely non-cook and nutritious, for example, a very low sugar cereal and milk, peanut butter and jelly sandwich, or yogurt with nuts or fruit mixed in it, etc, that you agree to serve if your child does not want to eat what the rest of the family is eating.

12) You can give your child a pediatric multivitamin. This tactic is not “giving up,” nor is it cheating, and it can give the Parent as Provider of Nutrients peace of mind. You can either give a multivitamin every day or just on the days that you are convinced that your child has eaten nothing.

If all else fails, your consolation is that your child will likely become a parent of a picky eater too, and she will ask you how to cope. You’ll be able to tell her what worked for you when she was a picky eater.

Julie Kardos, MD with Naline Lai, MD
©2013 Two Peds in a Pod®
Originally posted on July 24, 2009, with modifications

August 21, 2013 by twopedsinapod

School backpack too heavy?

Just in time for the fall sales, physical therapist Dr. Deborah Stack returns to give us the low-down on backpacks.

———————————-

Believe it or not, there are only a few weeks left before school starts for the fall. As I look at last year’s first day of school photo, I notice my not-quite-100-pound child bending in half under the weight of a backpack, trombone, lunchbox and art portfolio. This year, I quietly decree, that scenario will not happen again. To make sure it does not happen at your house either, consider a few tidbits as you plan your back-to-school purchases:

-A traditional backpack with two shoulder straps distributes the weight more evenly than a pack or messenger bag with a single strap.

-Look for wide, padded straps. Narrow straps can dig in and limit circulation.

-A chest or waist strap can distribute weight more evenly.

-Look for a padded back to protect your child from pointy pencils etc.

-Look for a lightweight pack that does not add much overall weight.

–Multiple compartments can help distribute weight.

–Compression straps on the sides or bottom of a backpack can compress and stabilize the contents.

–Reflective material allows your child to be more visible on those rainy mornings.

–A well fitting backpack should match the size of the child. Shoulder straps should fit comfortably on the shoulder and under the arms, so that the arms can move freely. The bottom of the pack should rest in the contour of the lower back. The pack should “sit” evenly in the middle of the back, not “sag down” toward the buttocks.

How much should your tike tote? Experts, including the American Academy of Pediatrics and the American Physical Therapy Association, recommend kids should not carry backpacks weighing more than 15-20% of the kid’s weight.

Here’s a chart to give you an idea of the absolute maximum a child should carry in a properly worn backpack:

Child’s Weight (pounds)	Maximum Backpack Weight (pounds)
50	7.5-10
60	9-12
70	10.5-14
80	12-16
90	13.5-18
100	15-20
110	16.5-22
120	18-24
130	19.5-26

Here are some ideas to help lighten the load, especially for those middle school kids who have a plethora of textbooks:

-Find out if your child’s textbook can be accessed on the internet. Many schools are purchasing access so the students can log on rather than lug home.

-Consider buying an extra set of books for home. Used textbooks are available inexpensively online.

-Limit the “extras” in the backpack such as one free reading book instead of five. I am not exaggerating; one day I found five free reading books in my child’s backpack!

-Encourage your child to use free periods to actually study, and leave the extra books in his locker.

-Remind your child to stop by her locker between classes to switch books rather than carrying them all at once.

-Consider individual folders or pockets for each class rather than a bulky 3-ring notebook that holds every subject.

You may need to limit the load even further if your child is still:

-Struggling to get the backpack on by herself

-Complaining of back, neck or shoulder pain

-Leaning forward to carry the backpack

If your child complains of back pain or numbness or weakness in the arms or legs, talk to your doctor or physical therapist.

When used correctly, backpacks are supported by some of the strongest muscles in the body: the back and abdominal muscles. These muscle groups work together to stabilize the trunk and hold the body in proper postural alignment. However, backpacks that are worn incorrectly or are too heavy can lead to neck, shoulder and back pain as well as postural problems. So choose wisely and lighten the load. Happy shopping!

Deborah Stack, PT, DPT, PCS

Dr. Stack has been a physical therapist for over 15 years and heads The Pediatric Therapy Center of Bucks County in Pennsylvania www.buckscountypeds.com. She holds both masters and doctoral degrees in physical therapy from Thomas Jefferson University.

August 17, 2013 by twopedsinapod

Overhauling the sports snack stand

As you stand watching your budding baseball star at his five o’clock practice, the rest of your kids start to whine. “Please, please, please,” they say. “Can we go to the snack stand? We can’t wait for dinner.” Feeling faint from hunger yourself, you begrudgingly acquiesce and later cringe as you see them trouping back from the snack stand with fluorescent nacho cheese covered chips and candy. Sound familiar? Today we bring you thoughts from a mom who did the unthinkable… she revamped her kids’ sports snack stand menu. Now she brings you ideas to overhaul yours. We are impressed. –Drs. Kardos and Lai

Skittles, hot dogs, nachos, soda, and ice cream. If you have been to your child’s sporting event recently, then this should sound like a typical snack stand menu. Somehow, sports and junk food are synonymous. But doesn’t that contradict itself? Aren’t we having our children participate in sports to keep them healthy? Well, then, why are we feeding our children junk food at the very moment that they need fuel to help them perform better? These foods are laden with sugar, trans fat, and sodium, foods which will adversely affect the health of your family.

As parents, we need to take back control of what we are feeding our children. Statistics show that type 1 and type 2 diabetes are on the increase among children. According to the SEARCH for Diabetes in Youth study, the prevalence of type 2 diabetes increased 21 percent among American youth from 2001-2009, while type 1 diabetes rose 23 percent. The effects of diabetes are staggering: heart disease, blindness, kidney disease, nervous system disease, and poor circulation leading to amputation. And diabetes is only one of the many negative results of eating processed junk food.

You may be thinking, what’s the harm in eating a little junk food at snack stands? Well, it wouldn’t be overly harmful if snack stands were the only place that our children occasionally purchase junk food. Think about all of the other locations that our children consume unhealthy food: school lunches, fast food restaurants, vending machines, and convenience stores. All of these poor food choices add up and will eventually lead to serious health consequences.

Over the past few weeks, I revamped the menu of the snack stand for my daughters’ summer swim team. I was apprehensive about making these changes because I was concerned about how the parents and children would react. Would my own children be subjected to teasing because I took away the M&M’s? I was able to transform the menu from items riddled with sugar and trans fat to whole foods fresh from our grocery store. Here’s a sample of items that we offered:

Old Menu New Menu

Skittles Fresh Fruit Salad

Cupcakes Smoothies made from fruit

Brownies Chocolate Covered Frozen Bananas

Cow Tails Trail Mix

Soft Pretzels Air Popped Popcorn

Hoagies on White Bread Subway Hoagies on Whole Wheat Bread

Snapple (with more sugar than soda!) Water

Gatorade 100% Fruit Juice

Of the hundreds of families that we served, I only had one person who complained. One! Instead, I had an outpouring of support and many families who appreciated having fresh, healthy food choices for their family. One dad went as far as emailing the president of our board to compliment us on our healthy snack stand.

So, what can you do if your snack stand does not yet offer healthy choices? Here’s a bit of food for thought:

Pack your own snacks! You can control what your family is eating by giving them healthy choices.* Here are my favorite items to pack in our cooler:
- Water
- Peanut Butter and Banana Sandwiches on whole wheat (cut them into quarters for little snacks to share)
- Make your own trail mix with a variety of nuts, plain cheerios, and toss in a few mini chocolate chips to make this feel like a sweet treat!
- Nature Valley Honey Oat Snack Bars
- Fruit Kabobs
- Applesauce cups (natural, no sugar)
- Fruit cups (packed in fruit juice)
- Cheese sticks
- Air popped popcorn – pop enough in an air popper to store in a new trash bag. Add a little melted butter and salt and shake. Bring solo cups and scoop out for your child to share with their friends.
If you must purchase an unhealthy choice from a snack stand, then try splitting it into two portions. Ask your child to eat half of it now, and save the other half. Cutting the portion size down is an important step towards getting healthy.
Try feeding your family before you leave for an event. You will have more control and choices about what your child eats.
Talk to the board of your child’s team and ask them to revisit the food that is served in your snack stand.
If you are visiting another team, then find the name and email address of the board members and email about making a change.

Together, let’s make steps towards changing the way that we think about the food that we feed our children. The next generation’s life depends upon it. If that is not enough incentive, then think about how much money you will be saving. Maybe you can save enough to treat yourself to a little something nice. Now, we’re talking!

*NOTE: If you child is resistant towards making these changes, focus on one area (i.e. drinks, sandwiches, or snacks) and make that your focus. Do not try to make too many changes all at one. You may find that your chances of success increase when you only focus on one food area at a time.

Mary McDonald, MA

Mary McDonald holds a Masters of Education from Arcadia University and a health coach certification from Institute of Integrative Nutrition. She is a high school teacher, a mom of four daughters, and an advocate for healthy food choices. For more information on her health coaching services, please contact her at nutrition101withmary@gmail.com or visit her website at nutrition101withmary.com.

August 11, 2013 by twopedsinapod

Another picture puzzle- connect the dots

We had such a great response to our Two Peds in a Pod® visual diagnosis post that we are posting another summertime picture puzzle:

What is it? Pictured below are the toes of one of my best friend’s toddler. She is happy, has no fever, and plays nearly everyday in the neighborhood pool. The round shiny pink bumps and dots on her toes appeared yesterday morning and haven’t changed much in a day. They don’t seem to bother her very much… answer below.

It’s Swimming pool pulpitis- a fancy word for a reaction of the pulp (the meaty tip) of fingers or toes. Mostly seen on the finger tips, the pulpitis is usually caused by irritation of the fingers by the rough side of the swimming pool as kids pull themselves in and out. Kids are sometimes annoyed by the dots, but they go away on their own as soon as the kids decide to use the ladder. In this case, this little swimmer irritated her toes, not her fingers, while “monkey walking” along the side of the swimming pool in the water.

Naline Lai, MD with Julie Kardos, MD

originally posted June 2011

July 24, 2013 by twopedsinapod

Picture Riddle: Whats crusty, tender and red all over?

red crusty rash We interrupt your summertime to present another Two Peds in a Pod® visual diagnosis learning session. Do you recognize this rash? Hint: it is mildly itchy and painful and can result from scratching bug bites or a skinned knee. Read on for the answer.

The rash on this child’s arm is impetigo. Impetigo is just a fancy name for a crusty skin infection on the surface of the skin. The infection is caused by the common germs that often lurk on our skin, Staphylococcus and Streptococcus. (You may recognize the germ Streptococcus from our sore throat post because it can also cause Strep throat). The germs wait for a break in our skin, from a tiny cut, pimple or a scrape, then invade the skin and spread. Impetigo is often seen next to the nose because the germs love to lurk in the nasal passages and kids often pick at the skin under the nose when it gets irritated from a cold virus.

Doctors tend to describe infections with appetizing food analogies (yes, we know- eew). In this case, impetigo is often described as having honey-colored-crusted lesions. The areas are tender and red, and often itchy. Kids often spread this infection on themselves when they scratch at the infection and then touch other areas of their skin.

Pediatricians treat impetigo with either a topical antibiotic or oral antibiotic for anywhere from 7 to 10 days. The choice of how to treat depends in part how much of the skin is affected and which body surfaces are involved. The infection is contagious until 24 hours after starting treatment.

Prevent this infection: Hand washing is a great way to prevent spread of impetigo. Washing all skin wounds well with soap and water is another way to prevent the emergence of this infection. See our prior post on wound care.

Ok, now back to the pool and barbeques for all our summertime readers. Just remember your bug spray and remind your children not to scratch and pick at their skin.

Naline Lai, MD and Julie Kardos, MD

July 23, 2013 by twopedsinapod

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