Two Peds in a Pod®

Why is my baby’s head flat? Positional plagiocephaly

Squeezed through the birth canal, many babies are born with pointy, cone-shaped heads. Others, delivered by caesarian section, start off life with round heads. No baby begins with a flat head. But as parents put babies on their backs to sleep in accordance with Sudden Infant Death Syndrome prevention guidelines, babies are developing flat heads.

Called positional plagiocephaly, a young infant’s head flattens when prolonged pressure is placed on one spot. Tricks to prevent positional plagiocephaly all encourage equal pressure over the entire head. Because babies’ heads are malleable, parents can easily prevent and treat the flatness. In fact, the flat shape begins to correct itself after six months of age, when babies spend less time lying down and more time sitting and crawling. Additionally, increased hair growth hides some of the flatness.

To prevent positional plagiocephaly, place your baby prone (belly down) frequently WHILE AWAKE, starting in the newborn period. This tummy time decreases pressure on the back of the head. Some babies are not fond of tummy time and will cry until they are back on their backs. For those kids, in our next post, guest blogger physical therapist Deborah Stack will address ways to make the time tolerable.

Encourage your baby to look to both sides while lying down. Too much time turned to one side will cause flattening on that side. Alternate how you place the baby in crib so that sometimes she turns to the right and other times she turns to the left to face into the room and away from the wall. If your baby seems to prefer looking only to the right or only to the left, place toys or bright objects toward the non-preferred side. If bottle feeding, switch off which arm you use to feed your baby, so that the baby sometimes turns to the right and sometimes to the left . If breastfeeding, start and end on the side that the baby tends to avoid. These actions will help prevent neck muscles from becoming too tight on one side and thus allow your baby to turn easily to both sides.

Some babies wear helmets to correct their abnormal head flattening. Neurosurgeons, who are head and brain specialists, prescribe these helmets for babies who have extreme flattening. Fortunately, the majority of babies with positional plagiocephaly do not need to wear helmets.

You also may have heard of babies who need corrective surgery for an abnormal head shape. This condition, called craniosynostosis, is rare. Pediatricians monitor the size and shape of the head and check the soft spot on the top of the head at every check-up. A baby’s skull develops in pieces as a fetus, and these pieces eventually come together at predictable places called sutures. If the pieces come together too early or the soft spot closes too soon, corrective surgery must be performed.

So, avoid head flatness by rotating your baby’s position frequently (think rotisserie chicken!) and provide plenty of “tummy time” when awake. Start when the baby first comes home.

If you are worried about your baby’s head shape, just head on over to your baby’s pediatrician and bring up your concern. Trust us, your concern will not “fall flat.”

Julie Kardos, MD and Naline Lai, MD

April 14, 2012 by twopedsinapod

How can I motivate my child in school? — Creating the resilient learner

“What will happen if your grade drops from an “A” to a “C”?” I sometimes ask during a check-up.

Many kids shrug and say, “Try harder next time, I suppose.” Others look shocked and anxious about the possibility and are speechless.

Still others will point at their parents and say,”THEY would kill me.”

Observe a toddler learning a new skill. You will see him repeatedly try to fit a ball into a hole until he is either successful or wanders way. He is not anxious or afraid of failure. He is not “stressed” about trying to learn. Although all children start this way, too often toddlers become big kids who end up in my office discouraged and worried about school performance. Today’s guests Principal Mr. Leonard Schwartz and Vice Principal Michael Testani, based on the work of Dr. Carol Dweck, discuss ways parents can influence their children so that they embrace learning.

– Drs. Lai and Kardos

Researchers under the leadership of Dr. Carol Dweck conducted a survey of parents of school aged children. The majority of parents thought it was necessary to praise their children’s intelligence in order to give them confidence in their abilities and motivate them to succeed. Instead, this approach can lead to fixed mindsets in children. Kids with fixed mindsets believe “my abilities are what they are.”

Instead, the most motivated and resilient students demonstrate a growth mindset. They are the ones who believe their abilities can be developed through their effort and learning. These students are resilient and persevere when tasks become challenging.

A study of students’ brain waves revealed students with a fixed mindset were interested in whether they got an answer right or wrong, but when they were wrong, they paid little attention to the correct answer. Students who were praised for their intelligence later lied about their scores. They felt the errors were so humiliating that they could not own up to them. The students failed to persevere, believing they were no longer “smart,” and therefore unable to meet academic challenges.

Students with a fixed mindset typically think it is best if they:

Don’t make mistakes – “I’m too smart to make mistakes.”
Don’t need to work hard –”I’m smart and learning comes naturally to me.”
Don’t try to repair mistakes- “I was wrong, and that is the end of it.”

Students with a growth mindset generally:

Take on challenges
Work hard
Confront their deficiencies and correct them

How should parents talk to their children in order to develop a growth mindset?

Wow, you got 10 out of 10 right! What strategy did you use to get a perfect score?
What can you learn from this mistake that will help you do better next time?
I am proud of how hard you worked on this project and look at how your hard work paid off!
The strategies you used last time didn’t work. Let’s take a look at them so I can help you figure out better strategies to use next time.
You’re becoming such a good learner!
Smart is not something you are; it’s something you become. Let’s figure out how you can become smart at this assignment.

What is your child’s mindset? Ask yourself, what is your own mindset? Have a conversation with your child as you discuss your child’s report card. Use any upcoming parent teacher conference to examine outlooks, attitudes, and strategies that are or are not supporting your child’s academic progress.

Where applicable, praise your child’s positive skills and attributes. Celebrate instances you observed that contributed to positive indicators.

When necessary, examine areas of poor performance and strategize with your child about how he or she can turn a weakness into a strength. Again, you may revisit situations you observed this past grading period in which your child took shortcuts, provided incomplete work products, or did not do his or her personal best.

Make your expectations very clear in terms of why you value attributes or traits of resiliency, and how they can and will develop into habits that will serve your child well.

Grades are a distant second to the level of effort a child invests in personal learning in any setting.

Leonard H. Schwartz, Principal, Mill Creek Elementary School

Michael R. Testani, Assistant Principal, Mill Creek Elementary School

Mr. Schwartz and Mr. Testani are part of the Central Bucks School System in Pennsylvania. After fourty-three years as an educator in two school districts and five schools, Mr. Schwartz retires this year. This post was published in it’s full original form in the publication Principal’s Prose of Mill Creek Elementary School.

April 4, 2012 by twopedsinapod

Potty Talk: the “Scoop On Poop” on philly.com

We’re pleased to bring to the Greater Phildaelphia Area our “Scoop on Poop” post which was published in the Healthy Kids blog for Philadelphia Inquirer’s philly.com.

Although many can not talk about the topic without snickering, face it. “Poop” is an essential of life. If pooping gets thrown off, everything gets thrown off. The kid who won’t poop in the potty sets everyone else in the household off kilter, and leads to bribes, threats and chaos. A constipated kid is a grumpy kid. Constipation can lead to tantrums, refusal to eat, and even an inability to fall asleep. If you still have have infant and toddler poop questions, check out our podcast on potty training and our post “When potty training gets hard: constipation.” On a related topic, please also visit our post “It’s a Gas, your young infant’s burps and farts.”

Until you are a parent, you can never fully appreciate the fierce desire for “everything to come out okay in the end.”

Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®

March 24, 2012 by twopedsinapod

Some like it hot: Hot Tub Folliculitis

hot tub rash From the start, a family I know was suspicious of the hot tub sanitation at the resort where they recently stayed. As time went by, even though the water looked clear, the hot tub seemed less chlorinated, and the water more tepid. They dubbed the tub “the scuz tub.” After their return, one of the kids broke out in the rash of hot tub folliculitis pictured to the left. You could say, they figured out just what the “scuz wuz”.

Hot tub folliculitis is a skin rash caused by a bacteria called pseudomonas aeruginosa. The rash appears a day or two after soaking in a hot tub. A light pink bump appears around hair follicles (hence the name). As you can see in this photo, the rash is typically worse on areas of skin where bacteria was trapped under a swimming suit. The rash can cover all body surfaces, including the face, if your child dunked his head under water.

The rash can be slightly itchy but is not usually painful. No other symptoms develop such as fever or sore throat. The rash is not contagious, but often other people who swam in the same hot tub also break out.

Treatment is to wait it out. Typically by one to two weeks, provided your child does not go back into the hot tub, the rash resolves on its own. If your child feels very itchy, you can treat her with oral diphenhydramine (brand name Benedryl). Rarely, just like mosquito bites, the rash can become infected with other bacteria if your child scratches too much.

Pseudomonas thrives in warm wet places. In fact, it’s the same bacteria that causes “swimmer’s ear.” Tight control of chlorine and acid content of the hot tub water limit the growth of the bacteria. Unfortunately, you can not tell the pseudomonas content of water just by eyeing it.

May you bring back a better souvenir than this family did on your next vacation.

Julie Kardos, MD and Naline Lai, MD

March 19, 2012 by twopedsinapod

Portable Parent: baby advice texted to your cell

“Calling” all moms and dads with cell phones! We discovered a new free service from the US National Healthy Mothers, Healthy Babies Coalition. The service text4baby texts health maintenance tidbits three times a week to your phone during pregnancy and during your baby’s first year of life.

Text BABY or BEBE (to receive messages in Spanish) to 511411, and you will receive three texts a week. This is an example text for expecting parents: “Your baby will be here soon, & it’s time to get a car seat. The hospital won’t let you leave by car or taxi without one.”

Since most cell carriers participate, even people in the United States without a text plan can get messages for free. If you have a text limit per month, text4baby won’t take away from that limit. Look at www.text4baby.org for more information.

Gotta <333 a service like this.

Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®

March 11, 2012 by twopedsinapod

It’s National Sleep Awareness Week: nothing to snooze at

Wake up!

Remember that sleeping, along with eating, peeing and pooping, is an essential of life that helps your child (and you) function well. Inadequate sleep is associated with obesity, learning difficulties, behavior problems, and emotional lability (gotta love the whining of an overtired kid.)

In honor of the National Sleep Foundation’s National Sleep Awareness Week, which ends on March 11when Americans “spring ahead” the clocks and we ironically lose one hour of sleep, please refer to our earlier podcasts and blog posts on sleep. We invite you to learn about how to teach healthy sleep habits to your kids and yourselves (the parents).

The podcasts:
–Sleep Patterns of the Newborn
–Helping your baby to sleep through the night
-“There’s a monster under my bed”: all about nightmares, night terrors, night wandering, and bedwetting
–The tired teen

The blog posts:
-Sleep Safety: How to decrease your baby’s risk of Sudden Infant Death Syndrome (SIDS)

-Parents of newborns: get your Zzzzzs back
–I Need a Nap!
–Wake up, sleepy-head, it’s time for school!

–When your child’s bedtime seems too late, or, will I ever get a late night alone with my spouse again?

Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®

March 6, 2012 by twopedsinapod

Hail to the Tooth Fairy: young school age child development

The Tooth Fairy rocks!

For kids, the Tooth Fairy takes the worry out of the stage around five to seven years when they start to worry about their “body integrity.” Kids are concerned about keeping their bodies intact. This is the age of Band-Aids and boo boos, of skinned knees on the playground and falls from bikes without training wheels. When a child loses her tooth, a PIECE of her BODY falls off. Often the child experiences discomfort as the tooth gets very loose. Many become anxious and have difficulty eating when the tooth gets to the “hanging by a thread” state. Kids BLEED if they lose a tooth by biting into an apple or knocking into something. Yet adults convert this potentially anxiety-provoking event of losing a tooth into an exciting rite of passage. Without the Tooth Fairy, we’d have a batch of kids mortified by a normal physical change. Who ever invented the Tooth Fairy was a GENIUS!

Our patients have taught us interesting “facts” about the tooth fairy over the years:

Some tooth fairies leave the token under the pillow, others leave it at the bedside.
Some tooth fairies leave money, others a small toy, and some write messages.
Some tooth fairies are boys and some are girls.
Some look like Tinker Bell and others look like trolls.
Some tooth fairies don’t have change for a twenty dollar bill.
Tooth fairies can look like someone the child already knows, even a mom or dad!
Tooth fairies can sense a missing tooth even if the child loses the tooth on the playground or swallows it by mistake, so it’s okay if the tooth is not left under a pillow for the Tooth Fairy. She’ll still come.

Pediatrician dentists recommend children begin regular dental visits within six months of getting their first tooth. Most babies get their first tooth between four months and twelve months, so by eighteen months of age your child should have had her first dental visit. Don’t forget to start brushing as soon as that first tooth appears. With this being said, it isn’t just kids who need to look after their teeth. No matter what age you are, you should clean your teeth at least twice a day.

It’s okay to brush with water alone or use a baby tooth and gum cleaner. Add toothpaste by age two years, when kids can learn how to spit. Ask your dentist or pediatrician about fluoride supplementation if there isn’t any fluoride in your water supply. For more tooth tips see our guest blog post by Dr. Paria Hassouri and take advantage of this free tooth brushing chart which you can personalize with your child’s name. Take good care of those primary teeth, even though they are destined to be taken away by the Tooth Fairy.

Julie Kardos, MD with Naline Lai, MD

Dr. Kardos feels nostalgic. Her oldest child, who stopped eating for the two days before his first baby tooth fell out, just lost his last baby tooth last week. And yes, the Tooth Fairy did visit her twelve-year-old.

February 29, 2012 by twopedsinapod

Cinnamon Challenge = Potential Choking Calamity

Do not take the cinnamon challenge Beware. There’s another choking “game” out there. This time, kids try to swallow a teaspoon (or more) of cinnamon without water as quickly as possible without coughing or vomiting. The cinnamon usually forms a thick slurry in the back of the throat and causes gagging and coughing. Hence, the “cinnamon challenge.”

We first saw warning reports of the cinnamon challenge via recent emails circulated by principals in local school districts, but yesterday Dr. Lai heard about it directly from a kid and his mother in her office. Luckily, the teen and his friends who played it the other day were fine. However, everyone did cough after taking in the cinnamon and one kid in his group threw-up.

“Do you know why people cough?” I asked him.

“Why?” he said.

“It’s a sign your body is trying to protect your airway,” I said.

The trend is spurred on by kids trying to copy YouTube videos and Daniel Tosh on the television show Tosh.0

Current statistics for emergency room visits or deaths related to this particular “game” are hard to come by. But we do know in 2000, according to the Centers for Disesase Control, 160 children aged 14 years and under died from airway obstruction associated with inhaled or ingested foreign bodies. Food was associated with about 40% of those deaths. Especially for those who already have sensitive airways such as those with asthma, any substance which tickles the back of the throat can produce spasm in the lungs. Also, the substance itself can get into the lungs.

Tosh starts off the video above by saying, “The internet is full of challenges.” Well, we’re on the internet too, Tosh, and we challenge you to model the healthy behaviors – not the dangerous ones.

Naline Lai, MD and Julie Kardos, MD

February 23, 2012 by twopedsinapod

How to treat bloody noses- nothing to sneeze at

Our fantastic Two Peds in a Pod photographer Lexi Logan recently put in a request for a post on bloody noses. I cringed, thinking any photo would not be pretty. “No problem,” she replied,” I’m thinking just a tissue and a top-of-nose shot… pinch angle.”

I was aghast. “Looks like you fell for the number one myth associated with bloody noses,” I said.”That’s the wrong spot to pinch.”

“See,” she told me,”that’s why I need the post.”

So, how does one squelch the fountain of red which spews from a bloody nose? Apply pressure to the SIDE of the nostrils—not up near the bridge of the nose. More blood vessels lay near the bottom of the septum, the divider which separates the nostrils, than near the top. Pinch the nose firmly. Since kids never seem to apply enough pressure on their own, go ahead and pinch for them. You’ll find it easier to pinch both nostrils simultaneously even if the blood is dripping from only one side.

Now hold. Hold. Hold. Hold in the middle of the night until you nearly fall back to sleep. Hold until the pot of spaghetti boils over. Hold for at least ten minutes before peeking in order to allow the blood to clot. If the nose is still oozing, pinch for another ten minutes. Have your kid sit up straight or lean slightly forward. Otherwise, blood will drip down the back of her throat and cause nausea and vomiting.

Do not be surprised after an episode if the next couple of nights bring more bloody noses. At night during sleep kids tend to rub their noses. Any scab that formed from a recent nose bleed gets sloughed off.

To prevent reoccurrence, protect those fragile blood vessels by keeping the inside walls of the nose moist. Once or twice a day, spritz saline into the nose, then apply a thin layer of petroleum jelly. Try running a cool mist humidifier in your child’s bedroom.

Prevent nasal irritation by decreasing environmental irritations such as cigarette smoke or dust. Teach your child to dab at his nose or blow gently when he has a cold. Ironically, some steroid nasal sprays, which treat runny noses caused by allergies, can irritate nasal passages.

Your kid is having too many bloody noses when you start to carry around tissues or your child sleeps with a box of tissues next to his pillow “just in case.” Go to your child’s doctor if this occurs. Also, go if there are signs of a clotting problem such as easy bruising, bleeding gums, or heavy periods. Likewise, if bloody noses take more than twenty minutes to clot, or if the nose bleed requires an emergency room visit or packing in the nose, make an appointment. Other reasons for more evaluation include if your family has a history of clotting disorders, your child gets speckled flat rashes that look like broken blood vessels (petechiae) which do not blanch (lose color for a second when you press on it) or if a nosebleed is caused by trauma.

Your child’s doctor may recommend sealing vessels with cauterization or investigating for possible blood clotting problems. Depending on your child’s age, she may also recommend a short course of oxymetazoline (eg Afrin). Be sure to use oxymetaxzoline according to directions- overuse can cause rebound symptoms.

Ultimately, you may find that your kid’s bloody noses are just the result of the perfect storm: dry air and a kid who picks his nose. In the meantime save that thirty percent-off Kohl’s coupon. You might be buying a lot of pillow cases.

February 21, 2012 by twopedsinapod

Infant CPR: Do you know what to do?

We asked Dr. Raymond Wu, the doctor behind the popular new infant iphone app babyCPR, to talk about how to perform CPR on babies under one years old. We even convinced him to time a discounted app price with the release of this post!

If you found your baby unconscious, would you know what to do? Could you pull it off correctly while in a panic? Every moment without Cardiopulmonary Resuscitation (CPR) increases your child’s possibility of brain damage and death. Learning CPR is just one of a number of safety precautions any parent should take.

Well-performed CPR can mean the difference between a good and bad outcome, which could be the difference between life or death. In this article, we’ll go over important aspects of CPR. After reading this article, you should have a good understanding of why CPR works and how to perform it effectively. CPR is different for when it comes to performing it on a baby. So you might have been trained in giving CPR to adults, but it won’t be the same for infants.

What is CPR?

CPR stands for Cardiopulmonary Resuscitation, or more simply, “heart-lung support.” The two main components include chest compressions and rescue breaths. When the heart stops beating, chest compressions are used to maintain some blood circulation. Since the body continues to use oxygen even when breathing has stopped, we help replenish oxygen by providing rescue breaths. The idea is to help pump oxygenated blood to the body’s organs — most importantly, the brain.

Infant CPR basics

The guidelines for infants (children less than 1 year old) are to provide 30 chest compressions and alternate with 2 rescue breaths.

For each chest compression, place the baby on a hard flat surface then place two fingers in the center of the child’s chest. Quickly press down 1.5 inches, or about 1/3 of the thickness of the baby’s chest. Then release until the chest recoils, which allows the heart to refill with blood for the next compression. Do this at a rate faster than 100 compressions per minute.

To deliver rescue breaths, first attempt to open the infant’s airway by tilting their head and lifting his or her chin. After opening the airway, put your mouth over the infant’s mouth and nose, and make a good seal. For each breath, blow gently for about 1 second. A good breath will make the baby’s chest rise. Avoid blowing too hard since that can damage the baby’s small lungs.

If someone is with you, send them for help right away while you perform CPR. If you are alone with the baby, perform 2 minutes CPR before calling for help, then immediately resume CPR as soon as possible.

Infant CPR is NOT like adult CPR

Babies are not just tiny little adults. They have special needs and therefore require special care. You may have heard about hands-only CPR for adults. This does NOT apply to infants. Since they are so small, they have limited oxygen reserves in their body. You need to provide rescue breaths regularly to replenish these reserves.

Why the compression rate is now faster than 100 per minute

The previous American Heart Association (AHA) guidelines asked people to do compressions at exactly 100 per minute, but the newest 2010 guidelines now simply ask to go faster than 100 compressions a minute. Researchers found that with the previous guidelines, most people were going too slow and had overly long breaks between sets. The new guidelines encourage people to focus on improving blood circulation in the baby.

Tip: Following the beat of songs in your head like “Staying Alive” or “Mary Had a Little Lamb” can help you maintain the correct timing while you do chest compressions.

Practice makes perfect

If you learn CPR correctly and then practice correctly, you won’t lose any precious time when your baby needs saving. Practicing allows you to quickly recognize what to do and cements the skills. That way, you can remember what to do even when in a panic. Your baby’s life may depend on this.

For more information

I covered some basic aspects of infant CPR here but there are more details that are important to know, including what to do when your baby is choking. Traditional CPR classes are available in many areas and usually take about 3-4 hours. The American Red Cross provides many of these courses and The American Heart Association has a class locator on it’s website.

Looking for other ways to learn? A new method of learning CPR is iphone app BabyCPR (available on itunes). This app allows you to practice on a simulated baby.

Raymond Wu, MD

Dr. Wu completed medical school and internal medicine training at Northwestern University. He founded Transcension HealthCare to pursue his passion and vision for improving healthcare through the effective use of technology. He specializes in medical simulation technology and is a leader in developing computer-based medical simulators. Recently, he had the pleasure of becoming an uncle, and looks forward to creating software for his niece as she grows older

February 13, 2012 by twopedsinapod

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