Beware the bewitching hour






Every day across the United States, sometime between 4:00 to 5:00 PM, millions of small children are crying and whining. Welcome to the bewitching hour.  



In our offices it’s bedlam during that hour. The phones start ringing off the hook: daycare called mom to report Johnny has a fever, Mildred came off the school bus bleeding from a gash from a flying lunch box, and help, the coach won’t let Mary play lacrosse until her school form is signed.

Meanwhile, you are trying to get home from work/ fix dinner/ walk a cranky baby/order new cleats for Jared, or all of the above, likely at the same time. 

Resign yourself. Even if your kids are well-fed, napped and had a great play date that day, the bewitching hour can still happen. Think of it as Colic: Part Two. Some think colic is related to the difficulty of young nervous systems trying to adjust to nightfall. We’re not sure anyone ever grows out of that stage! We just hide our crankiness better as adults. When you think about it, it’s a hard point of day for adults, even childless ones. After a full day around the house or at work, you’d rather curl up on the couch and read a good book than grapple with, well, anything. Remember those ads for bath soap? “Calgon take me away.”  

I remember when my oldest was a toddler. At the bewitching hour I’d stare out the window looking for my husband’s car as he drove home from work. We’d have conversations like this, “Daddy should be home any minute.  Let’s go to the window and see. No Daddy? Let’s read a book on the porch and watch for him. No Daddy? Then let’s move to the lawn. I’m sure he will be in the next car.”

Your best defense against your desperation at this time:  drill down to the basics: eat, sleep, drink, pee, poop. Make sure they are all going okay entering the bewitching hour- for your kids and for YOU! You may be too harried to notice that you did not drink anything for hours and a dehydrated dad will feel like he’s hallucinating during the bewitching hour. 

When my oldest was three and my younger child was one, I surprised the furnace repair guy by cooking dinner at two in the afternoon. The crock pot is your friend. A crock pot dinner will cook itself. Do everything possible: cook the dinner, set the table, give the baths and make your phone calls before the hour hits. 

If you are picking the kids up from daycare, make sure you have something healthy for them and yourself to munch on in case everyone is starving. Alternatively, pack a dinner for the daycare teachers to give to your children before you pick them up. These strategies will prevent your children’s hunger from fueling the bewitching hour. Additionally,  having a healthy snack prevents them from becoming so full from goldfish crackers that they later refuse to eat their meal. Even if your kids eat dinner before you, they can join the adults at the dinner table and eat some fruit or veggies or have a cup of milk, allowing for some quality family time.


 


Several years ago during a particularly horrific bewitching hour,  Dr. Kardos’s three children melted down simultaneously.  In desperation, she grabbed the video camera for some footage of one five-year-old and twin two-year-olds all tantruming at the same time. Now the replay is as entertaining to her family as the funniest of America’s Funniest Videos. Sometimes you have to use humor and remind yourself that you might, one day in the not so far off future, miss this time. 

And don’t forget. Just as you are questioning whether or not you will go insane… there are times when the bewitching hour will go smoothly… at least until you wake up!

Naline Lai, MD with Julie Kardos, MD


©2011 Two Peds in a Pod®




 

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September 12, 2011 by

A message to our children: Don’t be afraid to reach for the sky

If you were around the New York area ten years ago on September 11, you know it was a beautiful crystal-clear day. It was the kind of day which made you gaze admiringly at the sky as you stepped out the door. No one knew that soon the sky over New York, Pennsylvania, and Washington, DC would be marred by the dark clouds of terrorist attacks. Many of your children were too young to remember much about the day, or perhaps they were not even born yet. 

As the ten year anniversary of that tragic day approaches, we remind you of previous posts which may help your children digest the images they see in the media and the raw emotions of adults around them. Above all, don’t be afraid to discuss the day and assure your children that it’s still ok to reach for the sky:

Explaining Tragedy to Children
Books for helping children through bereavement
How to explain death to a young school aged child

This link from Common Sense Media may also help: Talking to your child about 9/11: What do you need to know?

Naline Lai, MD and Julie Kardos, MD

©2011 Two Peds in a Pod®



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September 10, 2011 by

A lovely surprise!

Special thanks to Lu Lu of YQY Jewelry for surprising us with a two peds in a pod necklace. Lu Lu, who custom handcrafts jewelry and is known for her distinctive woven silver basket designs modified her three peas in a pod necklace into two peds! 

Naline Lai, MD and Julie Kardos, MD 
©2011 Two Peds in a Pod®
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September 5, 2011 by

It’s a gas! your young infant’s burps and farts

gassy babyGas is another topic most people don’t think much about until they have a newborn. Then suddenly gas becomes a huge source of parental distress, even though parents are not the ones with the gas. It’s the poor newborn baby who suffers, and as all parents know, our children’s suffering becomes OUR suffering.

So what to do?

First, I reassure you that ALL young babies are gassy. Yes, all. But some newborns are not merely fussy because of their gas. Some become fussy, ball up, grunt, turn red, wake up from a sound sleep, and scream because of their gas. In other words, some babies really CARE about their gas.
Remember, newborns spend nine months as a fetus developing in fluid, and have no experience with air until they take their first breath. Then they cry and swallow some air. Then they feed and swallow some air. Then they cry and swallow some more air. Eventually, some of the air comes up as a burp. To summarize: Living in Air=Gas Production.
Gas expelled from below comes from a different source. As babies drink formula or breast milk, some liquid in the intestines remains undigested, and the normal gut bacteria “eat” the food. The bacteria produce gas as a byproduct of  their eating. Thus: a fart is produced.
The gas wants to escape, but young babies are not very good at getting out the gas. Newborns produce thunderous burps and expulsions out the other end. I still remember my bleary-eyed husband and I sitting on the couch with our firstborn. On hearing a loud eruption, we looked at each other and asked simultaneously, “Was that YOU?” Then looked at our son and asked “Was that HIM?”
Gas is a part of life. If your infant is feeding well, gaining weight adequately, passing soft mushy stools that are green, yellow, or brown but NOT bloody, white, or black (for more about poop, see our post The Scoop on Poop), then the grunting, straining, turning red, and crying with gas is harmless and does not imply that your baby has a belly problem or a formula intolerance. However, it’s hard to see your infant uncomfortable.
Here’s what to do if your young baby is bothered by gas:
  • Start feedings before your infant cries a long time from hunger. When infants cry from hunger, they swallow air. When a frantically hungry baby starts to feed, they will gulp quickly and swallow more air than usual. If your infant is wide awake crying and it’s been at least one or two hours from the last feeding, try to quickly start another feeding.
  •  Burp frequently. If you are breastfeeding, watch the clock, breastfeed for five minutes, change to the other breast. As you change positions, hold her upright in attempt to elicit a burp, then feed for five more minutes on the second breast. Then hold your baby upright and try for a slightly longer burping session, and go return her to the first breast for at least five minutes, then back to the second breast if she still appears hungry. Now if she falls asleep nursing, she has had more milk from both breasts and some opportunities to burp before falling asleep.
  •  If you are bottle feeding, experiment with different nipples and bottle shapes (different ones work better for different babies) to see which one allows your infant to feed without gulping too quickly and without sputtering. Try to feed your baby as upright as possible.
  • Hold your infant upright for a few minutes after feedings to allow for extra burps. If a burp seems stuck, lay her back down on her back for a minute and then bring her upright and try again.
  •  To help expel gas from below, lay her on her back and pedal her legs with your hands. Give her tummy time when awake. Unlike you, a baby can not change position easily and may need a little help moving the gas out of their system.
  • If your infant is AWAKE after a feeding, place her prone (on her belly) after a feeding. Babies can burp AND pass gas easier in this position. PUT HER ONTO HER BACK if she starts to fall asleep or if you are walking away from her because she might fall asleep before you return to her. Remember, all infants should SLEEP ON THEIR BACKS unless your infant has a specific medical condition that causes your pediatrician to advise a different sleep position.
  • Parents often ask if changing the breast feeding mother’s diet or trying formula changes will help decrease the baby’s discomfort from gas. There is not absolute correlation between a certain food in the maternal diet and the production of gas in a baby. However, a nursing mom may find a particular food “gas inducing.”  Remember that a nursing mom needs nutrients from a variety of foods to make healthy breast milk so be careful how much you restrict. Try any formula change for a week at a time and if there is no effect on gas, just go back to the original formula.
  • Do gas drops help? For flatulence, if  you find that the standard, FDA approved simethecone drops (e.g. Mylicon Drops) help, then you can use them as the label specifies. If they do not help, then stop using them.
The good news? The discomfort from gas will pass. Gas discomfort typically peaks at six weeks and improves immensely by three months. At that point, even the fussiest babies tend to mellow. The next time your child’s gas will cause you distress won’t be until he becomes a preschooler and tells “fart jokes” at the dinner table in front of Grandma. Now THAT is a gas.

 

Julie Kardos, MD with Naline Lai, MD

©2011 Two Peds in a Pod®

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September 3, 2011 by

That bites: recognizing spider bites

Wondering what crawled into your child’s room and bit her in the middle of the night? If you see two little pinpricks side by side, it’s probably a spider. Spider fangs make two little bite marks. Unfortunately, by the time you examine it in the morning, the bite may be so puffy and red that the two marks are no longer visible. With the exception of the Black widow spider and the Brown recluse spider, most spider bites are harmless and cause only a little bit of irritation. Over-the-counter hydrocortisone 1% ointment, ice, and an analgesic such as acetaminophen or ibuprofen can take the edge off of the itch and/or pain.

Naline Lai, MD and Julie Kardos, MD
©2011 Two Peds in a Pod®

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August 26, 2011 by

When it’s not comfort food

The preschool class was going on a field trip to a park.  It was a breezy spring day and the four-year-old boy with the closely cropped hair was thrilled.  Even though he didn’t usually attend school on Fridays, his mom brought him to meet up with his classmates at the park. The four-year-old’s eyes lit up as the yellow school buses rolled into the park just in time for lunch.  Out tumbled the children, loud with excitement. In a flash, teachers spread brightly colored floral bed sheets on picnic tables, transforming the park into a little cafeteria. Twenty kids squashed together at the tables and forty sets of hands plunged into brown paper lunch bags.  Holding onto his mother with one hand and holding his lunch bag in the other, the four-year-old boy shyly approached the crowd. 


Upon spotting the boy, a little girl with a Scooby Doo shirt ran up and jumped up and down in delight. 


“You’re here, you’re here!” she squealed. 


The boy went happily with his mother to find a seat.  But something was wrong.  The boy and his mom went from table to table in a futile attempt to find a spot.  But each table was the same: every child had a field-trip-friendly peanut butter sandwich in his hand. Peanut butter was everywhere.  Some had it on white doughy bread, some had it on crackers.  Another had a bag of peanuts mixed in with chocolate chips.  The mom recoiled with horror and tightened her grip on the boy’s hand. Allergic to peanuts, the boy stood hesitantly at the edge of the crowd. As a baby, the boy had broken out in hives after his sister touched him with her hands sticky from her own peanut butter and jelly sandwich. 

Imagine having to scrutinize the ingredients of all your food. Imagine being wary of a basic necessity that brings not only nutrition, but also feelings of warmth and comfort. Most children with food allergies have a reaction only when they ingest the offending substance, but the allergenic ingredients can pop up in unlikely dishes. The hyper vigilance of families with food allergies can be wearing. Studies on the psychological impact of food allergies show that families with children with food allergies have an overall lower quality of life than families without food allergies.  In fact, although not obvious, families with food allergies rate their own lifestyle quality similar to families who have a child with diabetes or even a child who is respirator dependent. 



For a moment a sense of isolation overwhelmed the mom. But just as quickly as it came, the feeling dissipated. In the future, the danger would become just a routine part of life, something to add to the long list of items to teach the boy to watch for.  Just as the mom would teach the boy to watch out for cars as he crossed the street, she would teach him to watch for nuts in his food. Perhaps his quality of life would be compromised, but as she watched him laugh with his friends, it didn’t matter, he did not perceive it that way.  Well loved, his quality of life index was still sky high. 

Finally, the mom found a child who had finished eating his sandwich and had cleaned his hands.  Half in jest, she fondly called her son “ostracized one” and placed her allergic boy next to the one who was done.  There he perched, surrounded by messy children, with their messy peanut butter covered hands. Thankfully, the boy was happy and too busy chatting with his friends to worry. To him, waiting for a lunch spot was a mere nuisance. The potential danger next to him was just an accepted part of his everyday life.


This scenario actually occurred. The little boy was my son. And the mom was me. 



Naline Lai, MD


As the beginning of school approaches, Drs. Lai and Kardos remind parents of children with food allergies to check the dates on their Epi-Pens or Twin Jets to make sure they have not expired. Practice discharging expired pens into a grapefruit. Now is the time to update your “allergy action plan” from your child’s health care provider for your child’s teachers and school nurses.


Dr. Lai serves as an advisor for the FAST (Food Allergy Support Team) of Doylestown, PA, a local support group of the national Food Allergy Anaphylaxis Network. 


©2011 Two Peds in a Pod®

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August 17, 2011 by

Bye-bye food pyramid, hello myplate

Teach nutrition with MyPlateWe love it! With MyPlate, the United States Department of Agriculture’s new depiction of “a good diet” is easier to understand than the food pyramid. Mentally cut your kid’s plate in half. On one side are fruits and veggies, on the other side are grains and protein. The dairy is represented by a cup. Check out choosemyplate.gov for all sorts of hints including a personal plan which calculates the amount of each food group kids (and adults) above two years old need daily.

We’re wondering when people will start hearing about the “new pyramid”. We think the food pyramid gained prominence partially because of it’s visibility on cereal boxes. After all, we all stare groggily at the back of cereal boxes while eating breakfast.  In the food pyramid days, grains were a large part of the pyramid base. Will the cereal companies have as much incentive to post MyPlate if grains have been relegated to a quarter of the plate?

We’ll find out.

Naline Lai, MD and Julie Kardos, MD

©2011 Two Peds in a Pod®

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August 11, 2011 by

French without the fry

I love French fries, I mean really, who doesn’t? They’re probably one of the most delicious treats on the planet, but unfortunately they’re also one of the worst treats when it comes to our health. You’ll likely want to opt for baked “fries.”


It’s about overall diet. Ideally we should enjoy a diet that includes lots of fresh fruits and vegetables, fish, grains, and legumes, and one that is devoid of processed foods and sugary sodas. Even diet sodas may be harmful as they are laden with sweeteners made from chemicals.


Also very important, according to doctors, is maintaining a healthy weight. If you’ve had the pleasure of eating baked “fries,” you know what a tasty option they are; if not, please give the baked variety a chance.


You can cut some russet potatoes a bit thick and coat them and coat them with a little extra-virgin olive oil, some rosemary, a little salt and pepper and bake them until golden at 350 degrees, usually between 30-35 minutes. You can do the same with sweet potatoes, but use a little cracked black pepper instead of the rosemary. I normally boil my sweet potatoes first for about 15 minutes. They are a lot easier to peel that way. The recipe is in my book, My Italian Kitchen on amazon.com.


There is no reason to give up the foods you love, just find healthier ways to make them. This way of thinking has become my mantra. It could well become yours too, if it isn’t already.


Buona Salute! To Your Health~


Janet


Returning guest blogger Janet Zappala is a certified nutritional consultant and author of My Italian Kitchen — Home-Style Recipes Made Lighter & Healthier. She is also a six-time emmy award winning television journalist and the host of Wealth of Health at www.janetzappala.tv. Janet is a busy mom as well and is always creating ways to offer up delicious, nutritious foods that are quick and easy to make. 


©2011 Two Peds in a Pod®

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August 5, 2011 by

A pain in the knee: Osgood Schlatter disease

Medical mystery: What is that lump?
Hint: Your basketball star now is taller than you and works out daily.
Hint: He talks about pain at this spot.
Answer: Your kid’s tibial tuberosity when affected by Osgood Schlatter disease

First, some knee anatomy. The knee cap (patella) is anchored into place by tendons and ligaments. One called the patellar tendon attaches to the shin bone (tibia) below the knee at a point called the tibial tuberosity .

Repetitive bending movements of the knee, such as running and jumping, cause the patella tendon to pull on the bone where it attaches at the tibial tuberosity. Strain can result in a large tender lump which forms as the body tries to repair this area. This condition called Osgood Schlatter disease is associated with puberty, so most kids eventually “grow out of it.”

Ice, rest, and ibuprofen will alleviate pain. Your child’s health care provider may recommend gentle stretching of the quadriceps muscles or a knee brace. Beware of increased pain because rarely the muscle tears away from the bone and causes stress fractures.

Never know when you will “kneed” this information.

Naline Lai, MD and Julie Kardos, MD
© 2011 Two Peds in a Pod®

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July 29, 2011 by