Two Peds goes undercover at your local pharmacy

Picture the Mission Impossible theme song in your head… da da da DUM DUM da da da DUM DUM dadada…dadada…dadada…DA DA! Keep this background music playing as you read.

Recently, Two Peds in a Pod went undercover as two unsuspecting moms surveying the scene on the shelves of a local chain pharmacy, seeking to uncover what medicines, ointments, and therapies avail themselves to the unsuspecting consumer. Today we break open the case.

All medication labels have an “active ingredient” list. This list contains the actual medicine that acts on your child’s body to hide symptoms or cure a condition. Read this list carefully so that you know what you are actually giving your child. For example, Flu-Be-Gone claims it “cures the aches and cough of flu and helps your child sleep better.” In order to know just what is actually in Flu-Be-Gone, you need to read the active ingredients. Included might be acetaminophen (brand name Tylenol), a fever reducer and pain reliever, and diphenhydramine (brand name Benadryl), allergy medicine that has the common side effect of causing drowsiness and has some mild anti-cough properties. Notice neither active ingredient actually kills the flu germ. Additionally, you may already have these two medications in your medicine cabinet, or you might have already given your child diphenhydramine recently and giving Flu-Be-Gone would overdose your child.

Also note, diphenhydramine is everywhere. If you see the word “sleep” or “PM” in the name of a product, you will usually find diphenhydramine in the active ingredient list.

Now, let’s hone in on your choices for the anti-itch therapy, hydrocortisone. When your child’s health care provider advises treating an itchy bug bite, poison ivy, or allergic rash with hydrocortisone, make sure that the ACTIVE INGREDIENT in the product is “hydrocortisone 1%.” Hydrocortisone comes as a cream, ointment, spray, or stick (looks like a glue stick) and can have aloe, menthol, or other ingredients thrown in as well. Don’t bother with anything less than maximum strength. Regular strength is 0.5% and is generally ineffective. Also, keep in mind that while ointment is absorbed a bit better, it is more greasy/messy than cream.

Don’t be fooled into thinking products with the same brand name contain similar active ingredients. Also, do not depend on your doctor to necessarily know the difference between the all the formulations.We noticed that the same brand name pain reliever, such as Midol, can have different active ingredients depending on which one you choose. Midol Teen contains acetaminophen, Midol liquid gels contains ibuprofen, and Midol PM contains acetaminophen and diphenhydramine.

Let’s talk bellyache. Did you know that kids should not take adult pepto bismol because it has a form of aspirin in it? Aspirin may cause Reye’s syndrome, a fatal liver disorder. However, we did see a product called Children’s Pepto Bismol and guess what the active ingredient is? It is calcium carbonate, which is the SAME active ingredient as in Tums, and is safe to give kids. However, watch your wallet: the children’s pepto bismol that we found cost $6.00 for a box of 24 tablets. The TUMS that we found cost $4.50 for a bottle of 150 tablets of the same stuff, just in slightly higher dose. Check with your child’s doctor but in most cases, the kids can take the adult dose.

Also, be aware that cold and cough medicine have not been shown to treat colds successfully or even to actually relieve symptoms in most kids. In fact these medicines have potential for harmful side effects, accidental overdose, or accidental ingestion and are just not worth giving your children. However, we found tons of cold and cough medicines marketed for children. Here are the three most commonly used active ingredients:

If you see “suppressant” you will likely find “dextromethoraphan” in the active ingredient list.
If you see “expectorant” you will likely find “guaifenesin” in the active ingredient list.
If you see “decongestant” you will likely find “phenylephrine” in the active ingredient list.

Many products combine two or all three of the above. We ask, even if these ingredients did work well in kids and were not potentially dangerous, what is the POINT of combining a cough suppressant with an expectorant? Can you really have it both ways?

( Remember, that Mission Impossible theme is still playing in the background.)

A few other tidbits. “Dramamine,” used for motion sickness, gets broken down in the body to diphenhydramine, that allergy medicine that we already talked about. So look at cost differences when choosing a motion sickness medicine. Both have the same side effect: sleepiness.

Many cough drops contain corn syrup and sugar. This is the same stuff lollipops are made of, so just call a candy a candy and keep your child’s throat wet with the cheaper choice, if you choose to do so.

Finally, we found one “natural children’s cough medicine” which claimed that it is superior because of its “all natural ingredients.” The first active ingredient listed? Belladonna. Sure it’s natural because it comes from a plant. So does marijuana. Just because it’s “natural” doesn’t mean it’s safe. Belladonna can cause delirium, hallucinations, and death and in fact has been used in high doses as a poison! Leave the cough medicine on the store shelf, and read our post about other ways to soothe a cough.

Bottom line: remember always to check the “active ingredient” list when buying any over-the-counter medication for your children.

As we were wrapping up our mission, one of the pharmacy employees came over to us, raised an eyebrow at our clipboard, and asked, “Can I help you ladies with anything?” We were tempted to answer “YES, can you help us take notes?” but we just smiled and said “No, we’re fine, thanks. Just checking out what’s available.”

So now, we will don our stethoscopes and come out of hiding, go back into our offices and onto our website. Thanks for tuning in to this episode of Two Peds in a Pod…. Da da da, DUM DUM da da da, DUM DUM dadada…dadada…dadada…DA DA!!!

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

May 27, 2011 by

Acetaminophen FYI

All acetaminophen (e.g., Tylenol) will soon be made at the same concentration, the Consumer Healthcare Products Association announced recently. In the past, manufacturers made most infant formulations more concentrated (thicker) than children’s formulations so parents would not need to give as much liquid to babies. However, this difference in concentration was the source of much confusion and accidental overdoses. Now all acetaminophen will be made the same concentration (160mg per 5ml ). Watch for these changes to hit the shelves as early as this summer.

You may also see other changes if the Federal Drug Administration implements the advice received from an advisory panel earlier in the week. Recommendations include adding weight based dosing guidelines for infants six months to two years of age and for medicine to come with measuring devices clearly marked in milliliters in order to ensure more accurate dosing.

Stay tuned.

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

May 22, 2011 by twopedsinapod

Don’t be rash: tidbits about Lyme disease, poison ivy, and sunburn protection

In today’s podcast we discuss how to spot the rash of lyme disease, what to do about poison ivy, and how to avoid sunburns. Pictured below is a creative way one child found to block the sun effectively. Notice there’s no burn underneath the areas of skin which were once covered by temporary tattoos.

Naline Lai, MD and Julie Kardos, MD

©Two Peds in a Pod®

May 17, 2011 by twopedsinapod

Happy Mother’s Day <3!

Happy Mother’s Day to the experts in the field. As Dr. Kardos and Dr. Lai’s mothers always say to them, “Even though you are a pediatrician, I’m still your mom!” Please see our Mother’s Day Top Ten list and enjoy your well deserved day.

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

May 8, 2011 by twopedsinapod

Avoiding allergy eyes

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

The pollen count is high 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. Filter the pollen out of your house by running the air conditioning. 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!

Naline Lai, MD with Julie Kardos, MD

April 28, 2011 by twopedsinapod

This is big: We’ll be at the Philadelphia Convention Center!

Welcome, early-childhood education teachers! We are excited to talk to you at the Philadelphia Convention Center on Friday, May 6 at 3:30pm as part of the DVAEYC Conference (Delaware Valley Association for the Education of Young Children Conference) “Picture Every Child Confident and Secure.” We will be teaching about when to send children home from school for medical reasons. Topics include fever, head lice, and MRSA. We look forward to seeing you then!

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

April 27, 2011 by twopedsinapod

Myth: butter’s better on a burn

One of Dr. Lai’s patients burned his arm on a hot cookie sheet. The child stopped further injury by immediately running the area under cool water. However, his well-meaning great-aunt decided to then apply butter to the burn. Please, do NOT put butter immediately on a burn. It’s like putting butter on a hot skillet.

We’re not sure where the myth of putting butter on a burn comes from. A better idea for pain control, after applying cool water for a few minutes, is to offer the child a pain reliever such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).

Burns caused by fire or burns covering large body areas are best treated at a hospital, but your first response, as you call 911, should be to get that burn in cool water. Run the water for several minutes. To avoid shock or extreme cold injury, do not use ice water. Don’t remove clothing stuck to skin but go ahead and put the burn and the stuck clothing in cool water.

Most burns sustained at home are mild or may cause blisters. Burns are easily infected because when you burn away skin, you burn away an excellent barrier to germs. Washing the affected area with soap and water and applying a topical antibiotic such as Bacitracin twice daily can prevent infection. Avoid popping blisters- you will take away a protective layer of skin.

Please remember that unlike for cookie batter, butter is not better for burns. Please pass this post on to anyone you know who cares for your children…it’s “hot off the press.”

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

Revised 5/17/2015

April 25, 2011 by twopedsinapod

The truth about lying: what to do when your child lies to you

Stunned, you find your child’s third quarter report card under his bed. Your child told you he got an A, but the teacher’s report shows a lower grade. A much lower grade. You are horrified, not about the grade, but about the lying. Refrain from running straight to school and yanking him out of class to confront him.

Lying is not uncommon in childhood. For very young children, “lying” is a normal part of developmental. Preschool children are at the developmental stage where they exaggerate and tell tall tales. Preschoolers rarely have a hidden agenda and truly believe in their fantasies.

Beyond the preschool age, there often is a hidden agenda. “There is a reason behind their lies,” says Pennsylvania based Buckingham Friends School teacher of over 25 years, Nancy Sandberg. Try to figure out your child’s underlying reason for lying. During elementary school children have developed a sense of right and wrong. They begin to lie to avoid disappointing a parent, to avoid a perceived punishment, or for attention. In their teens, kids protect their privacy and begin to separate their identity from their parents. Teens may lie because they are afraid of losing face with peers or in order to get something they want. A lying teen may also be covering up underlying problems such as alcoholism.

Before talking to your child about his lying, clear your head of anger. An emotionally charged confrontation will end up in a blow-up rather than a rational discussion. If he lies when you talk to him, state that you are not sure that he is telling the truth and plan a later time to discuss the issue. Also, do not ask your child questions to which you already know the answer and avoid giving him a reason to lie further. In the report card example, when your child comes home, do not ask him where his report card is or if he had seen his grades. Instead, start the conversation with facts: “I found your report card. I see that your grades are not what you said they would be. I am concerned because you hid the truth from me. Let’s talk about it.”

Sometimes anger may impede your ability or your child’s ability to have a rational discussion. Wait until things cool down or have an objective third party present during your conversation. In your discussion, give your child an alternative to lying. For instance, if she is concerned about your reaction to a grade, tell her to go to another adult first, such as a teacher, if the situation reoccurs and they can approach you together. Talk about how your child would feel if someone lied to her. Discussing a book with a protagonist who lied can give your child a way to indirectly discuss her own situation. And reassure, reassure, reassure her that in no way does the incident diminish your love for her.

Keep in mind, most episodes of lying are isolated incidents. However, a child who chronically lies and also shows negativity and hostility or defiance towards adults should be evaluated by a health care professional. For more information, click on the American Academy of Child and Adolescent Psychiatry’s site www.aacap.org.

Sandberg proudly recalls a child whom she worked with years ago. At the beginning of the school year, the child lied about his school work. Later, the child went on to play Hercules in the school play. Sandberg and the child talked about how like Hercules, he had struggled, but because he faced his challenges head-on, he turned into a hero.

Naline Lai, MD with Julie Kardos, MD

April 19, 2011 by twopedsinapod

Tips to help the socially awkward child: guest blogger Amy King

“I am not asking for my child to be the life of the party, or a social butterfly. I just want her to be happy and have some friends of her own. She is a wonderful kid, and I hope someday others can see that.” -Scott Bellini, Ph.D.

Does your child spend recess walking around by himself? Does he lack play dates with kids after school and on the weekends? Is it shyness or something more?

Possessing good social skills is important for our children. However, in today’s fast moving, highly technological society, we are seeing an increase in the number of children with social skill deficits. Children may be simply be shy or may have true difficulties relating and socializing with others. Experiencing some social pain from being teased or left out once in awhile can be normal. However, some children are at risk for serious psychological damage because of ongoing rejection or bullying. The “at risk” group may eventually suffer from a number of different problems including: anxiety, depression, loneliness, aggression, even suicide or homicide.

Social competence is the topic of conversation among parents and professionals around the country as more and more children are reported to be socially struggling and awkward. Good social skills have been shown in studies to be a better indicator of future success than straight ‘A’s. The socially awkward child is often regarded as the “misfit”: annoying, rejected and ridiculed by peers. Below are some tips to help children develop social skills

.Consider these techniques:

Listen to children with the “third ear,” i.e., active listening, not only to the words they say, but the feelings they are expressing.
- If your child is talking to a peer, watch for her non-verbal cues. Help her develop strong non-verbal cues (stand close but not too close, look person in the eye but don’t stare, act interested even when you aren’t)

Initiate and practice pro-social skills at home, including:

How to initiate, maintain, and end a conversation
The art of negotiation — how to get what you want appropriately
How to be appropriately assertive without being overly aggressive
How to give and receive compliments
How to respond to teasing by peers
How to accept constructive criticism

Here are other ways in helping children who may feel rejected or lonely:

Ask teachers, friends and other parents what they see when they observe your child interacting with peers or classmates.

Provide a variety of group opportunities.
Church groups, scouts, drama club, sports teams – these all provide an alternative to school as a place for a child to make friends and gain acceptance.

Don’t go back to school yourself!
Resist the temptation to march onto the playground and yell at the big kids for picking on your child. Resist the urge to gossip about other moms in the parking lot after school.

Always intervene if one child is made a scapegoat or is ostracized by the group.
Help that child learn how to fit in and, more importantly, help the group be more empathic and kind.

Give shy children a gentle push to try new social challenges.
They need lots of support and encouragement as they push out of their “comfort zone.” If a child is shy but would like to make a friend, it can help to invite over a classmate and the classmate’s parents; the kids will find the adults boring and, eventually, go off to play together.

Help the child find other children who have similar interests.

If your child likes to play chess or build with legos, sign them up for the chess club or look into camp programs that focus on your child’s interests. They are bound to meet other kids that share their interests.

Teach socially awkward children basic skills for getting along.

Examples include: how to guess what other people are feeling, how to join a group, and how to make friends.

Make sure the child pays attention to personal hygiene. This is so important because kids are big on first impressions. Why give another reason for others to make fun of them! If your child doesn’t wash or comb her hair, it will be noticed. Make sure your child bathes regularly and wears deodorant, if needed- kids are sensitive and often intolerant of body odor. Also make sure the child grooms those not-so-obvious areas, including cleaning her ears and clipping her fingernails and toenails. It may not seem so important to your child, but others will notice!

Children who have suffered repeated rejection and isolation are at risk for more serious difficulties. Please seek professional help for these children!

Amy King, MA, CCC/SLP; owner and facilitator of “Making Friends” A Social Communication Training Program, email makingfriendspa@yahoo.com

Sources:

Building Social Relationships: A Systematic Approach to Teaching Social Interaction Skills to Children and Adolescents with Autism Spectrum Disorders and Other Social Difficulties, by Scott Bellini.—1^st Edition, Shawnee Mission, KS: Autism Asperger Publishing Co. 2006.

Best Friends, Worst Enemies, by Michael Thompson, Catherine O’Neill Grace and Lawrence Cohen, Ballantine Books, 2001. Explores children’s social relationships and how to help kids deal with peer problems.

Mom, They’re Teasing Me, by Michael Thompson , Lawrence J. Cohen Ph.D., Catherine O’Neill Grace. The range of difficulties children face in social situations, from bullying and name-calling to rejection and socialization is the focus of this primer for parents, with specific tips on how to deal with these issues.

April 16, 2011 by twopedsinapod

Join us this Sunday – summer myths

Join us at the Central Bucks Family YMCA, Doylestown PA this upcoming Sunday, April 17 for an informal Q and A session about some of our favorite summer myths: learn about Lyme Disease, poison ivy, and sunscreen. Catch us at 12:30 pm during the Y’s Healthy Kids Day (noon-3pm)!

April 11, 2011 by

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