Two Peds in a Pod®

How long do germs live?

I spent all day doing laundry. All right, maybe it wasn’t all day but it sure felt like it. Cleaning up after a vomiting child can be tough in the winter time. Unfortunately, it’s too cold to rinse off any sour curds outside. As I scraped off the sheets into the kitchen sink, I wondered how long the germs could live. I turned to my Disease Prevention Manager, Clare Edelmayer at Doylestown Hospital, PA to find the answer.

She says depending on the germ and the surface it lands on, a germ can live for hours to days and sometimes months.

Most bacteria and viruses die within hours if they are outside the body. Surprisingly, survival does not depend on how deadly the germ is. For example, HIV virus in blood will die as soon as the blood dries outside the body. However, some strains of flu viruses can survive 24-48 hours on non-porous surfaces such as your kitchen counter or on the handle of a plastic spoon and 2-8 hours on porous surfaces such as your toddler’s sleeve or on paper tissues.

Methicillin Resistant Staphylococcal Aureus (MRSA), a bacteria which can cause skin infections filled with pus, stays alive for several hours to several days on surfaces. Hepatitis B virus, a cause of liver disease, can stay viable on surfaces for 2 weeks or more, and the bloody-diarrhea producing Clostridium Difficile can live on surfaces up to 5 months.

In other words, most germs die within hours, but don’t count on germs dying before they have a chance to enter your unsuspecting child’s mouth or nose. A dilute bleach solution works well to clean surfaces outside the body and of course, have your children frequently wash their hands.

The next time one of my kids throws up this winter, I’m tempted just to bury the sheets under the snow out back and fetch them in the spring.

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

February 9, 2011 by twopedsinapod

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

A mom recently wrote to us about her grade school aged child’s bedtime creeping later while her wake up time stayed the same. She wondered how to reclaim the earlier bedtime.

Many parents notice as their kids get older, they seem to take longer to fall asleep at night or push their parents for a later bedtime. This trend is largely biological— the older kids get, the less sleep they need. Also as kids age, their body clocks naturally signal them to stay up later at night and sleep later in the morning. Sometimes children are worried about something and this stress prevents them from falling asleep. Parents should ask their kids what they think about while lying in bed at night. However, many times the child is just fine emotionally but begins shifting sleep patterns anyway.

According to sleep experts, adults function best on 7-8 or more hours of sleep per night. In kids and teens, a wide variation exists for how much sleep is sufficient for any individual. In general, if your child is easy to awaken in the morning, cheerful, able to concentrate during the day, easily completes school work and homework and is not having emotional outbursts, then she is sleeping enough. So, when your grade school child transitions from getting 11-12 hours of sleep per night to getting 10, if her days are still rosy, then this sleep shift is okay. Some people just don’t need very much sleep.

If your child needs more sleep, it’s tough to simply move his bedtime up earlier. To him, the sudden change will feel like he flew from California to New York. A gradual approach works best. Put your child to bed first very near the time that he is already falling asleep, even if that seems inappropriately late.

For instance, if your child won’t fall asleep until 11:00 pm, establish a soothing night time routine that ends with reading in bed or listening to soothing music for a few minutes, and turn out the lights out at 10:45 pm. Avoid television within an hour of sleep time because this can interfere with falling asleep. No matter how late he fell asleep, even on weekends, make sure he wakes up at the same time every morning. Once he falls asleep consistently within a few minutes of lights out, move the bedtime another fifteen minutes earlier. Continue to do this until the daytime sleep-deprivation symptoms have resolved. A child may still need an alarm to wake up in the morning but if he is well rested, he should wake easily.

Be sure to limit or avoid caffeine (found in soda, tea, coffee, some sports drinks, and chocolate) because caffeine stays in the body 24 hours and hinders falling asleep. Also, make weekend sleep routines, including wake up times, as similar to weekdays as possible. If you allow a child to sleep until noon on Saturday and Sunday, he will never be able to fall asleep early on Sunday night and he will start the school week sleep deprived.

Time to end this post. I’ve got to go put my kids to bed. Sweet dreams.

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

February 5, 2011 by twopedsinapod

Winter reminder: shovel well to avoid carbon monoxide poisoning

While much of the US is getting pummeled by the latest snow storm, we want to remind everyone to shovel out space around your home’s furnace vent. While some furnaces vent out of a home’s chimney, other vents are located just two feet off the ground on the side of the house. If these vents become blocked with snow, deadly carbon monoxide levels can build up inside the home. Aim for three feet of snow clearance around the vents.

We thank Dr. Lai’s sister Melisa Lai, MD, toxicologist and emergency room physician in Boston who has treated patients with carbon monoxide poisoning, for reminding us of this winter storm hazard. For more about keeping safe from carbon monoxide, please see our earlier post on this subject.

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

February 2, 2011 by twopedsinapod

Stay healthy: how to prevent illness this winter

Reporter Melanie Cutler interviews Two Peds in a Pod for Five Tips to Keep Your Child Healthy This Winter in the online news source Newtown.Patch.com.

February 1, 2011 by

Get moving: increasing your teen’s activity level

Have a teenage couch potato from January through March? We all tend to decrease our activity level in the winter months. Physical Therapist Deb Stack gives us ideas to keep teens active.

Let’s face it, it’s hard to move when it’s cold and it’s freezing at my home. I believe today’s high is 20 degrees Fahrenheit. Now while this may not deter younger children from bundling up and going sledding, teen couch potatoes are busy whining that it’s “too cold.” So there they sit.

What’s the secret to keeping them active in the winter months? Have them schedule an activity, and be an example yourself. Ideas for teens (and you) to do when it’s cold outside:

Have a 15-minute dance party

Have a Wii contest

Try swimming (indoors please!)

Dust off the treadmill or stationary bike in the basement and GET ON IT

Play ping-pong

Do a few chores

Jump rope

Jog during T.V. commercials

Pull out some “little kid games” such as hopscotch, hula-hoop or Twister

Let each child in your house choose an activity for everyone to try

Teens, like everyone else, need exercise to stay healthy. Staff from the Mayo Clinic recommend kids ages 6-17 years should have one hour of moderate exercise each day. Exercise can help improve mood (through the release of endorphins), improve sleep and therefore attention (critical with finals coming up), and improve cardiovascular endurance. Those spring sports really ARE just around the corner.

Here are some numbers to get the kids moving: All activities are based on 20 minutes and a teen who weighs 110 pounds. The number of calories burned depends on weight. If your teen weighs more, he will burn a few more calories, if he weighs less, he’ll burn a few less. Below the table are links to some free and quick calorie calculators on the web so your teen can check it out for him self. For those attached to their phones, there are web apps too.

ACTIVITY	CALORIES USED
Shooting Basketballs	75
Pickup Basketball game/practice	100
Biking on stationary bike	116
Dancing	75
Hopscotch	67
Ice Skating	116
Jogging in place	133
Juggling	67
Jumping Rope	166
Ping Pong	67
Rock Climbing	183
Running at 5 mph	133
Sledding	116
Treadmill at 4 mph	67
Vacuuming	58

What’s the worst that can happen? You’ll have a more fit, better rested, and happier teen! Or at least you’ll have a cleaner home!

Try these activity calculators:

http://primusweb.com/fitnesspartner/calculat.htm

www.caloriesperhour.com/index_burn.php

http://www.caloriecontrol.org/healthy-weight-tool-kit/lighten-up-and-get-moving

References:

www.mayoclinic.com/health/fitness/FL00030.
www.caloriesperhour.com/index.burn.php

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.

January 26, 2011 by twopedsinapod

Waxing philosophically: ear wax and eew

Babies are gooey. Spew tends to dribble out of every orifice and the ear is no exception. Devin’s mother tipped her four month old baby’s head sideways in the office the other day and asked me what to do about the oily, yellow wax smeared around the opening of his ear canal.

Some say wax evolved to help keep bugs and other debris from reaching deep into our ear canals. Case in point: one of my least favorite memories during residency was when I picked out pieces of a cockroach entrapped in the wax of a child’s ear. The amount of wax you see on the outside is not indicative of the actual amount inside the ear canal. Chances are, the wax is not hard and does not block the ear drum. Even if there is a large amount of wax, it is unlikely to greatly affect a baby’s hearing. Equally normal is that some babies and children don’t seem to produce any ear wax. If you are concerned about your child’s ear wax, have your pediatrician take a peek with a light.

Despite the copious amount of wax on the outside, Devin’s ear canals were clear. “But the wax is simply disgusting,” said Devin’s mom, “Can I clean his ears? “

“Yes”, I answered. “Wipe off what you see, doesn’t matter if you use a wash cloth or cotton swab. The special shaped cotton swabs with the safety tips are unnecessary. Anything you see is fair game. Rest assured, you will not go too deeply into the ear canal if you only scrape off what is visible.” Dr. Kardos goes one step further and tells her patients: if you can get the wax with a wash cloth, it’s fair game. Otherwise, leave it alone.

Now suppose your pediatrician does say the wax should be removed. Place an over-the-counter solution such as Debrox in the ears (children and adults can use the same formulation) – three to four drops one or two times a day (during sleep is easiest for babies and toddlers) for a few days. The solution softens wax. For maintenance, mineral oil and olive oil are favorite remedies. Place one drop daily in ears. In the office some pediatricians can use a water irrigation system (like a water squirter in your ear) to wash out the wax. The worst side effect is that the child’s shirt sometimes gets wet. Irrigation is a very effective for removing wax in a school-aged or teenaged child who complains of difficulty hearing.

If you find you are constantly cleaning your baby’s waxy ears, take heart. At least there won’t be any roaches “bugging” them.

Naline Lai, MD with Julie Kardos, MD

January 20, 2011 by twopedsinapod

What? That’s not what we said: Real Simple Magazine

Take a look at the February 2011 issue of Real Simple magazine. We are two of the experts cited on page 124. The good news is that some of our thoughts on the essentials of a medicine cabinet were integrated into a photo-essay piece. The bad news is that children’s cough medicine is listed as a component of the medical cabinet. While the other contributors to the piece may encourage use of over-the-counter cold and cough medications, we discourage use.

Of concern, safety and effectiveness of cough and cold medicine has never been fully demonstrated in children. In fact, in 2007 an advisory panel including American Academy of Pediatrics physicians, Poison Control representatives, and Baltimore Department of Public Health representatives recommended to the U.S. Food and Drug Administration (FDA) to stop use of cold and cough medications under six years of age.

Thousands of children under twelve years of age go to emergency rooms each year after over dosing on cough and cold medicines according to a 2008 study in Pediatrics . Having these medicines around the house increases the chances of accidental overdosing. Cold medications do not kill germs and will not help your child get better faster. Between 1985 and 2007, six studies showed cold medications didn’t have significant effect over placebo.

So why are children’s cough and cold medicines still around? A year after the advisory panel published their recommendations, FDA advised against using these medications in children younger than two years but data about these medications in older children is still rolling in. FDA continues to advise caution with these medications. The producers of cold medicines said at that point they would launch new studies on the safety of medication for those two to twelve years of age. In the meantime pharmaceutical companies stopped manufacturing cold medicine products for those under two years of age and changed the labels to read “for four years old and above.”

Yes, watching your child suffer from a cold is tough. But why give something that doesn’t help her get better and has potential side effects? There is plenty to do besides reach for cold medicine. Give honey for her cough if she is over one year of age. Run a cool mist humidifier in her bedroom, use saline nose spray or washes, have her take a shower with you, and teach her how to blow her nose. Break up that mucous by hydrating her well- give her a bit more than she normally drinks.

If you have young children and want to make your medicine cabinet truly “real simple” then take out the over the counter cough and cold medication.

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

January 17, 2011 by twopedsinapod

Closure: there is no link between the MMR vaccine and autism

It’s confirmed. Dr. Wakefield was a fraud. Recently, on January 5, 2011, reporter Brian Deer published a report in the British Medical Journal exposing more flaws in the Wakefield study- the study which proposed a link between Measles, Mumps, and Rubella vaccine (MMR vaccine) and autism. Of note:

Lawyers who were trying to win a law suit for parents who believed that the MMR caused their children’s autism paid Wakefield to do the study.
Wakefield falsified his findings. The medical records of all 12 children in the study were inconsistent with Wakefields’s data.
Almost half of the children in the study already showed signs of developmental abnormalities before they received the MMR vaccine. Therefore, the MMR vaccine did not cause their disabilities.
Rather than randomly choosing the children for the study, Wakefield obtained most of his subjects through an anti-MMR campaign group.
Ten out of twelve other authors of Wakefield’s paper have withdrawn their support of the paper.

To read about the original study and the controversy around it, please see our earlier post, “Do vaccines cause autism?” For more information about how vaccines work, please read “How vaccines work.” To learn signs of early communication delays in your infant, please see “How do I know if my baby has autism?”

Too bad it’s too late for some children. Since Wakefield published his paper, measles cases have steadily risen in the UK. Hopefully the damage caused by Wakefield’s 1998 paper will be mitigated by more parents who vaccinate their children.

Julie Kardos, MD with Naline Lai, MD

January 11, 2011 by twopedsinapod

Teaching Kids Money Smarts

“The Great Recession has truly changed peoples’ attitudes towards money and parents are in need of help.” Thus observes award winning author John Lanza, our guest blogger today, who gives us ways to teach kids the value of money.

Just as New Years kicks off the “goal-setting season,” a powerful way to teach kids the value of money is setting goals. I’ve seen goal-setting work first hand with my kids. I’ve also seen how frivolous spending increases when a savings goal is absent. Teaching your kids to set goals, not just monetary ones, is an essential life skill.

To get started, kids must receive some type of steady stream of money – an allowance. I use David McCurrach’s Allowance Magic as a guide. David’s short workbook makes a strong case with which most money experts and I agree –- that parents should not tie chores to allowance. Because most parents were given an allowance tied to chores when they were kids, they believe that they should do the same. Times change and just as we’ve learned that a five-point harness beats a single-point one for car seats used when we were kids (see Drs. Kardos and Lai’s carseat safety post ), we money experts realize that allowance is a tool to teach kids to become comfortable with money.

It’s okay to pay your children for “above-and-beyond” chores as noted kids money expert, Karyn Hodgens, author of Raised for Richness, calls them. Clearing the table, for example, is a chore they must do because it’s a family requirement, but mowing the lawn might be an “above-and-beyond” chore for which they could be paid. For more on the allowance/chores debate, I highly recommend Karyn’s piece on Motivation Theory.

Learning to be money smart is largely about learning to make choices. Therefore, allowance distributions should be split into three parts. One of the first things parents should do when creating an allowance system is to set up a system of three jars –- one for sharing (charity), one for saving and one for spending smart. You can certainly create your own jars or simplify the process and purchase them from companies, such as my own, that provide inexpensive three-jar systems (www.themoneymammals.com).

So here’s what my wife and I do. We give our seven-year-old six dollars per week. She is required to save two dollars and to put one dollar into her share jar. She can do what she wants with the other three dollars. To encourage saving, we “match” any additional dollar put into the save jar with a quarter, a novel idea straight out of Allowance Magic. The matching program, along with pasting a picture of a specific, achievable goal on the save jar, truly helps influence the saving behavior you want to encourage in kids. To set an achievable goal, consider the horizon with which a young child can cope. Four to eight weeks for a five- or six-year-old is a good starting point.

One of the most difficult aspects of giving your kids money is relinquishing control of the money to them, within reason. Just remember that your purpose for an allowance system is to teach your kids to be money smart. They need some autonomy to make decisions and they will, inevitably, make mistakes. Learning from small mistakes now will help prevent devastating choices years down the road. Though I’m not a big fan of those $104 American Girl dolls (with tax), that’s what my oldest wanted. Saving six months for it taught her a valuable lesson that she wouldn’t have learned had I nixed the idea.

We parents have an opportunity to raise a money smart generation and I hope some of the pointers in this article are helpful.

John Lanza

John Lanza is the Chief Mammal at Snigglezoo Entertainment and is the Creator of The Money Mammals DVD that helps kids learn to “Share & Save & Spend Smart Too.” John also runs The Money Mammals Saving Money Is Fun Kids Club and blogs, tweets and writes often about youth financial literacy. His new children’s book, “Joe the Monkey Saves for a Goal” was just awarded a Dr. Toy Best Pick of 2010. Find out more at www.themoneymammals.com.

January 5, 2011 by twopedsinapod

Happy New Year 2011 from Two Peds in a Pod

We know the first time your child rides a two wheel bike or loses a tooth is a momentous occasion. In honor of January first, we’ve compiled a list of some of our favorite, lesser known, firsts. Have we missed any of your favorites? Please add to this list.

First time he tries peas

First time she walks on sand or grass in bare feet

First time he sees snow

First time she explains to you how to work your computer

First time she sleeps through the night (if ever)

First he calls grandpa on the telephone

First poop in potty- remember saving it to show your spouse?

First time she buckles herself into the car, with no help from you

First time she sleeps over someone else’s house

First time he gives you a handmade gift

First time finding the restroom by himself in a restaurant, and you allow him to “got it alone”

First time you leave her home alone to babysit herself

First time he is too old to qualify for the restaurant’s kids menu

First time she shaves her legs or first time he shaves his face

First time your teen drives herself to a sports practice

First day your youngest starts kindergarten

We wish you a year filled with many successful “firsts.”

December 31, 2010 by twopedsinapod

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