Two Peds in a Pod®

Acne, an unwelcome bump on the road to adulthood

Why does that big pimple always appear 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.

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. 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

-Other topical medications 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

-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 with the topical medications, use noncomedogenic (non acne forming) moisturizer liberally.Dermatologists and pediatricians 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 soap) once daily. Tell him also to use a clean washcloth or soft paper towel to dry off after each washing. 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
©2010 Two Peds in a Pod?

July 23, 2010 by twopedsinapod

What could be lurking in your pool-Cryptosporidium

We welcome guest blogger Dr. Alissa Packer who informs us about Cryptosporidium.

-Drs. Kardos and Lai

Here in the state of Utah we are starting to see cases of Cryptosporidium crop up. “Crypto” is a nasty bug that hides in water (both drinking and recreational), is resistant to chlorine, and caused a massive diarrhea outbreak in 2007. Crypto is present throughout the United States and originates in the stool of an infected human or animal. The little germs then hunker down in the closest water, soil, or food, just waiting for their next host.

If your little one becomes that next host you can look forward to diarrhea, vomiting, stomach cramps, fever, nausea and weight loss. Symptoms occur 2 to 10 days after becoming infected. These symptoms typically last, on and off, for 1 to 2 weeks. Not everyone exposed will develop symptoms–some lucky ones will be just fine.

So, does that mean you need to ditch your summer pass to the pool? Give up your fresh raspberries? Skip that trip to the lake? Probably not. Find out how your local pool treats for crypto and what their policies are regarding swim diapers. Ultraviolet (UV) treatment is better than chlorine, and requiring swim diapers is probably a good thing. Thoroughly wash all fresh fruits and vegetables. Use common sense with good hand washing. And make sure the lake water is adequately treated before drinking it—or better yet, bring your own drinking water.

If you think your child may have crypto, visit your pediatrician so he or she can test your child’s stool. The test is a little tricky and may require a few different stool samples over several days. If it turns out to be crypto there is a medication called nitazoxanide that can help. Also try to keep your child tanked up on fluids. A hydrated child is a happy child.

Hopefully we won’t see the same kind of outbreak we did in 2007…but if we do, you’ll be prepared.

Alissa Packer, MD
Dr. Packer is a pediatrician and mom in West Jordan, Utah. She loves kids- both the snotty nosed and the well kind, the outdoors, and good books. The above post was expanded from her original post in her wonderful blog at: southpointpediatrics.blogspot.com .

July 19, 2010 by twopedsinapod

Podcast Party Potpourri-milk and more milk, daycare guilt and thumb sucking

Join us as we talk with moms from Building the Family, part of Child, Home and Community, a Pennsylvania based organization dedicated to empowering young parents. We share with you a few tidbits on milk, daycare and thumb sucking – topics gathered from a podcast recording party held this summer. Here we are pictured with the fabulous moms and some of their children (listen carefully and you will hear the pitter-patter of little feet in the background).

Play the podcast here!

Naline Lai, MD and Julie Kardos, MD

July 16, 2010 by twopedsinapod

Happy Birthday Two Peds in a Pod!

One year ago today we posted our first blog post Maiden Voyage and what an adventure it has been! In honor of Two Peds in a Pod’s first birthday we reprint Dr. Kardos’s post “Let ‘Em Eat Cake”:

After completing my pediatric training, I worked for a couple of years in a large pediatric office before I had any children of my own. I was always struck by the Life Event of a child’s first birthday. This milestone carries so much meaning and emotion for families. My patients’ parents described huge birthday parties with characters such as Elmo walking around or Moon Bounces, large catered affairs with numerous friends, family members, and entire neighborhoods. Often I would see a child sick in my office a few days before such an event with parents who were panicked that their child might be sick on his Big Day, or I would see a child for his one year well check and hear many details about the enormous party. Of course I also saw plenty of children a few days after their first birthday party who became ill, most likely, from a well-intentioned friend or relative who was already sick and passed the illness on to the birthday child at the party. I heard about the kids who clapped for the Happy Birthday song and kids who cried and one who vomited from excitement… all over the birthday cake. Many of my patients had their first full blown temper tantrum during their own over-stimulating first birthday party.

I remember not quite understanding why parents go through such effort and expense to throw a party that their child will never remember at a developmental stage where 99 percent of children are having stranger anxiety and separation anxiety. Well meaning famillies would often forgo daily routine to skip naps, eat at erratic times, and then expect their birthday child to perform in front of a large crowd singing loudly at them. “My husband and I will do it differently,” I would tell myself.

Now, three of my own children later, I must apologize for not quite understanding about that first birthday. I remember waking up on the day my oldest turned one year. My pediatrician brain first exclaimed “Hurray! No more SIDS risk!” Then my mommy brain took over, “Ohmygosh, I survived the first year of parenthood!” This day is about Celebration of the Parent. I finally understood completely why my patients’ parents needed all the hoopla.

Because I am actually a little uncomfortable in large crowds, my son’s first birthday party included all close relatives who lived nearby, people he was well familiarized with. Some pediatric tips I had picked up which I will pass on:

1) Sing the Happy Birthday song, complete with clapping at the finale, for about one month straight leading up to the birthday. Children love music and hearing a very familiar song sung by a large group is not as overwhelming as hearing an unfamiliar song.

2) Plan mealtime around your child, not the guests. If you are inviting people close to your heart, they will accommodate. Dinner can be at 5:00pm if that’s when your child usually eats, or have a lunch party that starts midmorning and then end the party in time to allow your child to have his regularly scheduled afternoon nap. Most one-year-olds are usually at their best in the morning anyway.

3) If your child becomes sick, cancel the party. Your child will not be disappointed because he won’t understand what he is missing. You as parent would have a lousy time anyway because all of your attention will be on your ill child and you will be anxious. Your guests who are parents will appreciate your refraining from making them and their own children sick.

Recently while performing a one-year-old well check I asked about my patient’s birthday party and her parents told me “Oh, we didn’t have a party. It was like any other day, although we did give her a cupcake for dessert.”

Now THIS is a pragmatic approach to parenting because, again, no child will ever have memories of her own first birthday. However, I hope the parents did take time, at least with each other, to congratulate themselves and to feel really good about making it to that huge milestone in their parenting career. I hope they savored their accomplishment as much as their child savored the cupcake.

_____________________________

How far we’ve come, and it is all thanks to you. We’ve watched with excitement as our readership climbed from two hits (from our husbands) to almost 20,000 hits. Two Peds in a Pod now has email and Facebook subscribers. You can find us through directories such as Technorati and iTunes and recently, Two Peds expanded to the West Coast of the United States with a bimonthly column in Family Magazine Group. Some of our Face book friends hail from Canada and we consistently receive hits from the United Kingdom. Looks like our goal to impact one million kids around the world may not be a far-fetched dream.

Our greatest reward is when people say to us, “That blog post was so helpful.” We are thrilled to reach out to many families.

While our main podcast recording studio continues to be our kitchen table, we also recorded with one mom’s group in their living room and another parenting group in a child care center. From focus group back out to cyperspace!

We still depend on you to tell other families about our site. Our sources of inspiration continue to be our patients, your children and our own clans. Please keep those topic suggestions coming! As working pediatricians and parents like you, we want to continue to be your reliable (and sometimes amusing) source of sound pediatric information.

Thank you for reading, listening, commenting and letting your friends know about Two Peds in a Pod. Let the adventure continue!

Sincerely,
Julie Kardos, MD and Naline Lai, MD
©2010 Two Peds in a Pod℠

July 13, 2010 by twopedsinapod

Celebrate! Westward ho

Two Peds in a Pod has made its way from Pennsylvania to California. Check out The Family Magazine Group. This informative print and online group of family magazines now features a bimonthly article from Two Peds in a Pod. The Family Magazine Group reaches a print audience of 350,000 and an online audience of about 100,000 each month.

(We’re on page 16)

Julie Kardos, MD and Naline Lai, MD

July 10, 2010 by twopedsinapod

More Warm Weather Tidbits: sunscreen, swimming, bug bites, and bike helmets

Here’s a quick blast of more summer hints.

Sunscreen: Apply SPF (Sun Protection Factor) of at least 15, and use more than you think is necessary. SPF gives you an idea of how long it may take you to burn. SPF of 15 means you will take 15 times longer to burn…if you burn in one minute, that’s only 15 minutes of protection! So apply, reapply and reapply. Sunscreen is fine for even young babies. For a baby’s first application of sunscreen, test the sunscreen by rubbing a small amount (size of a quarter) on the inner forearm and watch for a reaction. Clothing and shade work best to protect the skin, but not all clothing is protective. Depending on the weave and the fabric, protection fluctuates with each piece of clothing. Look for UPF (ultraviolet protection factor) ratings. A UPF rating measures the amount of UV light that reaches your skin. Higher numbers are better. For example, a rating of 100 means 1/100 or one percent of all rays will reach the skin.

Swimming: Lessons are fun and safe for all ages (including young toddlers). Studies have shown that children who drown are more likely to NOT have had swimming lessons compared to same age children who have not drowned. Even if he graduated from swimming lessons, attend to your child around water, whether it is a swimming pool, lake, puddle or bath. Lessons are not a substitute for adult supervision. Also, do not submerge your baby underwater. Contrary to media hype, your baby will NOT automatically hold his breath.

Patients frequently ask me when pool water is safe for a baby’s skin. Frankly, I worry more about sunburn from sunlight reflecting off the water than damage from contact with pool water. Just wash her with soap and water after she is done swimming for the day. If the chlorine in a pool seems to dry your baby’s skin, apply moisturizer after her bath.

Mosquito Bites: Initially wash with soap and water. For the itch: apply hydrocortisone 1% cream or ointment up to 4 times daily. Give oral diphenhydramine (brand name Benadryl) before bedtime to prevent your child from scratching in his sleep. Signs of an infected bite include new or worsening pain, increasing redness, any pus-filled area, or red streaks extending from the bite. Swelling, itchiness, and some redness at the site of the bite are signs of local irritation but not necessarily infection.

Bike helmets: Insist on the use of bike helmets. Head trauma from falling off bikes, roller blades, scooters, and skateboards often happen in the summer when kids say they are “too hot” to wear their helmet.

I would write more, but I have to go adjust a bike helmet on my sun-screened son who is scratching his bug bite as he is getting ready to bike to a neighbor’s pool to swim, under adult supervision.

Julie Kardos, MD with Naline Lai, MD
©2010 Two Peds in a Pod℠

July 9, 2010 by twopedsinapod

The latest friend torture game: cracking knuckles

Okay ready? Put your palms together. Fold your pinkie and ring fingers down. Tuck in your middle and pointer fingers. Cross your thumbs. Allow your BFF to lean over and suddenly push your knuckles together: c-r-a-c-k ! She cracks your knuckles.

It’s one in a long line of mildly torturous friendship games children play. Remember building a “rose garden” on your friend’s arm by pinching his forearm until it turned beet red?

As I watch my kids play the “knuckle cracking game,” I am reminded of a question parents often ask: “He is always cracking his knuckes! Won’t that cause early arthritis?”

When I look over at the object of the parent’s complaint in the office, the child usually gives me a big grin, and c-r-a-c-k, happily demonstrates to me the reason for the parent’s question. To the parent’s dismay, I tell the family knuckle cracking will not lead to early arthritis. However, I always laugh and warn the kid that harm from cracking knuckles comes not from the action of cracking knuckles but rather from an irritated parent’s wrath.

What’s the consequence of allowing a friend to crack your knuckles? That I do not know… although I have a suspicion the parental consequence is similar to when you crack your own.

Naline Lai, MD with Julie Kardos, MD
©2010 Two Peds in a Pod℠

July 5, 2010 by

How will my own childhood impact how I raise my children?

Earlier in the month I attended a developmental pediatrics conference in Philadelphia. The keynote speaker, Barry Zuckerman MD, professor and chairman of pediatrics at Boston University, raised a set of thoughtful questions. Parents can use the answers as a starting point for understanding how they were raised. Here are some of the questions with modifications:

-What was it like growing up? Who was in your family? Who raised you?

-Do you plan to raise your child like your parents raised you?

-How did your relationship with your family evolve throughout your youth?

–How did your relationship with your caregivers (mother/father/aunt/grandparent/etc) differ from each other? What did you like or not like about each relationship?

–Did you ever feel rejected or threatened by your parents? What sort of influence do they now have on your life?

–Did anyone significant die during your youth? What was your earliest separation from your parents like? Were there any prolonged separations?

–If there were difficult times during your childhood, were there positive role models in or outside your home that you could depend on?

Some of these questions may be tougher than others to answer. Ultimately you are not your parents (although you may feel otherwise when you hear a familiar phrase escape your own lips), and likewise your children are not you. Parenting techniques that worked, or did not work, for your parents will not necessarily work, or not work, for you. However, stopping to reflect on your own youth will help you understand why you parent the way that you do.

Naline Lai, MD with Julie Kardos, MD

June 28, 2010 by twopedsinapod

When potty training gets hard: constipation

help your child with constipation - count squares while she sits on the toilet Unfortunately, constipation and potty training go together.

This should come as no surprise. Let’s consider the two favorite words of two and three-year-olds:
“Mine,” and “No.”

Now think of how these words apply to a toddler who is starting to understand the purpose of the potty. The well meaning parent says, “Honey, we want you to put your poop to the potty.”

For many toddlers, the answer is… “NO! MINE!”

The problem begins when the toddler is determined NOT to give up her own poop. The longer your child holds in the poop, the harder and more difficult it will be to pass the poop. Thus, a vicious cycle begins. Your child finds pooping painful and scary. This cycle must be interrupted. Here are some tips:

Stop potty training and go back to diapers.

Before you groan at this suggestion, hear this story: The parents of one 2 ½-year-old were pleased that all “pee pee” was making it into the potty, but dismayed that she demanded a Pull-Up for poop. I suggested that she should wear diapers full time, and when pee AND poop go in the potty, then the princess underwear would come back. The child responded to me, “That isn’t very nice!” But guess what? That night, she pooped in the potty. Of course, her baby sibling is due in a few weeks, so we’ll see if success continues… but regression with new babies is a topic for another blog post.

Make the poop easy to pass.
Use natural interventions: increase water throughout the day and give undiluted juice such as prune, pear, apple, or pineapple (the other juices don’t hurt but do not actually help the cause) once a day. Offer fresh fruits, fresh vegetables, and high fiber cereals (just read the labels, try for more than 3 grams per serving). Encourage exercise.

Practice regular potty/toilet sitting.

Catch the poop when it’s naturally likely to come. The most likely time a toddler will poop is just after eating because of the gastrocolic reflex, a reflex which causes the bowels to move after eating. After every meal, have your potty trainer sit for 2-5 minutes. Treat this as a house rule. Read a book on the potty or tell stories to help pass the time.

Teach your child to prioritize pooping over playing.
If kids “really have to go” but they are busy playing, they will hold in the poop to avoid interruption. Watch for signs of a need to defecate such as squirming (better known as the potty dance) or hiding. To avoid a power struggle, say something like, “The poop wants to come out, let’s go,” rather than, “Do you want to go to the potty now?” and reward the child for sitting, not for producing.

Some over-the-counter products can help. You should discuss dosing, timing, risks, and benefits of each with your child’s health care provider before choosing. Medicines include:

Mineral oil: mix with something that tastes good such as juice or chocolate milk. The brand Kondremul tastes sweet and is hidden easily in milk because it’s white. Mineral Oil makes poop so slippery that even a determined toddler will not “hold it.”
Polyethyleneglycol (PEG) 3350 (Miralax): with a prescribed amount of liquid, it has no taste and pulls extra water into the bowels so that the poop stays soft.
Glycerin suppositories: can be the “quick fix” step before you have to resort to enemas, which are more traumatic.
Children’s laxatives such as Milk of Magnesia.
Senna-containing products – in the past there were concerns of bowel dependency with long-term use. This concern has been questioned by specialists. Ask your doctor about the products.

At one potty training child’s three year birthday party, the poor birthday boy spent half his party trying to pass a large hard poop, the result of several days of withholding. After one small glycerin suppository and a large amount of anxiety, he rejoined his friends; leaving his parents feeling guilty that they had not paid attention to his pooping frequency prior to the party. While the goal is for our children to be completely independent potty users, we have to help our potty trainers by keeping track of the frequency and consistency of their poop in order to prevent a withholding/painful pooping/constipation cycle from starting.

Be alert to potential medical causes of constipation (as opposed to behavioral or situational) and consult your child’s health care provider if you can’t seem to remedy the problem.

In the world of young potty trainers, try to avoid power struggles, “keep things moving,” make things soft and easy, and remember that this too shall pass.

June 23, 2010 by twopedsinapod

Can’t you just call in an antibiotic for me?

Our guest blogger today is Dr. Jason Komasz. Practicing pediatrics in Pennsylvania for nearly a decade, he is the father of two and a respected colleague.

“Can’t you just call in an antibiotic for me?”
As doctors we hear this question a lot. Parents are often disappointed and upset when we answer that question with a “No.” Your child is sick, you missed the Saturday office hours, and now you can’t schedule an appointment until Monday morning. There are reasons why doctors usually do, and should, answer “no” to this question.

Not every illness requires an antibiotic. Only bacterial illnesses respond to antibiotics and many illnesses are viral. In fact, misuse of antibiotics can lead to antibiotic resistance in our population.

The physical exam is very important in the evaluation of a patient. The exam helps doctors determine if a patient needs antibiotics, and if so, what type. If we do not see a patient, we are “flying blind.” This puts the patient as risk for misdiagnosis and incorrect treatment.

Antibiotic use before a patient is evaluated can affect laboratory results. For example, after starting antibiotics, Strep Throat and urinary tract infection tests may be inaccurate and therefore obligate the patient to an unnecessary course of antibiotics.

All but the most severely ill patients can usually be managed at home with pain/fever control and symptomatic care (fluids, etc) until they can be evaluated by a doctor.

If your child is ill enough to require an antibiotic, he is sick enough to need an evaluation by a physician. It is better to wait in an ER and receive proper care than to just treat without proper evaluation.

As always, your physician is trying to do what is best for your child. Your doctor should always be able to offer an explanation for why he or she is choosing a particular course of action for your child’s illness. We do not want them to suffer, just as you don’t. Just remember, the antibiotic is not always the answer.

June 17, 2010 by twopedsinapod

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