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Rotten News: A Salmonella Story

Eeew! Pictured is the raw chicken I left sitting out in a pot for a day (inadvertently, of course).  The putrid mess was teaming with germs and amongst them was probably salmonella. This bacteria is in the news because of the thousands of eggs recently recalled for contamination (Centers for Disease Control , New York Times, National Public Radio.)


 


Non-typhoidal Salmonella usually causes fever and crampy diarrhea.  This stomach bug mainly lurks in raw poultry, raw eggs, raw beef, and unpasturized dairy products. Luckily, salmonella does not jump up and attack humans. People are safe from disease as long as they do not eat salmonella-infested food.


 


In the case of my pot of rotten chicken, the obvious stench warned me that it was inedible.  However, salmonella often hides in food and it is difficult to tell what is or is not contaminated.  A perfectly fine looking egg may harbor the germ. Even before this outbreak, the Centers for Disease Control estimates in the United States as many as 1 in 50 people are exposed to a contaminated egg each year.


 


Luckily salmonella is killed by heat and bleach.  Even if an egg has salmonella, adequate cooking will destroy the bacteria. Gone are the days when parents can feed kids soft boiled eggs in a silver cup, have kids wipe up with toast the yolk from a sunny-side up egg, or add a raw egg to a milkshake.  Instead, cook your hardboiled eggs until the yolks are green and crumble, and tolerate a little crispness to your scrambled eggs.  Wash all utensils well. The disinfecting solution used in childcare centers of ¼ cup bleach to 1 gallon water works well to sanitize counters. Do not keep perishable food, even if it is cooked, out at room temperature for more than two hours.




A mom once called me frantic because her child had just happily eaten a half-cooked chicken nugget. What if this happens to your child? Don’t panic. Watch for symptoms — the onset of diarrhea from salmonella is usually between 12 to 36 hours after exposure but can occur up to three days later.  The diarrhea can last up to 5-7 days. If symptoms occur, the general recommendation is to ride it out. Prevent dehydration by giving plenty of fluids. My simple rule to prevent dehydration is that more must go in than comes out. 


 


According to the American Academy of Pediatric’s 2009 infectious diseases report, antibiotic treatment may be considered for unusually severe symptoms or if your child is at risk for overwhelming infection. People at high risk for overwhelming disease include infants younger than three months old and those with abnormal immune systems (cancer, HIV, Sickle Cell disease, kids taking daily steroids for other illnesses). Using antibiotics in a typical case of salmonella not only promotes general antibiotic resistance, but in fact does not shorten the time frame for the illness. Also, the medication can prolong how long your child carries the germ in his stool.


 


I ended up tying the chicken up, pot and all, in a plastic grocery bag and throwing out the whole mess.  Don’t tell my husband, he is the kind of guy who gets annoyed because I throw out germy sponges on a frequent basis. If he knew, he’d probably want me to at least keep the pot. Yuck.

Naline Lai, MD with Julie Kardos, MD


©2010 Two Peds in a Pod℠

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Cry Baby- Why do infants cry?

crybabyonesieWhy do babies cry? This may seem like a silly question, but sometimes you really want to know why your infant is crying.

Remember, newborns cannot talk. They can’t even smile back at you until around six weeks of age.  Why do babies cry? In short, newborns cry to communicate.

Ah, but what is it, exactly, that they try to communicate? Babies cry when they…

      – Are tired.

      – Are hungry.

      – Feel too cold.

      – Feel too hot.

– Need to be changed –I never really believed this reason before I had my twins. My firstborn couldn’t have cared less if he was wet and could nap right through a really poopy diaper. Then I had my twins.  I was amazed that their crying stopped if I changed the tiniest bit of poop or a wet diaper. Go figure.

– Are bored. Perhaps she is tired of the Mozart you play and prefers some good hard rock music instead. Maybe she wants a car ride or a change of scenery. Try moving her to another room in the house.

– Feel pain. Search for a piece of hair wrapped around a finger or toe and make sure he isn’t out-growing the elastic wrist or ankle band on his clothing.

– Need to be swaddled. Remember a fetus spends the last trimester squished inside of her mom. Discovering her own randomly flailing arms and legs can be disconcerting to a newborn.

– Need to be UN-swaddled. Hey, some like the freedom to flail.

– Need to be rocked/moved. Dr. Lai’s firstborn spent hours tightly wrapped and held by her dad in a nearly upside down position nicknamed “upside-down-hotdog” while he paced all around the living room.

– Check to see if there is a burp stuck inside her belly. Lay her down for a minute and bring her up again to see if you can elicit a burp. 

– Does your baby seem gassy? Bicycle his legs while he is on his back. Position him over your shoulder so that his belly presses against you. You’d be gassy too if you couldn’t move very well. The gassy baby is a topic for an entire post- talk to your doctor for other ideas.

– Are sick. Watch for fever, inability to feed normally, labored breathing, diarrhea or vomiting. Check and see if anything is swollen or not moving. Listen to his cry. Is it thin, whimper-like (sick) or is it loud and strong (not sick)? Do not hesitate to check with your pediatrician. Fever in a baby younger than eight weeks old is considered 100.4 degrees F or higher measured rectally. A feverish newborn needs immediate medical attention.

What if you’re certain that the temperature in the room is moderate, you recently changed his diaper, and he ate less than an hour ago?

– Walk outside with your baby- this can be a magic “crying be gone” trick. Fresh air seems to improve a newborn’s mood.

– Offer a pacifier. Try many different shapes of pacifiers. Marinade a pacifier in breast milk or formula to increase the chance your baby will accept it.

– Pick her up, dance with her, or walk around the house with her. You can’t spoil a newborn.

– Try vacuuming. Weird, but it can work like a charm. Place her in a baby frontal backpack or in a sling while cleaning.

– Try another feeding, maybe she’s having a growth spurt.

-When all else fails, try putting her down in her crib in a darkened room. Crying can result from overstimulation. Wait a minute or two. She may self-settle and go to sleep. If not, go get her. The act of rescuing her may stop the wailing.

-If mommy or daddy is crying at this point, call your own mom or dad or call a close friend. Your baby knows your voice and maybe hearing you speak calmly to another adult will lull her into contentment.

– Call your child’s health care provider and review signs of illness.

– If you feel anger and resentment toward your crying baby, just put her down, walk outside and count to ten. It is impossible to think rationally when you are angry and you may hurt your child in order to stop your frustration. Seek counseling if these feelings continue.

Now for the light at the end of the newborn parenting tunnel: the peak age when babies cry is six weeks old. At that point, infants can cry for up to three hours per day. Babies with colic cry MORE than three hours per day. (Can you believe people actually studied this? I am amused that Dr. Lai won a prize in medical school for a paper on the history of colic). By three months of age crying time drops dramatically.

While most crying babies are healthy babies and just need to find the perfect upside-down-hot-dog position, an inability to soothe your baby can be a sign that she is sick. Never hesitate to call your baby’s health care provider if your baby is inconsolable, and don’t listen to the people who say, “Why do babies cry?…They just do.”

———

Thanks to our Facebook friends for other ideas for what the cartoon baby is saying:

“Stop looking at me like that and please loosen this blanket and don’t hold me up here like this and where is my hat my diaper is giving me a wedgie! JUST MAKE IT ALL STOP!”

“WHY CAN”T YOU LET ME GO BACK TO SLEEP, PEOPLE!”

———

 

Julie Kardos, MD with Naline Lai, MD

©2010 Two Peds in a Pod℠

 

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Better Balance

I conduct sports-clearance physicals by the dozens these days, and I notice that although most kids have endurance, they lack balance. Balance will save your child from twisting an ankle on uneven turf. Balance helps your child stay straight when she stops suddenly. I have long wondered the easiest way for kids to practice their balance. When I suggest spending time in yoga’s “tree” or “half-moon” position, the kids all look at me quizzically.

Today a mom passed on to me a very simple balance exercise. Have your kids stand on one leg while they brush their teeth! Not as graceful looking as my yoga suggestions, but far more practical.

Naline Lai, MD with Julie Kardos, MD

©2010 Two Peds in a Pod℠

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Back to School Transitions

Ah…you’ve tucked in your tired kids, now kick back and take out your Kleenex while you read Dr. Lai’s personal letter to her own child as she started school. The post is meant for all parents with a child who is approaching a major milestone. Then, come back to reality and read Dr. Kardos’s post on how to help kids get back to a healthy school year sleep pattern.


Best wishes for a smooth transition to school.


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

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Packing your child’s school lunch: Beware of junk food disguised as healthy food

Need ideas on what to pack in your child’s lunch bag? Beware of junk food masquerading as healthy food. Dr. Roxanne Sukol, an internist who writes the popular nutrition blog Your Health is on Your Plate , mom of three children, and friend of Dr. Kardos’s from medical school, shares her insights…

What should we pack in our children’s lunch bags?  The key to retraining our children to eat real food is to restore historical patterns of food consumption.  My great-grandparents didn’t eat potato chips, corn chips, sun chips, or moon chips.  They ate a slice of whole-grain rye bread with a generous smear of butter or cream cheese.  They didn’t eat fruit roll-ups.  They ate apricots, peaches, plums, and grapes.  Fresh or dried.  Depending on where your family originated, you might have eaten a thick slice of Mexican white cheese (queso blanco), or a generous wedge of cheddar cheese, or brie.  Sunflower seeds, dried apples, roasted almonds.  Peanut butter or almond butter.  Small containers of yogurt.  Slices of cucumbers, pickles, or peppers.  All of these make good snacks or meals.  My mom is proud to have given me slices of Swiss cheese when I was a hungry toddler out for a stroll with my baby brother.  Maybe that’s how I ended up where I am today.

When my own children were toddlers, I gave them tiny cubes of frozen tofu to grasp and eat.  I packed school lunches with variations on the following theme:  1) a sandwich made with whole grain bread, 2) a container of fruit (usually apple slices, orange slices, kiwi slices, berries, or slices of pear), and 3) a small bag of homemade trail mix (usually peanuts + raisins).  The sandwich was usually turkey, mayo and lettuce; or sliced Jarlsberg cheese, sliced tomato, and cream cheese; or tuna; or peanut butter, sometimes with thin slices of banana.  On Fridays I often included a treat, like a few small chocolates. 

Homemade trail mix is one terrific snack.  It can be made with any combination of nuts, seeds, and/or dried fruit, plus bits of dark chocolate if desired.  Remember that dark chocolate is good for you (in small amounts).  Dried apple slices, apricots, kiwi or banana chips, raisins, and currants are nutritious and delicious, and so are pumpkin seeds and sunflower seeds, especially of course in homes with nut allergies.  Trail mix can be simple or involved.  Fill and secure baggies with ¼ cup servings, and refrigerate them in a closed container until it’s time to make more.  I would include grains, like rolled oats, only for children who are active and slender.

If possible (and I do know it’s a big “if”), the best way to get kids interested in increasing the amount of real food they eat is to involve them in its preparation.  That might mean smearing their own peanut butter on celery sticks before popping them into the bag.  It might mean taking slices of the very veggies they helped carry at the weekly farmer’s market.  Kids are more likely to eat the berries in their lunch bag if they picked them themselves.  There’s a much greater chance they’ll eat kohlrabi if they helped you peel it, slice it, or squeeze a fresh lemon over it.  That’s the key to healthy eating.

What do I consider junk food?  Chips of all kinds, as well as those “100 calorie packs,” which are invariably filled with 100 calories of refined carbohydrate (white flour and sugar) in the form of crackers (®Ritz), cereal (®Chex), or cookies (®Chips Ahoy).

You can even find junk food snacks for babies and toddlers now:  The main ingredients in popular ®Gerber Puffs are refined flour and sugar.  Reviewers tout: “You just peel off the top and pour when you need some pieces of food, then replace the cap and wait for the next feeding opportunity.” [Are we at the zoo?] “He would eat them all day long if I let him.” [This is not a benefit.  It means that the product is not nutritious enough to satisfy the child’s hunger.]

Beware not only of drinks that contain minimal amounts of juice, but also of juice itself.  Even 100% fruit juice is simply a concentrated sugar-delivery system.  A much better approach is to teach children to drink water when they are thirsty, (See my post entitled One Step at a Time) and to snack on fresh fruit when they are hungry.  Milk works, too, especially if they are both hungry and thirsty!

© 2010 Roxanne B. Sukol, MD, MS

TeachMed, LLC

http://yourhealthisonyourplate.com

Reprinted with permission in edited form for Two Peds in a Pod

Roxanne B. Sukol, MD is a 1995 graduate of Case Western Reserve School of Medicine.  She is board-certified in Internal Medicine and practices in suburban Cleveland, Ohio.  With special interests in the prevention and management of diabetes and obesity, Dr. Sukol writes the blog Your Health is on Your Plate .  Because her patients (the grown-ups) are the ones packing the school lunches for our patients, we thank her for this post.

Julie Kardos, MD and Naline Lai, MD

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Quick flu vaccine update: what’s new in 2010 for kids

Vaccine protection against flu (influenza) is coming soon. Thankfully, last year’s confusion caused by two separate vaccines is eliminated. This year’s flu vaccine, both the injectable and the nasal forms, protects against both novel H1N1 and the season strains of flu. Not only from a confusion standpoint, but also from a health benefit standpoint, this is good news. Unlike seasonal flu, which causes severe disease in both the elderly and youngsters, 90 percent of deaths from H1N1 were in people younger than age 65 years.

The current recommendation of the US Center for Disease Control  (http://www.cdc.gov/flu ) is to immunize ALL children against flu starting at six months of age (if local supplies are limited, the highest risk groups will be targeted).  All household members and caregivers of babies too young to receive the immunization should also be vaccinated, as well as all caregivers of children of any age.

As always, children nine years old and older need only ONE dose of flu vaccine this year. Children below nine (eight years old and younger) will receive one dose of flu vaccine this year as long as they received at least two doses of seasonal flu and one dose of H1N1 vaccine in the past.

The children who need two doses of flu vaccine this year are the ones younger than nine years old who received zero or one seasonalflu vaccine in the past or who have never received H1N1 vaccine.

With school start comes illness season, so remember to schedule your children for their flu vaccines early this fall. Speak with your child’s health care provider about which form of flu vaccine is appropriate for him or her. Then schedule your own flu vaccine.

Remember the artwork from last year? The picture is a rendition of H1N1 from the perspective of a kindergartener. Note the large boogie to nose ratio. The red represents “boss germs” and the purple shows the “just plain mean ones.”

Ah-CHOO! Banish FLU!

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

Sept 16, 2010  a quick add- if your child actually had H1N1 last year (confirmed by a test) you can consider it the same as getting the H1N1 vaccine in the 2009 season (just building up immunity the hard way)


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Tips on caring for your son’s circumcision

Ok, so now you are in charge of caring for a newly circumcised penis. As a mom who’s never had a penis or as a dad who has no memory of his pre-circumcised days, you may have questions after you leave the hospital about how to care for this “wound.” 

Unlike most infants in the world, in the United States, most boys are circumcised. Parents choose to circumcise their sons for various reasons including medical and cultural beliefs. In this blog post I will not address any debates about circumcision. I will only address care of the recently circumcised penis.

It takes about one week for a circumcised penis to fully heal. This is not long in the scheme of things. While there are no absolute standards of circumcision care, most providers recommend putting a walnut size amount of either petroleum ointment or antibiotic ointment directly onto the head of the penis at every diaper change for the first 3 or 4 days. Some find it easier to dollop the ointment onto a gauze pad and then tuck the ointment covered pad into the diaper.

Be sure to clean any stool on the penis using mild soap and water. Some white, gray, or yellow material will accumulate on the head of the penis around the third or fourth day. This material, called granulation tissue, is a normal part of the healing process. (You may remember a similar healing process occured when you skinned your knee as a child). Go ahead and wash the goo with warm water, the secretions will disappear over the next few days.

Infection is rare, but does occur. Watch for an increase in swelling, an increase in redness, redness extending down the shaft of the penis, an increase in pain, pus discharge from the wound site, and fever of 100.4 F or higher. With any of these symptoms, take your child to be evaluated by your child’s health care provider.

Sometimes extra, or redundant, foreskin remains around the head of the penis. Over time, this extra tissue does retract back. Scar tissue rarely forms permanently because with each erection (yes, infants have erections) the head of the penis pulls away from the shaft. As the baby gets older, parents can gently pull back redundant skin with their hands when they give the baby a bath. If you are concerned about the appearance of your child’s penis, ask his health care provider to take a look.

One last tip: remember to point the penis DOWN when putting a new diaper on your son; otherwise he will urinate “up” through the diaper and all over his shirt. Trust me on this one.

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

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The Heart Ache of Heart Break-how to help your teen through a break-up

As summer dwindles, unfortunately so do the summer romances. Psychologist John Gannon guest blogs today on how to help your teen when a first love goes sour…

It happens to almost every adolescent. At some point or another, we all experienced our first love. In the early stages, it was the greatest feeling we had ever felt. When it ended, it was the largest and most powerful feeling of hurt that we had ever experienced. Each moment felt like 10 years. Days went by and life went on for everyone else. Yet, for us, life stopped and we felt lost and paralyzed.

Your child will not be the exception either. They will feel their feelings the same way we felt ours. Your response to their heart break might offer them comfort. It may also infuriate them. They might claim that you just don’t understand. They might sob inconsolably. In practicality, your life will also suffer! Nothing can take their pain away except the passage of time. I always speak about the scar that occurs from first love. I believe it is a necessary scar, so that we do not become lost without emotional boundaries.  The price of the scar though, is the loss of emotional love with another person.

There are things you may want to consider when this occurs for your child. For instance, some teenagers have more than just a traditional break up syndrome. They enter a state of significant sadness or anxiety. It can be difficult to distinguish what is a break up and what is something else. Sometimes, they will try to self medicate with drugs or alcohol. They may be more likely to have poorer judgment than they typically would have. It’s good to try and be as emotionally available as they will let you. Don’t take it personally if they shut you away.

Fortunately, time does heal most of these feelings. One day, you will see they look brighter. They may start to smile. Luckily, first love happens only once in a lifetime for most of us. (Some people live life with every relationship as a first love.) Keep in touch with your kids during this time. Even if it appears they are being overly dramatic, they are inexperienced when it comes to affairs of the heart. The pain is real for them. First love can teach how to balance love. Sometimes, they may need to have several breakups to figure this out. Most of the time, we ultimately learn how love is kept in perspective and by doing so we do not lose our emotional well-being.

Finally, this is a passage of your child’s becoming an adult. Enjoy the ride!

John Gannon, MS, licensed psychologist

Gannon has over 25 years experience as a marriage and family therapist in the Philadelphia area. He has spoken both locally and nationally on family matters. He has addressed numerous teacher and parent groups, given advice on radio, and has appeared on The Montel Williams Show.

© 2010 Two Peds in a Pod℠

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Avoid back strain- what to look for in a school backpack

Just in time for the fall sales,  physical therapist Dr. Deborah Stack returns to give us the low-down on backpacks.

———————————-

Believe it or not, there are only a few weeks left before school starts for the fall.  As I look at last year’s first day of school photo, I notice my not-quite-100-pound child bending in half under the weight of a backpack, trombone, lunchbox and art portfolio. This year, I quietly decree, that scenario will not happen again.  To make sure it does not happen at your house either, consider a few tidbits as you plan your back-to-school purchases:


-A traditional backpack with two shoulder straps distributes the weight more evenly than a pack or messenger bag with a single strap.


-Look for wide, padded straps.  Narrow straps can dig in and limit circulation.


-A chest or waist strap can distribute weight more evenly.


-Look for a padded back to protect your child from pointy pencils etc.


-Look for a lightweight pack that does not add much overall weight.


–Multiple compartments can help distribute weight.


–Compression straps on the sides or bottom of a backpack can compress and stabilize the contents.


–Reflective material allows your child to be more visible on those rainy mornings.


–A well fitting backpack should match the size of the child. Shoulder straps should fit comfortably on the shoulder and under the arms, so that the arms can move freely. The bottom of the pack should rest in the contour of the lower back. The pack should “sit” evenly in the middle of the back, not “sag down” toward the buttocks.

 

How much should your tike tote? Experts, including the American Academy of Pediatrics and the American Physical Therapy Association, recommend kids should not carry backpacks weighing more than 15-20% of the kid’s weight.


Here’s a chart to give you an idea of the absolute maximum a child should carry in a properly worn backpack:

 

 

Child’s Weight

(pounds)

Maximum Backpack Weight

(pounds)

50

7.5-10

60

9-12

70

10.5-14

80

12-16

90

13.5-18

100

15-20

110

16.5-22

120

18-24

130

19.5-26

 

 

 

 

 

 

 

 

 

 

 

 

 

Here are some ideas to help lighten the load, especially for those middle school kids who have a plethora of textbooks:


-Find out if your child’s textbook can be accessed on the internet.  Many schools are purchasing access so the students can log on rather than lug home.


-Consider buying an extra set of books for home.  Used textbooks are available inexpensively online.


-Limit the “extras” in the backpack such as one free reading book instead of five.  I am not exaggerating; one day I found five free reading books in my child’s backpack!


-Encourage your child to use free periods to actually study, and leave the extra books in his locker.


-Remind your child to stop by her locker between classes to switch books rather than carrying them all at once.


-Consider individual folders or pockets for each class rather than a bulky 3-ring notebook that holds every subject.

 

You may need to limit the load even further if your child is still:


-Struggling to get the backpack on by herself


-Complaining of back, neck or shoulder pain


-Leaning forward to carry the backpack

 

If your child complains of back pain or numbness or weakness in the arms or legs, talk to your doctor or physical therapist.

 

When used correctly, backpacks are supported by some of the strongest muscles in the body: the back and abdominal muscles. These muscle groups work together to stabilize the trunk and hold the body in proper postural alignment.  However, backpacks that are worn incorrectly or are too heavy can lead to neck, shoulder and back pain as well as postural problems.  So choose wisely and lighten the load.  Happy shopping!


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.


© 2010 Two Peds in a Pod℠

 

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It’s a tough pill to swallow

In the wake of liquid Tylenol and Motrin recalls, some parents are facing empty shelves of liquid medications in the stores. Check to see if your child weighs enough to take the dose in pill form. If so, it’s time to learn to swallow pills! Here are some of our favorite helpful ideas:

-Don’t wait until your child is ill. She may not feel up to learning a new skill.

 

-Practice swallowing peas, tic-tacs or watermelon seeds. You can start with a cake sprinkle and move up to something larger.

-Demonstrate for your child the process of swallowing.

-Thick liquid will carry down a pill better than thin liquid. Try orange juice or milk instead of water.

-Try having your child tilt her head forward as she drinks so that she is “upside down.”

-Use mind over matter, for a nervous kid, tell him to first take three breaths, sit-down, gulp and quickly swallow.

-Take a pill while simultaneously eating apple sauce, yogurt, or pudding.

-Put a pill in his mouth and have him suck liquid quickly up through a straw. This action will push back the pill before it dissolves in the liquid.

-Remind your child: if you can swallow food, you can swallow a pill.

What if nothing works? Some pills can be chewed, and the contents of some capsules can be sprinkled on food; check with the pharmacist first. Then teach your child the song “I know an old lady who swallowed a fly…”

Naline Lai, MD and Julie Kardos, MD

©2010 Two Peds in a Pod?

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