This sign now sits on my friend’s lawn. I still remember four years ago when I pulled my big blue minivan up in front of their house after the moving van left. A mommy sat on the stoop with her children. “How old are they? I hollered out. The ages of the children matched my children’s and I was delighted. Indeed they became good friends. And now, there’s the “For Sale” sign.
It’s nearing the end of the school year, and “For Sale” signs dot lawns all over the United States. Chances are, one of them belongs to your child’s friend. Just as the child who moves will have to adjust to a new environment, your child will have to adjust to a world without a friend who was part of his daily routine.
Much has been written about how to transition the child who moves into a new environment, but how can you help your child when his close friend moves away?
Your child may experience a sense of loss and feel that he was “left behind.” Some children perseverate over the new hole in their world. Others take the change in stride.
In the late 1960’s, psychiatrist Elisabeth Kubler-Ross described “the five stages of grief.” The stages were initially applied to people suffering from terminal illness, but later they were applied to any type of deep loss such as your child’s friend moving. The first stage is denial: “I don’t believe he moved.” Anger follows in the second stage: “Why me? That’s not fair!” Your child may then transition into the third stage and bargain: “If I’m good maybe he will hate it there and come back.” The fourth stage is sadness: “ I really miss my friend,” or, “Why make friends when they end up moving away?” The final stage is acceptance: “Everything is going to be okay. We will remain friends even if he doesn’t live here.”
Some pass through all stages quickly and some skip stages altogether. The process is personal and chastising your child to “just get over it” will not expedite the process. However, there are ways to smooth the journey:
· Reassure your child that feeling sad or angry is common. Parents need to know that sad children may not show obvious signs of sadness such as crying. Instead, rocky sleep patterns, alterations in eating, disinterest in activities or a drop in the quality of school work can be signs that a child feels sad. If feelings of depression in your child last more than a month or if your child shows a desire to hurt himself, consult your child’s health care provider.
· When you discuss the move with your child, keep in mind your child’s developmental stage. For instance, preschool children are concrete and tend to be okay with things being “out of sight, out of mind.” Talking endlessly about the move only conveys to the child that something is wrong. Children around third or fourth grade can take the move hard. They are old enough to feel loss, yet not old enough to understand that friendships can transcend distance. For teens, who are heavily influenced by their peers, a friend’s moving away can cause a great deal of disruption. Acknowledge the negative emotions and reassure your child that each day will get better. Reassure him that despite the distance, he is still friends with the child who moved.
· Prior to the move, don’t be surprised if arguments break out between the friends. Anger can be a self defense mechanism employed subconsciously to substitute for sadness.
· Set a reunion time. Plan a vacation with the family who moved or plan a trip to their new home.
· After the move, send a care package and write/ help write a letter with your child.
· Answer a question with a question when you are not sure what a child wants to know. For example if he asks,” Will we always be friends?” Counter with “What do you think will happen?”
· Share stories about how you coped with a best friend moving when you were a child.
As for my children, when I told one of my kids that I will sign her up for soccer, she squealed with delight, “Oh, that’s the league Kelly belongs to.”
My heart sank. I said as gently as I could, “She’s moving- she won’t be here for soccer season.”
And so we begin the process…
Naline Lai, MD
© 2010 Two Peds in a Pod
When the Tin Man was a child in Oz, I’m sure his pediatrician never told his parents, “Has anyone ever said your child has a heart murmur? I hear one today.”
I know that when I tell parents about a heart murmur in their child, their hearts skip and jump. But not all heart murmurs are bad.
A heart murmur is an extra sound that we pediatricians hear when we listen to a child’s heart with a stethoscope. A normal heart beat sounds like this: “lub, dub. lub, dub. lub, dub.” A heart murmur adds a whooshing sound. So what we hear instead is “lub, whoosh, dub” or “lub, dub, whoosh.”
The “whoosh” is usually caused by blood flowing through a relatively narrow opening somewhere in or around the heart. Think of your blood vessels and heart like a garden hose. If you run the water (blood) very hard, or put a kink or cut a hole in the hose, the whoosh of the water grows louder in those locations.
Heart murmurs signal different issues at different ages. In a newborn, some types of heart murmurs are expected. Normal newborn hearts contain extra holes that close up after the first hours or days of birth. One type of murmur occurs as the infant draws in his first breath and holes in the heart, present inside the womb, begin to seal. As the holes get narrower, we sometimes hear the “whoosh” of blood as it flows through the narrowing opening. Then these holes close completely and the murmur goes away.
However, some murmurs in infancy signal “extra holes” in the heart. As pediatricians we experience our own heart palpitations when moms want to leave the hospital early with their infants who are less than 48 hours old. We worry because many infants who have abnormal hearts may not develop their abnormal heart murmurs and other signs of heart failure until the day after birth.
Preschool and early school age children often develop “innocent” heart murmurs. “Innocent” implies that extra blood flows through their hearts, but the hearts are structurally normal. These murmurs are fairly common and can run in families. However, there are heart problems which do not surface until this age. For this reason, remember to schedule those yearly well child checkups.
For teens, during the pre participation sports physical, pediatricians listen carefully for a murmur that may indicate that an over grown heart muscle has developed.
Again, holes are not the only culprit behind a murmur. The whoosh sound can also arise when a person is anemic and blood flows faster than normal. In anemic kids, the blood flows faster because it lacks enough oxygen-carrying red blood cells and the heart needs to move blood faster in order to supply oxygen to the body. The most common cause for anemia is a lack of sufficient iron intake. Subsequently, we hear these flow murmurs in children whose diets lack iron, in teenagers who are growing rapidly and quickly use up their iron stores, and in girls who bleed too much at each period. Replenishing the iron level makes a heart murmur from anemia go away.
Even a simple fever (see our earlier blog posts to learn more about fevers) can cause a heart murmur on physical exam. The murmur goes away when the fever goes away.
Pediatric health care providers can often distinguish between “innocent” heart murmurs and not-so- innocent heart murmurs by the sound of the murmur itself (not all “whooshes” sound alike). If any question exists, your child will be referred for more testing, which could include a chest x-ray, an EKG (electrocardiogram), and ECHO (echocardiogram, or ultrasound of the heart) or evaluation by a pediatric cardiologist.
If your child’s pediatrician tells you that your child has a heart murmur, “take heart”. Many times a murmur comes and goes or just becomes part of your child’s baseline physical exam. Even if your child has a serious heart problem, most cases respond well to medication, surgery, or both. While not all heart problems cause heart murmurs, and while not all murmurs signal heart problems, the presence of a heart murmur in a child can signal that your child needs further testing.
Unless, of course, your child is the Tin Man. In this case, extra sounds indicate that your child needs more oil!
Julie Kardos, MD
©2010 Two Peds in a Pod
This spotted the other day- tendonitis. In plain English, wrist pain at the base of the thumb from the strain of playing too much Nintendo DS/iPod touch or texting on your phone with your thumbs.
Imagine what the iPad will bring.
Naline Lai, MD 2010© Two Peds in a Pod
Hurry, hurry, hurry!!! Off to soccer practice, or the orthodontist’s office, or swim class, or a scout meeting, or a violin lesson. Don’t forget homework, that spelling test… oh no! Wasn’t there a special poster project due soon? Quick, run into Staples to get that poster board. Oh, and yes, we can’t forget to grab some take-out because with all the rush, who had time to make dinner?Standing in line at a fast food restaurant off an East coast highway during spring break, I overheard the cashier greet the family in front of me by name. I cringed. Was the family a regular customer at the chain? Hopefully, they were just friends with the cashier.
Most of us, including me, are not always health food angels. However, a family who is a regular customer at a fast food restaurant may simply not know how to break the habit. For those who still need to get those healthy eating New Year’s resolutions rolling, our February podcast, “Helping the Overweight Child,” gave the 5-4-3-2-1-0 rules for healthy eating. This post gives more hints:
BMI, or Body Mass Index (weight in kg divided by height in meters squared) is a number which indicates whether your child’s weight is normal for his or her height and age. Normal weight school aged kids DO look a bit scrawny.Children’s bellies should NOT hang over their pants. On the other hand, normal weight toddlers do look a bit pudgy. The Centers for Disease Control and Prevention has a nice BMI calculator.
Snacks aren’t needed at sports games which last only an hour. Supply water bottles and forget the snack.
Don’t feed your younger child snacks to keep him occupied during an older sibling’s event. Bring books, paper and crayons, a doll, or a matchbox car instead.
Make a stack of peanut butter and jelly or cheese sandwiches and keep them wrapped, ready to go, in the fridge. Keep some washed apple slices or carrot sticks along side the sandwiches and this stash can be your “fast food” at those times you need to feed your family “on the run”.
Don’t give your children a junky snack in order to carry them over until dinner. If your kids come home from school STARVING!!, give them a REAL dinner, and then give them a fruit or vegetable when the entire family later sits down.
A holiday is one day, Halloween is October 31st. . Why eat the candy for days and weeks afterwards?
Don’t keep junk food in your home. This will avoid arguments about what to eat.
Have your children ask you if they can have something to eat, rather than allowing “free access” to your pantry/refrigerator. That allows you decide if it is too close to mealtime to have a snack (remember from the Picky Eaters blog post,“hunger is the best sauce”) and will allow you to choose an appropriate snack and portion size. If kids inherently knew healthy choices and portion sizes, they wouldn’t need parents! Also this allows you to determine if the child is truly hungry, bored, or attention seeking.
Now back to the the fast food establishment I find myself in with my family. “Maybe this restaurant chain should offer a Two Peds in a Pod kid’s lunch box,” I mused as my family finished up their greasy, salty meal. Everyone’s curiosity was piqued. My husband and I began to hypothesize what kind of food would be inside a Two Peds box.
“What do you think?” I asked the kids.
“We’re actually more interested in what kind of prize would you would offer,” they said.
Gotta love my regular customers.
Naline Lai, MD and Julie Kardos, MD
©2010 Two Peds in a Pod®
For all the kids who received separate seasonal and 2009 H1N1 (Swine flu) vaccines last year, there is good news from Kimberly Parnell, PhD, our favorite flu vaccine vigilant-scientist-mom (see the last H1N1 vaccine blog post). The World Health Organization, who meets on a yearly basis in February to decide on the strains for the upcoming fall’s “flu shot” has decided to roll the new/novel H1N1 into this year’s Northern Hemisphere vaccine.
Winter flu season … it’s only nine months away !
For more detailed information:
http://www.who.int/csr/disease/influenza/recommendations2010_11north/en/index.html
Naline Lai, MD
© 2010 Two Peds in a Pod
“Help, help, my EAR HURTS!!!”
I admit to having no statistics on this observation, but as a pediatrician and a mom, I have observed that ear infections strike disproportionately on Friday nights. Have you observed this as well?
I wish children had some kind of external ear indicator that would flash “infection” or “not an ear infection” when they have middle of the night attacks of pain. Unfortunately, most people can not diagnose their child in the middle of the night. Even I can’t diagnose my own children at home because my portable otoscope, the instrument used to examine ears, died from overuse a year ago. However, there are ways to treat ear pain no matter what the cause.
Of course we all want to know the cause of our children’s pain. However, there is no danger in treating pain while we investigate the cause, or until daytime comes and pediatricians open their offices. Good pain relievers such as acetaminophen (brand name Tylenol) or ibuprofen (brand names Advil and Motrin), given at correct doses, will treat pain from any source. Treating pain does not “mask” any physical exam findings so go ahead and ease your child’s misery before going to your child’s health care provider. I feel bad for my young patients whose parents tell me, “We didn’t give him any pain medicine because we wanted you to see how much his ear is hurting him.”
Heat in the form of warm wet compresses or a heating pad will also help. Prop your child upright. If the pain is from an ear infection, the position will relieve pressure. Distraction such as a 2:00 am Elmo episode will also blunt pain.
Only about half of all patients seen in the office with ear pain or “otalgia” actually have a classic middle ear infection. Pain can stem from many sources, including the outer part of the ear. Swimmer’s ear, which is an outer ear infection (see swimmer’s ear blog post) is treated differently than a middle ear “inside” infection. Nearby body parts can also produce pain. Throat infections (pharyngitis), from strep throat (see strep throat posts) or viruses, often cause pain in the ears. Even pain from jaw joint strain and dental issues can show up as ear pain. Over the years I have sent several children straight from my office to the dentist’s office for treatment of tooth ailments masquerading as ear pain.
No article on ear pain would be complete without addressing“ear tugging.” Many babies by nine months of age discover their ears and then play with them simply because they stick out (I will leave to your imagination what boy babies tug on). Babies often tug on ears when they are tired. Therefore, tugging on ears alone may not indicate an ear infection, especially if not coupled with other symptoms.
Although ear infections are one of the most common ailments of childhood and most children have at least one ear infection by age three, remember that not all ear pain is caused by ear infections. In the middle of the night, and even in the middle of the day, it IS okay to give some pain relief before seeing your child’s health care provider.
Why ear pain always seems to awaken a child in the middle of the night, I’ll never know. All I know is that I have to remember to buy a new otoscope for home.
Julie Kardos, MD
©2010 Two Peds in a Pod
Mud is everywhere. My jeans are splattered—the result of chasing after my dog who was running loose in the neighborhood. Unlike my children, my dog might go home with any stranger. Then again, I wonder, would my children ever be tricked into wandering off with a stranger? Every week there seems to be a story about an attempted child abduction circulating via email. I brought this up with Doylestown Township Pennsylvania Police Chief Stephen White who shared with me a few ideas on how to protect your children beyond telling them “don’t take candy from strangers.”
In order to distinguish between a real police officer and an impostor, tell your child that if he is confronted by someone who claims to be a police officer, have him tell the officer to call for another one. Real officers rarely work without a partner.
Naline Lai, MD
© 2010 Two Peds in a Pod
As I pack for an upcoming family vacation, I am reminded of the numerous questions over the years that parents have asked me about traveling with children. Often they ask, what is the best way to travel that will allow everyone to enjoy the vacation?
Ha,ha, I think to myself. The real answer is to hire a sitter or enlist grandparents to babysit and leave the kids at home. My husband and I always refer to family vacations as “family displacements.”
No, really, family vacations are wonderful experiences as long as you hold realistic expectations. First you have to get there.
Easier said than done.
When traveling by air, parents wonder if they should bring a car seat for the plane. Young children who sit in a car seat in the car should sit in a car seat in an airplane. Unfortunately, not all car seats fit into the airplane seat properly. The best advice I can give is to bring your car seat and make an attempt to fit it properly. If it doesn’t fit properly, you will still need it for the car ride from the airport after you arrive at your destination. Not all car rental facilities provide car seats.
Another question I am frequently asked about long plane rides is “Should I give my child Benadryl (diphenhydramine) so he/she will sleep through the flight?” Unfortunately, Benadryl’s reliability as a sleep aid is spotty at best. Most kids get sleepy, but the excitement of an airplane ride mixed in with a “drugged” feeling can result in an ornery, irritable child who is difficult to console. I advise against this practice. On the other hand, Benadryl can help motion sickness and is shorter acting than other motion sickness medications.
Ear pain during an airplane’s descent is also a common worry. Yes, it is true that ears tend to “pop” during the landing as the air pressure changes with altitude. Some young children (and their parents) find this sensation very unpleasant. However, most babies are lulled to sleep by the noise and vibration of an airplane and are unaffected. If your child is safely in a car seat, I do not advise taking him out of it to breastfeed during landing. Offer a pacifier if you feel he needs to suck/swallow during the landing, and offer an older child a snack so she can swallow and equalize ear pressure if she seems uncomfortable during the landing.
Speaking of food, try to carry healthy snacks rather than junk food when traveling. Staying away from excessively salty or sweet food will cut down on thirst. Also, keep feeding times similar to home schedules in order to prevent toddler meltdowns.
Remember that young children hate to wait for ANYTHING and that includes getting to your destination. Bring along distractions that are simple and can be used in multiple ways. For example, paper and crayons or pencils can be used for: coloring, drawing, word games, origami, tic-tac-toe, math games, etc.
When traveling internationally, check the Center for Disease Control website www.cdc.gov for the latest health advisories for your travel destination. Do your research several weeks in advance because some recommended vaccines are available only through travel clinics. Also, some forms of malaria prevention medicine need to be started a week prior to travel.
Please refer to our “Happy, Healthy Holiday” blog post from 12/10/2009 for further information about keeping kids on more even keel during vacations. In general, attempt to keep eating and sleeping routines as similar to home as possible. Also remember to wash hands often to prevent illness during travel. Finally, locate a pediatrician or child friendly hospital ahead of time in case illness does strike. Unfortunately, most illnesses cannot be diagnosed by your child’s health care provider over the phone.
While traveling with young children can seem daunting, the memories you create for them are well worth the effort. And it DOES get easier as the kids get older. Now I can laugh at the image of my husband with two car seats slung over his back lugging a large diaper bag and a carry-on, leading my preschooler struggling with his own backpack filled with snacks and air plane distractions, while I am balancing two non-walking twin babies, one in each arm, as we all take our shoes off for the airplane security checkpoint.
We’ve come a long way, and so can you. Happy Travels!
Julie Kardos, MD with Naline Lai, MD
©2010 Two Peds in a Pod