Two Peds in a Pod®

Driving to distraction: cell phones and our teens

Phone Photo One of my office nurses was clearly rattled when she came into work the other day. “I was in the Acme parking lot,” she told me. “The parking was tight. As I was backing out, I saw a woman engrossed in a conversation on her cell phone driving towards me. There was nothing I could do to avoid an accident. If I pulled forward, away from the phone-talking driver, I would have hit an elderly person lugging groceries. If I backed up I would have driven into the car. I pushed against my horn. The woman did not even blink. All I could do is brace for a crash.”

Cell phones. Even for an experienced driver they can be a distraction. You would think that these kind of accidents would deter people from becoming distracted, but apparently not. Yes, they are ubiquitous. What would we do without them? Even now I am typing this post on my iPhone during my kindergardener’s swim lesson.Our teens are equally as glued to their phones. At the New Jersey shore this summer, I noticed teens away from home with no keys, no purses; just a cellphone tucked under a bikini strap. One time during an office visit with a teen,I started to talk to his mother when I noticed that he had his hand in his coat pocket. He was texting with one hand– most likely about the office visit. On week day afternoons, adults drivers know to avoid the local high schools because teens driving cars swarm into the streets, too often with phones glued to their ears. Some even text while driving.

One time I cornered a group of teens in my office.”Adults are concerned that young drivers are texting and driving simultaneously. What can be said to teens in order to make them stop?” I asked. They simply shrugged their shoulders. Nothing short of a law, they told me.

According to the Governor’s Highway Safety Association, 26 states have laws curtailing the use of cell phones (hand held or texting) while driving. In my home state of PA, legislation is currently pending. Despite what those teens in my office said, parents can and should guide their children–even without a law. Here are facts, courtesy of Pennsylvania State Representative Marguerite Quinn, to share with your teen.

Driver inattention is the leading factor in most crashes and near-crashes, according to a 2006 report by the National Highway Traffic Safety Administration and the Virginia Tech Transportation Institute.

According to the National Safety Council, traffic crashes are the leading cause of teen deaths, accounting for 44% of all teen deaths in the United States.

The 100-car Naturalistic Driving study found cell phone use associated with the highest frequency of distraction-related crashes and near-crashes.

As my office nurse found, a cell phone can be more than”just a little” distraction. Hopefully your teen will never find that out the hard way.

Naline Lai, MD

March 18, 2010 by twopedsinapod

Do Vaccines Cause Autism?

Do vaccines cause autism?

Concerned parents ask me this question, and I am relieved to be able to tell them “NO.”

Amazingly, most of the autism/vaccine hoopla can be traced to one very small report.

In 1998 a doctor named Andrew Wakefield published a paper in a well respected British medical journal called The Lancet. He said that in his study of twelve children who were patients in a GI (Gastroenterology) clinic, eight of them had evidence of abnormal intestines and abnormal behavior that began after they received the MMR vaccine. He wondered if the combined MMR vaccine may have triggered abnormalities in the gut, allowing unspecified toxins to leak out from the gut, causing brain damage.

Unfortunately, this one small paper involving 12 children caused huge controversy about the safety of vaccines. Many parents lost confidence in the very vaccines that were so successful at protecting the lives of their children. They stopped vaccinating and caused the measles rate to increase. For evidence of this please see:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5733al.htm

http://www.parliament.uk/commons/lib/research/briefings/snsg-02581.pdf.

On February 6, 2010, The Lancet published a retraction of this paper because the study design was flawed and thus any conclusions cannot be reliable. Specifically, the UK General Medical Council’s Fitness to Practise Panel, after investigations, concluded that the children in the study were not “consecutively referred,” meaning that they were not “random samples” as stated in the paper.

In addition, the panel discovered that Dr. Wakefield did not have permission from any institutional review board (panels that review the ethics of research done on people) to perform the lumbar punctures, MRIs, EEGs, endoscopies, and intestinal biopsies that he conducted on the children whom he studied.

Despite the original study being flawed, a question about a connection between MMR and autism had been raised. In the years since 1998, scientists performed subsequent studies to see if the MMR vaccine might have a link to autism. No association was found. These studies involved thousands of children and showed that the rate of autism in vaccinated children is THE SAME as the rate of autism in unvaccinated children. To read these articles as well as the original article that caused the controversy, you can go to www.TheLancet.com and register to view the articles for free.

I urge all parents reading this blog post to speak with your child’s health care provider if you have ANY doubts about vaccinating your children. In addition, if you are going to conduct your own research on this subject on the Internet, I urge you to consult the following credible sites:

www.aap.org, www.cdc.gov, www.vaccine.chop.edu, www.webmd.com, www.mayoclinic.com

Vaccines save lives. Unfortunately, for those too young to be vaccinated, those who have immune system diseases, and those who do not receive immunizations, vaccine preventable diseases still can potentially cause severe illness and death.

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

January 10, 2011: The above links to the CDC and UK parliament are down. For more information on trends in measles rate, please see http://news.bbc.co.uk/2/hi/health/7872541.stm.

March 15, 2010 by twopedsinapod

“There’s a monster under my bed”: all about nightmares, night terrors, night wandering and bedwetting

Just last night my ten year old sounded the “MOMMY, MOMMY!!!” alarm in the middle of the night. Almost without opening my eyes I went to his room and calmly walked him to the bathroom where he emptied his bladder with gusto and went right back to bed. Witness: A nightmare with a purpose.

Ever wonder when you, the parent, get to sleep through the night? Now that your child has graduated from the crib, tune into this podcast to learn how to handle situations that sabotage sleep in children: nightmares, night terrors, night wanderings, and bedwetting.

Julie Kardos, MD and Naline Lai, MD

March 11, 2010 by twopedsinapod

Starting out with Pearly Whites: infant and toddler dental tips

My sister-in-law was startled when brown spots began to appear on her preschooler’s teeth. A trip to the dentist revealed that my nephew had eleven cavities, the result of constantly drinking juice as an infant and toddler. Unfortunately, time in the operating room was required to fill all the rotten spots. Today our guest blogger, Dr. Paria Hassouri, answers frequently asked questions on infant dental care. Starting care as an infant can prevent your child from ending up like my nephew with a mouthful of cavities. Dr. Hassouri is a board certified pediatrician who completed her training at the Cleveland Clinic Foundation. She has been in practice for seven years and is with Cedars Sinai Medical Group in Beverly Hills, California. She is currently writing abook about the experience of pediatrician moms across the United States. – Dr. Lai

When do I need to start brushing my baby’s teeth?

You should start brushing your baby’s teeth as soon as they come out. You can either use a clean moist washcloth or a soft baby toothbrush to do this. Before this point, many pediatricians advocate wiping your infant’s gums with a washcloth a couple times a day.

While plain water is enough to clean the teeth and gums, you can also use a small amount of fluoride-free toothpaste. Flossing should begin anytime there is tight contact between the teeth, particularly when the molars come in.

When will my baby get his/her first tooth?

While most babies will get their first tooth between 6 to 10 months, your baby may not get his/her first tooth until 15 to 18 months.

What is “baby bottle tooth decay” and how do I prevent it?

Baby bottle tooth decay is caused by frequent and long exposure of an infant’s teeth to liquids that contain sugar. The sugar penetrates the gums and affects the teeth even while they are below the surface. Sugar-containing drinks include milk and formula (even breastmilk), fruit juice, and other sweetened drinks. Putting a baby to bed for naps or at night with a bottle increases the risk. And again, remember that your baby does not need any juice.

When does my baby need to first see a dentist?

While the American Academy of Pediatric Dentistry recommends dental visits starting at age one, you can ask your pediatrician when he/she thinks that your baby should first see the dentist. If you are already following a good dental care regimen which includes brushing your baby’s teeth regularly and not letting your baby fall asleep with a bottle, your pediatrician may say that you can wait longer for the first dental visit.

What to I do if my baby dislikes or refuses to let me brush his/her teeth?

Even if your child resists brushing, it is still very important to brush the teeth twice a day. You can try brushing in front of a mirror or taking turns with your child. You can also try having your child hold a larger, thicker handled toothbrush while you use a thinner handled toothbrush to brush the teeth. In this way, the thicker toothbrush acts as a “door stop” that your child can bite on to keep his mouth open while you follow through with the thinner toothbrush. Finally, you can try blowing bubbles or singing a special song while you are brushing your child’s teeth. That way your child associates this special activity with tooth brushing; but keep in mind that this only works if you reserve the blowing bubbles or other special song for tooth brushing.

What should we do if we don’t have fluoride in our water ?

If your water does not contain fluoride, ask your pediatrician or dentist about fluoride supplements starting at six months old.

Paria Hassouri, MD

March 7, 2010 by twopedsinapod

Ankle Strengthening Exercises- what to do after an ankle sprain

Today, our esteemed guest pediatric physical therapist Deborah Stack helps us with therapy for twisted ankles. Dr. Stack has been a physical therapist for over 15 years and heads The Pediatric Therapy Center of Bucks County in Pennsylvania. She holds both masters and doctoral degrees in physical therapy from Thomas Jefferson University.

______________________________

As I watched my ten-year-old play basketball today, my first question was “Will my child might finally get the ball into the basket?” My second question was, “Will all the kids make it through the game without spraining an ankle?

Kids are playing competitive sports at younger and younger ages and children are suffering sports injuries earlier as well. Acute ankle trauma is responsible for 10 to 30 percent of sports-related injuries in young athletes.¹With all the rapid starts, stops, and turns on the basketball court some injury is inevitable. But what is an ankle sprain? What can you do to help your child from joining the crutches crew? What do kids need to do to get back to full play after an injury?

A sprain is stretching and or tearing of ligaments that connect bones to one another. Sprains are graded from one to three with one being the mildest and three being the most severe. In a grade one sprain the ligament simply is overstretched. Grade two sprains involve partial tearing of the ligaments and grade three feature a complete tear. This could happen for a multitude of reasons, from play or even an accident that might not have been their fault, this type of sprain may need attention from a doctor, especially if it is after an accident.

The most common ankle sprain is an inversion sprain where the ankle turns over so the sole of the foot faces inward and damages the ligaments on the outside of the ankle. In younger children, the ligaments tend to be stronger than their bones,so growth plate fractures occur instead of sprains. Therefore, if a child refuses to walk on his leg or seems to be in excessive pain, you should have your pediatrician rule out a fracture.

To help avoid injury, make sure those sneakers are in good condition. Pull laces snug and tie them securely. High top sneakers are recommended for basketball for added protection. Physically three things are needed for a healthy ankle: range of motion, muscular control, and proprioception. Proprioception is the information that comes from your joints and muscles to your brain and lets your brain know what position the ankle is in.

My child turned his ankle. Now what do I do? Remember the acronym RICE: rest, ice, compression, elevation. Rest means to stay off the ankle. For more severe sprains this may mean using crutches for a few days. Ice should be applied (over a thin towel to protect skin) immediately and then for up to 20 minutes every few hours until swelling is minimal. Compression refers to wrapping an elastic bandage over the area. When you use a bandage, it is important to make sure the bandage is not too tight and that any bandage is wrapped at an angle, not straight around the leg, to prevent circulatory problems. The ankle should also be elevated above the level of the heart several times a day while swelling is still present. Recline on the couch while putting ice on for 20 minutes.

How does your future Olympian get back into the game? Range of motion exercises can begin as soon as they can be done without pain, preferably in 48-72 hours. Ankle circles and alphabet letters (below) are two good exercises. These should then be followed by isometric (muscle contraction without movement) and isotonic strengthening exercises (toe and heel raises, see below) such as the ankle heals. Finally, rehab is not complete until the child works to regain proprioception on balance boards, compliant foam etc. One low-tech option is to stand on a firm pillow while watching television. For a bit more excitement, try some Wii balance board games. Remember, full ligaments strength does not return until months after an ankle sprain.²Without full rehabilitation, the ankle is prone to reinjury.

So tell your child to play, but play smart. An ankle sprain is a real injury and needs proper attention before your child returns to the court.

Exercises

Ankle circles³
Sit on the floor with your legs stretched out in front of you. Move your ankle from side to side, up and down and around in circles. Do five to ten circles in each direction at least three times per day.

Alphabet Letters³
Using your big toe as a “pencil,” try to write the letters of the alphabet in the air. Do the entire alphabet two or three times per day.

Toe Raises⁴
Pull your toes back toward you while keeping your knee as straight as you can. Hold for 15 seconds. Do this ten times at least three times per day.

Heel Raises⁴
Point your toes away from you while keeping your knee as straight as you can.Hold for 15 seconds. Do this ten times at least three times per day.

1. Perelman M, Leveille D, DeLeonibus J, Hartman R, Klein J,Handelman R, et al. Inversion lateral ankle trauma: differential diagnosis, review of the literature, and prospective study. J Foot Surg. 1987;26:95–135.

2. Wolfe MW, Uhi T, McCluskey, L.Management of Ankle Sprains. Am Fam Physician 2001;63:93–104.

3. http://www.med.umich.edu/1libr/sma/sma_anksprai_rex.htm

4. http://familydoctor.org/online/famdocen/home/healthy/physical/injuries/010.html

Deborah Stack, PT, DPT, PCS
www.buckscountypeds.com
© 2010 Two Peds in a Pod

March 6, 2010 by twopedsinapod

Always something-those rubber bands

The newest trend in kidville- trading rubber bands in various shapes. The kids wear the bands like bracelets and strut around with the colorful bands jutting out in all directions from their arms and wrists. The elementary school crowd is fascinated by them. Teachers, who find them a distraction, are not as enamored. Somewhere there is one teacher today who is particularly appalled. During a check up, a nine year old told me today that a classmate was sent to the nurse’s office- the reason? The bands were on so tight that they were cutting off circulation to the classmate’s arm.

Always something.

Naline Lai, MD

March 3, 2010 by twopedsinapod

Holes In Your Head: Sinus Infections

You have a hole in your head.

Actually, you have several.

You, your children, and everyone else. These holes are called sinuses.

These dratted air pockets in your skull can fill with puss and cause sinus infections. Scientists hypothesize they once helped us equilibrate water pressure during swimming. Now, sinuses seem only to cause headaches.

Sinuses are wedged in your cheek bones (maxillary sinuses), behind your nose (ethmoid sinuses) and in the bones over your forehead (frontal sinuses). When your child has a cold or allergies, fluid can build up in the sinuses. Normally, the sinuses drain into the back of your nose. If your child’s sinuses don’t drain because of unlucky anatomy, the sludge from her cold may become superinfected with bacteria and becomes too thick to move. Subsequently, pressure builds up in her sinuses and causes pain. A sinus infection of the frontal sinuses manifests itself as pressure over the forehead. The pain is exacerbated when she bends her head forward because the fluid sloshes around in the sinuses. Since frontal sinuses do not fully develop until around ten years old, young children escape frontal sinus infections.

Another sign of infection is the increased urge to brush the top row of teeth because the roots of the teeth protrude near the maxillary sinuses. Bad breath caused by bacterial infested post nasal drip can also be a sign.

The nasal discharge associated with bacterial sinus infections can be green/yellow and gooey. However, nasal drainage from a cold virus is often green/yellow on the third to fourth day. If your child has green boogies on the third or fourth day of a cold, does not have a fever, and is comfortable, have patience. The color should revert to clear. However, if the cold continues past ten days, studies have shown that a large percentage of the nasal secretions have developed into a bacterial sinus infection.

Because toddlers in group childcare often have back-to-back colds, it may seem as if he constantly has a bacterial sinus infection. However, if there is a break in symptoms, even for one day, it is a sign that a cold has ended.

Hydrate your child well when she has a sinus infection. Your child’s body will use the liquid to dilute some of the goo and the thinner goo will be easier for her body to drain. Since sinus infections are caused by bacteria, your pediatrician may recommend an antibiotic. The usual duration of the medicine is ten days, but for chronic sinus infections, two to four weeks may be necessary. Misnamed, “sinus washes” do not penetrate deep into the sinuses; however, they can give relief by mobilizing nasal secretions. When using a wash, ask the pharmacist for one with a low flow. Although the over the counter cold and sinus medicines claim to offer relief, they may have more side effects than good effects. Avoid using them in young children and infants.

Who knows. Someday we’ll discover a purpose to having gooey pockets in our skulls. In the meantime, you can tease your children about the holes in their heads.

Naline Lai, MD
© 2010 Two Peds in a Pod

March 1, 2010 by twopedsinapod

How to Help Your Bedwetting Child

bedwetting “Help, Mommy, Daddy, I wet the bed!”

As you wash yet another set of bed sheets and wet pajama bottoms, you may be wondering WHEN your child will stay dry at night and WHY your child still wets the bed when his friends, or worse yet, his younger siblings, are dry. This post addresses primary bedwetting (doctors call this “primary nocturnal enuresis”), kids who have NEVER been dry at night. Children who have had months or years of dry nights and then start bedwetting consistently should go see their pediatrician to rule out medical causes of new bedwetting.

Here are a few things parents of bed-wetters should know.

Most children master staying dry during the day BEFORE staying dry during the night. Only a small number of children actually wake up dry in the morning before they start potty training. Daytime dryness is under your child’s cognitive control. Night time dryness is not learned or controlled by your child’s rational brain, but rather is a function of your child’s bladder being mature enough to send a WAKE UP!! signal to your child. Quick hint here: nightmares can result from a full bladder. As you comfort your child from a bad dream, don’t forget to take him to the bathroom.

About 80 percent of children are dry overnight by age four. They sleep through the night and wake up dry or they wake up once to urinate in the bathroom and go back to bed. What about the other 20%? Each year after age four years, about 10% of kids who are wet at night become dry without any intervention. Genetics play a big role in this. If one parent was a bedwetter until age 7, for example, then the child has a 35% chance of bedwetting until this age. If both parents wet the bed until school age, then their child has at least an 80% chance of being just like Mom and Dad.

However, some kids just wet the bed even though their parents were dry at an early age. Regardless, parents can help.

· Do NOT punish your child for wetting the bed. It truly isn’t his fault.

· It is reasonable to limit fluid intake in the few hours before bed but do allow your child to drink water if thirsty or with teeth brushing.

· By all means let your child wear training pants at night or at least put some form of water repellent mattress protector on your child’s bed. These are not “crutches” or “enablers” but rather save you from having to wash sheets and mattresses.

· Not all kids are actually upset about bedwetting, but they can become very upset if parents let them feel that way. Reassure your child that someday “the pee pee will wake you up to go potty in the night” just like it tells your child to go to the bathroom during the day.

Older kids might become self-conscious, and their self-esteem gets impacted by their bedwetting. Typically this happens between the ages of 8 to 10 years, when sleep-overs and camp gain popularity.

Ways to help your child approach potentially awkward situations include:

Have the sleep-over at your house and have our child’s absorbent training pants already in the bed hidden under the covers. Your child can put them on after “lights out.”
Tell your child that he does not have to share the reason for not wanting to sleep away from home.
Alternatively, he can tell his friends that YOU, the mean parent, will not allow him to attend sleepovers yet.
If your child is motivated to try to become dry overnight, you can try a bed wetting alarm system. These systems work well over a period of several months. With alarms, both parents and children have to be active participants.

Additionally, there is one medical option.

Talk to your child’s health care provider about medicine called DDAVP that can give a “quick fix.” The medication can keep your child dry on the night he takes the medicine. The medicine comes in pill form. Your child could either take it only for sleepovers or can take it for a few months at a time if bedwetting compromises his self-esteem. Note that even after months of dry nights on medicine, your child will likely bed wet if he stops taking the medicine. However, there is also a chance that nature will have taken over and by the time the medication is stopped, your child will have reached the age that his body was programmed to stay dry at night.

Of course, your child’s health care provider can help ensure that your child merely has an immature bladder-to-brain messaging system and not any other cause of his bed-wetting. Your doctor can also help evaluate if your child’s self esteem is affected by his bedwetting.

While not the most glamorous part of the parenting game, washing up after a bedwetting child and keeping a positive attitude for him are very important. The next time you will play this supportive role is when you become grandparents and your former bedwetter calls you for advice about his own bedwetting child.

February 21, 2010 by twopedsinapod

Dry winter skin – guidance from a guru

It’s that itchy, scratchy time of year. Today our guest blogger, dermatologist Mary Toporcer MD, gives us hints on how to combat dry skin. For the past 21 years, Dr. Toporcer has practiced general medical dermatology in Doylestown, PA. She did her dermatology training at Hahnemann University and at St Christopher’s Hospital, both in Philadelphia, PA.

Many patients suffer from severe dry skin (xerosis) in the winter when the air is cold and the humidity low. Those who are atopic (have a personal or family history of eczema, allergies, asthma, hayfever or sinus problems) are much more affected by their environment. A few MUST DO’s include:

1. Moisture every day especially after bathing with Cerave Cream or Lotion. It contains ceramides which “waterproofs”the skin and keeps moisture in, but without that greasy feel.

2. Use gentle soaps such as Dove in the shower and keep the shower water luke warm, not hot. Hot water just irritates and ultimately dries the skin even more. It also increases itch.

3. Avoid irritants such as anti-static sheets in the dryer. Even if they say “free”, they still put a coating on your clothing in an effort to prevent it from sticking together. This substance is very irritating to dry, sensitive skin. Liquid, fragrance-free fabric softener is much gentler on skin.

4. Lastly, for those terribly dry, scaly, fissured hands and feet, try vaseline or Aquaphor under the soft stretchy gloves and socks that you can buy at Bath and Body Works…they’re often impregnated with aloe for extra moisture.

Mary Toporcer, MD

February 17, 2010 by twopedsinapod

Count down the pounds: six simple guidelines to helping overweight children

A common question that many parents ask us in the office is “How can I help my overweight child?”

Our newest podcast provides six simple rules for healthy eating. Listen in to find out the “5-4-3-2-1-0” rules of what to feed your children, how to portion their foods, and how to change their behavior to help them lose excess pounds and maintain a healthy weight.

(If the podcast is not embedded in your RSS reader page,visit the www.TwoPedsInAPod.com home page directly.)

Julie Kardos, MD and Naline Lai, MD

February 14, 2010 by twopedsinapod

Older Posts

Newer Posts