Two Peds in a Pod®

Sleep Safety: How to decrease your baby’s risk of Sudden Infant Death Syndrome (SIDS)

Sudden Infant Death Syndrome, or SIDS, refers to the sudden unexplained death of an infant between the ages of 1-12 months and seems to occur during sleep. We (meaning pediatricians and the rest of the scientific community) still don’t know exactly what causes SIDS, although we do know that some babies seem to be more at risk, such as premature infants and infants of multiple births (twins, triplets, etc).While parents cannot control prematurity and multiple births, parents CAN control other risk factors.

Here is a summary of ways to reduce the risk of Sudden Infant Death Syndrome (SIDS) as recommended by the American Academy of Pediatrics:

· Place babies on their backs (supine) to sleep. Do not waste money buying positioners or wedges for the crib because they are not proven to prevent SIDS and are not endorsed by the American Academy of Pediatrics. A newborn cannot roll from back to stomach. If you start out always placing your infant down on his back to sleep, he will stay this way and learn to like to sleep this way. Side sleeping is not as safe as back sleeping.

· Do not sleep with your baby in a chair, couch, or adult bed. You can take your infant into your bed to nurse/feed but then put him back in his own sleep space.

· Do not let your infant sleep in a bed with older siblings. Put your baby in his own crib.

· Put nothing in the crib other than your baby. No stuffed animals, blankets, pillows, etc. Even bumpers are not recommended.

· Do not smoke in the room where your baby sleeps.

· Offer a pacifier. This has a protective effect.

· Breastfeeding has a protective effect.

Some parents admit to us that they place their babies stomach down (prone) to sleep because “the baby sleeps better that way.” Unfortunately, what seems to be easier in the short run isn’t always the best for children in the long run. For the same reason that you should insist your children wear bike helmets and seatbelts, even if they protest at times, you should put your children down on their backs (supine) to sleep as infants. The rate of SIDS in the USA has dropped by over 50% since 1994 after the start of a “Back to Sleep” campaign. This sleep position change has been the single most effective way, to date, of reducing the rate of SIDS. Of course if your child has any rare medical condition that may prevent supine sleep, your child’s doctor should advise you on the safest sleep position for your child.

The best way to form good habits is to use them from the beginning. It is perfectly safe to position your newborn on his belly during awake time/ playtime while you are with him. However, if you are putting your baby down to sleep, or if you are putting your baby down and walking away and during this time he might fall asleep, just put your baby down on his back. And remember to tell anyone else who cares for your baby the same instructions, including daycare workers, nannies, and even well-meaning grandparents, because safe sleep advice has changed over the generations.

Julie Kardos, MD and Naline Lai, MD
©2009 Two Peds in a Pod

November 5, 2009 by twopedsinapod

Technical talk

We noticed Atom 1.0 readers did not pick up the podcast. Try the RSS 2 feed instead.

Let us know about any technical glitches. We are still very new to cyberspace and appreciate your feedback. We say in our podcasts, “Right now our recording studio is our kitchen table”…. you should see our computer help desk

Naline Lai, MD and Julie Kardos, MD

November 5, 2009 by twopedsinapod

Podcast- The tired teen

Drs. Kardos and Lai advise parents on what they can do for their tired teen. Although we all enjoyed an hour’s extra sleep this past weekend with the resetting of the clocks, many teens are back to their “usual” sleep deprived state. Listen here to find out how to help reset your teen’s internal clock, and what to consider when you have a tired teen.

Julie Kardos, MD and Naline Lai, MD

November 4, 2009 by twopedsinapod

H1N1 as a source of artistic inspiration

Boo (boo-hoo)

A lot of Halloween festivities in our area have been dampened by H1N1 flu. For all the parents of the boys and ghouls in a similar situation, this picture will make you smile. It was sent to me by Ben’s mom. It is flu from the perspective of a kindergarten boy. The arrow points to Ben’s nose. Note the huge boogie to nose ratio. The red represents “boss germs” and the purple ones are the “just plain mean” ones.

Don’t let the “Boogie” man get your family this Halloween

Naline Lai, MD

© 2009 Two Peds In a Pod

October 31, 2009 by twopedsinapod

How Vaccines Work

Do you ever wonder how vaccines work?

To understand how vaccines work, I will give you a brief lesson on the immune system.

Trust me, it is interesting. Let me give you an example of me. When I was eight, I had chicken pox. It was a miserable week. I started out with fever and headache, then suffered days of intense body itching from blister-like spots, and ultimately, because I “scratched off” some scabs, ended up with scars.

During this time, my immune system cells worked to battle off the chicken pox virus. Immune cells called memory cells also formed. These cells have the unique job of remembering (hence the name “memory cells”) what the chicken pox virus looks like. Then, if ever in my life I was to contact chicken pox again, my memory cells could multiply and fight off the virus WITHOUT MY HAVING TO GET SICK AGAIN WITH CHICKEN POX. So after I was well again, I was able to play with my neighbor even while he suffered with chicken pox. I even returned to school where other children in my class had chicken pox, but I did not catch chicken pox again. Even now, as a pediatrician, I don’t fear for my own safety when I diagnose a child with chicken pox, because I know I am immune to the disease.

This is an amazing feat, when you think about it.

And now, how vaccines work.

A vaccine contains some material that really closely resembles the actual disease you will protect yourself against. Today’s chicken pox vaccine contains an altered form of chicken pox that is close to but not actually the real thing. However, it is so similar to the real thing that your body’s immune system believes it is, in fact, real chicken pox. Just as in the real disease, your body mounts an immune response, and makes memory cells that will remember what the disease looks like. So, if you are exposed to another person with chicken pox, your body will kill off the virus but YOU DON’T GET SICK WITH THE CHICKEN POX. What a beautiful system!

Before chicken pox vaccine, about 100 children per year in the US died from complications of chicken pox disease. Many thousands were hospitalized with secondary pneumonia, skin infections, and even brain damage (encephalitis) from chicken pox disease. Now a shot in the arm can prevent a disease by creating the same kind of immunity that you would have generated from having the disease, only now you have one second of pain from the injection instead of a week of misery and possible permanent disability or death. I call that a Great Deal!

How vaccines are safer than the diseases they prevent.

All vaccines operate by this principle: create a safe environment for your immune system to make memory cells against a potentially deadly disease. Then when you are exposed to someone who actually has the disease, you will not “catch” it. Your body will fight the germs, but you do not become sick. If everyone in the world were vaccinated, then the disease itself would eventually be completely eradicated. This happened with small pox, a disease that killed 50 percent of infected people. There is no longer small pox because nearly everyone on earth received the small pox vaccine. Now we do not need to give small pox vaccine because the disease no longer exists. This is a huge vaccine success story.

Friedrich Nietzsche said “What doesn’t kill us makes us stronger.” We pediatricians feel this is unacceptable risk for children. We would rather see your child vaccinated against a disease in order to become immune rather than risking the actual disease in order to become immune.

Hopefully this blog post answers your questions about how vaccines work. For more details or more in depth explanations, I refer you to the AAP (American Academy of Pediatrics), the Children’s Hospital of Philadelphia’s Vaccine Education Center, and the book Vaccines: What You Should Know, by pediatricians Dr. Paul Offit and Dr. Louis Bell.

Julie Kardos, MD and Naline Lai, MD

updated 1/18/2015

October 29, 2009 by twopedsinapod

How to Take the Sting Out of Injectable Vaccines

Unless your child is getting the flu mist, your child may receive not only the seasonal flu vaccine as an injection this year, but also the H1N1 vaccine as an injection. Here’s how you can take away the sting of any needle:

Set the stage. Your child looks to you for clues on how to act. If mommy and daddy are trembling in the corner of the room, it will be difficult to convince your child that the immunization is “no big deal.” Do not tell your child days in advance that she will be immunized. The more you perseverate, the more your child will perceive that something terrible is about to happen. Simply announce to your child right before you leave to get the immunization, “We are going to get an immunization to protect you from getting sick.”

Do not say “I’m sorry.” Say instead,”Even if this is tough, I am happy that this will protect you.”

Never lie. If your kid asks “will it hurt?”say “less than if I pinched you.”

Watch your word choice. Calling an immunization “a shot” or “a needle” conjures up negative images. In general, avoid negative statements about injected vaccines. I cringe when parents in the office threaten children with,” If you don’t behave, then Dr. Lai will give you a shot.”

Remember the mantra, if all is well in the basic areas of eat, sleep, drink, pee, and poop, then any stressor is easier to handle.

Kids talk. Be aware that kids, especially those in kindergarten, like to scare each other with tall tales. Ask your child what they have heard about vaccines. Let children know that Johnny’s experience will not be their experience.

The moment is here.

You may have heard about a topical cream which numbs up an area of skin. Unfortunately, because the creams anesthetize the surface of the skin and most vaccines go into muscle, I do not find the creams very effective at taking the pain away.

Instead, practice blowing the worries away. Have your child practice breathing slowly in through her nose and blowing out worries through her mouth. For the younger children, bring bubbles or a pin wheel for your child to blow during the immunization. In a pinch, take a piece of the exam paper in the room and have your child blow the paper.

The cold pack: holding something very cold can distract your child’s brain from feeling the pain of an injection.

“Transfer” the immunization to mommy or daddy. Have your child squeeze your hand and “take the immunization” for him.

Tell your child to count backwards from 10 and it will be over. In reality, it will be over before your child says the number seven.

Have as much direct contact with your child as possible. The more surfaces of his body you touch, the less your child’s brain will focus on the injection. Again, this is the distraction principle at work. By touching your child, you are also sending reassuring signals to him. For the younger child, if he is on the table, stay close to his head and hug his arms, or have him on your lap. For the older child and teen, hold their hand. I sometimes see parents of older teens and college students leave the room. Even the big kids may need someone to keep them company.

Help hold your child firmly. Holding him will make him feel safe and will prevent him from moving during the injection. Movement causes more pain or even injury.

After the drama is over.

Have your older child sit quietly for a moment. As the anxiety and tension suddenly falls away, the body sometimes relaxes too suddenly and a child will start to faint. This phenomenon seems to happen most often with the six foot tall stoic teenage boys. We have a saying in my office- The bigger they are, the more likely they are to fall.

Compliment your child. Remind them that you will never let anyone really hurt them.

Now a story:

When my middle daughter was two years old, my family trouped into my office for the flu vaccine injection. We all sat calmly in a circle and smiled.

First, the nurse gave me my immunization. I smiled. My middle daughter smiled.

Second, the nurse gave my husband his immunization. He smiled. My middle daughter smiled.

Then the nurse gave my oldest daughter her immunization. She smiled. My middle daughter smiled.

Then the nurse gave my middle daughter her immunization. She did not smile. She did not cry. Instead, she slugged the nurse with her little fist. I think the nurse felt more pain than my child.

Someday all immunizations will be beamed painlessly into children via telepathy. Until then, I have no advice on how to take the sting away from the punch of a two year old.

Naline Lai, MD

October 26, 2009 by

Tamiflu for influenza- be careful when dosing

If your child’s health care provider prescribes the liquid form of Oseltamivir, brand name Tamiflu, to treat your child’s flu, pay particular attention to how you dose the medication.

The dosing syringe that comes with the manufacturer’s liquid formulation is marked in milligrams (mg), not in the customary milliliters (ml) or teaspoons (tsp).

Also, be aware that if your pharmacist makes up a liquid version from the tablets (because the liquid formulation is in short supply), the concentration (amount of medicine per amount of liquid volume) is different than what the manufacturer makes. The manufacturer makes 12mg/ml and the commonly used recipe your pharmacist will use for making a liquid formulation makes a 15mg/ml formulation.

Confused? Before you leave the pharmacy with Tamiflu, just make sure you clarify the proper amount to give with your pharmacist.

Naline Lai, MD and Julie Kardos, MD

October 21, 2009 by twopedsinapod

A lot of Pediatricians

We just returned from this year’s American Academy of Pediatrics National Conference and Exhibition in Washington D.C. It was heartening and motivating to meet with thousands of pediatricians from across the country all dedicated to improving the health and welfare of children locally and globally. We attended numerous seminars, workshops, and lectures and even ran a 7 a.m. 5K race to benefit the American Academy of Pediatrics Friends of Children Fund. We plan to incorporate what we’ve learned these past few days both in our offices and in future blog posts.

We were fortunate to find other pediatricians who promote pediatric education outside of the office setting. We enjoyed exchanging ideas with fellow pediatric blogger Dr. Roy Benaroch. In addition to writing his blog, Dr. Benaroch has authored two books for parents: A Guide to Getting the Best Health care for Your Child and Solving Health Behavioral Problems from Birth Through Preschool: A Parent’s Guide. Also, we spent time with Dr Kardos’s medical school friend Dr. Laura Jana, author of Heading Home with your Newborn, from Birth to Reality and Food Fights. She is also a pediatric media spokesperson.

It was also nice to meet Dr David Hill from North Carolina whose work can be found as well on the internet.

With pediatricians like these, the health of our nation’s children is in good hands.

Julie Kardos, MD and Naline Lai, MD

October 21, 2009 by twopedsinapod

Erasing: an unsafe teen game parents should know about

Even after over a decade in pediatrics, teens always surprise me.

Last week a junior high student came into a checkup with the scabbed hand pictured in the photo above. Apparently there is a game new to me called “Erasing”. My patient told me the game can be played with any type of eraser, but the pink one at the end of a number two pencil works best. The object of the game is rub with an eraser hard enough to “erase” as much of your skin on the back your hand as possible. The players each choose a ligament (one of the cords which run from your knuckles to your wrist) to “erase.” The first person to stop erasing loses the game.

If you find your teen erasing, tell them about the dangers of infection and scarring. Since a teen often does not understand long term ramifications, it is often a more a more effective deterrent to tell him/her to stop because it “looks ugly”. Even if your teen is not erasing, use a discussion about erasing as a starting point to talk about other self injurious behaviors (i.e. “choking games” where the object is to cut off someone’s breathing and the “find your true laugh” game).

Since I thought erasing was a brand new trend, I took the photograph to show the other doctors in my office. When I flashed the photo in front of one of my colleagues, he glanced briefly at it and said, “Oh, that’s erasing- I did that when I was a kid.”

Amazing we all got through.

Pass this info on to other parents.

October 16, 2009 by twopedsinapod

A “cool” novel use for a diaper

Stumbled onto a novel use for a diaper, courtesy of the nursery nurses at Doylestown Hospital.

Diapers make a perfect ice pack. At the end of the diaper which has adhesive tabs, make a hole in the inner lining. Push your hand into the diaper to separate the the lining from the back of the diaper. This will make a pouch. Put crushed ice into the pouch and roll the end of the diaper with the hole a couple times. Secure with adhesive tabs. Now you have a soft, waterproof ice pack which will remain cool as the ice melts and is absorbed by the gelatinous diaper innards.

Perfect for all sorts of boo-boos.

When I told one of my patient’s mom about this hint today, she told me that she used a number 5 diaper when her water broke. I suppose Plato was right: necessity is the mother of invention.

October 12, 2009 by twopedsinapod

Older Posts

Newer Posts