Our goal is to educate, encourage, and entertain as we provide general pediatric advice. However, please understand that Two Peds in a Pod does not replace your relationship with your pediatric health care provider. Parents should address specific questions about their child’s health with their child’s health care provider and not delay seeking this advice because of content learned from Two Peds in a Pod. Please know also that while our anecdotes are based on real patients, identifying features have been changed in order to protect patient confidentiality.


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Two Peds in a Pod

Avoid Allergy Eyes

Arrggh, sitting on top of kid's items that need to be returned to Target are the allergy eye drops that need to go back to the pharmacy. With growing kids, it's an endless cycle of buy-return-buy-return. I suppose I was duped by the sale price, but the drops which contain "red out" ingredients are not appropriate for long term use. Hoping the post below doesn't have you running back and forth from the store this allergy season:

allergy eyes"I see green stuff all over my car and I park in the garage," a mom said to me today.

It's finally spring on the east coast and with it comes green cars and itchy eyes. Eighty percent of the older kids I saw today, including those seen for routine check-ups, had red irritated eyes.

So what to do? Pollen directly irritates eyes, so start with washing the pollen off. One parent told me he applied cool compresses to his child's eyes. This is not enough- get the pollen off. Plain tap water works as well as a saline rinse. Have your child take a shower. Filter the pollen out of your house by running the air conditioning. Pollen counts tend to be higher in the morning, so plan outdoor activities for later in the day. Some people will leave shoes outside the house and wipe the paws of their dogs in order to keep the green stuff from tracking into the house.

Oral medications do not help the eyes as much as topical eye drops. Over-the-counter antihistamine drops include ketotifen fumarate (eg. Zatidor and Alaway). Prescription drops such as Pataday or Optivar add a second ingredient called a mast cell stabilizer. Avoid use of a product which contains a vasoconstictor (look on the label or ask the pharmacist) for more than two to three days to avoid rebound redness. Contacts can be worn with some eye drops– first check the package insert. Place drops in a few minutes before putting in contacts and avoid wearing contacts when the eyes are red.

Hopefully allergy season will blow through soon. After all, as a couple teens pointed out-prom is around the corner and allergies can make even the young look haggard. One teen male told his mom that he shaved today because having a beard and blood shot eyes made him look THIRTY years old. Miserable allergies!

Naline Lai, MD with Julie Kardos, MD 
modified from a 2011 post,  
©2014 Two Peds in a Pod®

I have Autism.

autismAccording to the latest CDC report, 1 in 68 children have some form of autism. April 2  is World Autism Awareness Day, and today we post, with permission, a speech that a 15-year-old friend of mine with autism gave to his classmates when school started last year.
---Dr. Kardos

Good morning everybody.  Today, I wanted to talk to you about Autism.  I have Autism.  Don’t worry, it’s not something you can catch from me… it’s not a like a virus or anything like that.  When I was very young, a doctor diagnosed me with Autism.  My parents took me to the doctor because I didn’t talk much – I talked a lot less than kids were supposed to.  Actually, I still talk a lot less than other kids.

A lot of people think things about Autism that just aren’t true.  They really shouldn’t because everybody is different and has different things they do well.   Actually, I am pretty smart. So are a lot of my friends with Autism.  I just have a hard time with words.  So reading, writing, and speaking are kind of hard, but I’m very good at math, science and stuff like that.

Every person with Autism has different things that they do well and other things that they have trouble with.  For me, like I said, I have a hard time with words, I have a hard time remembering people’s names, and sometimes, I may have trouble knowing if someone is joking with me.  You may see me walking around by myself – sometimes I pace back and forth when I’m thinking.  I also sometimes flap my hands when I get excited or frustrated.  So, if you see me doing that, just come over and say “Hey, Rob!” or something like that to me. That usually helps me stop right away.  It may look funny, but really everybody does this a little bit.  Other people may jump up and down when they are excited or clench up when they get angry.  Unfortunately, I flap.  But don’t worry, I’m OK.

Other than that stuff, I am just like everybody else.  I really like movies and music.  I go to concerts all the time… the next concert I’m going to is Bruno Mars.  By the way, if anyone likes Bruno Mars, let me know – my sister doesn’t want to go… so we have a free ticket!

That’s really all I have to say.  Just remember that you shouldn’t judge anyone without getting to know him or her.  I’m just a normal kid that happens to have Autism.  I don’t mind if you don’t mind.

Thanks for letting me tell you about myself.  Does anyone have any questions?


2014 Two Peds in a Pod®

My tummy hurts! Stomach pain in children

stomach painIt’s 24 hours after your teenager finished up a competition for National History Day. Now she’s curled up in a ball whimpering with belly pain. Post adrenaline let down? Ate something wrong for breakfast? Appendicitis? Just as a mom’s mind goes berserk thinking of all the possible causes, a doctor’s does too. There are many organs that live inside a belly, including the stomach, the intestines, the liver, and the bladder, that cause pain. Then there are the organs next to the belly which can cause pain including the lungs and the female reproductive organs. On top of it all, chemical imbalances and emotional issues can cause or exacerbate pain. So, how can one tell if your teen should ignore the pain and go to the showing of Divergent or consult with her pediatrician?

Here are some “Red Flags” of belly pain. Pay close attention to pain associated with any of the following:

  • Pain which wakes your child out of sleep
  • Severe pain – prevents walking, moving, makes kids not want to be touched. Severe pain makes kids unable to jump up and down easily.
  • Diarrhea or constipation
  • Vomiting
  • Blood in the stools
  • Refusal to eat/not hungry—We do not mean the refusal to eat brussel sprouts, but rather refusal to eat any food
  • Change in behavior. To gauge severity, it helps to stand back and observe your kid. Block out what he is saying. Instead, watch how she acts. Your child may play with friends, run by you, say “My belly hurts,” and then continue to play. This is not as worrisome as the child who stops playing with friends and goes to lie down by herself on the couch.  School avoidance is also a sign that something is not right. 
  • Pain with a pattern- Perhaps you notice that your child experiences pain after downing milk or ice cream (dairy intolerance), or pain only on school mornings and not weekends (possible bullying at school).

Be aware, young kids often use the phrase “my tummy hurts” for any type of belly discomfort. A child whose belly pain disappears after he eats may mean, “I’m hungry.” New potty trainers may mean,” I need to go potty.” Young kids also use the phrase to mean, “I am nauseous.”

Finally, the most important “red flag” is if your child’s belly pain makes YOUR belly hurt; that is, if your gut tells you that something is wrong with your child, consult with your child’s doctor immediately.

Julie Kardos, MD and Naline Lai, MD

©2014 Two Peds in a Pod®

Take the sting out of vaccines and blood draws

immunizationOne of Dr. Kardos’s kids yelled in our office a few years ago: “I’m getting a SHOT?! NOOOO! GET AWAY FROM ME!!”

Even the front desk staff could hear him, and he was in the exam room farthest to the rear of the building. Meanwhile, his twin brother just sat and pouted but did not flinch.

Even a pediatrician's child does not always approach the prospect of an immunization or blood draw with a grin on his face. Here are ways you can take away the sting of a 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, shots protect against deadly diseases and are in no way punishments for children.

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, rip off a piece of the exam paper from the table in the room and have your child blow the paper.

The cold pack: holding something very cold, placing a cold pack on your child's arm around the area to be vaccinated,  or placing a cold pack on the NON-vaccine arm 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. Holding him firmly will make him feel safe and will prevent him from moving during the injection. Movement causes more pain or even injury.

For the older child and teens, hold their hands. I sometimes see parents of older teens and college students leave the room, believing that their kids are beyond the age of fearing vaccines. However, we find that even the big kids may need company during vaccines.

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, but we’ve also seen teen girls and some younger kids get a bit light-headed. We have a saying in my office- "The bigger they are, the more likely they are to fall." If your child becomes pale (or green) have him lie down for a few minutes until he feels better.

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

Now my story:

When my middle daughter was two years old, my family trouped into my office for our flu shots. 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 with Julie Kardos, MD
©2014 Two Peds in a Pod®
Revised from 2009 post on this topic.

Poison Control 1-800-222-1222

poison controlPut poison control's phone number on the back of your cell phone, on your cell phone case, and on your wall phone. Put it everywhere:  1-800-222-1222.

Did your toddler eat dog food? Or a berry from your backyard bush? Did you give the wrong medication to your child? Call poison control. Experts at poison control will direct your next step. They have access to extensive data on poisoning, and they can give you that information much quicker than a drug-manufacturer or pharmacist or even your own doctor. One of Dr. Lai's kids ate a mushroom from the yard when she was 20 months old—she called poison control. A mom asked Dr. Lai about carbon monoxide exposure—she called poison control. If doctors have a question about any ingestion or poisoning—we call poison control. But don't wait for us to call, go ahead yourself and call. 

People often first jump to the internet for information. However, a recent small study found that the internet is NOT the best place to research questions about toxins. Many sites fail to direct readers to the US Poison Control Center, and those who do, fail to supply the proper phone number – again, that’s 1-800-222-1222.

If your child needs emergent treatment, surfing the internet for what to do next wastes precious time. Don't reach for your phone to “google it,” in the case of a possible poisoning, reach for your phone and make a CALL. It could be life-saving.

Julie Kardos, MD and Naline Lai, MD

© 2014 Two Peds in a Pod®

Diaper Rash-don't be bummed

potty training appDespite what your grandmother says, teething is not the underlying cause of diaper rash. The underlying cause of all diaper rash is, well...the diaper. Whether your baby wears cloth or plastic diapers, the first treatment for diaper rash is to take the diaper off.

Yuck, you say? We agree. This first treatment isn't practical. Luckily there are other ways to combat the common diaper rashes:

Contact rash- This diaper rash appears as  patches of red, dry, irritated skin. Poop smooshed  against a baby’s sensitive skin is the main source of irritation for this type of rash. Contact rash is often accentuated where the elastic part of a plastic diaper rubs against the skin. Experiment to see if one brand of disposable diapers causes more irritation than others or if the detergent used for a cloth diaper is the culprit.  Even the soap on a wipe or the friction from scrubbing off poop can exacerbate a contact rash.

Treatment: If you see a rash, use a soft, wet cloth with a gentle moisturizing soap to clean off poop or splash water gently on your baby's bottom. Try to avoid rubbing an already irritated bottom—splash and dab, don't  scrub. Just urine in the diaper? Just pat or fan dry the bottom and change the diaper. Don't bother to wipe all of the urine off. After all, urea, a component of urine, is used in hand creams. In addition, after  every diaper change apply a barrier cream (one containing zinc oxide or petroleum jelly) to prevent your baby's skin from coming into contact with the next round of irritants.

yeast diaper rashYeast rash- This rash is caused by a type of yeast called Candida. The rash typically looks beefy red on the labia or the scrotum. “Satellite lesions” or tiny red bumps surround the beefy red central rash. Babies on antibiotics are particularly susceptible to candidal rashes. Yeast love warm, wet, dark environments  so  remove the diaper as much as possible to create a cool, dry, light environment.

Treatment: Since yeasts are a type of fungus, yeast rashes respond to antifungal creams such as clotrimazole (sold over the counter as Lotrimin in the anti-foot fungus aisle) or nystatin (prescription). Treatment can take as long as 2-3 weeks. 

Pimples- Sometimes you will see a pimple, or a several pimples, in the diaper area . Pimples that look like they have pus inside of them are usually caused by overgrowth of bacteria that live on the skin or around poop. Sometimes a tiny pimple transforms into a boil, or abscess.   Suspect an abcess when a pimple grows, reddens, and becomes tender. 

Treatment: In addition to usual washing poop off with soap and water, apply an over-the-counter topical antibiotic cream or ointment to the pimples with diaper changes. Soak your baby's bottom in a bath a couple of times a day in warm water. If you suspect a boil or abscess, take your baby to her doctor who may drain the infection and/or prescribe a prescription topical or oral antibiotic.

Eczema- If your baby has red, dry, itchy patches on her body she may have eczema and eczema  may appear anywhere... including in the diaper area. 

In addition to applying barrier creams, treat eczema in the diaper area with hydrocortisone 1% ointment four times daily for up to one week.  

Viral- Viruses such as molluscum contageosum may cause flesh colored bumps in the diaper area. Other viruses, like the ones which cause hand-foot-mouth disease,
may cause red bumps in the diaper area. Be suspicious of hand-foot-mouth disease if your see red bumps on your child's hands and feet as well as sores in her mouth.

Reasons to bring your child to her doctor: If you are unsure of the cause or treatment for your baby’s diaper rash, then it’s time to call your pediatrician.

Don't worry... no one will think you are acting rashly. 

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®

Dry chapped hands- home remedies

chapped handsI wash my hands about sixty times a day, maybe more. This frequent washing, in combination with cold Pennsylvania air, leads to chapped hands. Here are the hands of a patient. Do your children's hands look like these?

To prevent dry hands:

• Don’t stop washing your hands, but do use a moisturizer afterwards.

• Whenever possible, use water and soap rather than hand sanitizers. Hand sanitizers are at minimum 60% alcohol- very drying. Be sure to fully dry hands after washing.

• Wear gloves or mittens as much as possible outside even if the temperature is above freezing. Remember chemistry class- cold air holds less moisture than warm air and therefore is unkind to skin. Gloves will prevent some moisture loss.

• Before exposure to any possible irritants such as the chlorine in a swimming pool, protect the hands by layering heavy lotion (Eucerin cream) or petroleum based product (i.e. Vaseline or Aquaphor) over the skin.

To rescue dry hands:

• Prior to bedtime, smother hands in 1% hydrocortisone ointment. Avoid the cream formulation. Creams tend to sting if there are any open cracks. Take old socks, cut out thumb holes and have your child sleep at night with the sock on his hands. Repeat nightly for up to a week. Alternatively, for mildly chapped hands, use a petroleum oil based product such as Vaseline or Aquaphor in place of the hydrocortisone.

• If your child has underlying eczema, prevent your child from scratching his hands. An antihistamine such as diphenhydramine (Benadryl) or cetirizine (Zyrtec) will take the edge off the itch. Keep his nails trimmed to avoid further damage from scratching.

• For extremely raw hands, your child’s doctor may prescribe a stronger cream and if there are signs of a bacterial skin infection, your child’s doctor may prescribe an antibiotic.

Happy moisturizing. Remember how much fun it was to smear glue on your hands and then peel off the dried glue? It’s not so fun when your skin really is peeling.

Naline Lai, MD and Julie Kardos, MD
©2014 Two Peds in a Pod®
Adapted from our 2009 post

Pseudo flu

vomitAward-winning journalist, mystery book author, and syndicated humor columnist Nicole Loughan interviews Two Peds about the “stomach flu” vs “real flu.”
Drs. Lai and Kardos

Despite up to date flu shots, my children and I found ourselves holding our hair back and praying to the porcelain goddess last week. I wondered why this terrible flu had happened to us? This rhetorical question usually just lingers, but this time, I had a chance to get answers and took it. I got the ear of Dr. Naline Lai, MD, FAAP and Julie Kardos, MD, FAAP from Two Peds in a Pod and cornered them about why exactly my brood and I experienced a terrible flu this season, and what we could have done to prevent it, and what’s to blame for it.

Click here to read on.

Nicole Loughan

Nicole writes for two daily newspapers in the Greater Philadelphia area, blogs as “The Starter Mom,” and has two books out: To Murder a Saint and All Saints’ Secret. She is the mom of two young children.

Avoid Carbon Monoxide poisoning

snow blowerMore polar vortex! Here in Bucks County, PA,  we are recovering from power outages and preparing for yet another winter blast. As the generators are started up, we remind our readers about a potentially deadly exposure.

Unfortunately, one of the biggest winter hazards is not loud and obvious. As the temperature drops, deaths rise from this insidious poisonous gas: carbon monoxide.

According to the Centers for Disease Control, about 400 unintentional deaths occur a year from carbon monoxide poisoning.

Carbon monoxide results from the incomplete combustion of fuel. The gas causes a chemical suffocation by competing with oxygen in your body. The colorless, odorless gas is impossible for human senses to detect, and unfortunately, loss of consciousness usually occurs before any symptoms appear. Those lucky enough to have warning symptoms before passing out may experience headaches, nausea, vomiting, or confusion.

Because carbon monoxide is a by-product of incomplete combustion, sources are related to energy use. Poisoning occurs more during the winter months when fuel is used to heat closed spaces and ventilation from exhausts is poor. My sister, toxicologist and Harvard medical school instructor, Dr. Melisa Lai, tells the story of a snowplow operator a few years ago who left the house early in the morning to plow snow, only to return and find his family dead. The reason—snow blocked the exhaust pipe from the furnace and caused lethal levels of carbon monoxide to accumulate in his home.

Carbon monoxide also occurs in warm weather. To avoid carbon monoxide buildup in all climates:

-Install carbon monoxide detectors. My sister says a $20 detector such as Kidde works as well as the $150 models. Put them on every level of your home and check that the batteries work. Smoke detectors are not the same as carbon monoxide detectors. However, combination detectors are available.

-Ventilate all appliances, heating units, and your chimney adequately. Have them serviced yearly.

-Shovel well around vents: While some furnaces vent out of a home’s chimney, other vents are located just two feet off the ground on the side of the house. If these vents become blocked with snow, deadly carbon monoxide levels can build up inside the home. Aim for three feet of snow clearance around the vents.

-Be wary of the exhaust from of any vehicle.

Parents have put their infants in running cars while they shovel snow, unaware that the car’s tailpipe is covered in snow. By the time they return to the car, the infant, who is extremely susceptible to carbon monoxide poisoning because of his size, is dead. Even opening the garage door when you run your car is not enough ventilation to prevent poisoning.

Like cars, boats also produce carbon monoxide. Since boats are less energy efficient than cars, they spew more of the gas. While your teen boogie boards behind a motor boat, the carbon monoxide can knock her tumbling unconscious into the water.

-Keep anything meant to burn fuel outdoors, OUTDOORS. Even an innocent barbeque can turn into a nightmare if you decide to grill inside your garage. Emissions from any type of grill, charcoal or gas, can send carbon monoxide levels skyrocketing. Additionally, hurricane season in the southern United States is known by toxicologists as “Carbon Monoxide Season.” During hurricanes (as with winter storms), people buy outdoor generators and auxiliary heating units. They work so well that people then bring them indoors, trapping fumes in their homes.

My sister says she has hundreds of stories about carbon monoxide poisoning, all which end tragically. Maybe I’ll let my husband store that larger-than-life-take-up-car-space neighborhood snow blower here this winter. Then, at least I know I’ll be able to make sure no one starts up the blower in a garage.

For more details please visit http://www.cdc.gov/co/faqs.htm.

Naline Lai, MD and Julie Kardos, MD
©2014 Two Peds in a Pod®

Adapted from our 2010 post

Raising an optimist

optimistIf you are in a part of the United States affected by the polar vortex shift, it’s tough to stay sanguine about the weather. How to create an optimistic child who can look at the “warm” side of winter? Guest bloggers psychologist Dr. Gage and pediatrician Dr. Penaflor join us today with ideas.

Recently, my daughter’s friend announced before a race, “I’m just not going to try my best.”

Why would a child give up before even starting?  Why such pessimism? 

It turns out that her friend’s mother would say after every race, “You just didn’t meet your potential.  Did you at least beat Sarah (a fellow competitor)?”

This scenario illustrates how a parent who constantly gives negative responses can build pessimism in a child.

Why is optimism important?

An optimistic child is strong, enterprising, and resilient.  He or she does not wait passively for good things to happen to him or her. The optimist consciously plans, works hard to make things happen, and persists through challenges.     

Research shows important benefits:

•        A healthier heart and a greater ability to fight infections and survive disease

•        Better response to stress

•        Less likelihood to develop anxiety and depression

•        More success in school, sports, social and recreational activities

•        Greater accomplishments in life

•        Higher motivation to keep on trying even when things get tough

How do I begin?

Does your child tend toward optimism or pessimism?  Is the glass half empty or half full?  Which would your child say, “It doesn’t matter... I won’t get it right anyway,” or “I did my best… I’ll get it next time”? Optimism is a learned skill that you can teach your child at home.

Here are some important tips.

  • Model positive behaviors and attitudes.

         “This is tough, but I can do it!” 

         “I will find that lost pair of socks!”

  • Create an environment that fosters love and trust

         When children have a sense of security and trust at home, they view the                                  world as a positive place to explore and try new things.

  • Encourage your child to view life in a positive way and to rise above negativity.

  For example, one of our favorite techniques is “Rise up! Don’t dwell on it.” If someone did or said something hurtful to your child, teach your child to pause. Have her ask herself “How important is it? Will it matter in 5 minutes, 5 months, or in 5 years?" Think of the big picture.   

   Another is to approach mistakes calmly. Say “Oops!” and move on.

   Validate your child’s feelings of disappointment or sadness, but teach your child that failures and mistakes are opportunities to learn and do something different and better.

After all, in life “Sometimes you win, sometimes you learn.”

Patricia Gage, PhD, NCSP and Gina Penaflor, MD, FAAP

©2014 Two Peds in a Pod®

Dr. Patricia Gage runs Brain Smart Academics, her own private practice as a school psychologist in Stuart, Florida, and has taken the lead in many charitable organizations that help promote children's social/emotional wellness and women's health. Dr. Gina Penaflor, mother of a school-aged child, tween and teen, is a primary care pediatrician in South Florida with a background in emergency and hospital medicine.  She and Pat have combined their knowledge and experiences to create a Hang-In-There educational card series.  Their mission is to help busy moms and dads lead a more rewarding (and less stressful!) parenting experience. 

To learn more, please visit their website at www.HangNthere.com or Facebook page, or e-mail them at busymoms@HangNthere.com.