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Two Peds In a Pod ®
Food For Thought with Janet Zappala
Newborn eyes: blocked tear ducts, crossed-eyes, vision, and eye color
This post was inspired by a newborn whose mom asked me about his eyes. “Here’s looking at you, kid”:What is this goop in my baby’s eye?
Blocked tear duct: About 25 percent of infants by the second or third week of life develop some slightly yellow or clear discharge. The discharge looks worse when the infants first awaken. At this age, they start to produce some tears (although they do not “cry tears" until closer to three months old). But because newborn tear ducts, the drainage system for tears, are not completely open, tears either spill over, causing a watery discharge, or accumulate in the eyes during sleep and become slightly thicker “goop” that wipes away easily.
Babies with blocked tear ducts have normal appearing sclera (the whites of the eyes) and normal vision. Blocked tear ducts are not painful. Fortunately, they spontaneously open up in most babies without intervention. This process, which is usually complete by three month of age, can take up to one year of age. An infection in the eye causes a baby’s eye to become painful, red on the inside, and sensitive to light. The discharge becomes pus-like and increases in amount. If you are not sure if your baby’s eye discharge is from an infection or a blocked duct, consult your pediatrician.
Why do my baby’s eyes cross?
Young infants’ eyes may cross as they gaze at an object. This crossing is a result of an immature nervous system. By three to four months of age, a baby’s eyes should always move in concert when she gazes or follows an object with her eyes. If your baby’s eyes cross after this age, alert your child’s pediatrician, who will likely refer your baby for an exam by an ophthalmologist who is comfortable examining babies. It is important to make sure the eyes are both seeing equally and adequately, as well as to make sure the eye muscles work properly. See our previous post on crossed-eyes.
What is normal vision for a newborn?
Babies are born nearsighted. They see clearly the distance to a face when being held. Some newborns will stick out their tongues in response to seeing their parents do the same. So, be sure to look at your infant when you are feeding or rocking her. Far vision develops gradually over months to years. A child's vision is not 20/20 until about five-years old.
When will my baby’s eyes change color?
The color of a baby’s eyes generally becomes established during the first year. Some stay the same color from birth. My own children were all born with either blue or grey eyes but now all are brown, much to the delight of their blue-eyed grandmother. My oldest was nine months before his eyes turned brown. Some of my patients did not develop their permanent eye color until two years.
The part of the eye with color is called the iris. The hole in the center of the iris is called the pupil. Pupils should always look black. In a photograph they can look red from a flash. If you ever see white, yellow, or grey reflected in the pupils, alert your baby’s doctor.
Julie Kardos, MD with Naline Lai, MD
©2011 Two Peds in a Pod®
When your kid comes out: How to support your gay, lesbian, bisexual, or transgender child
Today our guest blogger, pediatrician Ilana Sherer, MD, Director of Primary Care for the Child and Adolescent Gender Center at University of California San Francisco, addresses how to respond supportively to your child if he or she “comes out.”
When Jaime recently came out as gay, his mother, a Catholic Mexican immigrant, initially felt fear: “When he told us that he was gay, we were afraid for him. We were afraid of what his life would be and we were afraid that he would not accomplish our dreams for him.”
Contrast this response to Laura's experience. Laura came out to her parents as lesbian when she was depressed and suicidal. Quickly recognizing the crisis, her parents responded by assuring Laura that they loved her no matter what, and got her into counseling with a local and Lesbian/Gay/Bisexual/Transgender (LGBT) conscious mental health professional. Her parents eventually joined the Board of Directors of their local Parents and Friends of Lesbians and Gays support group (PFLAG) and now Laura and her mom speak to other groups about their experiences.
How can parents support their child? Many parents react in loving ways from the moment their child comes out. However, if you’re reading this article, you may have already responded in a way that you regret. That’s okay, and it’s okay to feel sad, hopeless, depressed, blamed, embarrassed, ashamed, or guilty—most parents feel all of these things at one point or another in the process of acceptance. In fact, even parents who feel they are open and accepting to LGBT issues or parents who are LGBT parents may react negatively. However, it’s never too late to show your child that you support and love him or her unconditionally.
Ways to Support your Child:
1. Talk with your child about his LGBT identity, express affection, and support him even if you feel uncomfortable. Support his or her gender expression, clothing choices, and physical expression.
2. Connect your child with community resources geared toward adolescents. If you live near an urban area, there may be an LGBT community center nearby with youth programming. If not, there may be a school or community group available. Check the internet and newspaper listings. If you know any LGBT adults who are part of your community, consider asking them for resources.
3. Connect your family with resources, such as PFLAG (see below). Siblings may also need support.
4. Check in with your child about bullying in school. If he is being bullied, demand that the school address the perpetrators and create a safe educational environment for your child. Advocating for your child is a powerful sign of acceptance.
5. Require that all family members respect your LGBT child.
6. Welcome your child’s friends and partners into your home.
7. It is important for your child (and family) to identify healthy adult LGBT role models. If none are available in your community, point out LGBT people in the media who are leading successful lives. Thankfully, there are no shortage of visible "out" LGBT people in television, music, and movies, but if you need help identifying them, Wikipedia has an exhaustive list.
8. If your church or religion contains messages demeaning the worth of LGBT individuals or suggests that homosexuality can be reversed, consider finding a new worship community.
9. Monitor internet usage. Your child has likely already been on the internet. Hopefully, she found some great resources or has made friends with LGBT teenagers in other parts of the country. However, there is also a lot of misinformation. There are also pornography and social networking sites which can take advantage of your child. As always, keep track of the sites she visits and who she networks with online.
10. Let your child know that you believe he will have a happy future as an LGBT adult.
Unsupportive Behaviors to Avoid:
1. Hitting, slapping, or physically hurting your child.
2. Verbally harassing or name-calling.
3. Excluding your child from family activities.
4. Blocking access to LGBT friends, events, and resources.
5. Blaming your child when she is discriminated against because of her LGBT identity.
6. Tolerating bullying and harassment.
7. Pressuring your child to be more or less masculine or feminine in clothing choices and external appearance.
8. Telling your child that God will punish him because he is gay.
9. Telling your child (or acting as if) you are ashamed of him or that he will shame the family.
10. Making your child keep her LGBT identity a secret or blocking her from telling close family members and friends, or conversely, “outing her" (telling others about her identity) against her will or without permission.
Resources:
Parents and Friends of Lesbians and Gays (PFLAG) www.pflag.org
Gender Spectrum Education and Training www.genderspectrum.org
Gay, Lesbian, and Straight Education Network www.glsen.org
Trevor Project (crisis intervention and suicide hotline for LGBT youth) www.thetrevorproject.org. 1-866-4-U-TREVOR
Center Link (for a listing of LGBT Community Centers) www.lgbtcenters.org
The National Gay and Lesbian Task Force www.thetaskforce.org/issues/youth
The National Youth Advocacy Coalition www.nyacyouth.org
Listing of rural youth resources at www.nyacyouth.org/docs/ruralyouth/resources/index.php
Advocates for Youth www.advocatesforyouth.org
Gay and Lesbian Medical Association Provider’s Directory (for finding an LGBT-competent medical provider) www.glma.org
Youth Resource: a website by and for LGBTQ youth www.youthresource.com
Illana Sherer, MD
Dr. Ilana Sherer is the Director of General Pediatrics of the Child and Adolescent Gender Center at UCSF. She is a recipient of the Chancellors Award for LGBT leadership at UCSF and also of the American Academy of Pediatrics Dyson Child Advocacy Award.
©2011 Two Peds in a Pod®
We give thanks for parental sanity savers
We give thanks for the opportunity to parent our children always. With the many challenges of raising children, this Thanksgiving we give thanks for things that save our sanity. We heave a huge sigh of relief for:
carpools
the neighbor who will meet your child at the bus stop when you are running late
double strollers
pizza
ability to Skype with your teen the first time he is way from home
those folding sports chairs you lug along to all of your children’s sports games
pacifiers
training wheels
Elmo
ketchup
Band aids—a sure cure-all
a same day laundry machine repair person
Happy Thanksgiving from your two Peds,
Naline Lai, MD and Julie Kardos, MD
©2011 Two Peds in a Pod®
What you need to know about Whooping Cough
Pertussis is “whooping cough,” also known as the “100 day cough.” In children and adults, the disease starts out looking like a garden-variety cold, complete with runny nose, runny eyes, and mild cough. Sometimes fever is present, sometimes not. However, after a few days, coughing spasms emerge - severe, persistent coughing spasms that go on and on and on. In between coughing fits, children may appear okay.
There is no treatment except to "ride it out" and the cough can last up to three months. Doctors prescribe antibiotics to a child with pertussis because antibiotics can decrease how much a person with whooping cough will spread it to others. Close contacts of kids with pertussis may also receive antibiotics to reduce their chance of getting pertussis.
Whooping cough gets its name from the “whoop” noise kids make after a coughing fit. The fits leave them so breathless that it’s difficult to take a breath in again after the coughing spell. To hear the “whoop” with coughing fit, visit www.whoopingcough.net.
Teens and adults with whooping cough don’t tend to make the whoop sound because their airways are bigger, but the coughing spasms can leave them feeling like they might throw up or pass out. Some in fact do end a coughing fit with vomiting or fainting.
Babies don’t make the whoop either. Instead, babies with pertussis simply cannot catch their breath and stop breathing. That is why babies are the ones who tend to die from this illness. Dr. Lai and I both have watched over hospitalized infants blue from pertussis.
Thankfully, we have a vaccine that is effective at preventing pertussis. The “P” in pertussis is the “P” in the DtaP vaccine that children receive as babies, usually at two, four, and six months of age. The DtaP vaccine is then next given after the first birthday, another between ages four and six years old, and another at age eleven years. Teens who have not received the pertussis vaccine since they were in preschool, and adults who care for infants also should also get the vaccine. For more specific up-to-date recommendations: www.vaccineinformation.org/pertuss/.
As we enter the season for catching snowflakes and coughs, we hope none of your children catch whooping cough.
Julie Kardos, MD with Naline Lai, MD
©2011 Two Peds in a Pod®
revised Nov 16, 2011 to reflect the indications for antibiotic prophylaxis
Not cute as a button: Babes and button batteries
In a couple of weeks my 16 month old nephew will visit my non-baby proofed house. Chances are, he will find things in my house to chew on besides turkey. The first items I am hiding are the devices which contain the tiny round batteries called button batteries. Below, Kristen Casavale of The Battery Controlled reminds us about the hidden hazards of button batteries.
Electronic devices are a part of daily life. And they’re getting smaller, slimmer and sleeker. But inside the battery compartment of mini remote controls, small calculators, watches, key fobs, flameless candles, singing greeting cards and other electronics, is a very powerful coin-sized button battery. When swallowed, these batteries can get stuck in the throat and food pipe, causing severe burns in as few as two hours.
“Our trauma surgeon told us that they see 10 ingestions a month. Unfortunately, I didn't really think twice about Emmett playing with the remote control,” said Karla Rausch, mom of son Emmett, age two.
Small children often have easy access to these devices; parents often don’t know about the risk and little ones can’t always communicate with adults. Grown ups may be unaware of an ingestion until the battery starts to erode through a child's food pipe. The Battery Controlled is a partnership to raise awareness about the severity of the issue and share information with parents, caregivers and the medical community. Launched by Energizer and Safe Kids USA, this effort is committed to helping parents prevent children from swallowing coin-sized button batteries.
three main points for parents:
1. Keep out of reach. Devices with coin lithium “button” batteries have no place in unsupervised hands or toy boxes.
2. Get help fast. Life-threatening damage can happen in as few as 2 hours.
3. Tell others.
We thank, and my nephew thanks Kristen for her safety alert.- Dr. Lai
Julie Kardos, MD and Naline Lai, MD
©2011 Two Peds in a Pod®
Those stinky kitchen sponges: how germy are they?
Dr. Lai and her husband had a running debate about when to replace kitchen sponges. Today we thank guest blogger Dr. Karina Martino, Food Safety Engineer, for exposing the germs in our kitchens. We certainly learned a lot, and Dr. Lai's husband lost a bet.
Naline Lai, MD and Julie Kardos, MD
WHO’S THE WORST OFFENDER IN THE KITCHEN???
The winner is…….the kitchen sponge (and dishcloth)! The next worst offender is your kitchen sink. This is where vegetarians have a definite advantage since they don’t bring raw meat into their homes. There’s less chance of E. coli and Salmonella spreading, but vegetarians still have to be on the lookout for viruses and parasites.
What are the kitchen’s hot germ zones?
In descending order by highest bacterial count, these are:
1. Sponges and dishcloths
2. Sink drain area
3. Faucet handles
4. Cutting boards
5. Refrigerator handles
Here are simple steps that you can follow to create a healthier kitchen environment:
Dip sponges after every use in dilute sanitizer water (1 teaspoon bleach per quart of water); boil them for 3 minutes on a weekly basis.
• Change dish cloths daily, especially after wiping up raw meat juices.
• Wash sinks with hot soapy water prior to food preparation and before washing dishes.
• Wipe down refrigerator handles daily with dilute sanitizer water.
• Choose non-porous cutting boards that are easy to clean.
• Avoid rinsing raw meats. It contaminates the sink. If you cook meat at the correct temperature for enough time, bacteria on raw meat will be killed.
When we are handling food products everything in the kitchen must be clean, especially ourselves. It is vital to wash our hands with soap and hot water for at least 20 seconds before handling any food product. Each time you re-enter the kitchen from outdoors or any other place in the house where you might have contaminated your hands, you should wash your hands again.
Clean clothing, including aprons, is also an important part of personal hygiene. Dirty clothes and dish towels are a good place for bacteria to hide and grow. Sneezing and coughing spreads germs from our lungs, throats, and noses. When handling food, we must control the spread of germs from these natural occurrences by covering our mouths with disposable tissues and then rewashing our hands.
While the Centers for Disease Control (CDC) provides information about illness from food in homes, it does not yet offer statistics about how many people become ill from their kitchen sponges. However, here are some facts for you to keep in mind:
• The kitchen environment can be more heavily contaminated with fecal bacteria (those bacterial species associated with feces) than the bathroom, suggesting that the risk of spreading infection in the home may be highest in the kitchen-the area in the home where food is prepared.
• Microbiological surveys of domestic kitchens have found significant contamination from a variety of bacterial contaminants, including E. coli, Campylobacter, and Salmonella.
• Pathogenic organisms (germs that cause disease) have been shown to be introduced in the home by people, food, water, pets and insects.
• The domestic kitchen is not used only for food preparation, but may serve as a laundry, a workroom, and a living area for family pets. Each of these functions can serve to introduce bacterial contamination into the kitchen environment.
Moreover, research focusing specifically on the kitchen environment has found:
• 67% of kitchen sponges may be contaminated with fecal bacteria
• Contaminated cloth towels serve to transfer bacteria to dishes during drying
• 82% of sink faucet handles are contaminated during food preparation
• 60% of people do not wash the cutting board after cutting raw meat or poultry and before cutting fresh vegetables for salads
• 9% do not wash the work surface at all after cutting raw chicken
So, please don’t duplicate these mistakes! The next time that you get ready to do your dishes with your six-month-old sponge… think again!... either toss it or get your Clorox immediately!
Karina G. Martino, PhD
Dr. Martino received her Masters degree and her PhD in Food Safety Engineering from Michigan State University. A former professor at University of Georgia, she now has her own consulting business (www.kgminnovations.com) and is the mom of two children.
©2011 Two Peds in a Pod®
Who would have thought? Walking in a prewinter wonderland
If you live on the East Coast of the United States, you were bombarded today by a surprise pre-Halloween snowstorm. Now that we have our power back, we thought we'd share with you a few posts we were reminded of today:
Naline Lai, MD and Julie Kardos, MD
©2011 Two Peds in a Pod®
Two Pediatricians return from Boston: dispelling myths about pot, steroids and prescription drugs
We’re back from the national American Academy of Pediatrics conference in Boston and we’re galvanized to make a positive impact on youth. Just in time for Red Ribbon Week, the national campaign for halting substance abuse Oct 23-31 (www.redribboncoalition.com), we bring you facts for you to use as you talk about three drugs kids generally consider “harmless”: marijuana, anabolic steroids, and prescription medications.
Marijuana: In 2010, one out of five high school seniors and eight percent of eight graders reported using marjuana. Unlike popular belief, marijuana is addictive. Use starting in adolescence is associated with an almost 20 percent risk of dependence. It’s strong stuff. As little as five uses of pot can lead to addiction and withdrawal symptoms are similar to withdrawal symptoms from heroin. The good news is that a teen can withdraw safely at home. If your kid tells you he is not addicted and can quit at any time, challenge him to stop smoking for two weeks. If he can’t, then he is in deeper than he realizes.
Pot clouds up the brain and makes it more difficult to remember recent events. Although kids say they can drive after smoking weed, their reaction time is impaired, just as it is with alcohol use. In the past researchers thought brains did not develop much in adolescence. However, brain development does continue to the early twenties, and pot can affect that development by altering mood and executive function (planning) centers in the brain. In short, marijuana causes brain damage.
Steroids: It’s just as likely to be the kid who wants to look “buff,” and not just the athlete who wants to play better, who uses anabolic steroids. Addiction does occur… and in a lot of users. One-third of all users end up addicted. Not only do steroids affect muscles, but also they affect the brain. Adolescents are already known for emotional volatility and steroids heighten aggressiveness. Additionally, sex organs pay a price for steroid. In males, testicles can atrophy and breast development can occur. For females, non-reversible facial hair growth and deepening of voice are side effects.
Prescription medications: Throw away those unused prescription pain killers and lock up controlled substances still in use. Prescription medications seem unintimidating to kids because they are prescribed legally and they see their parents taking them. Over the last few years, reported use of Vicodin in the past year by 12th graders ranged from about eight to ten percent. Deaths occur from overdose or from accidents from impaired driving.
Data show teens listen to advice they hear from their parents and their pediatricians, even if they sometimes take time to digest and act on that advice. We pledge to do our part when we talk to your kids about the harmful effects of drug use. We urge you to continue communicating with your children, even if they are away at college. One helpful website to assist you in talking to your kids about drugs is The National Institute on Drug Abuse: http://www.nida.nih.gov/nidahome.html.
Culled from talks given at the American Academy of Pediatrics National Convention and Exibition, 2011, by Patricia Kokotailo, MD, MPH and Greg Landry, MD, FAAP University of Wisconsin School of Medicine and Public Health, Madison, WI, John Kulig MD, MPH,FAAP, Tufts University School of Medicine, Boston. If you live in the Central Bucks area of Pennsylvania contact CBCares for more information on local Red Ribbon Week events.
Naline Lai, MD and Julie Kardos, MD
©2011 Two Peds in a Pod®
Should I vaccinate my child?
Yes, yes, yes.
There are many deadly diseases we can't prevent, but we do have the power to prevent a few. We now have the ability to prevent your children from getting some types of bacterial meningitis, pneumonia, and overwhelming blood infections. With vaccines we can prevent cases of mental retardation, paralysis, blindness, deafness, and brain infections. Immunizations are a safe way of boosting children's natural immune systems. Yet some of our parents continue to doubt the benefits of vaccines and to fear harm from them.
Let’s look at another kind of prevention. You would never drive your car without putting a seatbelt on your child. Even if you don't know anyone who was in a fatal car accident, you still buckle you and your child up. You may know a kid who emerged from a car accident with only a scrape, yet you still buckle you and your child up.
You may never know a child who is paralyzed by polio or who died of whooping cough, but it does happen and can be prevented. Just like with car accidents, it's better to prevent the injury than to play catch-up later. Dr. Kardos's grandfather routinely rode in the front seat of his car without his seatbelt because he "had a feeling" the seatbelt might trap him in the car during an accident. Never mind that epidemiologists and emergency room doctors have shown people are much more likely to die in a car accident if they are not wearing a seat belts, he just “had a feeling.”
When it comes to your children, parental instinct is a powerful force. We routinely invite our patients' parents to call us about their children if their instincts tell them something might be wrong, and we always welcome and at times rely on parents’ impressions of their children's illnesses to help us make a diagnosis and formulate a treatment plan.
However, in the face of overwhelming evidence of safety and benefits of vaccines, we pediatricians despair when we see parents playing Russian roulette with their babies by not vaccinating or by delaying vaccinations. We hope fervently that these unprotected children do not contract a preventable debilitating or fatal disease that we all could have prevented through immunizations.
There is no conspiracy here. We both vaccinate our own children. We would never recommend any intervention where the potential for harm outweighs the potential for good. We have valid scientific data that every year vaccines save thousands of lives. One of them could be your child's life.
Should you vaccinate your child?
YES!
Julie Kardos, MD and Naline Lai, MD
©2011 Two Peds in a Pod®
Visit these posts for more infomation about vaccines: How Vaccines Work, Evaluating Vaccine Sites on the Internet, and Closure: there is no link between the MMR vaccine and autism
Also, please visit the recent Institute of Medicine's analysis of vaccine side effects.