5 dangers worth worrying about

Posted by on 12:38 pm in Injury, School-Age Child, Toddlers | 0 comments

5 dangers worth worrying about

I only have 3 rules for my own kids; wear helmets, buckle up and brush your teeth. Otherwise, I let my kids run, jump and play without much intervention. But that’s because I’m a pediatrician that works in an emergency room and I know what’s really dangerous. Your child is far more likely to be harmed by things you aren’t even thinking about. Here’s what makes my palms sweat:   1. CHOKING New parents choose baby’s first solid foods carefully to make sure they are soft and small enough. But when kids are learning to eat they will gag, and struggle a little as they tackle new textures. Kids have a built in safety mechanism that closes their airway if food is trying to get in. So an 18-month-old may gag and choke when they over ambitiously shove a taco in their mouth. But that’s how they learn to eat. Introduce a variety of textures and sizes of food for kids to tackle, particularly so they grow up to be adventurous eaters — and ignore their gagging and spitting noises. What choking hazards should you worry about? Popped balloons are one of the most dangerous, so I never take my eyes off a baby playing with a balloon. In the pediatric ER we see a lot of young kids who have swallowed coins and other objects. Typically it happens when the child is alone with their older sibling. So in terms of choking risks, leaving young children alone to play with older kids is a slightly riskier situation since older kids may have toys that are unsafe for young kids. And don’t let kids run with a lollipop or toothbrush in their mouth. While not a common injury, it can be very dangerous if a child falls and punctures their palate.   2. DOG BITES Parents worry about the cleanliness of animals because they often come to the emergency room explaining that they are concerned their child got sick from playing with a cat or dog. But don’t worry about a pet being “dirty,” there’s virtually no risk of infection from a dog lick. Instead focus your efforts to prevent dog bites. By far the most harmful animal injuries I see are from a friendly family dog attacking a child. Teach your child how to approach a dog and to never take something away from a dog. Every dog, no matter how mild-mannered, is capable of biting a child.   3. WATER You take your kids to swim lessons and warn not to run around the pool. But that’s not gonna keep kids safe around water. We can fix a cut chin or bruised knee from tripping on the pool deck. So why do swimming pools scare me? Kids drown right in front of you. Even older kids who know how to swim can drown. And unfortunately swim lessons really aren’t protective. Be sure to have a dedicated set of eyes on the pool at all times. Consider having a ridiculous looking “lifeguard” hat that you can pass around between adults at a pool party to designate that one person is always responsible for keeping an eye on the swimmers. And if you are visiting a house with a pool, make sure there is a locked door or gate between...

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The Sunscreen Scoop: recommendations for every age

Posted by on 6:26 pm in Babies, School-Age Child, Toddlers | 0 comments

The Sunscreen Scoop: recommendations for every age

Lost in the sea of sunscreen choices? Here’ s how to choose the perfect sun protection for every situation Although there is no perfect sunscreen, it’s a little easier to choose a good one these days. Older sunscreens were only designed to block UVB rays because they cause sunburn. But scientists recently discovered that although UVA rays don’t cause sunburn, they do cause skin cancer and photo-aging (aka wrinkles and age spots). SPF only measures the UVB protection of a sunscreen. Modern sunscreens protect against both UVB and UVA (look for the label “Broad-spectrum”). And sunscreen manufacturers are constantly re-engineering their products to make them easier to apply and longer lasting. So now there are billions of different products on the shelves. Here’s how to find the right protection for your family: Infants under six months Use hats, clothing and umbrellas to protect infants. Babies have a very thin outer layer of skin so they can absorb the chemical compounds in sunscreen. Plus, babies don’t detoxify chemicals they absorb as easily as older kids. Babies also make less melanin, the skin pigment that protects cells from UV radiation. So they are highly susceptible to DNA damage from the sun. If you can’t keep a baby in the shade, it’s better to use sunscreen in small areas of skin than to risk direct sun exposure. Look for sunscreens labeled for sensitive skin or babies. Infants over 6 months and toddlers I like sunscreen sticks for this age. Unless you can convince an 18 month old to stand still, sunscreen needs to be super-convenient to apply. Stick forms are easy to smear on the face, neck and ears, won’t drip into the eyes and they won’t inhale the fumes from a spray can. For the body, choose thicker white creams because at least when Phoebe runs away mid-application, you’ll know what areas you’ve missed. Also look for products labeled “no tears” because young kids often rub products into or near their eyes. Elementary-school kids Any sunscreen at all will do for this age. The key issue is to teach children the importance of sun protection since studies show this is when kids tend to stop using sunscreen AT ALL. Also, be aware that many sunscreen ingredients stop working after more than 2 hours in the sun, so if you (or your 4th grader) won’t remember to re-apply, look for “photo-stabilized” products with names like HelioplexTM, Active Photobarrier ComplexTM, AvoTriplexTM, SunSureTM, DermaplexTM, which are all forms of stabilized avobenzone, a UVA blocker. Teach children the important “life skill” of how to use sunscreen correctly and encourage use throughout life.   Tweens and Teenagers Gel-based sunscreens are a good choice for the acne-prone population or to put on hairy places and the scalp. Also, be sure to encourage daily moisturizer with SPF 30.   Choosing the best type of sunscreen is really important, but don’t ignore other methods of protection. Avoid midday sun Avoid direct exposure to the sun, especially between the hours of 10 a.m. and 4 p.m. when UV rays are the most intense. Encourage your kids’ sports teams to practice early in the morning or later in the afternoon. Wear sunglasses Ironically, your eyes are exposed to the strongest rays in the morning and late afternoon when the sun is lower and its...

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Bedtime snacks help kids sleep

Posted by on 7:59 pm in Babies, Eating, Normal or Not?, School-Age Child, Sleep, Toddlers | 0 comments

Bedtime snacks help kids sleep

If dinner is at 5:30 p.m. it makes perfect sense that your child will be hungry again at 8:30 pm. So, go ahead and give them a bedtime snack. They aren’t necessarily trying to postpone sleep; they might just need some calories to get them through the night. Toddlers who wake up with the sun may have a circadian rhythm that tells them to get up very early (and apparently tells them to wake everyone else!) But these kiddos might wake up early because they are hungry. Twelve hours is a long time not to eat! So if your little one doesn’t ask for a bedtime snack, consider whether they may need one. Some children might not feel the sensation of hunger or recognize they are hungry. But their brain can still send signals that wake them up. Two hormones, leptin and ghrelin regulate hunger. When we eat, leptin signals the body that we are satisfied and suppresses ghrelin, the hunger hormone. If you have enough leptin to suppress ghrelin all night you’ll sleep through the night. But when ghrelin is unleashed, your brain will be signaled to wake up and feed the body. Sometimes that happens at 2am. Consider this: you may not think you are serving breakfast at 5:15am when you give your toddler a big cup of milk. But that is exactly what you are doing. Try giving your early riser a snack before bedtime for a week and see if they sleep just a little later. And keep the bedtime bite to a snack – not a heavy meal. The digestive system slows down when we sleep, so eating too much can be uncomfortable or over-stimulating. Carbs help regulate the circadian rhythm Eating a steady amount of calories throughout the day improves nighttime sleep by regulating the circadian rhythm. Researchers from Japan’s Yamaguchi University found that eating a carbohydrate-rich snack in the evening may help reset your circadian clock. Insulin influences the crucial sleep-regulating gene PER2 (in mice studies). Since carbohydrates (like crackers and fruit) increase insulin secretion more than protein and fat, they also help regulate your body’s PER2 cycles so that you’re drowsy at the right time of day. Bedtime snacking may also help daytime behavior. Snacks definitely improve nighttime sleep, and good sleep improves kids’ behavior. But a bedtime snack can actually make a child more alert in the morning. And that means she may be more cooperative with putting on her shoes. Giving any snack in the hour before bed will suppress hunger all night, though some specific foods may be more sleep-inducing. High fat foods interfere with all aspects of sleep and high protein snacks seem to affect the quality of sleep. So, what should we serve? Pumpkin seeds and almonds – high in magnesium, which can relax muscles Milk, turkey and hazelnuts – high in tryptophan, an amino acid that converts into melatonin, which helps the body sleep Popcorn – carbohydrate-rich foods like popcorn increases tryptophan in the blood. Choose air-popped corn to reduce pre-bedtime fat consumption. Cherries, bananas and pineapples – any fruit is a good choice, they all have complex carbohydrates and are low calorie. Cherries have the highest concentration of naturally occurring melatonin. Kiwi – linked to longer sleep time in problem sleepers, possibly because its antioxidants...

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Righty or Lefty? When will you know?

Posted by on 2:10 pm in Babies, Milestones, Normal or Not?, School-Age Child, Toddlers | 0 comments

Righty or Lefty? When will you know?

Will your child be an accomplished athlete or mathematical genius? We grownups love looking for subtle clues to our child’s future self. Surely you’ve seen your baby reach with his left hand and wondered – could your genius-athlete be a lefty? A preference for one hand can be determined around 6 months. So if you suspect your baby is right-handed, you’re probably correct. However, children’s hand use fluctuates until kindergarten. For example, a completely normal child shifts between picking up objects with only their preferred hand, then a few weeks later using both hands equally. And they often shift from using mostly their right to using mostly their left hand several times before 18 months.   We have a stronger eye and ear; babies even have a preferred side for their leg kicks and head turns. Even unborn babies have a preferred side. In a study of 75 fetuses observed in utero and re-examined at age 12, all 60 right hand suckers were right-handed and 10 of the 15 left hand suckers were left-handed. So hand preference starts earlier than we thought!   There is good reason for this. Our brains are wired to make us ambidextrous during times when we are learning new motor skills. For example, kids who predominantly use their right hand will start using both hands equally when they are learning to crawl. In one study, researchers observed a group of kids in a task of taking a toy out of a box at the time when they were just learning to crawl . Right-handed kiddos used their left as often as their right hand during multiple trials of the task. Just as they were alternating their hands while crawling, they were alternating use of their hands while playing. When these same kiddos started taking their first steps they suddenly began using both arms together to open the box and take out a toy. They used their arms symmetrically for tasks during the time that they were precarious walkers. While walking they held their arms in a high guard position to control their balance. As soon as they became stable walkers, they began to lower their arms along the side of their body while walking and returned to one-handed reaching in the task. Hands look symmetric, yet we choose a favorite. And they look the same, but don’t work quite the same. While a young child will often have a preferred hand, there’s a difference between hand preference and true adult-like handedness – as in the dominant use of one hand, and relative clumsiness with the opposite hand. There’s no consensus about when complete handedness is attained: researchers put it anywhere between ages 3-12. Most studies have shown that a child’s preferred side is set by age 4. Children need time and practice to develop the performance difference that we see between the two hands in adults. Practice using one hand more than the other helps us become coordinated at precise tasks like sewing and holding a pen. So there is a period of several years when kids refine their fine motor skills and they may occasionally use their non-dominant hand, particularly when they are learning new skills including cutting with scissors and drawing. 90% of the population is right-handed. When babies pick a favorite hand there is definitely a genetic influence,...

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The secret to rolling over: an unpredictable milestone

Posted by on 9:58 pm in Babies, Milestones, Normal or Not? | 0 comments

The secret to rolling over: an unpredictable milestone

When and how should a normal baby roll-over and what does it mean? Rolling over is the most mysterious of the milestones. Some babies roll from front-to-back before they roll back-to-front and others choose the opposite order. Some babies roll over once and never again, and some babies log roll to get around rather than crawl. And all of the above are perfectly normal. Four months is the most typical age to start rolling, but anytime between 4 and 6 months is in the normal range. The age when your baby starts rolling over depends on a bunch of things: First, a baby has to develop their leg, neck, back, and arm muscles enough to twist their torso around. That’s why your plump infant might have a harder time rolling her cute little mass over. You can help develop her muscles by providing plenty of tummy time. And speaking of tummy time: babies enjoy it more when you give them some “belly bait.” Place an incentive like a mirror, toy, or your own face nearby to encourage your baby to reach out, arch his back, and exercise his torso. So the second ingredient to encourage rolling over is to keep that bait far enough away that he has to figure out a way to move towards it. Lastly, rolling over can be scary. Plenty of babies scare the poop out of themselves when they suddenly flip over and the entire room changes. It’s like time travel to them. And the scariest experience is when a baby rolls off a piece of furniture. So, whether you have seen your child roll over or not, once they hit about 2 ½ months, be extra careful about leaving a child on a raised flat surface. Babies love to surprise their parents with their first roll when it is most dangerous. And if their first roll is frightening they may avoid the motion altogether. Conditions have to be just right for a baby to roll over, and to keep doing it. So don’t worry if your child rolled over once and then stopped. And also don’t fret over which direction they rolled, or how old they were when they started. Whether your baby rolls over, wiggles, scoots, or jigs, as long as your child is trying to move their body towards objects in some manner they are developing normally . It is very common for a baby who can roll to stop rolling over. Usually non-rollers are busy working on another motor skill and most babies can only work on one skill at a time. So ask yourself what else she’s working on. It might be scooting or even just babbling a lot more. Learning to eat takes a lot of brain-power too, so her intellectual capacity may just be occupied by food. And don’t freak out that your baby will roll over and suffocate during sleep. If she has developed the ability to roll, she has also developed the ability to sense trouble when she’s sound asleep and will move her head to avoid being caught in a blanket. When should you worry? Tell your pediatrician if your child has not rolled over by 6 months and isn’t scooting, sitting, or locomoting in some other way. Another worrisome sign is if your child...

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The bright side of dark chocolate

Posted by on 6:40 pm in Babies, Eating, School-Age Child, Toddlers | 1 comment

The bright side of dark chocolate

Looking for the perfect Valentine’s gift or Easter surprise? Introduce your kids to the taste of dark chocolate and you’ll improve their health for eternity. Dark chocolate has many beneficial health effects on adults including improved cardiovascular health, cholesterol, insulin levels, and it even improves mood. Few studies have looked at these effects on children. However since it is scientifically proven that children grow up to be adults, introducing kids to the unique flavor of dark chocolate is great preventive medicine. Dark chocolate is loaded with nutrients, healthy fats and anti-oxidants. One class of compounds found in chocolate, the alkaloids, include caffeine and phenlyethylamine (PEA). PEA is the same chemical that your brain makes when you are falling in love. PEA releases endorphins, serotonin and dopamine, all of which make you feel happy and relaxed. The powerful antioxidants in dark chocolate are anti-inflammatory and have such effects as protecting blood vessels and improving blood flow in the brain as well as increasing “good” HDL cholesterol and lowering “bad” LDL cholesterol. Finally, dark chocolate is full of minerals like potassium, zinc, iron and selenium that the body needs to maintain basic metabolic processes. The details of many of these positive effects are pretty well studied in adults with high blood pressure, and even Alzheimer’s disease. Though kids’ bodies are a little different, so these effects may not be as relevant. However, there are a few effects that we know are beneficial in children. The flavonoids in dark chocolate actually protect the skin from sun damage. Eating dark chocolate regularly before sun exposure reduced the redness from ultraviolet radiation by up to 25% in one study. The chemicals in chocolate increased the skin’s density and provided better skin hydration. You’ll still need sun block, but every bit of protection helps. Chocolate also helps regulate your appetite. Melting a small square of dark chocolate on your tongue 20 minutes before a meal triggers hormones in the brain to signal that you’re full. Subjects in one study were brought to an all-you-can-eat buffet and ate far less after they had a square of dark chocolate. And a square after dinner prevents snacking later. There is a direct correlation between a country’s annual per capita chocolate consumption and the number of Nobel laureates. And for you pregnant moms who are avoiding sushi, soft cheese, wine and practically every other indulgence: Go ahead and eat dark chocolate! In one study dark chocolate reduced stress in pregnant moms and their babies smiled more than babies of non-chocolate eating parents. With so many important nutrients and health benefits, I advise you skip your child’s multivitamin and replace it with a square of dark chocolate every day! Be sure to look for chocolate with more than 70% cocoa for the most benefits. The darker the chocolate, the less sugar it contains and the greater the positive effects. Happy Valentine’s Day!  ...

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4 vaccines you need before you visit the baby

Posted by on 6:34 pm in Babies, Immunizations | 0 comments

4 vaccines you need before you visit the baby

Washing your hands isn’t enough. Anyone who will be in close contact with your new baby needs to be vaccinated to prevent transmitting these deadly infections.  Pertussis Also known as whooping cough, this disease is perhaps the most dangerous and easily preventable. Mom’s doctor will make sure she has the vaccine, and most will recommend the Tdap (Tetanus, Diptheria, and acellular Pertussis) for the other parent. But don’t forget the nanny, grandparents and other children at home. Tdap needs to be updated every 10 years, but some adult doctors will repeat the immunization as early as 2 years from the most recent shot to ensure good protection. And if you can’t remember when you had your last vaccine it is safe to get it again. If you’re getting pushback from family or friends, blame the doctor. Tell your skeptical brother that your obstetrician or pediatrician insisted on protecting your baby (we don’t mind taking the flack). Or show your family the CDC Vaccine Information sheet that says “anyone having close contact with a baby younger than 12 months” needs the vaccine. How deadly is whooping cough? Before the pertussis vaccine was available, 200,000 children were sick and 9,000 died every year. Since the vaccine’s introduction in the 1940s, up to 40,000 people still get whooping cough every year, but we’ve only seen 10-20 deaths a year. Increasing the number of people who are immunized can eliminate pertussis deaths.   Influenza It’s a good idea to get this vaccine every year. You can’t give a baby an illness that you don’t have. And don’t think you can get away with avoiding the baby if you’re sick. You can be quite contagious the day before you start experiencing symptoms.   Zoster This vaccine protects against shingles (a re-activation of the chicken pox virus) that causes painful blisters in adults. An adult with shingles can cause chicken pox in unvaccinated babies. Grandparents over age 60 should have this vaccine. Rumors abound that this live-virus vaccine can be contagious, but you do not need to avoid seeing the baby after the vaccine. There has not been a single case of the disease after close contact with someone recently immunized. But there are plenty of cases of babies getting very sick from chicken pox from contact with a grandparent with shingles.   Pneumococcus The pneumococcal vaccine is recommended for older caregivers and grandparents over age 65. Pneumococcus causes pneumonia, meningitis and blood infection. Babies receive this vaccine starting at 2 months and reach their best immunity when they finish the vaccine series after they turn 1. The best way to protect your newborn is to make sure that they are surrounded by vaccinated people. Asking your friends and family to check their vaccinations before visiting is one of the most important things you can do to protect the baby. As an added benefit, you may prevent your loved ones from serious diseases they weren’t even aware they were at risk...

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Pulling on Ears is Super-Fun According to Kids

Posted by on 1:00 pm in Normal or Not?, Toddlers | 2 comments

Pulling on Ears is Super-Fun According to Kids

Every parent (including myself) has suspected that their child has an ear infection when in fact they don’t. How does such deception occur?  According to my two-year old source, it is very cool to play with your ears. This 21 month-old patient I saw in the ER admitted to me that she discovered that when she puts her fingers in her ears it sounds really cool.  And the sound is even more interesting when she chews!  Thanks to this exceptionally verbal child, I was given a peek into the toddler’s world. My colleague’s 24 month-old patient similarly was thought to be pulling on her ears, but really was just pretending to talk on an invisible phone. Fooled again! I see at least one patient every day with the concern of an ear infection, when in fact their ear drums look fine. So don’t be embarrassed if you bring your child to their pediatrician for an ear-infection false alarm. There are tons of reasons kids pull on their ears. For example, ear-pulling is very popular among 4-6 month-old babies. If they could talk well enough to tell you why they pull on their ears they’d say “I just found these things on my head, aren’t they cool”? Soon enough they’ll grab your ears too: “Oh, hey! You’ve got those things too!” It’s easy to think your child has an ear infection if they can’t speak well enough to tell you their ear hurts. But the bottom line is if your child has a fever or is very fussy you should have them examined. But if they are just pulling on their ears, you can ignore it. Or stick your fingers in your ears and hum. It does sound kinda cool. Wanna learn about other baby fake-outs? Read: It’s not a seizure. Weird movements and other baby tricks. More information about ear-pulling at...

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Need to find a new pediatrician NOW?

Posted by on 4:39 pm in Babies, School-Age Child, Toddlers | 0 comments

Need to find a new pediatrician NOW?

Does the New Year mean a new health insurance company for your family? Or maybe your 14 year-old daughter asked if she could possibly see a female pediatrician. Whatever the reason you are searching for a new health care provider these guidelines may help you find the right practice:   Choose an office located near home/work/daycare Ask other moms or your local pharmacist for recommendations Check out how easy it is to make an appointment: call and see how long you are on hold to speak to the office staff Make sure the office has separate waiting rooms for well and sick visits Look for an office that will grow with your family. They should have male and female clinicians for when your kids are older (and more modest). Size matters: offices with more than one doctor always have coverage, but you may not see the same provider in a large practice. Weekend hours are a huge plus! Also, ask whether the practice has convenient radiology and lab facilities. Ask about how the office approaches alternative treatments: do they stay up-to-date on the latest alternative treatments so they can offer sound advice, or do they ignore them?   The pharmacists all recommended the same practice and I couldn’t be happier with it!                                                                                            – a BabyScience...

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Best gift EVER? Play with your kids

Posted by on 4:13 pm in Babies, School-Age Child, Toddlers | 0 comments

Best gift EVER? Play with your kids

What single thing develops every aspect of a child’s health? A. Giving them LOTS of gifts B. Giving in when your child whines C. Roughhousing The answer is C. Roughhousing seems an easy way to get hurt. But I assure you that I’ve seen hundreds of kids with broken bones from jumping on trampolines and slipping in socks on wood floors; but never a roughhousing injury. What I do see are kids who take life way too seriously, so that every bump in the road (or to the head) seems a catastrophe. Playing with your children, and even wrestling with them is one of the best ways to raise a great kid. The physical benefits of play may be obvious; children develop coordination through physical play. And getting out of breath is healthy for the heart and lungs. But roughhousing also improves social graces, morality, and even intelligence. When children roughhouse with their parents, or other kids, they learn to adapt to unpredictable situations, deal with minor discomfort and see first-hand that failure is temporary. There really is no better way for children to start practicing these important life skills than through rough play. Wrestling with your kids teaches them to read body language, to practice give-and-take and helps them develop self-control. And the spontaneous nature of roughhousing teaches them to be a more flexible thinker – in fact, the unpredictability of roughhousing actually wires connections between neurons that help with being a more flexible thinker in other situations. Some studies have shown that the brain releases a growth chemical that affects memory, logic and language development during rough play. Even very young kids benefit. Go ahead and toss your baby in the air and catch him. It builds trust! Non-contact play like pretending and joking with your kids is also beneficial. The give and take between you and your child when you are playing with toy ponies or action figures teaches creativity. And knowing how to joke is a learned skill that helps kids make friends, be creative and solve problems. So make time to play with your kids, and joke around with them. And if grandma is yelling at the kids to stop wrestling in the living room, tell her it’s okay. They are developing their emotional health and wiring their brains for...

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