Two Peds In a Pod ®
Despite 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 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.
Treatment: 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®
Award-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 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.
More 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
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.
“This is tough, but I can do it!”
“I will find that lost pair of socks!”
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.
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.
Parents often ask how they can tell if their child has the flu or just a common cold. Here’s how:
Colds, even really yucky ones, start out gradually. Think back to your last cold: first your throat felt scratchy or sore, then the next day your nose got stuffy or then started running profusely, then you developed a cough. Sometimes during a cold you get a fever for a day or two. Sometimes you get hoarse and lose your voice. Kids are the same way. They often feel tired because of interrupted sleep from coughing or nasal congestion.
Usually kids still feel well enough to play and attend school with colds, as long as their temperatures stay below 101°F and they are well hydrated and breathing without any difficulty. The average length of a cold is 7-10 days although sometimes it takes two weeks or more for all coughing and nasal congestion to peter out.
Important news flash: the mucus from a cold can be thick, thin, clear, yellow, green, or white, and can change from one to the other, all in the same cold. The color of mucus does NOT tell you if your child needs an antibiotic and will not help you differentiate between a cold and the flu.
The flu, caused by influenza virus, comes on suddenly and makes you feel as if you’ve been hit by a truck. Flu always causes fever of 101°F or higher and some respiratory symptoms such as runny nose, cough, or sore throat (many times, all three at once). Children, more often than adults, sometimes will vomit and have diarrhea along with their respiratory symptoms. Usually the flu causes body aches, headaches, and often the sensation of your eyes burning. The fever usually lasts 5-7 days. All symptoms come on at once; there is nothing gradual about coming down with the flu.
So, if your child has a runny nose and cough, but is drinking well, playing well, sleeping well and does not have a fever and the symptoms have been around for a few days, the illness is unlikely to “turn into the flu.”
Remember: colds = gradual and annoying. Flu = sudden and miserable.
Fortunately, a vaccine against the flu can prevent the misery of the flu. In addition, vaccines against influenza save lives by preventing flu-related complications that can be fatal such as pneumonia, encephalitis (brain infection), and severe dehydration.
Be sure to read our article on ways to prevent colds and flu and our thoughts on over the counter cold medicines. Now excuse us while we go out to buy really yummy smelling hand soap to entice our kids to wash germs off their hands. After that you'll find us cooking up a pot of good old-fashioned chicken soup, just in case…
Julie Kardos, MD and Naline Lai, MD
revised from a Sept 2009 post
©2014 Two Peds in a Pod®
Does it make sense to change your car's tires one at a time? (A vaccine parable)
Ron was puzzled. He had been a mechanic for many years, and had known Ms. McCarthy through two previous vehicles. But what could he say to a request like this?
“I don’t see why you wouldn’t want to do it this way. What’s the harm?” The mother of two seemed sincere and earnest. Ron knew she wanted to take good care of her car, and the kids who rode with her every day.
“It’s just not done this way. You need four new tires, let’s just replace them all at once.” Ron stuck his finger into a well-worn tread, showing his customer how shallow the grooves had become.
“But isn’t that too hard on the car? I mean, that seems like a lot to do, all at once. Let’s space them out, one tire every two weeks. I’ll just come back.”
Ron scratched his head. Cars: that’s what he knew. Light trucks, electrical systems, AC systems too. He had even studied and learned how to fix and maintain foreign cars, and hybrids, and the newer electric cars—more computer than car, really. If it rolled on wheels, Ron knew how to fix it. It was his job.
“No, you see, it’s a safety thing. A tire could blow—see how bare these are? And you won’t get good steering on these, which is also unsafe.” Safety, thought Ron, that will convince her. He took safety very seriously, and imagined that this nice lady with the kids would put safety first. “Besides, cars are designed to have their tires replaced. Tires wear out, so the car was designed to safely go up on this lift so we can replace the tires. No problem!”
“But how do I know it’s safe? I read on the internet that replacing all of the tires at once can stress out the suspension, and lead to premature angulation of the mesmerglobber, and on Oprah I saw this actress and she said three months after she had all four tires replaced, her transmission broke!” Ms. McCarthy started to sob.
“OK, look, it’s ok, look, um…” Ron looked for one of his less-greasy rags to offer as a handkerchief.
“Waiting a few weeks between each tire won’t really hurt, will it?”
“Probably it’ll be OK, I guess. But tires are an important part of your safety system, like good brakes and seat belts and air bags.”
“Oh, I make sure we never wear seat belts! I heard that once a guy was wearing his seat belt, and he went into a lake, and he couldn’t get it off, and he drowned! I’m not wearing anything that isn’t 100% safe!”
Ron felt lost. “Look, nothing’s 100% safe! A seat belt might occasionally make an accident worse, but 99 times out of 100 it’s much better to wear your belt.”
“I can’t risk that 1 out of 100 chance!”
The mechanic tried another avenue. “But it’s the law, you have to wear your seat belt, and your kids need to be in the right kind of car safety seats too.”
Ms. McCarthy’s eyes grew dark. “Yeah, the law. That’s just it—the government is forcing these seat belts and new tires on us, because the government is controlled by the car manufacturers and the insurance industry! If seat belts really saved lives would there have to be a law about it? That’s why I disconnected my front brakes.”
“The front brakes are just a booster anyway. If the brakes work as well as they’re supposed to, why do we need a booster? It’s just more money, it’s all about the money!”
Ron had been fixing cars for years, and he owned his own shop. He made pretty good money, but selling new tires and simple brake maintenance jobs weren’t really profitable. He did those things to keep cars running well, and to prevent bigger problems later. In fact, if he let more rotors go bad and transmissions fail, he’s probably make even more money from the expensive jobs needed to fix them.
“Tell you what—I’ll fix up your brakes for free, just my cost for parts, OK? Really, it’s not safe for you and the other drivers if you don’t have good brakes and tires.”
“What do you mean, the other drivers? They have their own brakes! That’s exactly what this web site I found was explaining, that you’d come up with all of these dumb reasons to take more of my money and hurt my car! You’re not really interested in keeping my car healthy, are you?”
Roy Benaroch, MD
©2014 The Pediatric Insider
In practice near Atlanta, Georgia, Dr. Roy Benaroch is an assistant clinical professor of pediatrics at Emory University, a father of three, and the author of The Guide to Getting the Best Health Care for your Child and Solving Health and Behavioral Problems from Birth through Preschool. We enjoy his blog The Pediatric Insider and also enjoy his posts on Web MD.
When I was a child, a special treat was to have a sleepover at my grandparents’ house. My grandfather was an early riser and to this day I can still hear him roaring “When Pop-Pop’s up, EVERYBODY’S UP!” as I awoke to the aroma of my grandmother’s hot breakfast.
As all parents know, when BABY’s up, EVERYBODY’s up. What‘s the secret to good sleep? It’s all in the bedtime routine.
Parents should establish a good bedtime routine starting when their children are babies and continue to enforce the routine throughout their child’s life. Just as prevention of heart disease begins with establishing healthy eating and exercise habits when your children are young, prevention of adult insomnia starts with establishing a healthy bedtime routine.
Here are ways to help your kids sleep from infancy through young adulthood: Start with our most commented upon podcast: how to help your baby to sleep through the night. Parents of preschool-aged kids will appreciate"sleep invaders": nightmares, night terrors, and other monsters under the bed . Even if you don't have a teen, plug in our podcast on the Tired Teen .
Now that winter break is a memory, it’s time to buckle down and rid your child of the jet lag that persists from the “vacation sleep schedule.” For more ways to do this, refer to Wakeup sleepyhead its time for school.
May you have a good night this and every night!
Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®
"A baby in my child's daycare was hospitalized for RSV," panicked parents said to us the other day. But RSV (Respiratory Syncytial Virus) is not just a daycare phenomenon, nor does the virus usually result in a hospitalization.
Right now, RSV season is in full swing everywhere in North America and most of Europe. RSV is one of the most common causes of the common cold. Most of us have had RSV many times. RSV tends to be particularly tough on babies and toddlers because the worst episode of RSV is usually the first time you catch the germ.
RSV glues to cells from the nose down to the lungs, causing breathing difficulties. The boogies from RSV tend to be very thick and kids’ lungs goo-up, sometimes causing a wheeze (like that of an asthmatic). The cough from RSV can easily last a month. The disease can be very dangerous in young infants, babies born earlier than 38 weeks (premature), and babies with chronic lung and heart disease, because of their inability to clear the gunk that RSV produces in their airways.
Like all cold viruses, no medication kills RSV, so the germ needs to "run its course." The third through the fifth day of the illness are generally the peak days for symptoms. Here are ways to help your ill child:
Just like you when you have a cold, your child may lose her appetite because she has a belly full of post nasal drip and overall feels lousy. Do not fret over her lack of food intake, but do hydrate her well. Breast milk or formula, because of their nutrition, is the best choice for hydrating infants with a cold. For older children, encourage water, but if your child is not eating, make sure there is salt and sugar in her fluids to keep her going. Don't be afraid to give your child milk when she has a cold. Good old-fashioned chicken broth is another great source of hydration.
For kids under two years of age, avoid the use of smelly chest rubs containing menthol or camphor (e.g. Vicks Vapor Rub) and in older children, don't introduce a rub for the first time when your child is ill. When he is sick is a terrible time to discover that a chest rub sends your child into an allergic coughing fit or to discover that he hates the smell.
How do you know if you need to take your child to the doctor? Read our prior post to help you decide. Watch for signs of difficulty breathing: rapid breathing, ribs sticking out each time your child breathes in (click here for our video example of this), and/or belly moving in and out with each breath, and grunting. A child who is short of breath will be unable to breathe and drink at the same time. A child who is inconsolable with RSV might have additional infections such as pneumonia, ear infections or sinus infections.
Since our immune systems do not make a long-lasting antibody response to RSV, our bodies do not “remember” RSV, and we can catch it again and again. This makes the creation of an RSV vaccine difficult, because vaccines work by boosting our natural defense systems. Vaccines cannot boost an immune response that does not occur naturally.
Take heart, even if your child gets RSV every winter, each episode will usually be less severe than the last. Just look at us pediatricians, we have contracted it so many times, we may sneeze only once before the germ retreats.
Hopefully your family escapes RSV this year!
Naline Lai, MD and Julie Kardos, MD
©2014 Two Peds in a Pod®
We welcome our guest blogger, Virginia Li, who addresses questions surrounding language delay.
Naline Lai, MD and Julie Kardos, MD
My 18-month old isn’t talking yet. Should I be worried? When is the right time to seek help?
This situation troubles both new and seasoned parents. Children generally speak their first words around their first birthdays, and string words together by the time they turn two. But what should you do if your child isn’t quite reaching these milestones? While well-intentioned friends and family might tell you not to worry, it’s never too early to voice your concerns and seek a professional evaluation.
Take note of your child’s progress in other areas of language development by asking yourself these questions:
Children who are behind in any of these areas are at risk for persistent language delays. On the other hand, if you’re answering yes to all of these questions, there is a good chance that your child is a “late talker” who is delayed in spoken language but otherwise developing normally.
While 70 to 80 percent of late talkers will soon catch up to their peers, the ones who don’t are at risk for future setbacks in school and will face further frustrations from being unable to express their needs and wants. It is hard to predict which children will outgrow their delay, and the “wait and see” method only postpones treatment for those children with true language disorders.
In any case, if your child is not reaching speech and language milestones, trust your instincts, talk to a health care provider, and schedule a screening with a licensed speech-language pathologist. Children in the United States under 3 are eligible for a free evaluation through their local Early Intervention program. The earlier a language issue is identified and treated, the better chance your child has of improving with speech therapy. And if it turns out therapy won’t be necessary, you can relax sooner rather than later.
Meanwhile, there’s plenty you can do to support those budding language skills at home. Talk to your child throughout the day, pairing words with familiar activities and objects. Point out and describe pictures while you read together, and always encourage your child’s use of sounds and gestures. Giving your child lots of opportunities to communicate with you each day will have benefits that last a lifetime.
©2013 Two Peds in a Pod®
Virginia Li is a communications associate at Pathways.org, a national not-for-profit organization dedicated to providing free resources and information for families and health professionals on children’s motor, sensory, and communication development. The Pathways.org Baby Growth and Development Chart has been recognized and endorsed by the American Academy of Pediatrics and the National Association of Pediatric Nurse Practitioners, and additional educational materials are available online to download, copy, and share freely. For more information, please visit Pathways.org, email email@example.com, or call our toll-free parent-answered hotline at 1-800-955-CHILD (2445).