Mommy, my friend dumped me

friend dumping

Dr. Kardos says she still remembers when her friend dumped her back in 7th grade. Guest blogging for Two Peds in a Pod, is child and adolescent counselor Dina Ricciardi with advice to help walk your kids through the experience.

It can happen very quickly, and often without explanation: your son or daughter gets “dumped” by his or her best friend or group of friends. One minute they are inseparable; the next, your child is left out and being ignored, and is completely bewildered as to why or what happened. Welcome to cliques, a typical part of the tween and adolescent landscape. While enduring these shifts in peer relationships can be extremely painful for both of you, there are some things you can do to help your child emerge safely on the other side of the experience.

Do empathize. Make sure your child knows that you understand why they are upset, and that you would be too.

Do take your child’s grief seriously. We adults know that friendships change and shift over time, and that we all survive. However, your child may see this as the worst thing that has ever happened to her, and she may be right.

Don’t downplay your child’s pain. It’s normal for him to feel hurt and rejected, and to question his own actions and the authenticity of the friendship.

Do keep an eye out for bullying or name-calling. If the situation seems to require it, enlist the support of school personnel to monitor things under their watch.

Don’t disparage or belittle the offending friend(s). It might feel good in the moment, but it can set the wrong example and make it difficult for your child to reconcile if the opportunity presents itself.

As a parent, it is hard to watch your child suffer. Our instinct is often to try to fix the situation, which we need to resist. Part of adolescence is allowing our children to develop their own identity and to learn relationship skills. Through their peer relationships, they learn sophisticated concepts such as trust, loyalty, empathy, compassion, and tolerance. They also start to encounter difficult emotions such as jealousy. The most important thing we can do as parents is be available to help our children sort out their feelings and to give them a different perspective. We can also help them discover that while peers are important, they can be strong and fine on their own, and do not need other people to give them their identity. This helps them value themselves as individuals. In the process, maybe we parents learn something new also. Buckle in; it can be a bumpy ride!

Dina Ricciardi, LSW, ACSW

Dina Ricciardi is a psychotherapist in private practice treating children, adolescents, and adults in Doylestown, PA. She specializes in eating disorders and pediatric and adult anxiety, and is also trained in Sandtray Therapy. Ricciardi is a Licensed Social Worker and a member of the Academy of Certified Social Workers. She can be reached at

Dr. Lai adds: Help your kids cultivate their interests. As they do their interests, they will look around and find that  those kids will become their friends. The hardest part about adolescence is figuring out your own interests, and not those of your peers.

2015 Two Peds in a Pod®


Ouch! Bee and wasp stings

Ouch! (photo courtesy of

(photo courtesy of


Ouch! Stung on the scalp.

Ouch! Stung on the hand.

Ouch! Stung on the leg.

Ouch! Ouch! Stung TWICE on the lips.

Those nasty, nasty wasps. During the hot days of August, they become more and more territorial and attack anything near their nests. Today, in my yard, wasps mercilessly chased and attacked a fourth grader named Dan.

As everyone knows, you’d rather have something happen to yourself than have something negative happen to a child who is under your watch. As I had rolled out the Slip and Slide, I was relieved not to see any wasps hovering above nests buried in the lawn. I was also falsely reassured by the fact that our lawn had been recently mowed. I reasoned that anything lurking would have already attacked a lawn mower. Unfortunately, I failed to see the basketball sized grey wasp nest dangling insidiously above our heads in a tree. So, when a wayward ball shook the tree, the wasps found Dan.

What will you do in the same situation?

Assess the airway– signs of impending airway compromise include hoarseness, wheezing (whistle like sounds on inhalation or expiration), difficulty swallowing, and inability to talk. Ask if the child feels swelling, itchiness or burning (like hot peppers) in his or her mouth/throat. Watch for labored breathing. If you see the child’s ribs jut out with each breath, the child is struggling to pull air into his/her body. If you have Epinephrine (Epi-Pen or Auvi-Q) inject immediately- if you have to, you can inject through clothing. Call 911 immediately.

Calm the panic– being chased by a wasp is frightening and the child is more agitated over the disruption to his/her sense of security than over the pain of the sting. Use pain control /self calming techniques such as having the child breath slowly in through the nose and out through the mouth. Distract the child by having them “squeeze out” the pain out by squeezing your hand.

If the child was stung by a honey bee, if seen, scrape the stinger out with your fingernail or a credit card. Removal of the stinger prevents any venom left in the stinger from entering the site. Some feel scraping, rather than squeezing or pulling a stinger with tweezers lessen the amount of poison excreted. However, one study suggests otherwise. Wasps do not leave their stingers behind. Hence the reason they can sting multiple times. (Confused about the difference between wasps, hornets and yellow jackets? Wasps are members of the family Vespidae, which includes yellow jackets, hornets and paper wasps.) Relieve pain by administering Ibuprofen (trade names Motrin or Advil) or Acetaminophen (trade name Tylenol).

As you would with any break in the skin, to prevent infection, wash the affected areas with mild soap and water.

Decrease the swelling and itch. Histamine produces redness, swelling and itch. Counter any histamine release with an oral antihistamine such as Diphenhydramine (trade name Benadryl). Any antihistamine will be helpful, but generally the older ones like Diphenhydramine tend to work the best in these instances. Just be aware that sleepiness is a common side effect.

To decrease overall swelling elevate the affected area.

Soothe the area by spreading on calamine lotion or by applying a topical steroid like hydrocortisone 1%.

And don’t forget, ice, ice and more ice. Fifteen minutes of indirect ice (wrap in a towel, for example) on and fifteen minutes off helps relieve both pain and itching.

Even if the child’s airway is okay, if the child is particularly swollen, or has numerous bites, a pediatrician may elect to add oral steroids to a child’s treatment

It is almost midnight as I write this blog post. Now that I know all of my kids are safely tucked in their beds, and I know that Dan is fine, I turn my mind to one final matter: Wasps beware – I know that at night you return to your nest. My husband is going outside now with a can of insecticide. Never, never mess with the mother bear…at least on my watch.


Naline Lai, MD with Julie Kardos, MD

2015, updated from 2009,  Two Peds in a Pod®


Does my baby have GERD or spit-up?

Baby spew doesn't always require reflux medications

Baby spew doesn’t always require reflux medications

In our office, two-month-old Max smiles ear to ear, naked except for a diaper and a bib. His worried mom asks me about the large amounts of spit up Max spews forth daily. “He spits up after every feeding. It seems like everything he eats just comes back up. It even comes out of his nose!” she says. Max gained the expected amount of  weight, an average of one ounce per day, since his one-month check-up. He breastfeeds well and accepts an occasional bottle from his dad. Even after spitting up and drenching  his bib and everything around him, he remains comfortable and cheerful. He is well hydrated, urinates often, and poops normally.

In short, Max is a  “happy spitter”  Other than creating piles of laundry, he acts like any healthy baby.

Contrast this to two-month-old “Mona.” She also spits up frequently. Sometimes it’s right after a feed and sometimes an hour later. She seems hungry, yet she’ll cry, arch her back, and pull off the nipple while feeding. She cries before and after spitting up. Her weight gain is not so good— she averaged one-half ounce of gain per day since her one-month visit. She seems more comfortable when upright and more cranky lying down.
Mona is not a “happy spitter.”
Last story and then the lesson:
“Chloe” is a two-month-old baby who cries. Often. Loudly. Although most of the wailing occurs in the late afternoon and early evening, she also cries other times. She eats great and in fact, seems very happy while she feeds. She smiles at her parents mainly in the morning. She  also smiles at her ceiling fan and the desk lamp. Movement calms her and her parents worry that she spends excessive time rocking in their arms or in her swing. Her cries pierce through walls and make her parents feel helpless. She often spits up during crying jags, and erupts with gas. She gained weight well since her last visit.
Here’s the lesson:


All babies cry. All babies pee and poop. All babies sleep (at times). AND: all babies spit up. The muscle in the lower esophagus that keeps our food and drink down in our stomachs and prevents it from sloshing upwards, called the “lower esophageal sphincter,” is loose in all babies. The muscle naturally tightens up and becomes more effective over the first year of life, which is why younger babies tend to spit up more than older babies.
Max has GER (gastroesophageal reflux) , Chloe has GER/ colic and Mona has GERD (gastroesophageal reflux disease). Max and Chloe have physiologic, or normal, reflux. Mona has reflux that interferes with her mood, her feedings, and her growth.

GER, GERD and colic (excessive crying in an otherwise healthy baby) improve by three to four months of age. If your baby cries often (enough to make you cry as well) then you should see your baby’s pediatrician to help determine the cause. It helps, before your visit, to think about when the crying occurs (with feedings? At certain times of the  day?), what soothes the crying (feeding? walking/rocking?) and other symptoms that accompany the crying such as spitting up, fever, or coughing. Keeping a three day diary for trends can help pinpoint a diagnosis.  We worry a lot when the babies are not “spitting up” but are actually “vomiting.” Spit blobs onto the ground. Vomit shoots to the ground. Vomit which is yellow, is accompanied by a hard stomach, is painful, is forceful (think Exorcist), or enough to cause dehydration, all may be signs of blockage in the belly such as pyloric stenosis or vovulus. Seek medical attention immediately.

The treatment for Max, the happy spitter with GER? Lots of bibs for baby and extra shirts for his parents.

Treatment for Chloe, the crier? Patience and tincture of time. You can’t spoil a young baby, so hold, rock and sway with her to keep her calm. Enlist a baby sitter or grandparents to help.

The treatment for Mona, the baby with GERD? Small, frequent feedings to prevent overload of her stomach, adding cereal any bottle feeds to help thicken the milk and weigh down the liquid, thus preventing some of the spit up (ask your doctor if this is appropriate for your baby), holding her upright after feeds for 15-20 minutes, and inclining her crib by putting a thick book under each of 2 crib legs to help her upper body stay higher than her feet which helps her stomach to empty sooner. To prevent Sudden Infant death Syndrome, she should still be placed on her back to sleep.  Sometimes, pediatricians prescribe medication that decreases the acid content of the stomach to help relieve the pain of stomach contents refluxing into the esophagus.

Treatment for parents? Knowing that someday your baby will grow up, no longer need a bib, and probably have a baby who spits up too.

Julie Kardos, MD with Naline Lai, MD
2015, 2012 Two Peds in a Pod®


Marijuana: Hashing out Fact from Fiction

marijuanaWith some states now legalizing pot for recreational use, drug education for kids has never been more critical. The American Academy of Pediatrics released a policy statement this past year opposing legalization because of its potential harm to children, teens, and young adults. We welcome Dr. Shannon Murphy who dispels myths surrounding marijuana. – Drs. Kardos and Lai

Why is pot so different today than 30 years ago? Pot is 5 times stronger than the 1980’s.

THC, the psychoactive ingredient in the plant, previously hovered around 3%. Now the average THC level is closer to 16%. As of this year, some plants have been tested with levels reaching between 20-30% THC. There is a new form of pot known as hash oil that is almost pure THC with levels around 90%

I heard pot was not addictive. Is that true?  Pot is addictive.

In fact, the younger you are when you start using pot, the more likely you are to get addicted.10% of adults and 17% of young adults who try pot will become addicted to it. If one chooses to use on a daily or near daily basis, the addiction rate climbs to 25-50%.

How long does pot stay in your body? Pot is different from many other drugs because it can stay in your body for days after use.

In addition, the more you use pot, the longer it stays in your body. For regular users, it can remain in your body for several weeks. As a result, there is a sub acute impairment that persists with many users once the initial “high” has worn off.

When used, pot is distributed throughout one’s body. These areas include the brain and spinal cord, heart, lungs, muscles, and fatty tissues. In fact, it is stored in fatty tissue. If one is pregnant and one uses pot, not only will the mom be affected by pot, but so will her unborn child. It also concentrates in breast milk. People who use marijuana should NOT breastfeed their baby.

Isn’t pot safe to use? I heard it was safer than other drugs. Pot is harmful to the brain, heart, and lungs.

Regular use of marijuana, particularly at a young age, can create biochemical and structural changes to the brain. Some of these changes are not reversible. Moreover, the effects are dose dependent. The more you use, the more likely to affect change.

Marijuana causes cognitive impairment. It harms learning, memory, attention, and critical decision-making. A recent study showed that regular use of marijuana at a young age causes a permanent decrease in IQ of up to 8 points.

Marijuana is linked to the development of mental health issues including anxiety, depression, and psychosis. Research has shown that regular daily to weekend use of pot increased one’s risk of psychosis 3-5 times that of the general population. Sadly, we are seeing this played out in states like Colorado where people have died from psychosis related events.

The American Lung Association has reported that pot has more cancer causing agents than tobacco smoke. Like tobacco, it causes chronic cough, wheeze, phlegm production, and frequent infections.

Marijuana has cardiac effects as well. Temporal links have been found between using pot and arrhythmias, stroke, and other major cardiac events.

What are “edibles”?

In 2014, with the legalization of pot in Colorado, the marijuana industry began selling food products with infused THC. These products, which include candy, cereal, pop tarts, and sodas, are indistinguishable from regular food.

In fact, exposure of kids to marijuana increased by 200% over this last year because of these products. These accidental poisonings were secondary to exposure of kids to edibles typically in their home. Many kids ended up in the ER, some with serious complications like seizures and difficulty breathing.

What does “dabbing” mean?

Dabbing is inhaling vapors from heating a concentrated form of pot. Dabs, which are also known as BHO (butane hash oil), “budder”, “honeycomb”, or “earwax” contain much higher concentrates of THC, usually upwards of 90%. Dabs are much stronger than a single joint and the high is administered all at once.

How does smoking pot affect driving?

Driving high is dangerous to the driver, others in the vehicle, and people sharing the road. In fact, marijuana is the number one illicit drug found in the blood stream of drivers involved in fatal car accidents.

Pot impairs skills needed to drive safely. It negatively impacts alertness, coordination, and reaction time.

Pot and alcohol don’t mix. Using both drugs at the same time has been shown to increase the THC level in one’s blood stream. This makes for a deadly combination on the road.

Is it okay to use pot while pregnant?

It is NOT okay to use pot while pregnant. As mom gets high and feels the effects of the drug, so does the unborn child.

Studies have shown that children exposed to marijuana in utero have lower scores on visual and motor coordination as well as lower scores on visual analysis and problem solving. In utero exposure is also associated with decreased attention span and behavioral problems. Finally, studies have shown that teens are more likely to be marijuana users if their mom used while pregnant.

What if my teen says that since pot isn’t a big deal anymore and many of their friends are using it?

Now more than ever, it is incredibly important to speak clearly regarding the risks of pot use. Many teens see legal as meaning safe, so we are entering a critical time when it comes to our kids and marijuana use. Here are a few suggestions when it comes to talking to your kids about drug use in general.

Talk early and often. This should not be a one-time conversation.

Make sure your child knows your rules on drug use and set clear consequences if these rules are broken. Role-play real life situations so kids can know how to respond when confronted with scenarios that may involve drugs.Base education about pot and other drugs on facts.

Check out the National Institute of Drug Abuse website for up to date information. To learn more visit .


Shannon Murphy, MD, FAAP

Dr. Murphy is a board certified general pediatrician who currently serves on the American Academy of Pediatrics Practice Advisory Committee for Adolescent Substance Use. She heads a non-profit coalition, SAM Alabama, whose goal is to educate parents and kids on the public health issues and safety concerns associated with marijuana.

2015 Two Peds in a Pod®


Tender red dots- spotted in the summer

red spots on toes or fingers


What is it? Pictured below are the toes of one of my best friend’s toddler. She is happy, has no fever, and plays nearly everyday in the neighborhood pool. The round shiny pink bumps and dots on her toes appeared yesterday morning and haven’t changed much in a day. They don’t seem to bother her very much… answer below.

It’s Swimming pool pulpitis- a fancy word for a reaction of the pulp (the meaty tip) of fingers or toes. Mostly seen on the finger tips, the pulpitis is usually caused by irritation of the fingers by the rough side of the swimming pool as kids pull themselves in and out. Kids are sometimes annoyed by the dots, but they go away on their own as soon as the kids decide to use the ladder. In this case, this little swimmer irritated her toes, not her fingers, while “monkey walking” along the side of the swimming pool in the water.

Naline Lai, MD with Julie Kardos, MD

©2011,2013, 2015 Two Peds in a Pod®


It’s no laughing matter: another tween game in town

A snippet from a quick search on youtube for “true laugh”

There’s another game in town called “Find your true laugh,” but it is no laughing matter. One kid lies down and another kid either sits on the recumbent kid’s chest or pushes hard on the recumbent kid’s chest with his hands (think CPR chest compressions). As the recumbent kid starts to laugh, his laugh purportedly changes. In this case, in addition to compromising a kid’s airway, the force of another person pushing hard on the chest can lead to rib fractures and, as one of our patients discovered painfully, even a fractured sternum. Rib fractures are acceptable as a side effect of CPR but are not an acceptable side effect of a game.

Tweens in particular seem vulnerable to trying the “Hey, this looks fun, let’s try it, ” airway blocking games. Explain to your tween that anything that can possibly interfere with breathing can hurt him.

Dr. Kardos tells tween patients:

Your nose is for breathing air. NOT for breathing fumes from glue or markers in order to get high. Called “huffing,” this can lead to sudden fatal heart arrhythmias.

Your mouth is also for breathing. Tweens can all recite the dangers of smoking cigarettes, but they can find it amusing to breathe in crushed candy, which can irritate lungs, or to try to swallow a spoonful of cinnamon while taking the “cinnamon challenge.”The coughing and vomiting that result from this challenge are evidence of its potential danger.

Air moves through your neck to reach your lungs. Tweens play the “choking game” by strangling themselves in order to get a brief high before passing out. Tell your kids to never tie or loop anything around their necks, for obvious reasons. Kids have died playing this game.

Your lungs are in your chest. To get back to the true laugh game: this game involves smushing the chest. Point out that lungs can’t expand to hold air if someone is crushing your chest.

Earlier in this summer, Dr Lai  turned  around at a party to find a pile of tween girls on the rug giggling and trying to push in each other’s rib cages. After explaining to the girls why one should never block her airway, one of the girls  ferevently nodded and said , “I see, like the bologna game?”

“What bologna game?” asked Dr. Lai

” The one where you take a piece of bologna, cover your mouth and inhale it in.”

“Yes, like the bologna game, ” said Lai with a sigh.

What will they think of next?


Julie Kardos, MD with Naline Lai, MD

©2015 Two Peds in a Pod®


The gassy baby

gassy babyGas is another topic most people don’t think much about until they have a newborn. Then suddenly gas becomes a huge source of parental distress, even though parents are not the ones with the gas. It’s the poor newborn baby who suffers, and as all parents know, our children’s suffering becomes OUR suffering.

So what to do?

First, I reassure you that ALL young babies are gassy. Yes, all. But some newborns are not merely fussy because of their gas. Some become fussy, ball up, grunt, turn red, wake up from a sound sleep, and scream because of their gas. In other words, some babies really CARE about their gas.
Remember, newborns spend nine months as a fetus developing in fluid, and have no experience with air until they take their first breath. Then they cry and swallow some air. Then they feed and swallow some air. Then they cry and swallow some more air. Eventually, some of the air comes up as a burp. To summarize: Living in Air=Gas Production.
Gas expelled from below comes from a different source. As babies drink formula or breast milk, some liquid in the intestines remains undigested, and the normal gut bacteria “eat” the food. The bacteria produce gas as a byproduct of  their eating. Thus: a fart is produced.
The gas wants to escape, but young babies are not very good at getting out the gas. Newborns produce thunderous burps and expulsions out the other end. I still remember my bleary-eyed husband and I sitting on the couch with our firstborn. On hearing a loud eruption, we looked at each other and asked simultaneously, “Was that YOU?” Then looked at our son and asked “Was that HIM?”
Gas is a part of life. If your infant is feeding well, gaining weight adequately, passing soft mushy stools that are green, yellow, or brown but NOT bloody, white, or black (for more about poop, see our post The Scoop on Poop), then the grunting, straining, turning red, and crying with gas is harmless and does not imply that your baby has a belly problem or a formula intolerance. However, it’s hard to see your infant uncomfortable.
Here’s what to do if your young baby is bothered by gas:
  • Start feedings before your infant cries a long time from hunger. When infants cry from hunger, they swallow air. When a frantically hungry baby starts to feed, they will gulp quickly and swallow more air than usual. If your infant is wide awake crying and it’s been at least one or two hours from the last feeding, try to quickly start another feeding.
  •  Burp frequently. If you are breastfeeding, watch the clock, breastfeed for five minutes, change to the other breast. As you change positions, hold her upright in attempt to elicit a burp, then feed for five more minutes on the second breast. Then hold your baby upright and try for a slightly longer burping session, and go return her to the first breast for at least five minutes, then back to the second breast if she still appears hungry. Now if she falls asleep nursing, she has had more milk from both breasts and some opportunities to burp before falling asleep.
  •  If you are bottle feeding, experiment with different nipples and bottle shapes (different ones work better for different babies) to see which one allows your infant to feed without gulping too quickly and without sputtering. Try to feed your baby as upright as possible.
  • Hold your infant upright for a few minutes after feedings to allow for extra burps. If a burp seems stuck, lay her back down on her back for a minute and then bring her upright and try again.
  •  To help expel gas from below, lay her on her back and pedal her legs with your hands. When awake, give her plenty of tummy time. Unlike you, a baby can not change position easily and may need a little help moving the gas out of their system.
  • If your infant is AWAKE after a feeding, place her prone (on her belly) after a feeding. Babies can burp AND pass gas easier in this position. PUT HER ONTO HER BACK if she starts to fall asleep or if you are walking away from her because she might fall asleep before you return to her. Remember, all infants should SLEEP ON THEIR BACKS unless your infant has a specific medical condition that causes your pediatrician to advise a different sleep position.
  • Parents often ask if changing the breast feeding mother’s diet or trying formula changes will help decrease the baby’s discomfort from gas. There is not absolute correlation between a certain food in the maternal diet and the production of gas in a baby. However, a nursing mom may find a particular food “gas inducing.”  Remember that a nursing mom needs nutrients from a variety of foods to make healthy breast milk so be careful how much you restrict. Try any formula change for a week at a time and if there is no effect on gas, just go back to the original formula.
  • Do gas drops help? For flatulence, if  you find that the standard, FDA approved simethecone drops (e.g. Mylicon Drops) help, then you can use them as the label specifies. If they do not help, then stop using them.
The good news? The discomfort from gas will pass. Gas discomfort typically peaks at six weeks and improves immensely by three months. At that point, even the fussiest babies tend to mellow. The next time your child’s gas will cause you distress won’t be until he becomes a preschooler and tells “fart jokes” at the dinner table in front of Grandma. Now THAT is a gas.


Julie Kardos, MD with Naline Lai, MD

©2011, 2015 Two Peds in a Pod®


The natural medicine cabinet in your kitchen

home remedies

You may not think of your kitchen as a convenient pharmacy, but parents used common kitchen items successfully to treat various maladies long before CVS and Walgreens were invented. 

Crisco– May not be healthy to eat, but smeared on skin, it’s an old fashioned but effective treatment for eczema or dry skin.

Oatmeal– Crush and put into the end of a hosiery sock. Float the sock in the bathtub for a natural way to moisturize skin.

Olive Oil

  • Put a couple drops into the ear three times a day to loosen ear wax (don’t put in if your child has a hole in their ear drum eg. myringotomy tubes).
  • For cradle cap, rub into your baby’s scalp and use your fingernail or a soft brush to loosen the greasy flakes.
  • Also use to kill lice.  Work the oil through the scalp, tuck hair into a shower cap and wash off in the morning. Although studies are unclear on how well this method works on lice, it certainly is worth a try.

White vinegar-If swimmer’s ear is suspected, mix rubbing alcohol one to one with vinegar and drop a couple drops in the ear to stop the swimmer’s ear from progressing (don’t put in if your child has a hole in their ear drum eg. myringotomy tubes).

Ginger– Boil ginger to make a tea to take the edge off nausea

Honey– Shown to soothe coughs-give a teaspoon of dark (buckwheat, for example) honey three times a day. However, NEVER give honey to a child who is younger than one year of age because it may cause infant botulism

Lemon– An old singer’s trick—combine lemon juice with honey in tea to alleviate hoarseness

Salt– Mixed into lukewarm water, gargling with salt water will help ease sore throat pain

Baking soda:

  • Mix with water to make a paste to help soothe itchy skin, from maladies such as poison ivy .
  • Can also be mixed with water to make toothpaste if you run out of your usual minty whitener.
  • Another use of baking soda: one part baking soda with 4 parts corn starch makes a natural underarm deodorant.

Sugar: Mix sugar into weak tea (or your ginger tea from above) and give small amounts frequently to soothe your older child’s nausea and help rehydrate after vomiting.

Ice: Ice not only decreases swelling when applied to injuries, it can also be used to combat the itch of bug bites and poison ivy.

Kitchen sink: This is an excellent place to wash any cut, scrape, or bleeding wound under running water with soap. Immediately after a burn, rinse the burned skin under cold water for several minutes to limit the extent of the heat injury. Contrary to popular lore, DO NOT put butter on a burn. You may, however, put butter on your toast. In small amounts.


Naline Lai, MD and Julie Kardos, MD

©2015 Two Peds in a Pod®, revised from 2011


How to remove ticks

how to remove a tick

ick, a tick

I was grumpy all morning after realizing that my dog was out of tick repellent. Really grumpy. After all, on the East Coast of the United States, we are seeing ticks galore. All month long, parents have been bringing us presents such as the one pictured here. Yes, that is a tick you see nicely trapped in tape. Sometimes when parents bring us a tick, it’s still clinging to the child and they ask us to remove it. To save you a trip, here is a quick refresher on how to pluck the bugs off:

1. Take a deep breath and pretend that it’s just a speck of lint—not an ugly critter with a bloated stomach and writhing legs.

2. Use tweezers and firmly clasp the head. If the tick is tiny, you will end up grabbing the entire body.

3. Pull the tick straight up and off. Hint: Press down on the skin on either side of the tick so that the skin doesn’t pull up when you pull the tick off. This lessens any pinching sensation your child may feel.
Don’t try to burn a tick off—you’ll just burn your child’s skin. Suffocation techniques such as covering a tick with petroleum jelly (Vaseline) or nail polish are not very effective, allow the tick to stay on for a longer period of time, and may cause the tick to become slippery and difficult to grasp.

After removal, if the tick’s head is left behind, don’t go digging for it. Just like a tiny splinter, your skin will naturally try to expel it. Soaking the area in warm water will help the process along. Don’t worry about disease transmission: there is not any disease stuck in a head.

After a tick is off, wash the skin as you would any cut to prevent a skin infection. A small, minimally tender, pimple like bump is a common reaction which may be present for a few days. This is an irritation response of the skin. If the tick was a deer tick (typically the size of a poppy or sesame seed), watch for the rash of Lyme disease that appears as a flat, pink, round patch about a week later. The patch may clear in the center and grows to at least two and a-half inches across.

My daughter told me a girl at her lunch table had a tick on her the other day. None of the kids could pick it off and the girl sat screaming until the lunch lady came over to help her. May be you’ll be the lucky adult called over to help next time.

Just remember…pretend it’s a speck of lint.

Naline Lai, MD with Julie Kardos, MD
©2013, 2015 Two Peds in a Pod®


Happy Birthday! Two Peds in a Pod turns Six!

Caroll Spinney a.k.a. Bird BIrd and Oscar the Grouch addresses the American Academy of Pediatrics National Conference in 2011 (Dr. Lai’s iPhone 3 or 4 captured this “high” quality photo)

Today, as Two Peds in a Pod turns six years old, we think about our favorite six-year-old, Big Bird.

A friend sent me this link to an interview with Caroll Spinney on NPR. Now 81 years old, Caroll Spinney has played Big Bird on Sesame Street since the show first aired in 1969. According to the puppeteer, Big Bird has always been six years old.

Spinney wanted Big Bird to forever bubble over with the curiousity and enthusiasm for  learning which characterize a six year old’s development. In kindergarten or first grade, a six-year-old rapidly gains new skills. They learn how to read at this age if not earlier.

They like to belong to a group and feel included. Sit in the back of a first grade classroom and listen to the class have a conversation. The teacher may ask the kids, “Who has ever been to the ocean?” and watch all the hands go up. As she calls on each child to tell his story about going to the beach, some kids tell about their beach vacations, some talk about which relative or friend they visited at the beach, and at least one six-year-old will say “I never saw the ocean, but I have a dog!” because they want so desperately to belong to the conversation.

As part of their interest in others, they will join sports teams, scouts, begin religious school or specialized language schools. Although they may seem interested in everything, be careful not to over schedule. This might be the first year of “all day” school, and even a child who attended an all day childcare or kindergarten can tire out after a full day of learning. Also, as part of their interest in group participation, children may start to form “clubs” as they play. To ward off future bullying, teach your child ,” You can’t be friends with everyone. You just have to be nice.”

Six-year-olds still have a great sense of wonder and imagination. They believe in Santa Claus and the Tooth Fairy. They also are interested in science and nature, planets and dinosaurs, and how things work. They can simultaneously believe in the very real and concrete and believe in magic.

Six-year-olds ask “Why?” and they are not shy about it: Why do I have to go to bed? Why does that man have only one leg? Why do helium balloons float? Why do people die?

Sometimes the “Why’s” can lead into  whining, but luckily, six-year-olds can be easily distracted out of their perceived injustices.

Kids at this age tend to concern themselves with body integrity and may cry over a relatively minor injury such as a paper cut or skinned knee. If you want attention from a room full of six-year-olds, put a Band-Aid on your arm and they will all ask, ” Why do you have a Band-Aid?”

We are excited that Two Peds in a Pod® turns six today. Like Big Bird, we hope to forever ask “Why,” as well as “How?” and “When?”  May your children continue to inspire a sense of wonder and curiosity in your lives, whether they are six months, six years, sixteen, or sixty!

Julie Kardos, MD and Naline Lai, MD

©2015 Two Peds in a Pod®

Click here to read our very first post from six years ago.