Baby updates: Time to eat – starting solid foods

In the next month, we’ll be updating our posts on baby basics. As we said to Robin Young on NPR’s Here and Now,  “a lot of life’s issues all boil down to the essentials of life…eat, sleep, drink, pee, poop and love.”  Over the next month we’ll be giving you ideas and updates on all of those essentials. We start off with “eat” and how to transition your baby to solid foods:

starting baby foods


While starting your child on solid food isn’t always “love at first bite” it also does not have to be complicated or stressful.

Here are some overriding principles to keep in mind when feeding your baby:

1) It’s not just about the food. It’s about teaching your child to eat when hungry and to stop when not hungry.

2) Eating a meal with family is social as well as nutritious. Keep eating pleasant and relaxed. No need to force-feed or trick your child into eating. Feed your baby along with other family members so your baby can learn to eat by watching others eat.

3) Babies start out eating pureed foods on a spoon between 4-6 months and progress to finger foods when physically capable, usually between 7-9 months. Teeth are not required; hand to mouth coordination is required.

Before four to six months of age, a baby slumps when propped in a sitting position and tends to choke on solids. After four months, babies are less likely to reflexively “tongue thrust” food right back out of their mouths.  Putting cereal into a bottle doesn’t count as “eating” and is not necessary.

Timing matters when offering solid food for the first time. Babies learn to expect a breast or a bottle when hungry. So make sure your baby is happy and awake but NOT hungry the first time you feed her solid food because at this point she is learning a skill, not eating for nutrition. You should wait about an hour after a milk feeding when she is playful and ready to try something new. Keep a camera nearby because babies make great faces when eating food for the first time. Many parents like to start new foods in the morning so that they have the entire day to make sure it agrees with their baby. Watch for rash or stomach upset.

What should you feed your baby first? There is no one right answer to this question. The easiest food to offer is one that is already on the breakfast, lunch, or dinner table that is easy to mush up.  In some cultures, a baby’s first food is a smash of lentils and rice. In other cultures it’s small bits of hard-boiled egg or a rice porridge. Just avoid honey before one year of age because honey can cause botulism in infants. The bottom line: it doesn’t matter much what you start with, as long as it’s nutritious. Dr. Kardos is proud to say that she fed her nephew his first solid food this summer: watermelon! (He loved it). Even if you start with a mashed up  banana or a yam, plan to add iron-containing foods sooner rather than later. Pediatricians recommend a diet with iron-containing solid foods because a baby’s iron needs will eventually outstrip what what she stored from her mother before birth as well as what she can get from breast milk or formula. Iron-containing food include iron-fortified baby cereal (such as oatmeal or rice) and  pureed meats (such as chicken, beef or fish). Note, with baby cereals, make them up with formula or breast milk, not water or juice, for more nutritional “oomph.”

Some babies will learn in just one feeding to swallow without gagging and to open their mouths when they see the spoon coming. Other babies need more time. They may tongue-thrust the food back out, cough when trying to swallow, cry, or appear clueless when the spoon comes back to them. To avoid the tongue-thrust reflex or the gag reflex, place the spoon gently to one side of your baby’s tongue during a feed. If you see your baby is distressed, just end the meal. Some babies take several weeks to catch on to the idea of eating solids. Try one new food at a time. Then, if your baby has a reaction to the food, you’ll know what to blame.

Some babies just never seem to like mushed up foods and prefer to suck on foods at first (like Dr. Kardos’s nephew did with his watermelon). One practice called baby-led weaning describes another way of introducing solids.

Stage one and stage two baby foods are similar. No need to test all stage one foods before going onto stage two. The consistency of the food is the same. The stages differ in the size of the containers and stage one foods do not contain meat. Some stage two foods will combine ingredients. Combinations are fine as long as you know your baby already tolerates each individual ingredient (i.e. “peas and carrots” are fine if she’s already had each one alone). Avoid the dessert foods. Your baby does not need fillers such as cornstarch and concentrated sweets.

Not all kids like all foods. Don’t worry if your baby hates carrots or bananas. Many other choices are available. At the same time, don’t forget to offer a previously rejected food multiple times because taste buds change.

Be forewarned: poop changes with solid foods. Usually it gets more firm or has more odor. Food is not always fully digested at this age and thus shows up in the poop. Wait until you see a sweet potato poop!

By six months, babies replace at least one milk feeding with a solid food meal. Some babies are up to three meals a day by 6 months, some are eating one meal per day. Starting at six months, for cup training purposes, you can offer a cup with water at meals. Juice is not recommended. Juice contains a lot of sugar and very little nutrition.

Offer finger foods when your baby can sit alone and manipulate a toy without falling over. When you see your baby delicately picking up a piece of lint off the floor and putting it into his mouth, he’s probably ready.  Usually this occurs between 7-9 months of age. Even with no teeth your baby can gum-smash a variety of finger foods. Examples include “Toasted Oats” (Cheerios), which are low in sugar and dissolve in your mouth eventually without any chewing, ½ cheerio-sized cooked vegetable, soft fruit, ground meat or pieces of baked chicken, beans, tofu, egg yolk, soft cheese, small pieces of pasta. Start by putting a finger food on the tray while you are spoon feeding and see what your child does. They often do better feeding themselves finger foods rather than having someone else “dump the lump” into their mouths.

Children should always eat sitting down and not while crawling or walking in order to AVOID CHOKING. Also, you don’t want to create a constantly munching toddler who will grow into a constantly munching ten year old.

Finger food sample meals: Breakfast: cereal, pieces of fruit. Lunch: pasta or rice, lentils or beans, cooked vegetables in pieces, pieces of cheese. Dinner: soft meat such as chicken or ground beef, cooked veggies and/or fruit, bits of potato, or cereal. need other ideas? Check out this post on finger foods. By nine months, kids can eat most of the adult meal at the table, just avoid choking hazards such as raw vegetables, chewy meats, nuts, and hot dogs. You can use breast feedings or formula bottles as snacks between meals or with some meals. By this age, it is normal for babies to average 16-24 oz of formula daily or 3-4 breast feedings daily.

Avoid fried foods and highly processed foods. Do not buy “toddler meals” which are high in salt and “fillers.” Avoid baby junk food- if the first three ingredients are “flour, water, sugar/corn syrup”, don’t buy it. We are amazed at the baby-junk food industry that insinuate that “fruit chews,” “yogurt bites” and “cookies” have any place in anyone’s diet. Instead, feed your child eat REAL fruit, ACTUAL yogurt, and healthy carbs such as pasta, cous-cous, or rice.

Organic and conventional foods have the same nutritional content. They differ in price, and they differ in pesticide exposure, but no study to date has shown any health differences in children who consume organic vs conventional foods. For more information, see this American Academy article and this study as well as our own prior post about organic vs conventional foods.

A word about food allergies: Even the allergists lack a definitive answer of what makes a child allergic to a food, and the American Academy of Allergy, Asthma, and Immunology now recommends offering foods, including the more “allergic” foods, early to avoid later food allergy. This is a change from recommendations issued about 15 years ago. For safety concerns, if a household member has a life threatening allergy to a food, continue to avoid bringing that food into the house to ensure the safety of the allergic person. However, if no one at home has a peanut allergy, then a thin spread of peanut butter on a bit of toast or cracker is safe for your finger-feeding baby. Focus more on avoiding choking hazards than on avoiding theoretically allergenic foods.

And a word about fish:  For years, experts fretted about pregnant women and children exposing themselves to high mercury levels by eating contaminated fish. However, the  realization that fish is packed with nutrition, and the data that show only a few types of fish actually contain significant mercury levels, now leads the FDA to encourage fish intake in young children and pregnant women. Please check this FDA advice for specific information about which fish to offer your child and the nutritional benefits of different kinds of fish.

Bon appetite,

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

Updated from our original 2009 post

Potty training tips

potty training dogs

Children master potty training typically between the ages of two and four years. Be patient, not everyone is “typical.” More important than your child’s age is whether she shows she is developmentally ready to train. These signs include:
- is generally agreeable/ can follow directions
- gets a funny expression on her face before passing urine or poop, or runs and hides, then produces a wet or soiled diaper
-asks to be changed/ pulls on her diaper when it becomes wet or soiled

- remains dry during the day time for at least two hours
-NOT because grandparents are pressuring you to start training their grandchild
- NOT if the child is constipated—the last thing you want to do is to teach withholding to a kid who already withholds
-NOT if a newborn sibling has just joined the family. A new baby in the house is often a time of REGRESSION, not progression. However, if your toddler begs to use the potty at this time, then by all means, allow her to try.

Hit play to listen to our potty training podcast:

Naline Lai, MD and Julie Kardos, MD

©2014 Two Peds in a Pod®


The return of measles- What to look for in your child

symptoms of measlesYet another reminder about the signs and symptoms of measles from a health agency landed in our email inbox the other day. The reason? According to the Centers for Disease Control, as of this point, the United States has seen more measles cases this year (almost 600 reported) than in the past decade (typically 60 cases per year). Organizations are reminding physicians about the symptoms of measles because thanks to  vaccinations, many pediatricians have not seen a case of the measles in decades. In this post, we pass the information on to you. After all, you will be the first to recognize that your child is ill.

Measles typically starts out looking like almost every other respiratory virus— kids develop cough, runny nose, runny bloodshot eyes, fever, fatigue, and muscle aches.

Around the fourth day of illness, the fever spikes to 104 F or more and a red rash starts at the hairline and face and works its way down the body and out to arms and legs, as shown here at the Immunization Coalition site. Many kids also develop Koplik spots on the inside of the mouth (small, slightly raised, bluish-white spots on a red base) 1-2 days before rash.

In the US, one in 10 kids with measles will develop an ear infection and one in 20 will develop pneumonia. Roughly one in 1000 kids develop permanent brain damage, and up to two in 1000 who get measles die from measles complications. Kids under age 5 years are the most vulnerable to complications. These statistics are found here. For global stats on measles, please see this World Health Organization page.

There is no cure for measles and there no way to predict if your child will have a mild or severe case. Fortunately, one dose of the MMR (Measles, Mumps, Rubella) vaccine is 92% effective at preventing measles, and two doses are 97% effective at preventing measles. That’s the best we can do, but this 97% protection rate works great when everyone is vaccinated. The American Academy of Pediatrics recommends giving the first dose of MMR vaccine at 12-15 months and the second dose at school entry, between 4-6 years of age.

If parents refuse the MMR vaccination for their children, then more people are left susceptible to measles. This leads to more people who can spread  the disease when it hits a community. Measles is one of the most contagious diseases known: 9 out of 10 unvaccinated people exposed to measles will become sick, and infected people are contagious even before symptoms appear. One of the reasons behind the increase in measles cases is the increase in unvaccinated children. One patient of Dr. Kardos’s was a four-year-old boy who was behind on his vaccines and hospitalized for measles pneumonia. Before he was diagnosed he exposed an entire Emergency Department to measles.

In our global world, another reason for the spike in measles cases is the increase in travel between countries. In fact,  young children traveling internationally often need to get the MMR vaccine outside of the routine schedule. If you plan on traveling,  check here to see if you need to give your child the MMR vaccine on an early schedule.

With increased vigilance and vaccination, hopefully measles will once again become a disease few doctors have ever encountered. After all, vaccines did eradicate small pox. The last case of smallpox in the United States was in 1949, and the last case in the world was in 1977. In the meantime, you’ll know how to “spot” a case of measles too.

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

On letting go and coming back

Friends make birthdays better

I have been musing ever since our hosting site told us they were switching blog platforms. In a blink of an eye, our blog was slated to disappear. The dynamic Two Peds in a Pod community would be plunged into silence. At first, disbelief gave away to intrigue. Was this a sign to change personal paths? As I started to think of all the things I could do with the time that I would have spent writing the blog, my to-do list grew and grew. I could hear my son’s closet, overflowing with outgrown clothing, crying out to be re-organized.

When I told friends of the opportunity to dissolve the blog, I heard time and time again “I think you should save it.” Even friends without children were aghast. When I told my own children that the blog was on the verge of imploding they looked at me blankly and said, “Why would you stop writing for Two Peds?”

Then I remembered the mom who read our article on croup seven times in one night. I remembered Dr. Kardos’s patient whose dad said our strep throat article  helped him decide not to cut his family’s vacation short. I thought of the many times parents thanked me  for posts which allayed their fears of fever.

The blog did eventually stop when the old hosting site went down. But as my friends and family reminded me, the goal of the blog is to positively impact children globally by guiding their caretakers; and by the time the blog went down, we had reached nearly three million views. Two Peds in a Pod is “Practical pediatrics for parents on the go.” After more thought, I decided it would be difficult to accomplish this goal from the back of one of my kid’s closets.

So today, I am happy to post that the stop was just a temporary suspension. I credit my friends and family for reminding me of the original goal of the blog. In particular, thanks to Dr. Kardos. While I was mulling, Dr. Kardos was busy staying up past midnight valiantly importing posts from the rapidly fading old site.

We’re back, albeit a little rough around the edges as we construct the new site. And it’s just in time for our 5th birthday!

Thanks, my friend, Dr. Kardos. I wouldn’t be able to blow those candles out without you.

Happy 5th Birthday Two Peds in a Pod- may there be many more.

Dr. Lai

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


Hand-foot-mouth Disease


hand foot mouth diseaseWe’re seeing a lot of this stuff around the office. It’s “hand-foot-mouth” disease, a common, self-limited illness caused by the Coxsackie virus, and it strikes most often in the spring and summer. Named for rashes which can affect the hands, feet, or mouth, this illness can cause fever for the first few days as well as some loose stools. 

If you look carefully at the photos above, you will see faint red bumps on this child’s feet. The rash may also look like tiny blisters and will always blanch (if you press on it and lift up your finger, the redness will briefly disappear- just as if you pressed on a sunburn). The same rash may appear on the hands and is not itchy. The child’s throat above is red in the back and has several ulcers, or canker sores. The hands, feet and mouth are not always simultaneously affected, and although we don’t call the illness “hand-foot-mouth-tush” disease,  sometimes kids also get a red bumpy rash on their buttocks. 

The throat ulcers can be quite painful and the rash on the feet may be slightly tender.  Usually the rash on the hands is not felt by the child. You can alleviate your child’s throat pain with acetaminophen (brand name Tylenol) or ibuprofen (brand names Advil or Motrin). For toddlers and older, Magic Mouthwash, a mix of 1/4 tsp diphenhydramine (plain liquid Benadryl) and 1/4 tsp Maalox (the regular adult stuff) squirted over mouth ulcers prior to eating a meal (three times a day)  is an age-old way to sooth sores. 

Because this virus is contagious through saliva, prevent kids from sharing cups, eating utensils, and tooth brushes, and clean up toddler drool in order to prevent the virus from spreading to family members and friends. Children with this virus can still attend daycare as long as they are not feeling ill, typically after the first few days of illness when fever and pain start to subside. Most commonly the rash and mouth ulcers last about a week.

Unfortunately there is no treatment for hand-foot-mouth disease, but fortunately your child’s body is fully capable of fighting off the virus. Your role is to help soothe pain. Otherwise, kids may refuse to drink and end up dehydrated. When my son had this illness at age two, he liked sucking on a washcloth soaked in very cold water. I also gave him lots of sherbet, ice cream, milk shakes, and noodles because these foods were easier for him to swallow while his throat was sore. 

Kids can get this virus more than once, and many strains of this virus circulate. Even parents are not always immune.

So now add Coxsackie virus, or hand-foot-mouth disease, to your Dr. Mom and Dr. Dad list of manageable diseases. Knowledge is power. However, if your child’s fever lasts more than three days, if he does not drink enough to urinate his baseline amount, if he is inconsolable, seems disoriented, or if your parent gut-instinct tells you something more might be wrong, do get your child to medical attention.

Julie Kardos, MD with Naline Lai, MD

©2014 Two Peds in a Pod®

Originally posted June, 2011, and right on cue, Coxsackie is back again this summer.

Father’s Day 2014: real words from real dads

This year we asked our dad readers to help us write our Father’s Day post. They completed this thought: “Before I became a dad, I never thought I’d…”

…Learn to curl hair for cheerleading competitions




…Become a stay at home dad AND love it so much after everything I’ve been through!!


…Learn all of the names of Thomas The Tank Engine’s friends and the many songs associated with them.


…Have a toys r us in my house.


…Go food shopping at midnight.


…Make so many pancakes on Sunday mornings.


…Volunteer in a dunk tank and have pie thrown at me.

One of our readers summed up his thoughts on becoming a dad:

Since I’ve become a father, nearly seven years and two beautiful daughters later, my life has become a series of jobs that I never thought I would have to tackle. These include:

Beautician: I never thought in a million years that I would be learning how to do pony tails, side pony’s, braids (not that I can braid yet), and painting little finger and toe nails.

Disney Princess Aficionado: At one point in my life I thought I was cool because I knew a lot about beer, how it was made, where it was from, where the best IPA’s were being poured. Now I am “cool” because I know where Mulan lived, and because I know the story about Ariel falling in love with Prince Eric.

Doctor: I am well versed here and can cover almost everything from the simple band-aid application and boo-boo kissing, to the complex answering of why daddy is different and why he gets to go to the bathroom standing up.

Cheerleader: Both of my daughters enjoy participating in sports. It’s been such a great experience to cheer them both on from the side line. I enjoy watching them grow with the sport and gain confidence game after game.

Becoming a father was one of the best choices I have made with my life. I love being a dad, and I look forward to the future dad challenges, good and bad, and beingthe best mentor I can be.

Thank you to our readers for contributing to this post.

Happy Father’s Day!

Julie Kardos, MD and Naline Lai, MD

©2014 Two Peds in a Pod®

Pediatric photo puzzler: What caused this skin discoloration?

phytophotodermatitisEvery child with a lemonade stand hopes for hot sunny days to drive in
customers. But if your kids squeeze fresh lemons for their stand, make sure they
wash their hands after squeezing the lemons. Otherwise, after a sunny day, your child’s hands may turn out
looking like the kid’s feet pictured to the left.

The juice of some fruits or plants
will cause a dark discoloration of the skin if exposed to sunlight. The
reaction, called phytophotodermatitis, usually starts a day after the juice
comes into contact with the skin. Redness and mild blistering eventually leads
into a discoloration which can that can last for months. Citrus fruits are the
most common culprits, but wild parsnip, wild dill, wild parsley and buttercups
also cause the photosensitivity. Often the initial redness and blistering is missed. 

The kid in the photo was walking in bare feet on
leaves near an apple tree. 

Makes you almost want to only use powdered
lemonade mix…almost.

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

Your thoughts on fatherhood

To all of the dads who read our blog: we invite you to help us with our Father’s Day post. Are there things you find yourself doing now that you are a dad that you never imagined you would be doing before you had a child? Try to finish this thought: “Before I became a dad, I never thought I’d…”

Please comment to this post or send us an email at:

We will post your responses on Father’s Day.

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

FAQs about swimming

baby sand sculptureBabies and children love bath time and are drawn to water play. Today we bring you the splash on swimming.

We’re going to the beach- can my baby go swimming? How about a pool?

  • Most pools, oceans, and lakes are much colder than bath water. Babies feel colder more quickly than adults. Remember your own parent telling you to come out of a pool because your lips were blue? Limit a baby’s exposure to cold water accordingly.
  • Chlorine will not hurt babies, but it can dry out skin. Apply moisturizer after swimming if your child’s skin gets dry. Kids with eczema can be particularly sensitive to chlorinated water.
  • Salt water is safe for babies and kids to swim in.
  • Young kids try to drink the water they swim in. Don’t let them. It’s not just your nephew who pees through his swim diaper that you need to worry about. Unfortunately chlorine and salt fail to kill all viruses, bacteria, and parasites that might lurk in swimming water.
  • If your child swims outside, remember that sunburns occur more easily because sunlight reflects off the water. Apply sunscreen liberally before and after swimming. Better yet, try to keep that baby hat on and have your child wear a sun protective shirt.

When should I start swim lessons for my child?

Start swim lessons as early as toddlerhood — it is a great life skill. However, swim lessons will not make your child “drown proof.” You can find more data in this drowning prevention article from The American Academy of Pediatrics. Unfortunately, even under adult supervision, drownings occur. When an adult’s attention is briefly diverted to answer the phone, their meal, etc,  a drowning can take place. The bottom line:

  • Always stay arm’s length of babies and toddlers in the water.
  • Even if your child can swim well, never let your child or teen swim alone or without a life guard.

A note about Baby Swim Lessons:

  • Babies can take “swim lessons,” meaning “spend quality time with a parent in the pool.” Despite the claims of some swim instructors, no studies have shown that infant swim lessons make infants “drown proof.”

Any other water safety tips?

A few years ago, Dr. Lai’s toddler-aged neighbor waddled over to the ice bucket at a Fourth of July party. Toddlers have big pumpkin shaped heads and before Dr. Lai  could blink an eye, her neighbor tumbled into the water head first. Luckily Dr. Lai’s husband was standing next to the bucket and pulled the toddler out.

  • As this case shows, you can’t let your guard down, even if no pool or large body of water is in sight.

  • Small blow-up backyard pools are the same as bath tubs in terms of drowning risk, so never leave kids unattended around these pools, just as you should never leave kids unattended, even briefly, in the bathtub. Stay at arm’s length of your babies and toddlers when they play in these pools.

Ideas on how to play with water? 

  • Water tables (which can double as sand tables in the spring, leaf tables in the fall and  indoor snow tables in the winter) allow young toddlers to stand and play with toys in very shallow water.
  • Fill a bunch of different sized stacking cups with water for kids to pour, dump, or perhaps to mix with rocks, dirt, or leaves.
  • Simple squirt bottles are great fun. When Dr. Kardos’s twins were little they spent large amounts of time “watering” every plant, bush, flower, and blade of grass in the yard.
  • Fill small cupcake tins with water and supply your kids with water-color paint to decorate the sidewalk or walkway of your house. Kids become entranced by the colors created as they rinse off the brushes. Warning— make sure the paint is water soluble. Dr. Lai still has the name of one of her children in fluorescent orange written on her driveway.
  • Wet down your walkway and blow bubbles onto the cement – they will cling onto the walkway for a long period of time.

Grab a towel and enjoy the summer with your children.

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®
originally published June 2013

On our minds: Concussions

concussions in kidsDr. Lai will be up at Brown University this weekend giving a primary care pediatrician’s perspective on concussions (traumatic brain injuries) at a parent forum. A lot has changed since you were a kid. As she prepared, we mulled over questions we commonly encounter and thought we’d pass them on to our parents:


What is a concussion? A concussion is an injury to the brain which does not show up on head scans such as CT Scans and MRIs. Think of a concussion like a sprained ankle, but instead of an injury to the ankle, it’s an injury to the brain. Just like an ankle sprain, it may not show up on X-ray, but your child is affected by the injury.


What are the signs of a concussion? Immediately after a head injury, we first look for signs of bleeding in the head. After we know there is not any bleeding, we look for signs of a concussion. Concussions affect kids physically, cognitively, and emotionally.  Common symptoms include persistent head ache, nausea, fatigue, sleep disturbances, light and noise sensitivity, balance problems, difficulty with memory, difficulty with concentration, and emotional lability. Parents often describe their children as moving or thinking slowly- as if they were in a fog.  Teens and young adults tend to belittle any injury, so if your kid tells you that she hit her head when you weren’t around, scrutinize your child very closely. If you “just know” your kid is not 100 percent his baseline, then she probably has a concussion.


How long is recovery?

In the not-so-old days we would clear kids for athletics 2 weeks after a teen had a normal neurological exam and symptoms disappeared. But the prescription for recovery has changed.  Now there is a new emphasis on brain rest and returning a kid to school before returning to sports. Just like you rest a sprained ankle, doctors now recommend resting the brain.  For the brain, that means no thinking or concentrating. Examples of prohibited activities include texting, video games, and homework.  Interestingly TV watching is considered mindless enough to be permitted during the period of brain rest. Once there are no symptoms we allow a little more brain activity in a stepwise fashion until a kid can return to school.  Only then can a kid consider starting a stepwise program to return to playing sports. For most kids, recovery takes about a month.  Kids with baseline neurological issues such as migraines or attention deficit hyperactivity disorder tend to take longer to recover fully.

I’ve heard it’s dangerous to hit your head again before you have fully recovered from a concussion- is that true? YES! The scary stuff you hear about possible brain swelling and death if a concussion occurs on top of a concussion is not just internet mumbo-jumbo.  Called second-impact syndrome, these secondary concussions occur during a window of vulnerability while the brain is healing from an initial concussion.  


How many concussions can you have before there is permanent brain damage? There is still a lot of research that still needs to be done on concussions and this is one area where people are actively seeking answers. So far, studies in youth are unclear on the impact of repetitive concussions and the development of long term neurodegenerative diseases.  


My kid wears a helmet or mouth guard to prevent concussions-right? While helmets and mouth guards help prevent skull fractures and jaw dislocations, current designs do little to prevent concussions.


I’m not going to keep my kid wrapped in bubble wrap, but do some activities pose a greater concussion risk than others?  While there is still a paucity of sports data at the grade school and middle school level, we do know that according to the Centers for Disease Control (CDC), over half of concussions in those under 14 years old are caused by falls. Boys’ football followed by girls’ soccer lead the injury rate amongst high school athletes according to a 2010 paper published in Pediatrics .


I have seen kids receive concussions from standing too close to swing sets, concussions from sudden stops on school busses, and from jumping off beds.  Once, a parent came into my office dazed after hitting her head on her trunk door in my parking lot.  So, concussions can occur in any activity. The most important “take-away” is to take head injuries seriously and learn to recognize and report concussions.

For more information on concussions the pathway to recovery, please visit the CDC website and the Children’s Hospital of Philadelphia webite.

ee you up at Brown.


Naline Lai, MD with Julie Kardos, MD

©2014 Two Peds in a Pod®