Two Peds In a Pod
Starting out With Pearly Whites- infant and toddler dental tips
My sister-in-law was startled when brown spots began to appear on her preschooler’s teeth. A trip to the dentist revealed that my nephew had eleven cavities, the result of constantly drinking juice as an infant and toddler. Unfortunately, time in the operating room was required to fill all the rotten spots. Today our guest blogger, Dr. Paria Hassouri, answers frequently asked questions on infant dental care. Starting care as an infant can prevent your child from ending up like my nephew with a mouthful of cavities. Dr. Hassouri is a board certified pediatrician who completed her training at the Cleveland Clinic Foundation. She has been in practice for seven years and is with Cedars Sinai Medical Group in Beverly Hills, California. She is currently writing abook about the experience of pediatrician moms across the United States. – Dr. Lai
You should start brushing your baby’s teeth as soon as they come out. You can either use a clean moist washcloth or a soft baby toothbrush to do this. Before this point, many pediatricians advocate wiping your infant’s gums with a washcloth a couple times a day.
While plain water is enough to clean the teeth and gums, you can also use a small amount of fluoride-free toothpaste. Flossing should begin anytime there is tight contact between the teeth, particularly when the molars come in.
While most babies will get their first tooth between 6 to 10 months, your baby may not get his/her first tooth until 15 to 18 months.
Baby bottle tooth decay is caused by frequent and long exposure of an infant’s teeth to liquids that contain sugar. The sugar penetrates the gums and affects the teeth even while they are below the surface. Sugar-containing drinks include milk and formula (even breastmilk), fruit juice, and other sweetened drinks. Putting a baby to bed for naps or at night with a bottle increases the risk. And again, remember that your baby does not need any juice.
While the American Academy of Pediatric Dentistry recommends dental visits starting at age one, you can ask your pediatrician when he/she thinks that your baby should first see the dentist. If you are already following a good dental care regimen which includes brushing your baby’s teeth regularly and not letting your baby fall asleep with a bottle, your pediatrician may say that you can wait longer for the first dental visit.
Even if your child resists brushing, it is still very important to brush the teeth twice a day. You can try brushing in front of a mirror or taking turns with your child. You can also try having your child hold a larger, thicker handled toothbrush while you use a thinner handled toothbrush to brush the teeth. In this way, the thicker toothbrush acts as a “door stop” that your child can bite on to keep his mouth open while you follow through with the thinner toothbrush. Finally, you can try blowing bubbles or singing a special song while you are brushing your child’s teeth. That way your child associates this special activity with tooth brushing; but keep in mind that this only works if you reserve the blowing bubbles or other special song for tooth brushing.
If your water does not contain fluoride, ask your pediatrician or dentist about fluoride supplements starting at six months old.
Paria Hassouri, MD
© 2010 Two Peds in a Pod
Always something-those rubber bands
Holes In Your Head: Sinus Infections
You have a hole in your head.
Actually, you have several.
You, your children, and everyone else. These holes are called sinuses.
These dratted air pockets in your skull can fill with puss and cause sinus infections. Scientists hypothesize they once helped us equilibrate water pressure during swimming. Now, sinuses seem only to cause headaches.
Sinuses are wedged in your cheek bones (maxillary sinuses), behind your nose (ethmoid sinuses) and in the bones over your forehead (frontal sinuses). When your child has a cold or allergies, fluid can build up in the sinuses. Normally, the sinuses drain into the back of your nose. If your child's sinuses don’t drain because of unlucky anatomy, the sludge from her cold may become superinfected with bacteria and becomes too thick to move. Subsequently, pressure builds up in her sinuses and causes pain. A sinus infection of the frontal sinuses manifests itself as pressure over the forehead. The pain is exacerbated when she bends her head forward because the fluid sloshes around in the sinuses. Since frontal sinuses do not fully develop until around ten years old, young children escape frontal sinus infections.
Hydrate your child well when she has a sinus infection. Your child's body will use the liquid to dilute some of the goo and the thinner goo will be easier for her body to drain. Since sinus infections are caused by bacteria, your pediatrician may recommend an antibiotic. The usual duration of the medicine is ten days, but for chronic sinus infections, two to four weeks may be necessary. Misnamed, "sinus washes" do not penetrate deep into the sinuses; however, they can give relief by mobilizing nasal secretions. When using a wash, ask the pharmacist for one with a low flow. Although the over the counter cold and sinus medicines claim to offer relief, they may have more side effects than good effects. Avoid using them in young children and infants.
Who knows. Someday we'll discover a purpose to having gooey pockets in our skulls. In the meantime, you can tease your children about the holes in their heads.
How to Help Your Bedwetting Child
“Help, Mommy, Daddy, I wet the bed!”
As you wash yet another set of bed sheets and wet pajama bottoms, you may be wondering WHEN your child will stay dry at night and WHY your child still wets the bed when his friends, or worse yet, his younger siblings, are dry. This article will address primary bedwetting (doctors call this “primary nocturnal enuresis”), or kids who have NEVER been dry at night. Children who have had months or years of dry nights and then start bedwetting consistently need to be evaluated by their health care providers to rule out medical causes of new bedwetting.
Here are a few things parents of bed-wetters should know.
Most children master staying dry during the day BEFORE staying dry during the night. Only a small number of children actually wake up dry in the morning before they start potty training. Daytime dryness is under your child’s cognitive control. Night time dryness is not learned or controlled by your child’s rational brain, but rather is a function of your child’s bladder being mature enough to send a WAKE UP!! signal to your child. Quick hint here: nightmares can result from a full bladder. As you comfort your child from a bad dream, don’t forget to take him to the bathroom.
About 80 percent of children are dry overnight by age four. They sleep through the night and wake up dry or they wake up once to urinate in the bathroom and go back to bed. What about the other 20%? Each year after age four years, about 10% of kids who are wet at night become dry without any intervention. Genetics play a big role in this. If one parent was a bedwetter until age 7, for example, then the child has a 35% chance of bedwetting until this age. If both parents wet the bed until school age, then their child has at least an 80% chance of being just like Mom and Dad.
However, some kids just wet the bed even though their parents were dry at an early age. Regardless, parents can help.
· Do NOT punish your child for wetting the bed. It truly isn’t his fault.
· It is reasonable to limit fluid intake in the few hours before bed but do allow your child to drink water if thirsty or with teeth brushing.
· By all means let your child wear training pants at night or at least put some form of water repellant mattress protector on your child’s bed. These are not “crutches” or “enablers” but rather save you from having to wash sheets and mattresses.
· Not all kids are actually upset about bedwetting, but they can become very upset if parents let them feel that way. Reassure your child that someday “the pee pee will wake you up to go potty in the night” just like it tells your child to go to the bathroom during the day.
If your child is old enough to become self-conscious or to have his self-esteem impacted by his bedwetting (somewhere between the ages of 8 to 10 years, usually, because sleep-overs and camp gain popularity at these ages), there are a few ways to help your child approach potentially awkward situations.
1) Have the sleep-over at your house and have your child’s absorbent training pants already in the bed hidden under the covers. Your child can put them on after “lights out.”
2) Tell your child he does not have to share the reason for not wanting to sleep away from home.
3) Alternatively, he can tell his friends that YOU, the meanie parent, will not allow him to attend sleepovers yet.
If your child is motivated to try to become dry overnight, you can try a bedwetting alarm system. These systems work well over a period of several months. With alarms, both parents and child have to be active participants. Alternatively, you can talk to your child’s health care provider about medicine called DDAVP that can give a “quick fix." The medication can keep your child dry on the night he takes the medicine. The medicine comes in pill form and can either be used for sleepovers only or can be taken for a few months at a time to help your child feel better if self-esteem is becoming compromised by bedwetting. Note that even after months of dry nights on medicine, your child will likely bed wet if the medicine is stopped. However, there is also a chance that nature will have taken over and by the time the medication is stopped, your child will have reached the age that his body was programmed to stay dry at night.
Of course, your child’s health care provider can help ensure that your child merely has an immature bladder-to-brain messaging system and not any other cause of his bedwetting. Your doctor can also help evaluate if your child’s self esteem is affected by his bedwetting.
While not the most glamorous part of the parenting game, washing up after a bedwetting child and keeping a positive attitude for him are very important. The next time you will play this supportive role is when you become grandparents and your former bedwetter calls you for advice about his own bedwetting child.
Julie Kardos, MD
©2010 Two Peds in a Pod
Dry winter skin - guidance from a guru
1. Moisture every day especially after bathing with Cerave Cream or Lotion. It contains ceramides which "waterproofs"the skin and keeps moisture in, but without that greasy feel.
Count down the pounds: six simple guidelines to helping overweight children
A common question that many parents ask us in the office is “How
can I help my overweight child?”
Our newest podcast provides six simple rules for healthy
eating. Listen in to find out the “5-4-3-2-1-0” rules of what to feed your
children, how to portion their foods, and how to change their behavior to help
them lose excess pounds and maintain a healthy weight.
(If the podcast is not embedded in your RSS reader page, visit the www.TwoPedsInAPod.com home page directly.)
Julie Kardos, MD and Naline Lai, MD
©
2010 Two Peds in a Pod
Download | Duration: 00:08:41
Of body odor, UGGs and arm pits- your stinky tween
Your nine-year-old sweetie pie still has baby fat on her cheeks and the changes of puberty have barely started, yet you find yourself in the aisles of a pharmacy scratching your head over the best starter deodorant. Yes, the dreaded body odor has started. Much to the consternation of parents in my office, adult-like body odor appears before periods and voice changes.
For stinky feet, make sure the kids wash with soap daily-this can be tough for a kid who is just learning how to balance in the shower.
Art Therapy : a picture is worth a thousand words
How do I know if my baby has autism?
Autism is a disorder of communication. Autistic children have difficulty relating to other people. Many parents are concerned about autism and ask me questions about how to know that their child does NOT have autism.
Tools for autism screens exist for older toddlers. For example, the M-CHAT is a standard autism screening tool used as young as 16 months and can be downloaded for free: http://www.firstsigns.org/downloads/m-chat.PDF.One hallmark of autism is delayed speech. This sign makes autism difficult to diagnose before the age of one year because language development really takes off after a child’s first birthday.
Here are some communication milestones that occur during the first year of life. Problems attaining these milestones can be indicative of autism or other communication disorders such as hearing loss, vision loss, isolated language delay, or other developmental delays:
By six weeks of age, your baby should smile IN RESPONSE TO YOUR SMILE. This is not the phantom smile that you see as your baby is falling asleep or that gets attributed to gas. I mean, your baby should see you smile and smile back at your smile. Be aware that babies at this age will also smile at inanimate objects such as ceiling fans, and this is normal for young babies to do.
By 2 months of age, babies not only smile but also coo, meaning they produce vowel sounds such as “oooh” or “aaah” or “OH.” If your baby does not smile at you by their two month well baby check up visit or does not coo, discuss this delay with your child’s health care provider.
By four months of age, your baby should not only smile in response to you but also should be laughing or giggling OUT LOUD. Cooing also sounds more expressive (voice rises and falls or changes in pitch) as if your child is asking a question or exclaiming something.
Six-month-old babies make more noise, adding consonant sounds to say things like “Da” and “ma” or “ba.” They are even more expressive and seek out interactions with their parents. Parents should feel as if they are having “conversations” with their babies at this age: baby makes noise, parents mimic back the sound that their child just made, then baby mimics back the sound, like a back and forth conversation.
All nine month olds should know their name. Meaning, parents should be convinced that their baby looks over at them in response to their name being called. Baby-babble at this age, while it may not include actual words yet, should sound very much like the language that they are exposed to primarily, with intonation (varying voice pitch) as well. Babies at this age should also do things to see “what happens.” For example, they drop food off their high chairs and watch it fall, they bang toys together, shake toys, taste them, etc.
Babies at this age look toward their parents in new situations to see if things are ok. When I examine a nine month old in my office, I watch as the baby seeks out his parent as if to say, “Is it okay that this woman I don’t remember is touching me?” They follow as parents walk away from them, and they are delighted to be reunited. Peek-a-boo elicits loud laughter at this age. Be aware that at this age babies do flap their arms when excited or bang their heads with their hands or against the side of the crib when tired or upset; these “autistic-like” behaviors are in fact normal at this age.
By one year of age, children should be pointing at things that interest them. This very important social milestone shows that a child understands an abstract concept (I look beyond my finger to the object farther away) and also that the child is seeking social interaction (“Look at what I see/want, Mom!”). Many children will have at least one word that they use reliably at this age or will be able to answer questions such as “what does the dog say?” (child makes a dog sound). Even if they have no clear words, by their first birthday children should be vocalizing that they want something. Picture a child pointing to his cup that is on the kitchen counter and saying “AAH AAH!” and the parent correctly interpreting that her child wants his cup. Kids at this age also will find something, hold it up to show a parent or even give it to the parent, then take it back. Again, this demonstrates that a child is seeking out social interactions, a desire that autistic children do not demonstrate. It is also normal that at this age children have temper tantrums in response to seemingly small triggers such as being told “no.” Unlike in school-age children, difficulties with “anger management” are normal at age one year.
As an informal screen for autism, children below one year of age should be monitored for signs of delayed or abnormal development of social and communication skills. Home videos of children diagnosed with autism reveal that even before their first birthdays, many autistic children demonstrate abnormal social development that went unrecognized.
Following the above guides and discussing your child’s development at all well child care check-ups will help you to pick out “red flags” that can prompt closer attention and further work up if indicated.
Julie Kardos, MD
©2010 Two Peds in a Pod
Speech and Language Milestones
Remember Elmer Fudd from the Bug Bunny cartoons? He was the hunter who would say “Where’s the wascally wabbit?” instead of “Where’s the rascally rabbit?” Think how frustrated Elmer was as a kid when his parents and teachers didn’t understand him.
Unclear speech or lack of speech development can be a sign of hearing loss or an inability to communicate (autism, retardation or developmental delay). Amy King, MA, CCC-SLP with over 12 years as a speech therapist outlines important speech and language milestones to watch for:
Receptive Language Milestones- what your child understands (children should be doing these things by the time they reach the year marker)
By the time they are:
1 year: shakes head to respond to simple questions such as “Want milk?” and identifies some body parts
2 years: Follows 1 step directions- “Go get the ball.”
3 years: Follows 2 step directions- “Go get the ball and give it to daddy.”
4 years: Understands if/then- “If you pick up your toys, then you can help Mommy make a cake.”
5 years: Follows 3 step directions- “After you wash your hands, get the napkins and put them on the table.”
Expressive Language Milestones- what your child is able to say
1 year: 1 word
2 years: 2 word sentences- two words with one meaning such as “thank you” does not count. Expect phrases such as “mommy up” for “mommy, pick me up.”
3 years: 3 to 5 words—Dr. Kardos tells parents think Cookie Monster from Sesame Street: “me want cookie”
4 years: 4 to 7 word sentences with consistent correct use of parts of speech (nouns, verbs, adjectives, pronouns, prepositions, etc.): “I want to go to the park.”
Speech Milestones- phonetics (sounds should be produced accurately and consistently in words and phrases)
By the time they are:
3 Years: sounds of the letters: m, b, p, h, w, n, f,
4 Years: t, k, g, ng, s, r, sh
5 Years: z, l, v, y, th, wh, ch
6 Years: j, st, br, cl, r (by now if not before)
Speech Intelligibility -how well strangers understand your child
2 Years: at least 25%-50% of what your two year old is saying
2 ½ Years: at least 60%-75% of what your two and a half year old is saying
3 Years: at least 75%-90% of what your three year old is saying
4 Years: at least 95% of what your four year old is saying
Fluency- stuttering
Stuttering is normal in the preschool years. Be sure to give the child time to say what she is trying to say. Dr. Lai likes to think of a preschool stutterer as a child whose mind is thinking faster than he can move his mouth. If stuttering lasts more than 6 months and is accompanied by facial contortions, grimaces, or repetitive body movements, speak to a medical professional.
Red flags that always need further workup:
o Does not coo by 4 months of age
o Does not babble by 9 months of age
o Child does not respond to his/her name by 9 months of age
o Child does not look at you, others or objects upon request by 9 months of age
o Does not gesture (point, wave, grasp, etc.) by 12 months of age
o Child does not respond to your simple verbal requests (e.g., “Look!”, “Wave bye-bye”, “Come here”, “Give a kiss,” etc.) by 12 months of age
o Does not say single words by 16 months of age
o Does not say two-word phrases on his or her own (rather than just repeating what someone says to him or her) by 24 months of age
o Loss of any language or social skill at any age
Amy King, MA, CCC-SLP
©2010 Two Peds In a Pod