Tips for holiday travel with young children

In spite of long TSA lines, rental car challenges and all the howling, the wolf family went to grandmother’s house every year for the holidays.

You don’t appreciate how much your baby has grown until you attempt a diaper change on a plane. For families with young children, Thanksgiving or any holiday can become stressful when travel is involved. Often families travel great distances to be together and attend parties that run later than children’s usual bedtime. Fancy food and fancy dress are common. Well-meaning relatives who see your children once a year can be too quick to hug and kiss, sending even not-so-shy kids running. Here are some tips for safer and smoother holiday travel:
If you are flying:

  • Do not offer Benadryl (diphenhydramine) as a way of “insuring” sleep during a flight. Kids can have paradoxical reactions and become hyper instead of sleepy, and even if they do become sleepy, the added stimulation of flying can combine to produce an ornery, sleepy, tantrum-prone kid. Usually the drone of the plane is enough to sooth kids into a slumber.
  • Not all kids develop ear pain on planes as they descend- some sleep right through landing. However, if needed you can offer pacifiers, bottles, drinks, or healthy snacks during take-off and landing because swallowing may help prevent pressure buildup and thus discomfort in the ears. And yes, it is okay to fly with an ear infection.

General tips for visiting:

  • Traveling 400 miles away from home to spend a few days with close family and/or friends is not the time to solve your child’s chronic problems. Let’s say you have a child who is a poor sleeper and tries to climb into your bed every night at home. Knowing that even the best of sleepers often have difficulty sleeping in a new environment, just take your “bad sleeper” into your bed at bedtime and avoid your usual home routine of waking up every hour to walk her back into her room. Similarly, if you have a picky eater, pack her favorite portable meal as a backup for fancy dinners. But when you return home, please refer to our podcast and blog posts on helping your child to establish good sleep habits and on feeding picky eaters! One exception is when you are trying to say bye-bye to the binkie or pacifier.
  • Supervise your child’s eating and do not allow your child to overeat while you catch up with a distant relative or friend. Ginger-bread house vomit is DISGUSTING, as Dr. Kardos found out first-hand when one of her children ate too much of the beautiful and very generously-sized ginger bread house for dessert.
  • Speaking of food, a good idea is to give your children a wholesome, healthy meal at home, or at your “home base,” before going to a holiday party that will be filled with food that will be foreign to your children. Hunger fuels tantrums so make sure his appetite needs are met. Then, you also won’t feel guilty letting him eat sweets at a party because he already ate healthy foods earlier in the day.
  • If you have a young baby, be careful not to put yourself in a situation where you lose control of your ability to protect the baby from germs. Well-meaning family members love passing infants from person to person, smothering them with kisses along the way. Unfortunately, nose-to-nose kisses may spread cold and flu viruses along with holiday cheer.
  • On the flip side, there are some family events, such as having your 95-year-old great-grandfather meet your baby for the first time, that are once-in-a-lifetime. So while you should be cautious on behalf of your child, ultimately, heed your heart. At six weeks old, Dr. Lai’s baby traveled several hours to see her grandfather in a hospital after he had a heart attack. She likes to think it made her father in law’s recovery go more smoothly.
  • If you have a shy child, try to arrive early to the family gathering. This avoids the situation of walking into house full of unfamiliar relatives or friends who can overwhelm him with their enthusiasm. Together, you and your shy child can explore the house, locate the toys, find the bathrooms, and become familiar with the party hosts. Then your child can become a greeter, or can simply play alone first before you introduce him to guests as they arrive. If possible, spend time in the days before the gathering sharing family photos and stories to familiarize your child with relatives or friends he may not see often.
  • Sometimes you have to remember that once you have children, their needs come before yours. Although you eagerly anticipated a holiday reunion, your child may be too young to appreciate it for more than a couple of hours . An ill, overtired child makes everyone miserable. If your child has an illness, is tired, won’t use the unfamiliar bathroom, has eaten too many cookies and has a belly ache, or is in general crying, clingy, and miserable, despite your best efforts, just leave the party. You can console yourself that when your child is older his actions at that gathering will be the impetus for family legends, or at least will make for a funny story.
  • Enjoy your CHILD’s perspective of Thanksgiving and other winter holidays: enjoy his pride in learning new customs, his enthusiasm for opening gifts, his joy in playing with cousins he seldom sees, his excitement in reading holiday books, and his happiness as he spends extra time with you, his parents.

We wish you all the best this Thanksgiving!

Julie Kardos, MD and Naline Lai, MD

©2014 Two Peds in a Pod®
Updated from our 2009 articles on these topics


More ideas and mouth watering recipes from our backyard organic gardening physician

vegetable recipes for kids

The many hues of cauliflower-photo by Dr. Mass

Pediatrician and mom Dr. Marion Mass writes this post in honor of Random Acts of Kindness Day, today November 19 in Bucks County, PA. This day is in memory of Abby Schumer, a friend of Dr. Mass’s family, who lost her life to a brain tumor at age 10. Gardening, cooking with her children, and donating meals to families in need is how Dr. Mass’s family celebrates this day.

* * * * * * * * * *

Despite the fact that it’s November and several frosts have hit the Northeast, we still have a surplus of fresh vegetables from our organic garden. If you would like to be in this enviable position next year, please see my former guest-blog post explaining why you should get started now!

We garden because we value healthy high quality organic food. There is a no more satisfying way for your family to get it than from your own yard. Right now, garden centers across the Northern Hemisphere are selling off their seeds for cheap. And these seeds can be saved until next year. How should you choose what to grow? Grow some produce you know your family is will eat. First, consider looking for seeds with different hues. For example, many kids will eat lettuce. How about a red or maroon-leafed variety? Ditto that with the gardener’s favorite, tomatoes. There are yellow, orange, pink, black and blue varieties. One of my pet hypotheses is that the more colors we ingest, the healthier we are…and kids love a rainbow plate. Grow some vegetables that are easy to grow: radishes, beans, beets, and the butternut squash and New Zealand spinach described below, all fall into this category.

Spinach is high in vitamins A, B2, B6, E and K, as well as numerous antioxidants and iron. Shockingly, one cup of spinach contains 25% of the US RDA of calcium, welcome information for those who do not consume dairy products. We grow New Zealand spinach because it does not get stringy and bitter like other varieties and doesn’t get mushy when cooked. In addition, two seeds of this variety grow a plant that is so prolific that it feeds my family and several others from late July (seed planted in May) until the hard frost takes it out.

Butternut squash is high in fiber and extraordinarily high in vitamin A. It is great to grow up a gate or fence, the flowers are edible, and if your kids don’t mind crushing stink bugs, easy to grow. This year only 6 seeds grew 65 pounds of our favorite hard squash!

Cauliflower is also high in fiber as well as vitamin C. Recent studies suggest that there are certain phytochemicals in cauliflower with cancer-fighting properties. It’s a little harder to grow, given its attractiveness to the cabbage loper caterpillar, one of my garden nemeses. Vigilance and a few tricks can help you! We purchase praying mantis egg cases and lacewing insect eggs from online stores such as Gardens Alive. These beneficial insects will eat the cabbage loper caterpillar. In addition, finding the green worms on the back of the leaves and hand crushing them depletes their population.

kid vegetable recipes

New Zealand Spinach

Mouth watering recipes:

Farfalle, Sausage and NEW ZEALAND Spinach

This recipe is good with any leafy greens, and would be OK with traditional spinach, but it is exceptional with New Zealand spinach which has a great bite and holds up after cooking. This  recipe is the creation of my wonderful foodie-friend Jeannine

Ingredients – (flexible on all quantities)

1 lb Italian sweet sausage, casing removed
2 cloves garlic, minced
1/3 cup red wine
salt/pepper to taste
New Zealand Spinach, washed/dried -enough leaves to cover (2) dish towels
Farfalle pasta, ¾ lb
Parmesan, freshly grated, to taste

Preparation – takes 15 minutes

1. Cook pasta in pot boiling salt water. Farfalle usually takes 10 minutes.
2. At the same time, in a deep skillet, cook sausage, crumbling with cooking utensil as it cooks; you can add a little water while it cooks, to prevent sticking, but don’t add too much; the meat sticking will help you when you deglaze pan later
3. Once sausage is cooked, add the minced garlic (1) minute
4. Add wine, simmering a few minutes, deglaze the pan with your spatula, all the stuck pieces of browned meats will come off bottom skillet.
5. Then add the dry spinach leaves; even if pan is overflowing with spinach, it will wilt to a much smaller amount. If using “new Zealand” spinach, it needs extra liquid to cook – scoop out a measuring cup of the boiling pasta water and add to the sauasage/spinach mixture to help cook. Cover with lid for approx 2 minutes. You want the spinach to be wilted, but not overcooked.
6. Season with salt and pepper to taste
7. Drain cooked pasta and mix in serving bowl with sausage mixture.
8. Pass grated parmesan cheese
9. Great leftover too.

kid butternut squash recipe

Butternut squash -photo by Dr. Mass

Roasted Butternut Squash with Pepitas and Pomegranates

Preheat oven to 375. Cube a medium butternut squash into ¾ inch pieces. I leave the skin on for extra fiber. Place on a rimmed cookie sheet and drizzle with 1-2 tbsp olive oil, sprinkle with ½ tsp salt. Roast in oven till fork tender, about 45 minutes. Remove from oven, sprinkle with roasted pepitas (pumpkin seeds) and sprinkle with pomegranate seeds. Serve warm or at room temp. Makes a great Thanksgiving vegetarian entrée, just add cubed fresh Mexican cheese (queso fresco)

Roasted Cauliflower

Preheat oven to 350. Cut 1 medium head of cauliflower into 1 inch florets and place on rimmed cookie sheet. Drizzle with 2 tbsp melted butter (it really tastes better than olive oil here) and sprinkle with 2 tsp organic cane sugar, ½ tsp salt, ½ tsp cumin, and a tiny pinch of cinnamon. Roast in oven for 30 minutes until fork tender. We serve this as an appetizer or a side dish. You can vary the spices used… We added chili powder last night, have done it with oregano and thyme or coriander.

Some of my favorite garden websites:

Kitchen Gardeners International (features forums, recipes, blogs and the ability for people to gather on a local level)

Chiot’s Run (garden journal of a small organic garden in the Midwest)

The Royal Horticultural Society (the UK’s leading gardening charity, promotes horticulture and gardening.)

You Grow Girl (unusual plants, recipes, beautiful pictures, and gardening tips)

Skippy’s Vegetable Garden (a Boston city vegetable garden)

Marion Mass, MD
©2014 Two Peds in a Pod®



Gift ideas by ages and stages

gift ideas by developmentIt’s gift-giving season! Now that your families are another year older, it’s time to update our sometimes-you-just-want-to-buy-something holiday gift idea list arranged by ages and developmental stages.

0-3 months: Babies this age have perfect hearing and enjoy looking at faces and objects with contrasting colors. Music, mobiles, and bright posters are some age appropriate gift ideas. Infants self-soothe themselves through sucking- if you can figure out what your nephew’s favorite type of binkie is, wrap up a bunch-they are expensive and often mysteriously disappear.

3-6 months: Babies start to reach and grab at objects. They enjoy things big enough to hold onto and safe enough to put in their mouths- try bright colored teething rings and large plastic “keys.” New cloth and vinyl books will likewise be appreciated; gnawed books don’t make great hand-me-downs.

6-12 months: Around six months, babies begin to sit alone or sit propped. Intellectually, they begin to understand “cause and effect.” Good choices of gifts include toys with large buttons that make things happen with light pressure. Toys which make sounds, play music, or cause Elmo to pop up will be a hit. For a nine-month-old old just starting to pull herself up to a standing position, a water or sand table will provide hours of entertainment in the upcoming year. Right now you can bring winter inside if you fill the water table with a mound of snow. Buy some inexpensive measuring cups and later in the summer your toddler will enjoy standing outside splashing in the water.

12-18 months: This is the age kids learn to stand and walk. They enjoy things they can push while walking such as shopping carts or plastic lawn mowers. Include gifts which promote joint attention. Joint attention is the kind of attention a child shares with you during moments of mutual discovery. Joint attention starts at two months of age when you smile at your baby and your baby smiles back. Later, around 18 months, if you point at a dog in a book, she will look at the dog then look back at you and smile. Your child not only shows interest in the same object, but she acknowledges that you are both interested. Joint attention is thought to be important for social and emotional growth.

At 12 months your baby no longer needs to suck from a bottle or the breast for hydration. Although we don’t believe mastery of a  sippy cups is a necessary developmental milestone , Dr. Lai does admire the WOW cup because  your child can drink from it like she does from a regular cup. Alternatively, you can give fun, colored actual traditional plastic cups, which difficult to break and encourage drinking from a real cup!

18-24 months: Although kids this age cannot pedal yet, they enjoy riding on toys such as “big wheels” “Fred Flintstone” style. Dexterous enough to drink out of a cup and use a spoon and fork, toddlers can always use another place setting. Toddlers are also able to manipulate shape sorters and toys where they put a plastic ball into the top and the ball goes down a short maze/slide. They also love containers to collect things, dump out, then collect again.

Yes, older toddlers are also dexterous enough to swipe an ipad, but be aware, electronics can be a double edged sword— the same device which plays karaoke music for your daddy-toddler sing-along can be transformed into a substitute parent. The other day, a toddler was frighted of my stethoscope in the office. Instead of smiling and demonstrating to her toddler how a stethoscope does not hurt, the mother repeatedly tried to give her toddler her phone and told the child to watch a video. Fast forward a few years, and the mother will wonder why her kid fixates on her phone and does not look up at the family at the dinner table. Don’t train an addiction.

2-3 years: To encourage motor skills, offer tricycles, balls, bubbles, and boxes to crawl into and out of. Choose crayons over markers because crayons require a child to exert pressure and therefore develop hand strength. Dolls, cars, and sand boxes all foster imagination. Don’t forget those indestructible board books so kids can “read” to themselves. By now, the plastic squirting fish bath toys you bought your nephew when he was one are probably squirting out black specks of mold instead of water- get him a new set. Looking ahead, in the spring a three- year-old may start participating in team sports (although they often go the wrong way down the field) or in other classes such as dance or swimming lessons. Give your relatives the gift of a shin guards and soccer ball with a shirt. Offer to pay for swim lessons and package a gift certificate with a pair of goggles.  

3-4 years: Now kids engage in elaborate imaginary play. They enjoy “dress up” clothes to create characters- super heroes, dancers, wizards, princesses, kings, queens, animals. Kids also enjoy props for their pretend play, such as plastic kitchen gadgets, magic wands, and building blocks. They become adept at pedaling tricycles or even riding small training-wheeled bikes. Other gift ideas include crayons, paint, markers, Play-doh®, or side-walk chalk. Children this age understand rules and turn-taking and can be taught simple card games such as “go fish,” “war,” and “matching.” Three-year-olds recognize colors but can’t read- so they can finally play the classic board game Candyland®, and they can rote count in order to play the sequential numbers game Chutes and Ladders®.  Preschool kids now understand and execute the process of washing their hands independently… one problem… they can’t reach the faucets on the sink. A personalized, sturdy step stool will be appreciated for years. 

5-year-olds: Since 5-year-olds can hop on one foot, games like Twister® will be fun. Kids this age start to understand time. In our world of digital clocks, get your nephew an analog clock with numbers and a minute hand… they are hard to come by. Five-year-olds also begin to understand charts— a calendar will also cause delight. They can also work jigsaw puzzles with somewhat large pieces.

8-year-olds: Kids at this point should be able to perform self help skills such as teeth brushing. Help them out with stocking stuffers such as toothbrushes with timers. They also start to understand the value of money (here is one way to teach kids about money). The kids will appreciate gifts such as a wallet or piggy bank. Eight-year-olds engage in rough and tumble play and can play outdoor games with rules. Think balls, balls, balls- soccer balls, kickballs, baseballs, tennis balls, footballs. Basic sports equipment of any sort will be a hit. Label makers will also appeal to this age group since they start to have a greater sense of ownership.

10-year-olds: Fine motor skills are quite developed and intricate arts and crafts such as weaving kits can be manipulated. Give a “cake making set” (no, not the plastic oven with a light bulb) with tubes of frosting and cake mix to bake over the winter break. Buy two plastic recorders, one for you and one for your child, to play duets. The instrument is simple enough for ten-year-olds or forty-year-olds to learn on their own. Ten-year-olds value organization in their world and want to be more independent. Therefore, a watch makes a good gift at this age. And don’t forget about books: reading skills are more advanced at this age. They can read chapter books or books about subjects of interest to them. In particular, kids at this age love a good joke or riddle book.

Tweens: Your child now has a longer attention span (30-40 minutes) so building projects such as K’nex® models will be of interest to her. She can now also understand directions for performing magic tricks or making animal balloons. This is a time when group identity becomes more important. Sleepovers and scouting trips are common at this age so sleeping bags and camping tents make great gifts. Tweens value their privacy – consider a present of a journal with a lock or a doorbell for her room.

Teens: If you look at factors which build a teen into a resilient adult, you will see that adult involvement in a child’s life is important.

We know parents who jokingly say they renamed their teens “Door 1” and “Door 2,” since they spend more time talking to their kids’ bedroom doors than their kids. Create opportunities for one-on-one interaction by giving gifts such as a day of shopping with her aunt, tickets to a show with her uncle, or two hours at the rock climbing gym with dad.

Encourage physical activity. Sports equipment is always pricey for a teen to purchase- give the fancy sports bag he’s been eying or give a gym membership. A running watch is always appreciated or treat them to moisture wicking work-out clothes or a gift card to a sports equipment store.

Sleep! Who doesn’t need it, and teens often short change themselves on sleep and fall into poor sleep habits.  Help a teen enjoy a comfortable night of rest and buy  luxurious high thread count pillow cases, foam memory pillows, or even a new mattress. After all,  it been nearly 20 years since you bought your teen a  mattress and he probably wasn’t old enough at the time to tell you if he was comfortable. Since a teen often goes to bed later than you do, a remote light control will be appreciated by all.

Enjoy your holiday shopping!

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

Modified from our original November 2012 post


Using melatonin in children

sleepingOur guest blogger, Dr. Kristann Heinz, a doctor who practices with a holistic and integrative approach, shares her knowledge about melatonin use in children. — Drs. Kardos and Lai

When we got back from Hawaii my three year old daughter, Ruby, was a hot mess! The eight-hour time difference made it hard for her to adjust her internal clock. At first, I just attributed it to routine jet lag but after a week of the same sleep-wake cycle, I knew something was going on. She was wandering around the house in her pink spotted pajamas WIDE AWAKE until 1am, 2am, and 3am. And then in the morning, she was dead asleep and I could barely get her up. So at this point, I took her to our doctor to make sure everything was all right. The doctor told us my daughter’s jet lag was leading to a sleep disturbance and suggested I try melatonin. I gave melatonin to Ruby that night. She was asleep by 11pm and slept soundly until morning. Over the next few days, she adjusted beautifully and we were back to a normal sleep routine in 3 days. After that, we stopped the melatonin.

What is Melatonin?
Melatonin is a hormone that occurs naturally in our bodies. A hormone is a signal containing a message from one part of the body to another. Melatonin is naturally secreted by the pineal gland, a gland located in the brain that is very sensitive to light. As night falls, the pineal gland secretes melatonin to tell the brain that it is time to sleep. This process is sometimes described as the “opening of the sleep gate.”

Why would my doctor prescribe melatonin to my child?
People often use melatonin to help adjust their sleep-wake cycles. For adults melatonin is used to treat a variety of medical disorders including cancer, headaches, and autoimmune disorders as well as insomnia. In children however, the primary reason melatonin is prescribed is for sleep disturbance. Some children with certain medical conditions are thought to have lower levels of naturally produced melatonin, which contributes to sleep-wake disturbances. For these children supplementing with melatonin can be beneficial and enhance sleep. Melatonin has been studied and shown to be helpful to children with developmental delays, ADHD, cerebral palsy, autism, and jet lag.

What dose should I use?
The dose of melatonin should be discussed with your doctor. Doses can range from 0.03mg – 6mg, generally given at bedtime. To establish the appropriate therapeutic dose, your doctor will take into account your child’s weight and the health condition you are trying to treat.

Are there different kinds of melatonin?
Melatonin is synthetically produced but there are also products that contain biological glandular material, a source of natural melatonin. Synthetically produced melatonin is recommended by most doctors because it provides a more consistent dose and is less likely to be contaminated.

Melatonin comes in three different forms: immediate release, sustained released and sublingual. The most convenient form of melatonin for children is the sublingual form because their bodies begin to absorb it as soon as it is placed in the mouth. The sublingual form is easier than swallowing a pill, which can be difficult or uncomfortable for some children. There are many different liquid brands available as well, which have the same benefit. Another good way to administer melatonin to a child is to dissolve an immediate release melatonin tablet in juice or mix it with applesauce before offering it to your child. Taking melatonin with food does not change the effectiveness of the supplement.

How long does it take to work?
Melatonin should work the first night it is given to a child and it does not require multiple doses to be effective. It can take up to 30 minutes after taking the medication to experience its full effect. Often your child will begin to feel drowsy and tired soon after taking the supplement.

Let’s use jet lag as an example of how to use melatonin. You may give the melatonin to your child just before bedtime in the new time zone. The supplement will facilitate sleep within 30 minutes of taking it. But, remember, our internal clocks usually adjust one hour a day when we travel to different time zones, and melatonin can only help to a point. The greater the time difference the more difficult it is for our bodies to resume a normal sleep pattern in the new time zone. If, for instance, there is a twelve-hour time difference, it will still take time for our biologic rhythms to change, even with the help of melatonin. However, the transition is often faster and smoother with the aid of melatonin. Melatonin is not a sleeping pill. It is used to enhance the onset of sleep naturally.

Are There Side Effects or Contraindications?
Melatonin is very safe. The most common side effect for children is excessive sleepiness, which can be moderated by decreasing the dose. In high doses, which are used mostly in treating adults (10mg-60mg melatonin), side effects include headaches, nausea, dizziness and fatigue. For children, taking melatonin is not associated with any short or long-term side effects in relation to growth, development or puberty. Drug interactions can take place between melatonin and sedatives, antidepressants and hormones, so if your child is taking medications of this kind, be sure to discuss whether it is safe to give your child Melatonin with your child’s doctor before doing so.

Kristann Heinz, MD, a graduate of University of Pennsylvania School of Medicine, is board-certified in Family Medicine and Integrative-Holistic Medicine, as well as certified in Medical Acupuncture. She is also a Registered Dietician and Licensed Nutritionist. A mom living in Bucks County, PA, she practices medicine at Stockton Family Practice in Stockton, NJ.

©2014 Two Peds in a Pod®



Cold weather is here: time to start an organic produce garden with your kids

gardening with kidsWe welcome pediatrician Dr. Marion Mass to talk about starting a garden from a piece of suburban lawn. — Drs. Kardos and Lai

A few years back, my family was getting ready for my parents to come for dinner and I was peeling the skins off the roasted beets we had grown for my mother.  One of her favorites…but not mine.  My five-year-old Brian had picked the beets and was eager to try them. As Brian brought a sliver of beet up to his mouth I braced myself for a “ yucky face”. Instead, I was shocked to see him gobble the beets up.  He loved them.  To this day, beets are one of his favorite veggies.

Hands down, the best activity I have ever done with my family is planting and nurturing an organic garden for 11 years.  Along the path to growing delectable vegetables, we have discovered together gardening’s health, intellectual and social benefits.

Actively tied to the process of supplying their own food, gardening kids will naturally want to eat more and more produce. Kids develop a sense of pride (truly, a basketful of beans, lettuce and cucumbers is so attractive) and eventually they develop a positive association with the outdoors and vegetables.  In addition to eating more quantity, what your kids eat will be healthier than store bought veggies.  Produce closer to harvest contains more nutrients and you don’t get closer than your own yard to table.   If you garden organically, you will also avoid potentially harmful chemicals.  Lastly, there is a sense of relaxation upon stepping into a garden.  It is a balm for anxiety, for depression, for anger; in short, one of the best adjuvants to mental health therapy that I know.

If you want to harvest a crop next year, and you live in a cold weather area of the northern hemisphere, NOW is the best time to start.  The most cumbersome task of starting a garden is to dig up the sod (existing lawn), but a few tricks in the fall can prevent this disc-slipping chore.

  • Chose a spot in your yard that gets at least 6 and preferably 8 hours of sunlight a day.
  • If possible, stay away from edges, tree lines and spots where large garden parasites (such as deer, rabbit and groundhogs) lurk.
  • If you live next to a pesticide happy neighbor, you will want to locate your garden away from a spray zone and will want to think about runoff.  A helpful site to determine runoff capabilities of specific pesticides is:
  • Remember you may need to water your organic garden bed once in awhile, so keep it close to a water source (or at least someplace to which you don’t mind lugging a hose).
  • Start small:  a 3 x 10 foot plot can grow a good bit if you plan well.  Lay out a 12 layer thick plot of newspaper over the grass where you want your garden to grow and dump 4 inches of composted manure, manure and hummus mix or mushroom soil over top of the newspaper.  You can purchase in bulk from a garden center (I would do 2 cubic yards for a 3 x 10 spot) or in bags (about 15 40 lb bags).

That’s it.  Now go away and leave the garden alone until spring. During the fall and winter, the grass will die and the newspaper will rot.  Both will become a source of composted nutrients for your garden veggies. While you hibernate this winter, start your wheels turning and think about what crops you will grow. Buy a few packs of discounted seeds now; they will still germinate next year.

When the ground is ready in the spring, rent a tiller or get a sturdy pitchfork (trust me, the tiller is SO much easier!!) and turn over the soil mixing the composted manure, rotted newspaper and dead sod into the rocky soil we have around here.  The result will be a much richer garden soil that your vegetables will love.

What are you waiting for??  Get cracking now and start your produce garden.  Hopefully, by next spring your kids will be eating and enjoying organic beets that they grew !!!!


Marion Mass MD, FAAP

©2014 Two Peds in a Pod®

In practice for 17 years, Marion Mass MD, FAAP graduated from Penn State and Duke University Medical School. She completed  her pediatric residency at Northwestern University’s Children’s Memorial Hospital in Chicago. Currently Dr. Mass works at Jellinek Pediatrics in Doylestown, PA and serves on the Wellness Council of the Central Bucks School District, PA.  Produce from her kids’ garden garnishes the plates of many local families as well as the plates of the restaurant Puck. All garden profits benefit Relay for Life.  When she is not in her home garden, you can find her also tending to her son’s middle school garden. 

Why is my potty trained child’s underwear occassionally damp?

damp underwearA mom of a six-year-old patient asked recently, “Why is my daughter’s underwear damp?”

—She’s been potty trained for 3 years.

—She is dry overnight.

—She urinates about 6 times in the daytime.

—She doesn’t complain of pain during urination.

Yet,  her underwear is occasionally slightly wet.

We don’t know if anyone has ever tracked the statistics, but this girl’s cause of wet underwear is common in little girls.  Called vaginal voiding,  vaginal voiding occurs when a girl urinates on the toilet with her legs tightly pushed together. She pulls her pants down minimally, to about mid-thighs so urine gets trapped in the vagina as it comes out the urethra. When she stands up and pulls up her pants, the drop of urine that was trapped in the vagina will drip out into her underwear.

The treatment of vaginal voiding is simple. Make sure your daughter pulls her pants all the way down to her ankles when sitting on the toilet and encourage her to spread her knees apart. A way to ensure proper positioning on the toilet while she urinates is to have her sit on the toilet seat BACKWARDS, facing the back of the toilet. This position forces the knees apart  and prevents any urine from becoming trapped. In turn, her underwear will remain dry.

A reason both girls and boys occasionally have wet underwear is giggle incontinence or cough incontinence, which is exactly what it sounds like—a bit of urine gets leaked during laughing or coughing.

To help kids who leak during coughing or laughing, first make sure that they are not holding in their urine for too long. Have your child do a potty check, as in “go sit on the potty,” every 2-3 hours throughout the day. Try setting an alarm on her iPod or on your cell phone. Often, merely providing enough opportunities during the day to empty the bladder cures the problem of leaking during laughing or coughing.

After trying these simple measures, if your child’s underwear is still wet or your child tells you that she still leaks during coughing or laughing, discuss this problem with your child’s doctor. In addition, please know that while laughing daily is wonderful, daily coughing is not normal and your child may need further evaluation for the source of the cough.

Damp or wet underwear may not be the most glamorous pediatric topic, but it is important for the kids who suffer from it. Hopefully this post offered a quick fix for some of your kids. You and your laundry machine will be happier.

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



Enterovirus D-68 put into perspective

enterovirus D-68 No doubt, there has been an uptick in respiratory illness in our area, but the news media is causing panic specifically over one of them: enterovirus D-68.
The name “enterovirus” does not imply “deadly.” Many of you are well familiar with hand-foot-mouth disease, aka “Coxsackie virus.” Guess what? This extremely common, benign but annoying virus is also an enterovirus!

Let’s put into perspective how this “new” respiratory virus compares with an “old” well-known respiratory virus, influenza (The Flu). Remember that both flu and enterovirus D-68 are tracked by REPORTED cases. Most of the time doctors do not test children with mild disease so most reported cases are hospitalized patients.

Enterovirus D-68, the numbers: From mid-August through the first week in October (peak enterovirus season)- 664 people are known to have been infected in the USA, most of whom are children. You can track these numbers on this Centers for Disease Control website.
Influenza, the numbers: Each year in the US, approximately 200,000 people (children and adults) are hospitalized from complications of the flu. This year’s flu season in the northern hemisphere is just starting. Generally peak flu season is in the winter months. Large numbers of people contract the flu but they are not sick enough to be hospitalized- they suffer a week of fever, cough, sore throat and body aches at home but recover uneventfully. Up to 20% of the population are infected with flu each season.

Death from enterovirus D-68: 1 child. Four other children died who tested positive for this virus but it is unknown if the virus caused their deaths.
Death from influenza during the 2013-2014 flu season: 108 children

Symptoms of enterovirus D-68: range from mild cold symptoms to high fever and severe respiratory symptoms
Symptoms of flu: usually abrupt at the onset: fever, body aches, cough, and runny nose. Please see our prior post for more information.

Prevent enterovirus D-68: same as for all “cold” viruses- wash hands, sneeze/cough into elbow, not hands.
Prevent flu: Same as for enterovirus D-68, AND we have an Influenza vaccine for all children aged 6 months and above, with a few exceptions-see our article for more information. Last year the flu vaccine was about 60% effective: it’s not perfect, but it is certainly better than not vaccinating.

Overall, remember that enterovirus D-68 is one of many cold viruses that circulate the country. We are all familiar with back-to-school viruses. My teen-aged son told me, amid his sniffles and nose-blowing last week, that “more than half my school has a cold now.”
Certainly some of those colds could be enterovirus-D-68. But please don’t panic. All respiratory illnesses, including colds, have the potential to travel into your child’s lungs. It is more important to practice good illness prevention techniques and to recognize the signs of difficulty breathing. As we have said before, if we parents could worry all illnesses away, no one would ever be sick.

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


The birth of Happy Healthy Kids

happyhealthykidsbannerWe’re thrilled to join the advisory board of Happy Healthy Kids as it kicks off its inaugural season. The new website, pioneered by Editor Kelley King Heyworth, is dedicated to all of us parents who say, “I just want my child to be healthy. And happy.” A frequent contributor to Parents Magazine, CNN and Sports Illustrated, King Heyworth brings  journalistic expertise to her website to create a kids’ health site chock full of nonjudgemental, reassuring posts.

We’re currently on her home page with a pediatrician’s wish list— check out 5 things we’d love for you to know.

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


When a peer dies: How to help your grieving teen

lonely backpackThree of my son’s high school classmates died in a tragic car accident just before school started this year. As parents, many of us may have lost someone close to us, and we know from our experience that over time, the acute pain of loss decreases as we ultimately derive strength and joy from our memories of our loved one instead of experiencing only sadness and pain over their loss. Our hearts ache watching our kids experience death first hand, often for the first time. But teens need time to experience this transition for themselves. Telling them “it will get better” will not help them.

If you are parents of a grieving teen who has lost a friend or classmate, following are some things that you can do to help:

Offer to be available, to listen, or to find someone outside your family for your teen to talk to if he wants. Do not insist that your teen talks about his feelings.
Refrain from lecturing- it does not help your teen at this time to hear things like “THAT’S why we won’t let you drive with young drivers.” She’s already figuring this out for herself.
Allow her to talk or gather with friends during the daytime.
Go back to basics: make sure your teen eats, drinks and sleeps. Enforce bedtime. Turn off phones and computers by a bedtime that allows your teen to get at least 8-9 hours of sleep. Do not allow your teen to text late into the night or to continue talking to friends late into the night, even if this means insisting that YOU take his phone for the evening. Be cautious of sleepovers, which only cause sleep deprivation, leading to exhaustion and more difficulty handling strong emotions.
Offer to go for a walk with your teen. Exercise is helpful and encourages dialogue.
Allow your teen to grieve by attend viewings and funerals. However, do not mandate that she goes. Giving her an idea of what to expect (e.g., there may be an open casket, here are some things you can say to the family) may help ease any discomfort. Offer to go with your teen, but again, don’t insist on going.
Help your teen to do something constructive to help other survivors. Send a condolence card to the deceased friend’s parents that includes an anecdote of how their teen helped your teen, or of how his deceased friend encouraged, made him laugh, or inspired him. Suggest that your teen cook a meal for the grieving family, mow their lawn, run some errand, or to babysit a younger sibling of the deceased.
Utilize community resources. School guidance counselors provide a wealth of information and support.

Your teen may experience intermittent, intense sadness even months or years after a tragedy, but as time goes by more time should pass between feelings of sadness. Kids who lose close friends learn, over time, to live with their grief. Continue to acknowledge your teen’s feelings of loss and continue to be available for your teen. Initial depression usually fades into sadness in a month’s time.

It is normal for the death of a classmate to trigger, for the first time, your teen’s contemplation of his own mortality. It is normal for him to express fears of his own death.

Normal grief behaviors include:
• Crying
• Talking about their loss
• Wanting to talk to other friends
• Spending more time with friends
• Some might want to be alone with their grief.
• Some kids might want to busy themselves with sports, reading, etc, in order to distract themselves from their grief.
• Temporary altered appetite and difficulty sleeping.
• Temporary difficulty with concentrating on schoolwork.

Abnormal grief behaviors:
• Inability to eat or sleep
• Gaining or losing more than a couple of pounds
• Inability to stop crying
• Refusing to attend school
• Failing classes
• Using alcohol or other drugs to cope with sadness
• Withdrawal from things your teen used to take pleasure in such as sports, hobbies, music, friends, or family.
• Preoccupation with death
• Suicidal thoughts, wishes, or plans

If you see any of these abnormal signs, or you are concerned about how your teen is coping, consult with your pediatrician or a psychologist. For more signs of clinical depression in children, please see our post on child and teenage depression.  Also know that the National Suicide Prevention Lifeline is 800-273-8255.

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


Baby Basics: How to get your baby to sleep through the night

sleep training cartoonContinuing our series on the essentials of life…

If you have a newborn, stop reading and go back to feeding. It’s too early for your baby to sleep through the night. All babies lose a little weight in the first couple days of life, but then they are expected to gain. In fact, you may find that you need to awaken your baby to eat every couple of hours to eat in order to stabilize her weight loss. (see our prior post on breast feeding your newborn and our formula feeding post). While you feed your newborn, listen here to understand newborn sleep patterns:

Click here for our podcast – Sleep During the First Six Months

So, when to expect your baby to sleep longer at night? Usually after three months, your baby naturally takes more milk at each feeding and thus lasts longer between feedings. And once your baby is at least six months old, your baby may be able to sleep through the night. Set reasonable expectations. For some babies, sleeping through the night means six hours, for others ten.

At six months, object permanence fully emerges. Your baby will understand that you are somewhere even when you are not within sight. This is why he laughs hysterically when you play peek-a-boo with him. If he is dependent on you rocking him or feeding him to fall asleep, then he will look for you every time he awakens for help falling back to sleep. Also, don’t be fooled into thinking that because your baby nurses or drinks from a bottle at every night time wakening, he must be hungry. Usually he’s just looking for a way to fall back to sleep.

Training starts with making sure your baby knows how to fall asleep on his own. Make sure he can fall asleep on his own at the beginning of the night before you train for the middle of the night and above all, make sure you and your partner are on board with the same training strategy.  Keep bedtime roughly the same time every night, and start the bedtime routine before your baby is crying from exhaustion so he can enjoy this time with you. A typical bedtime routine for an older infant is bath (if it is a bath night), formula/breastfeed, wipe gums/brush teeth, read book, lullaby, kiss, and then bed. The exact order and events do not matter much, just finish the routine BEFORE your baby falls asleep. Lay him down on his back awake so that he has an opportunity to fall asleep on his own.

Don’t be frustrated if you try to sleep train for a few days and give up. There is no such thing as “missing” a golden window of opportunity to sleep train. If it’s not working out this week, try again next week.

Ultimately, use these principles behind a soothing, consistent bedtime and bedtime routine all the way through high school!

Sweet dreams

Click here for our podcast- Sleep from 6mo to toddler

Naline Lai, MD and Julie Kardos, MD

©2014 Two Peds in a Pod®