Allergies and asthma, which typically start in childhood, are by far the most common chronic diseases among children in the United States. Consider the following statistics:

Some 50 million Americans have allergies (about 1 in 5 people in this country).
The most common type of allergy is hay fever (allergic rhinitis); the medical cost of treating it, when direct and indirect costs are added up, now exceeds $7 billion a year.
More than 17 million Americans have asthma, and about one-fourth of these are younger than 18 years. Asthma accounts for about 4,000 deaths a year.
Seventy to 80% of school-aged children with asthma also have allergies, which are among the most common triggers for asthma, closely tied with viral respiratory infections.
If one parent has allergies, there’s a 25% chance that a child will also be allergic. The risk is more than doubled to 60% to 70% if both parents have allergies.
Many aspects of allergies, eczema, and asthma still are not fully understood. But advances in the diagnosis and treatment of these disorders are helping millions of sufferers.

What Are Allergies?
Many people mistakenly use the word allergy to refer to a disease or almost any unpleasant or adverse reaction. We often hear someone say, “I have allergies,” “He’s allergic to hard work,” or “She’s allergic to anything that’s green.” In reality, allergies are reactions that are usually caused by an overactive immune system. These reactions can occur in a variety of organs in the body, resulting in diseases such as asthma, hay fever, and eczema.

Your immune system is made up of a number of different cells that come from organs throughout the body—principally bone marrow, the thymus gland, and a network of lymph nodes and lymph tissue scattered throughout the body, including the spleen, gastrointestinal tract, tonsils, and the adenoid (an olive-shaped structure that is located at the top of the throat behind the nose).

Normally, it’s the immune system that protects the body against disease by searching out and destroying foreign invaders, such as viruses and bacteria. In an allergic reaction, the immune system overreacts and goes into action against a normally harmless substance, such as pollen or animal dander. These allergy-provoking substances are called allergens.

Who Is at Risk?
Although allergies can develop at any age, they most commonly show up during childhood or early adulthood. A search of family medical histories of a child with allergies will usually turn up a close relative who also has allergies. If one parent, brother, or sister has allergies, there is a 25% chance that a child will also have allergies. The risk is much higher if both parents are allergic. But the child will not necessarily be allergic to the same substances as the parents or always show the same type of allergic disease (eg, hay fever, asthma, eczema).

Symptoms Associated With Allergies
Eyes, Ears, Nose, Mouth
Red, teary, or itchy eyes
Puffiness around the eyes
Runny nose
Itchy nose, nose rubbing
Postnasal drip
Nasal swelling and congestion
Itchy ear canals
Itching of the mouth and throat

Hacking dry cough or cough that produces clear mucus
Wheezing (noisy breathing)
Feeling of tightness in the chest
Low exercise tolerance
Rapid breathing; shortness of breath

Eczema (patches of itchy, red skin rash)
Hives (welts)

Cramps and intestinal discomfort
Nausea or vomiting

Feelings of restlessness, irritability
Excessive fatigue

When to Suspect an Allergy
Allergies can result in various types of conditions. Some are easy to identify by the pattern of symptoms that invariably follows exposure to a particular substance; others are more subtle and may masquerade as other conditions. Here are some common clues that should lead you to suspect your child may have an allergy.

Patches of bumps or itchy, red skin that won’t go away
Development of hives—intensely itchy skin eruptions that usually last for a few hours and move from one part of the body to another
Repeated or chronic cold-like symptoms, such as a runny nose, nasal stuffiness, sneezing, and throat clearing, that last more than a week or two, or develop at about the same time every year
Nose rubbing, sniffling, snorting, sneezing, or drippy nose
Itchy, runny eyes
Itching or tingling sensations in the mouth and throat
Coughing, wheezing, difficulty breathing, and other respiratory symptoms
Unexplained bouts of diarrhea, abdominal cramps, and other intestinal symptoms.

Where does ASTHMA fit in?
Although allergies can trigger asthma and asthma is often associated with allergies, they are actually 2 different things. In simple terms, asthma is a chronic condition originating in the lungs, whereas allergies describe reactions that originate in the immune system and can affect many organs, including the lungs. Many different substances and circumstances can trigger an asthma attack—exercise, exposure to cold air, a viral infection, air pollution, noxious fumes, tobacco smoke, and for many asthma sufferers, a host of allergens. In fact, about 80% of children with asthma also have allergies. Although allergies are important in triggering asthma, severe asthma exacerbations are often set off by the good old common cold virus, totally unrelated to allergy.
Last Updated
 Guide to Your Childs Allergies and Asthma (Copyright © 2011 American Academy of Pediatrics)

Ear Infections

Ear Infection Information
When is it an Ear Infection?
A typical middle ear infection in a child begins with either a viral infection (such as a common cold) or unhealthy bacterial growth. Sometimes the middle ear becomes inflamed and causes fluid buildup behind the eardrum. In other cases, the eustachian tubes — the narrow passageways connecting the middle ear to the back of the nose — become swollen.

Children are more prone to both of these problems for several reasons. The passages in their ears are narrower, shorter, and more horizontal than the adult versions. Because it’s easier for germs to reach the middle ear, it’s also easier for fluid to get trapped there. And just as children are still developing, so are their immune systems. Once the infection takes hold, it’s harder for a child’s body to fight it than it is for a healthy adult’s.

The symptoms of an ear infection may be hard to detect. A child who constantly tugs or pulls at the ear could simply be exploring, or simply showing a self-soothing reflex — even though that tops the list of signals listed in many books and Web sites.

Other symptoms can include:
More crying than usual, especially when lying down
Trouble sleeping or hearing
Fever or headache
Fluid coming out of the ears
Doctors can use special instruments to see if an infection is present.

Treatment: Less May Be More
Perhaps the most surprising news is that common ear infections rarely require medication or any other action, except when severe or in young infants. “The body’s immune system can usually resolve them,” says Dr. Robert M. Jacobson, chair of the Mayo Clinic’s Department of Pediatric and Adolescent Medicine. “More and more studies show that children treated or untreated are at the same place 10 days out. We are constantly amazed at how many ear infections resolve on their own.”

It’s true: Fewer doctors are relying on antibiotics. As Dr. Jacobson points out, it’s important to understand that taking antibiotics might or might not speed recovery, and overusing them can lead to bacteria developing resistance to the drugs, as the germs mutate to defend themselves against medicine. As a result, many pediatricians have adopted a wait-and-see approach, rather than prescribing antibiotics at the first sign of infection.

Asking the parents to observe the child for 48 to 72 hours is becoming the most common first step among pediatricians. That doesn’t mean that an office visit isn’t a good idea, however. Doctors can prescribe numbing drops and suggest over-the-counter pain relievers to treat symptoms, which can help the child feel better as she recovers. 

Along with getting away from prescriptions, pediatricians are also shying away from ear tubes, a procedure in which a small tube is surgically inserted in the ear to drain fluid. According to Dr. Jacobson, tube placement is best used with those children who have recurring hearing problems caused by multiple infections.

“Tubes don’t actually stop ear infections, just symptoms and fluid retention,” says Dr. Jacobson. “We don’t want to do it too often because there is an increased risk of damage to the eardrum.”

According to Dr. Jacobson, diagnosis and treatment should be a three-step process:
First, the pediatrician determines whether or not an ear infection is present.
Second, the pediatrician and parent discuss risk factors and how to reduce them.
Finally, observation and treatment of symptoms ensure the child is recovering without pain.
Reducing the Risks for Ear Infection
While parents can’t head off every germ that’s headed for their children, they can take steps to reduce their children’s risks.

Avoid Secondhand Smoke Exposure
Smoking is a huge contributor to childhood illness. Ear infections are no exception to that rule. Smoking is addictive and hard to quit, but not every smoker realizes the harmful effects that secondhand smoke could have on his or her child. Quitting is just as important for your child’s health as your own.

Proper Hygiene
Bad hygiene habits are another major problem. Children in child care are more exposed to widespread bacteria, as are those who drink from a bottle as opposed to asippy cup, says Dr. Jacobson. That’s because bottles have more surface area for germs to live on. Teach children to wash their hands frequently to prevent the spread of germs that spread illness.

Keep Your Child Up-To-Date with Vaccines
Talk with your child’s doctor about the vaccines that protect against pneumonia and meningitis. Studies show that vaccinated children experience fewer ear infections.

Breastfeed Your Baby
Breastfeed infants for the first year. Breast milk has many substances that protect your baby from a variety of diseases and infections. Because of these protective substances, breastfed children are less likely to have bacterial or viral infections, such as ear infections.

Get A Flu Shot
Consider getting immunized against influenza. Aside from protecting against this yearly disease, it can help prevent ear infections.
Last Updated
 Adapted from Healthy Children Magazine, Summer 2007
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Baby Teeth Eruption Charts

Eruption Charts

 Teeth vary in size, shape and their location in the jaws. These differences enable teeth to work together to help you chew, speak and smile. They also help give your face its shape and form. At birth people usually have 20 primary (baby) teeth, which often erupt about 6 months of age. They are then shed at various times throughout childhood. By age 21, all 32 of the permanent teeth have usually erupted.

Download the following eruption charts:
Primary Teeth Eruption Chart (PDF) : click below


Primary Tooth Development


Permanent Teeth Eruption Chart (PDF)



Baby Teeth

A child’s primary teeth, sometimes called “baby teeth,” are as important as the permanent adult teeth.

When Do Baby Teeth Come In?
A baby’s 20 primary teeth are already present in the jaws at birth and typically begin to appear when a baby is between 6 months and 1 year.

Check out this baby teeth eruption chart to see the order in which teeth break through and at what ages you can expect specific teeth to appear. 

When teeth first come in, some babies may have sore or tender gums. Gently rubbing your child’s gums with a clean finger, a small, cool spoon or a wet gauze pad can be soothing. You can also give the baby a clean teething ring to chew on. If your child is still cranky and in pain, consult your dentist or physician. Most children have a full set of 20 primary teeth by the time they are 3.

Why Baby Teeth Matter
Not only do primary teeth help children chew and speak, they also hold space in the jaws for permanent teeth that are growing under the gums. When a baby tooth is lost too early, the permanent teeth can drift into the empty space and make it difficult for other adult teeth to find room when they come in. This can make teeth crooked or crowded. That’s why starting infants off with good oral care can help protect their teeth for decades to come.

When Should I Start Taking My Child to the Dentist?
The ADA recommends that a dentist examine a child within six months after the first tooth comes in and no later than the first birthday. A dental visit at an early age is a “well-baby checkup” for the teeth. Besides checking for tooth decay and other problems, the dentist can show you how to clean the child’s teeth properly and how to evaluate any adverse habits such as thumbsucking.

How to Care for Your Child’s Teeth
It’s important to care for your baby’s teeth from the start. Here’s what to do:

Begin cleaning your baby’s mouth during the first few days after birth by wiping the gums with a clean, moist gauze pad or washcloth. As soon as teeth appear, decay can occur. A baby’s front four teeth usually push through the gums at about 6 months of age, although some children don’t have their first tooth until 12 or 14 months.
For children younger than 3 years, caregivers should begin brushing children’s teeth as soon as they begin to come into the mouth by using fluoride toothpaste in an amount no more than a smear or the size of a grain of rice. Brush teeth thoroughly twice per day (morning and night) or as directed by a dentist or physician. Supervise children’s brushing to ensure that they use of the appropriate amount of toothpaste.
For children 3 to 6 years of age, use a pea-sized amount of fluoride toothpaste. Brush teeth thoroughly twice per day (morning and night) or as directed by a dentist or physician. Supervise children’s brushing and remind them not to swallow the toothpaste.
Until you’re comfortable that your child can brush on his or her own, continue to brush your child’s teeth twice a day with a child-size toothbrush and a pea-sized amount of fluoride toothpaste. When your child has two teeth that touch, you should begin flossing their teeth daily.





UPDATES Car Seat Safety

Car Seat Checkup

Using a car seat correctly makes a big difference. Even the right seat for your child’s size must be used correctly to properly protect your child in a crash. Here are car seat tips from the American Academy of Pediatrics (AAP).

Does your car have air bags?
Never place a rear-facing car seat in the front seat of a vehicle that has a front passenger air bag. If the air bag inflates, it will hit the back of the car seat, right where your baby’s head rests, and could cause serious injury or death.
The safest place for all children younger than 13 years to ride is in the back seat.
If an older child must ride in the front seat, a child in a forward-facing car seat with a harness may be the best choice. Be sure you move the vehicle seat as far back from the dashboard (and air bag) as possible.
Is your child facing the right way for weight, height, and age?
All infants and toddlers should ride in a rear-facing car seat until they are at least 2 years of age or reach the highest weight or height allowed by their car seat manufacturer.
Any child who has outgrown the rear-facing weight or height limit for his car seat should use a forward-facing seat with a harness for as long as possible, up to the highest weight or height allowed by his car seat manufacturer.
Is the harness snug?
Harness straps should fi t snugly against your child’s body. Check the car seat instructions to learn how to adjust the straps.
Place the chest clip at armpit level to keep the harness straps secure on the shoulders.
Does the car seat fit correctly in your vehicle?
Not all car seats fi t properly in all vehicles.
Read the section on car seats in the owner’s manual for your car.
Can you use the LATCH system?
LATCH (lower anchors and tethers for children) is a car seat attachment system that can be used instead of the seat belt to install the seat. These systems are equally safe, but in some cases, it may be easier to install the car seat using LATCH.
Vehicles with the LATCH system have anchors located in the back seat, where the seat cushions meet. Tether anchors are located behind the seat, either on the panel behind the seat (in sedans) or back of the seat, ceiling, or floor (in most minivans, SUVs, and hatchbacks). All car seats have attachments that fasten to these anchors. Nearly all passenger vehicles and all car seats made on or after September 1, 2002, are equipped to use LATCH. All lower anchors are rated for a maximum weight of 65 pounds (total weight includes car seat and child).
The top tether improves safety provided by the seat. Use the tether for all forward-facing seats, even those installed using the vehicle seat belt.
Always follow both the car seat and vehicle manufacturer instructions, including weight limits, for lower anchors and tethers. Remember, weight limits are different for different car seats and different vehicles.
Is the seat belt or LATCH strap in the right place and pulled tight?
Route the seat belt or LATCH strap through the correct path. Convertible seats have different belt paths for when they are used rear facing or forward facing (check your instructions to make sure).
Pull the belt tight. Apply weight into the seat with your hand while tightening the seat belt or LATCH strap. When the car safety seat is installed, be sure it does not move more than an inch side to side or toward the front of the car.
If you install the car seat using your vehicle’s seat belt, you must make sure the seat belt locks to keep a tight fit. In most newer cars, you can lock the seat belt by pulling it all the way out and then allowing it to retract to keep the seat belt tight around the car seat. Many car seats have built-in lock-offs to lock the belt.
It is best to use the tether that comes with your car seat to the highest weight allowed by your vehicle and the manufacturer of your car seat. Check your vehicle owner’s manual and car seat instructions for how and when to use the tether and lower anchors.
Has your child outgrown the forward-facing seat?

All children whose weight or height is above the forward-facing limit for their car seat should use a belt-positioning booster seat until the vehicle seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are 8 through 12 years of age.
A seat belt fits properly when the shoulder belt lies across the middle of the chest and shoulder, not the neck or throat; the lap belt is low and snug across the upper thighs, not the belly; and the child is tall enough to sit against the vehicle seat back with her knees bent over the edge of the seat without slouching and can comfortably stay in this position throughout the trip.

Do you have the instructions for the car seat?

Follow them and keep them with the car seat.
Keep your child in the car seat until she reaches the weight or height limit set by the manufacturer. Follow the instructions to determine whether your child should ride rear facing or forward facing and whether to install the seat using LATCH or the vehicle seat belt.
Has the car seat been recalled?
You can find out by calling the manufacturer or the National Highway Traffic Safety Administration (NHTSA) Vehicle Safety Hotline at 888/327-4236 or the NHTSA Web site.
Follow the manufacturer’s instructions for making any repairs to your car seat.
Be sure to fill in and mail in the registration card that comes with the car seat. It will be important in case the seat is recalled.
Do you know the history of your child’s car seat?
Do not use a used car seat if you do not know the history of the seat.
Do not use a car seat that has been in a crash, has been recalled, is too old (check the expiration date), has any cracks in its frame, or is missing parts.
Make sure it has a label from the manufacturer and instructions.
Call the car seat manufacturer if you have questions about the safety of your seat.
If you have questions or need help installing your car seat, find a certified child passenger safety technician (CPST). Lists of certified CPSTs and child seat-fitting stations are available on the following Web sites:

NHTSA Parents Central
National Child Passenger Safety Certified Technicians  
Additional Information from
Car Seats: Information for Families
Car Seats: Product Listing  
Car Seats and Obese Children: Suggestions for Parents

Figure 1 adapted from National Highway Traffic Safety Administration. LATCH Makes Child Safety Seat Installation as Easy as 1-2-3. 2011. DOT HS publication 809 489. Published March 2011. Accessed November 5, 2015.

Figures 2, 3, 4, 5, and 6 by Anthony Alex LeTourneau.​

Last Updated
 Car Seat Checkup (Copyright © 2016 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

New Year’s Resolutions for Kids

Healthy New Year’s Resolutions for Kids

​​The start of the new year is a great time to help your children focus on forming good habits. The American Academy of Pediatrics (AAP) provides the following list of ideas for you to talk to your children about trying, depending on their age. ​

I will clean up​ my toys by putting them where they belong. 

I will let my parents help me  brush my teeth twice a day.
I will wash my hands after going to the bathroom and before eating.

I will help clear the table when I am done eating. 
I will be friendly to all animals. I will remember to ask the owners if I can pet their animal first.

I will be nice to other kids who need a friend or look sad or lonely.

I will talk with my parent or a trusted adult when I need help or am scared.

Kids, 5 to 12 years old
I will drink reduced-fat milk​ and water every day, and drink soda and fruit drinks only at special times.

I will take care of my skin by putting on sunscreen before I go outdoors on bright, sunny days. I will try to stay in the shade whenever possible and wear a hat and sunglasses, especially when I’m playing sports.

I will try to find a sport (like basketball or soccer) or an activity (like playing tag, jumping rope, dancing or riding my bike) that I like and do it at least three times a week!

I will always wear a helmet when riding a bike, scooter or skateboard.

I will wear my seat belt every time I get in a car. I’ll sit in the back seat and use a booster seat until I am tall enough to use a lap/shoulder seat belt.

I’ll be friendly to kids who may have a hard time making friends by asking them to join activities such as sports or games.

I will always tell an adult about any bullying I may see or hear about to help keep school safe for everyone. 

I will keep my personal information safe and not share my name, home address, school name or telephone number on the Internet. Also, I’ll never send a picture of myself to someone I chat with on the computer without asking my parent if it is okay. 

I will try to talk with my parent or a trusted adult when I have a problem or feel stressed.

I promise to follow our household rules for videogames and internet use.

Kids, 13 years old and older

I will try to eat two servings of fruit and two servings of vegetables every day, and I will drink sodas only at special times.

I will take care of my body through physical activity and eating the right types and amounts of foods.

I will choose non-violent television shows and video games, and I will spend only one to two hours each day – at the most – on these activities. I promise to follow our household rules for videogames and internet use.

I will help out in my community – through giving some of my time to help others, working with community groups or by joining a group that helps people in need.

When I feel angry or stressed out, I will take a break and find helpful ways to deal with the stress, such as exercising, reading, writing in a journal or talking about my problem with a parent or friend.

When faced with a difficult decision, I will talk about my choices with an adult whom I can trust.

When I notice my friends are struggling, being bullied or making risky choices, I will talk with a trusted adult and attempt to find a way that I can help them.

I will be careful about whom I choose to date, and always treat the other person with respect and without forcing them to do something or using violence. I will expect to be treated the same way in return.

I will resist peer pressure to try tobacco-cigarettes, drugs, or alcohol. I will also avoid the use of e-cigarettes. 

I agree not to use a cell phone or text message while driving and to always use a seat belt.

 12/16/2015 12:00 AM

Happy Holidays! Holiday Safety and Mental Health Tips

Holiday Safety & Mental Health Tips

The holidays are an exciting time of year for kids, and to help ensure they have a safe holiday season, here are some tips from the American Academy of Pediatrics (AAP). 

When purchasing an artificial tree, look for the label “Fire Resistant.”
When purchasing a live tree, check for freshness. A fresh tree is green, needles are hard to pull from branches and needles do not break when bent between your fingers. The trunk butt of a fresh tree is sticky with resin, and when tapped on the ground, the tree should not lose many needles.
When setting up a tree at home, place it away from fireplaces, radiators or portable heaters. Place the tree out of the way of traffic and do not block doorways.
Cut a few inches off the trunk of your tree to expose the fresh wood. This allows for better water absorption and will help keep your tree from drying out and becoming a fire hazard.
Be sure to keep the stand filled with water, because heated rooms can dry live trees out rapidly. 
Check all tree lights (even if you’ve just purchased them) before hanging them on your tree. Make sure all the bulbs work and that there are no frayed wires, broken sockets or loose connections.
Never use electric lights on a metallic tree. The tree can become charged with electricity from faulty lights, and a person touching a branch could be electrocuted.
Some light stands may contain lead in the bulb sockets and wire coating, sometimes in high amounts. Make sure your lights are out of reach of young children who might try to mouth them, and wash your hands after handling them.
Before using lights outdoors, check labels to be sure they have been certified for outdoor use. To hold lights in place, string them through hooks or insulated staples, not nails or tacks. Never pull or tug lights to remove them.
Plug all outdoor electric decorations into circuits with ground fault circuit interrupters to avoid potential shocks.
Turn off all lights when you go to bed or leave the house. The lights could short out and start a fire.
Use only non-combustible or flame-resistant materials to trim a tree. Choose tinsel or artificial icicles of plastic or nonleaded metals.
Never use lighted candles on a tree or near other evergreens. Always use non-flammable holders, and place candles where they will not be knocked over.
In homes with small children, take special care to avoid decorations that are sharp or breakable. Keep trimmings with small removable parts out of the reach of children to prevent them from swallowing or inhaling small pieces. Avoid trimmings that resemble candy or food that may tempt a young child to eat them.
Wear gloves to avoid eye and skin irritation while decorating with spun glass “angel hair.” Follow container directions carefully to avoid lung irritation while decorating with artificial snow sprays.
Remove all wrapping papers, bags, paper, ribbons and bows from tree and fireplace areas after gifts are opened. These items can pose suffocation and choking hazards to a small child or can cause a fire if near flame. 
Keep potentially poisonous holiday plant decorations, including mistletoe berries, Jerusalem cherry, and holly berry, away from children.
Select toys to suit the age, abilities, skills and interest level of the intended child. Toys too advanced may pose safety hazards for younger children.
Before buying a toy or allowing your child to play with a toy that he has received as a gift, read the instructions carefully.
To prevent both burns and electrical shocks, don’t give young children (under age 10) a toy that must be plugged into an electrical outlet. Instead, buy toys that are battery-operated.
Young children can choke on small parts contained in toys or games. Government regulations specify that toys for children under age three cannot have parts less than 1 1/4 inches in diameter and 2 1/4 inches long.
Children can have serious stomach and intestinal problems – including death — after swallowing button batteries or magnets. In addition to toys, button batteries are often found in musical greeting cards, remote controls, hearing aids and other small electronics. Small, powerful magnets are present in many homes as part of building toy sets. Keep button batteries and magnets away from young children and call your health care provider immediately if your child swallows one.
Children can choke or suffocate on uninflated or broken balloons; do not allow children under age 8 to play with them.
Remove tags, strings, and ribbons from toys before giving them to young children.
Watch for pull toys with strings that are more than 12 inches in length. They could be a strangulation hazard for babies.
Parents should store toys in a designated location, such as on a shelf or in a toy chest, and keep older kids’ toys away from young children.
Bacteria are often present in raw foods. Fully cook meats and poultry, and thoroughly wash raw vegetables and fruits.
Be sure to keep hot liquids and food away from the edges of counters and tables, where they can be easily knocked over by a young child’s exploring hands. Be sure that young children cannot access microwave ovens.
Wash your hands frequently, and make sure your children do the same.
Never put a spoon used to taste food back into food without washing it.
Always keep raw foods and cooked foods separately, and use separate utensils when preparing them.
Always thaw meat in the refrigerator, never on the countertop.
Foods that require refrigeration should never be left at room temperature for more than two hours.                          
Clean up immediately after a holiday party. A toddler could rise early and choke on leftover food or come in contact with alcohol or tobacco.
Remember that the homes you visit may not be childproofed. Keep an eye out for danger spots like unlocked cabinets, unattended purses, accessible cleaning or laundry products, stairways, or hot radiators.
Keep a list with all of the important phone numbers you or a baby-sitter are likely to need in case of an emergency. Include the police and fire department, your pediatrician and the national Poison Help Line, 1-800-222-1222. Laminating the list will prevent it from being torn or damaged by accidental spills.
Always make sure your child rides in an appropriate car seat, booster seat, or seat belt. In cold weather, children in car seats should wear thin layers with a blanket over the top of the harness straps if needed, not a thick coat or snowsuit. Adults should buckle up too, and drivers should never be under the influence of alcohol or drugs.
Traveling, visiting family members, getting presents, shopping, etc., can all increase yourchild’s stress levels. Trying to stick to your child’s usual routines, including sleep schedules and timing of naps, can help you and your child enjoy the holidays and reduce stress.
Before lighting any fire, remove all greens, boughs, papers, and other decorations from fireplace area. Check to see that the flue is open.
Use care with “fire salts,” which produce colored flames when thrown on wood fires. They contain heavy metals that can cause intense gastrointestinal irritation and vomiting if eaten. Keep them away from children.
Do not burn gift wrap paper in the fireplace. A flash fire may result as wrappings ignite suddenly and burn intensely.
If a glass-fronted gas fireplace is used, keep children and others well away from it with a screen or gate. The glass doors can get hot enough to cause serious burns and stay hot long after the fire is out.
Take care of yourself both mentally and physically. Children and adolescents are affected by the emotional well-being of their parent or caregivers. Coping with stress successfully can help children learn how to handle stress better, too.
Make a plan to focus on one thing at a time. Try a few ideas from “mindfulness” as a strategy to balance the hustle and bustle of things like shopping, cooking, and family get-togethers during the holidays: Stop and pay attention to what is happening at the moment, focus your attention on one thing about it ,and notice how you are feeling at the time. Withhold immediate judgment, and instead be curious about the experience.
Give to others by making it an annual holiday tradition to share your time and talents with people who have less than you do. For example, if your child is old enough, encourage him or her to join you in volunteering to serve a holiday meal at your local food bank or shelter or sing at a local nursing home. Help your child write a letter to members of the armed forces stationed abroad who can’t be home with their own family during the holidays.
Remember that many children and adults experience a sense of loss, sadness or isolation during the holidays. It is important to be sensitive to these feelings and ask for help for you, your children, family members or friends if needed.
Try to keep household routines the same. Stick to your child’s usual sleep and mealtime schedules when you can, which may reduce stress and help your family enjoy the holidays.
Kids still need to brush their teeth twice a day!
Don’t feel pressured to “over-spend on gifts.” Consider making one or two gifts. Help your child make a gift for his or her other parent, grandparents, or other important adults and friends. Chances are, those gifts will be the most treasured ones and will teach your child many important lessons.
Most important of all, enjoy the holidays for what they are — time to enjoy with your family. So, be a family, do things together like sledding or playing board games, and spend time visiting with relatives, neighbors, and friends.
 11/17/2015 12:00 AM


UPDATED Media and Screen Time Recommendations

Where We Stand: TV Viewing Time

The American Academy of Pediatrics (AAP) recommends that parents and caregivers minimize or eliminate altogether media exposure for children under the age of two.

For older preschool-aged children, media limits are very appropriate and parents should have a strategy for managing electronic media when choosing to maximize its benefits.

Remember that supervised independent play for infants and young children has been shown to have superior benefit to the use of screen media when you cannot sit down and actively engage in play with your child. For example, have your child play with nesting cups on the floor nearby while you prepare dinner.

Also, avoid placing a television set in your child’s bedroom and recognize that your own media use can have a negative effect on children.

Additional Information:
How to Make a Family Media Use Plan
The Benefits of Limiting TV
What Children are NOT Doing When Watching TV
Why to Avoid TV Before Age 2
Sleep and Mental Health
Last Updated
 Caring for Your Baby and Young Child: Birth to Age 5, 6th Edition (Copyright © 2015 American Academy of Pediatrics)

The Benefits of Limiting TV

The AAP discourages TV and other media use by children younger than 2 years and encourages interactive play. For older children, total entertainment screen time should be limited to less than 1 to 2 hours per day.
You’ll all discover more constructive ways to fill the time, separately and together. Some examples include:



Taking part in outdoor activities

Talking more to one another 

Expect to encounter resistance at first. After all, change is never easy. If yours is a household where the TV regularly blares for five, six or seven hours a day, wean the family gradually. Try cutting down by an hour a week or go cold turkey. The two-hour maximum includes time spent in front of any screen, including the computer and video games

Make TV viewing an active choice, as if you were picking a movie from the newspaper. “How about if we watch at seven-thirty?” 

Hide the remote! Eliminate channel surfing, which encourages passive viewing. When family members have to get up to change the channel, they may be more selective about the programs they watch. If nothing else, at least they’ll be getting some exercise. 

When the show you wanted to watch is over, turn off the set. Also, if the program you choose isn’t compelling enough to watch actively, it’s not worth keeping on as background noise. 

Make a household rule: no TV in your youngster’s bedroom. Although adolescents deserve their privacy, they hardly need another reason to isolate themselves from the rest of the family. Children should watch their favorite shows in a central area of the home. Even if you’re not sitting down with them, this allows for conversation when you’re passing through and enables you to  keep closer tabs on what they’re watching. 

Whenever possible, videotape programs and watch them later. Fastforwarding through commercials will shave ten minutes off every hour of TV viewing, not to mention help your youngster hold on to her allowance longer. (When watching TV in “real time,” mute the sound during the breaks.) Taping shows ahead of time also allows you to hit the PAUSE button when you want to make a point or have a family discussion about something you’ve just seen onscreen. 

Discourage repeated viewings of the same video. The graphic language, violence and sexual content of movies rated PG-13 and R can have a cumulative effect on a child if they’re watched over and over again. 

Harness the power of television in a positive way. For all its flaws, TV can be a valuable tool for learning and expanding one’s awareness of the world.

Here’s what you can do to help your child get the most enjoyment out of the experience: 

>Peruse the TV listings for programs, specials, documentaries and other films that explore areas of interest to him. 
>Use events in the news and subjects of fictitious programs as springboards for discussion. 
>Encourage your youngster to broaden her horizons by watching programs that transport her to other times and places, or that expose her to different perspectives or philosophies. 
>Make use of ratings systems to know whether or not a program or movie is appropriate for your child. The National Association of Broadcasters (NAB), the National Cable Television Association (NCTA) and the Motion Picture Association of America (MPAA) jointly developed the “TV Parental Guidelines,” similar to themovie-rating system adopted by the MPAA in 1966. 

Talk back to your TV! Parents are rightfully perturbed about  the seemingly endless stream of violence and sex in television  programs and films, including those aimed at young people. We  should be equally concerned about what they don’t show: namely, the real-life consequences of such actions. For example, 75 percent of the violent scenes on TV fail to show the perpetrator expressing remorse, or being criticized or penalized  for his actions. Similarly, a study from the Henry J. Kaiser Family Foundation found that over a one-week period, roughly 90 percent of the television programs containing sex scenes did not include a single reference to the risk of pregnancy or acquiring a sexually transmitted disease from unprotected sex.
Last Updated
 Adapted from Caring for Your Teenager (Copyright © 2003 American Academy of Pediatrics)

Insect Bites and Stings

Your child’s reaction to a bite or sting will depend on her sensitivity to the particular insect’s venom. While most children have only mild reactions, those who are allergic to certain insect venom can have severe symptoms that require emergency treatment.

In general, bites are usually not a serious problem, but in some cases, stings may be. While it is true that most stings (from yellow jackets, wasps, and fire ants, for example) may cause pain and localized swelling, severe anaphylactic reactions are possible, although uncommon.


Although insect bites can be irritating, they usually begin to disappear by the next day and do not require a doctor’s treatment. To relieve the itchiness that accompanies bites by mosquitoes, flies, fleas, and bedbugs, apply a cool compress and/or calamine lotion freely on any part of your child’s body except the areas around her eyes and genitals. If your child is stung by a wasp or bee, soak a cloth in cold water and press it over the area of the sting to reduce pain and swelling. Call your pediatrician before using any other treatment, including creams or lotions containing antihistamines or home remedies. If the itching is severe, the doctor may prescribe oral antihistamines.

If your child disturbs a beehive, get him away from it as quickly as possible. The base of a honeybee’s sting emits an alarm pheromone (hormone) that makes other bees more likely to sting as well.

It is very important to remove a bee stinger quickly and completely from the skin. The quick removal of a bee stinger will prevent a large amount of venom from being pumped into the skin. If the stinger is visible, remove it by gently scraping it off horizontally with a credit card or your fingernail. Avoid squeezing the stinger with a pair of tweezers; doing this may release more venom into the skin. The skin may be more swollen on the second or third day after a bee sting or mosquito bite.

Keep your child’s fingernails short and clean to minimize the risk of infection from scratching. If infection does occur, the bite will become redder, larger, and more swollen. In some cases you may notice red streaks or yellowish fluid near the bite or your child may get a fever. Have your pediatrician examine any infected bite right away, because it may need to be treated with antibiotics.

Call for medical help immediately if your child has any of these other symptoms after being bitten or stung:

  • Sudden difficulty in breathing
  • Weakness, collapse, or unconsciousness
  • Hives or itching all over the body
  • Extreme swelling near the eyes, lips, or penis that makes it difficult for the child to see, eat, or urinate
  • Prevention
  • Some children with no other known allergies may have severe reactions to insect stings. But if you suspect that your child is allergy-prone, discuss the situation with your doctor. He may recommend a series of shots (hyposensitization injections) to decrease your child’s reaction to future insect stings (but not bites). In addition, he will prescribe a special auto-injection kit containing epinephrine for you to keep on hand for use if your child is stung.

It is impossible to prevent all insect bites, but you can minimize the number your child receives by following these guidelines.

Avoid areas where insects nest or congregate, such as garbage cans, stagnant pools of water, uncovered foods and sweets, and orchards and gardens where flowers are in bloom.
When you know your child will be exposed to insects, dress her in long pants and a lightweight longsleeved shirt.
Avoid dressing your child in clothing with bright colors or flowery prints, because they seem to attract insects.
Don’t use scented soaps, perfumes, or hair sprays on your child, because they also are inviting to insects.
Insect repellents are generally available without a prescription, but they should be used sparingly on infants and young children. In fact, the most common insecticides include DEET (N, N-diethyl-m-toluamide), which is a chemical not recommended for use in children under two months of age. Do not apply DEET-containing repellents more than once a day on older children.

The concentrations of DEET vary significantly from product to product—ranging from less than 10 percent to over 30 percent—so read the label of any product you purchase. Some products have concentrations much higher than 30 percent, and the higher the concentration of DEET, the longer the duration of action. Its effectiveness peaks at a concentration of 30 percent, however, which is also the maximum concentration currently recommended for children. The safety of DEET does not appear to be related to its level of concentration; therefore, a prudent approach is to select the lowest effective concentration for the amount of time your child spends outdoors. You should avoid products that include DEET plus a sunscreen, because sunscreen needs to be applied frequently while DEET should be applied only once a day. If you apply DEET more frequently, it may be associated with toxicity. Also be sure to wash off the DEET with soap and water at the end of the day.

An alternative to DEET is a product called picaridin (KBR 3023). While it has had wider use in Europe, picaridin has more recently become available in the US. It is a generally pleasant- smelling product without the oil residue associated with DEET, and is available in concentrations of 5 to 10 percent.

The American Academy of Pediatrics recommends that repellents used in children over six months of age have 30 percent DEET or 5 to 10 percent picaridin repellent, applied once before going outdoors. These repellents are effective in preventing bites by mosquitoes, ticks, fleas, chiggers, and biting flies, but have virtually no effect on stinging insects such as bees, hornets, and wasps. Contrary to popular belief, giving antihistamines continuously throughout the insect season does not appear to prevent reactions to bites.

Insect Bites and Stings

Water (pools, lakes, birdbaths)
Stinging sensation followed by small, red, itchy mound with tiny puncture mark at center.
Mosquitoes are attracted by bright colors and sweat.

Food, garbage, animal waste
Painful, itchy bumps; may turn into small blisters.
Bites often disappear in a day but may last longer.

Cracks in floor, rugs, pet fur
Multiple small bumps clustered together; often where clothes fit tightly (waist, buttocks).
Fleas are most likely to be a problem in homes with pets.

Cracks of walls, floors, crevices of furniture, bedding
Itchy red bumps occasionally topped by a blister; usually 2–3 in a row.
Bedbugs are most likely to bite at night and are less active in cold weather.

Fire ants
Mounds in pastures, meadows, lawns, and parks in southern states
Immediate pain and burning; swelling up to 1⁄2 inch (1.2 cm); cloudy fluid in area of bite.
Fire ants usually attack intruders.

Bees and wasps
Flowers, shrubs, picnic areas, beaches
Immediate pain and rapid swelling.
A few children have severe reactions, such as difficulty breathing and hives/swelling all over the body.

Wooded areas
May not be noticeable; hidden on hair or on skin.
Don’t remove ticks with matches, lighted cigarettes, or nail polish remover; grasp the tick firmly with tweezers near the head; gently pull the tick straight out.


Introducing CloudVisit Telemedicine at Petite Pediatrics

imagesCloudVisit Telemedicine:

We are excited to offer our patients the option of a telemedicine visit. 

Telemedicine is a secure way to communicate with Dr. Barry via electronic devices such as smart phones, tablet and lap/desktop computers. For families that may be traveling outside of the Santa Barbara area, this enables us to maintain continuity of care by discussing and evaluating non-emergent medical concerns.

The American Academy of Pediatrics has endorsed the use of telemedicine for children’s healthcare and recommends that telemedicine services be delivered in the context of a medical home, because this model of health care provides continuity and efficiency. 

You can register with our telemedicine service CloudVisit Connect by linking to the icon above.

This is a service that is billable to insurance and  is based upon the duration of time for the telemedicine appointment. 

Newborn Eye Color

Newborn Eye Color

New parents often ask what color I think the baby’s eyes are going to be. I never answer this question until the child is at least 1 year old; I mean, what if the parents believe me and use my answer to make major life decisions? When we talk about eye color, we’re really talking about the appearance of the iris, the muscular ring around the pupil that controls how much light enters the eye. After all, the pupil will always be black, except in flash photos, and the whites (sclera) should stay pretty much white, although jaundice may turn them yellow and inflammation may make them look pink or red.

Gray or Blue Eyes at Birth
Iris color, just like hair and skin color, depends on a protein called melanin. We have specialized cells in our bodies called melanocytes whose job it is to go around secreting melanin where it’s needed, including in the iris. When your baby is born his eyes will be gray or blue, as melanocytes respond to light, and he has spent his whole life in the dark.

Eye Color Changes Over Time
Over time, if melanocytes only secrete a little melanin, your baby will have blue eyes. If they secrete a bit more, his eyes will look green or hazel. When melanocytes get really busy, eyes look brown (the most common eye color), and in some cases they may appear very dark indeed. Because it takes about a year for melanocytes to finish their work it can be a dicey business calling eye color before the baby’s first birthday. The color change does slow down some after the first 6 months of life, but there can be plenty of change left at that point.

Eye color is a genetic property, but it’s not quite as cut-and-dried as you might have learned in biology class.

  • Two blue-eyed parents are very likely to have a blue-eyed child, but it won’t happen every single time.
    Two brown-eyed parents are likely (but not guaranteed) to have a child with brown eyes.
    If you notice one of the grandparents has blue eyes, the chances of having a blue-eyed baby go up a bit.
    If one parent has brown eyes and the other has blue eyes, odds are about even on eye color.
    If your child has one brown eye and one blue eye, bring it to your doctor’s attention; he probably has a rare genetic condition called Waardenburg syndrome.

Parents also often note that their newborns’ eyes appear to cross from time to time. For the first 6 months of life this can be normal. To begin with, to look at something the brain has to know where to point the eyes. For the first 2 to 4 weeks of life vision is not accurate enough for the baby’s eyes to find a target a lot of the time. Parents often feel like their newborns are looking past them rather than at them, because they are. By the fourth week of life, however, your baby will focus on your face if you’re cradling him.

Most visual development occurs in the brain, not in the eyes themselves. One of the greatest challenges for the developing brain is to coordinate visual signals from one side to the other. Nerve signals from the eyes travel through optic nerves and split off to both sides of the brain. To make sense of those signals, the 2 sides of the brain have to cooperate, comparing information and coordinating eye movement in the desired direction. Until age 2 months you may notice your infant will follow your face or a toy a little way, then lose it as it crosses from one side to the other. By 2 months, however, he should be able to track from right to left and back again.

The next big visual milestone occurs at 6 months of age. By this time the 2 sides of the brain are on good terms with each other. Until this point the eyes track together as long as they both have something to look at, but if one is deprived of input (from being covered by a hat, for example), it might drift off in its own direction. By 6 months of age the eyes should continue looking the same direction even if one of them is covered temporarily. We test this in the clinic by covering 1 eye for 3 seconds, then suddenly uncovering it and looking to see if it’s still tracking with the opposite eye. We call this test the cover-uncover test.

Sometimes the shape of a child’s face makes it look as though the eyes are crossed even when they are not. A child with a broad nasal bridge may appear to have an inward-looking eye, when in fact he’s just looking off to the side. You can check this by watching the light reflection in your child’s eyes from a window or lamp; if it falls in the same place on each eye, the eyes are working together.

Even with office screening, however, we don’t always catch an eye that tends to deviate. Deviations occur more often when the child is tired. If you ever notice that your 6-month-old or older child has an eye that doesn’t always look the same way as its partner, alert his doctor. It’s critical that an eye specialist (ophthalmologist)examine the child. What some people call a lazy eye (amblyopia) may be a sign that one eye doesn’t see as clearly as the other. When the brain is forced to make 1 picture from 2 very different inputs, it starts to ignore the signals from the worse eye. Over time this process becomes irreversible, leading to partial blindness in the weaker eye. In most cases, you should address the problem before the child turns 3 to ensure he’ll grow up with normal depth perception. Treatments for amblyopia vary based on the cause and severity of the condition. Some children require glasses or patches that force the brain to pay attention to signals from the weaker eye. Other kids need surgery to shorten or lengthen certain muscles that control eye movement.
 David L. Hill, MD, FAAP
Last Updated
 Dad to Dad: Parenting Like a Pro (Copyright © American Academy of Pediatrics 2012)