White House Nannies

As a pediatrician, I get asked lots of questions about having children that don’t fall into the “medical advice” category. Everything from advice about different pre-schools to my favorite place to host a birthday party. One area that comes up frequently is nannies – how to find them, what to ask them, how to keep them. Sadly these topics are not covered in medical school though some may argue they should be!

I do offer some child care tips to my families searching for the perfect person to care for their little ones. Getting recommendations and following up on references is key. So is making sure your nanny is CPR certified and up to date on vaccines (this includes being on board with getting the yearly flu shot). It’s also a good idea to discuss sick day policies ahead of time and coming up with an agreed-upon plan for when the nanny is sick or your child is. Being on the same page regarding feeding, boundaries, and sleeping is also important. If you plan to have your child cry it out for naps but your nanny intends to rock her to sleep, you are going to have some disagreements. Beyond that most of my nanny recommendations come from my experience as a mom and the lucky employer of the best nanny ever.

That’s why Spring Valley Pediatrics is bringing in professionals to answer the myriad other childcare questions we know you have. On Thursday, January 23rd at 7pm, Barbara Kline, the owner of White House Nannies, will be at our office answering all of your nanny questions. Come ready to raise your hand – we look forward to hosting you!

Head Lice

Back to school comes with lots of fun things – a new backpack and lunch box, seeing old friends and making new ones, the start of Fall.  Unfortunately, it also causes an increase in the amount of lice we see in our office.  While harmless, these bugs are irritating for the whole family and can lead to absences from school and work.  This school year, be armed with the knowledge of how to prevent and, if needed, treat these pesky uninvited guests.

 

What are lice?

Lice are tiny gray bugs that can infest the scalp.  They are about the size of a sesame seed and move quickly so can be difficult to see.  What you often do find are their white eggs, called nits, which firmly attached to hair shafts near the skin.  Unlike dandruff or sand, nits cannot easily be shaken off the hair shaft.  Most people who get lice complain of an itchy scalp. Lice do not carry diseases and will not make you feel sick.

 

Lice life cycle

Nits hatch into lice in about one week.  They can survive off the scalp during that time which makes cleaning your house imperative when treating a lice infection in the family.  Adult lice can live three weeks on the scalp and feed every few hours on tiny amounts of blood from the scalp.  Off the scalp, adult lice cannot survive for more than one day without a blood meal.

 

Transmission

Nits cannot pass from person to person; only live lice can infect other people. Almost all transmission is from direct head-to-head contact.  Since lice cannot jump or fly, it takes about 30 minutes of direct contact for a louse to crawl from one head to another.  However, indirect transmission from hats, hairbrushes, headphones and other objects is possible though less common.  Most transmission of lice happens at home, through sleepovers and bed sharing.

 

Treatment

Anti-lice shampoo (such as Nix which is over the counter) is the mainstay of treatment and requires two treatments so be sure to follow the package directions. Prescription anti-lice medication such as Sklice, is also available and requires only one application.  Discuss with your doctor if this is a good choice for your family.

When using the anti-lice shampoo, first wash hair with a regular shampoo and towel dry.  Do not use conditioner on the hair as it interferes with the lice treatment.  Pour 2 ounces (one box of Nix if that’s what you are using) into damp hair.  People with long hair may need to use two boxes.  Work the cream into all the hair down to the roots and add a little warm water if needed to work up a lather.  Leave the shampoo on for a full 10 minutes and then rinse the hair thoroughly with water and towel dry.  Again, do not use conditioner.  Do not shampoo the hair for 48 hours after application of anti-lice shampoo and avoid hair conditioner before treatment as well as for 2 weeks after.

Most importantly, most over the counter shampoos require that you repeat the entire process 9 days later to kill any nits that survived.  Since nits hatch 6-9 days after being laid, the second treatment will ensure that lice that hatch from surviving nits are also killed.

 

Preventing Spread

Now that the hair is under control, it’s time to address the house.  Vacuum your child’s room thoroughly as well as the rest of the house.  Soak hairbrushes for 1 hour in a solution containing anti-lice shampoo.  Wash bed sheets, blankets, pillowcases and any clothes worn in the past three days in hot water; water temperature of 130 degrees Fahrenheit kills lice and nits.  For items that cannot be easily washed, such as hats or stuffed animals, place them in sealed plastic bags for 2 weeks to ensure that all nits and lice are dead.  Remind family members not to share combs or hairbrushes to prevent passing lice in the future.

 

Most importantly

Don’t stress!  Lice infection does not happen because of a lack of cleanliness – it just happens. If you follow the above steps, lice and their nits should be successfully killed.  Children can return to school and daycare after treatment with an anti-lice shampoo.  A child does not need to miss any school or childcare due to nits remaining after treatment since nits are not contagious.  Always contact your doctor if you are unsure if your family has lice, are unable to successfully treat them with the above steps, or have additional questions.

Wishing you a happy and lice free school year!

 

Preparing Your Child for a Sibling

Expanding your family is an exciting time but preparing your children for the addition of a baby can be tricky.  Dr. Jessica Long gives her professional, as well as personal, advice on how to prepare your child for a sibling.

When I was pregnant with my second child, I was concerned about how an additional baby would transform the dynamic in our household.  I was most worried about how it would change, for better or worse, life for my oldest. Would she resent her baby sister? Would it affect her relationship with me?  Is it even possible to love multiple children equally (spoiler alert: it is!)?

I spent a lot of sleepless nights brainstorming how to make the transition from only child to big sister as smooth as possible.  While there were certainly hiccups along the way (and, to be honest, there continue to be 3 years later), having a sibling has been the best thing to happen to my sweet firstborn.  So much so that we gave her another!

When preparing your child for the arrival of a baby, get them involved as much as is developmentally possible.  Have your oldest help pick out or make artwork for the nursery, choose some books for the bookshelf, and put clothes in the drawers with you.  Talk about the baby and reminisce about when your oldest was a newborn by looking at pictures together.  There are lots of good books, for kids of all ages, that talk about having a sibling in language they will understand.  Communicating with your child and getting them involved in preparing for the baby’s arrival will make your big kid feel part of the excitement.

Make sure you prepare your oldest for what it will be like when you go to have the baby.  Let them know you’ll be gone for a few days but that some fun special things will happen (Grandma is going to have a sleep over with you or Daddy is going to take you to the Zoo that day).  If you decide to have your child visit you at the hospital, have the baby snuggled in the bassinet and not in your arms so you are 100% available for big kid hugs and cuddles before the sibling introduction occurs. Having a small present “from the baby” to the big sibling also works magic – nothing like a little bribery to get the relationship off to a good start.

Once you are home, expect some unusual behavior.  Sometimes children regress and your toilet trained three-year old-may start having accidents, or your eighteen-month-old who sleeps through the night suddenly starts a sleep protest.  Give it time – everything will get back to normal soon.  Though your newborn needs most of your time and attention, try to block off some alone time for just you and your oldest each day.  You’ll appreciate the one-on-one time as much as she will.

Try to keep the sixty days before and after the birth of a sibling as laid back for your older child as possible.  That is not the time to transition from a crib to a toddler bed, start potty training, or throw out the pacifier.  As things settle down, your child will get back to her old routine.

My only other advice is to think long and hard about when you tell your child you are expecting.  Be prepared that they will ask you every single day thereafter if today is the day the baby is coming.  So learn from my mistakes and consider keeping that a secret and save your sanity for a bit longer.

Ear Piercing Safety

You know the day is coming when your tween is asking to have her ears pierced. Do it the safe way with these tips from Dr. Jessica Long.

Getting your ears pierced can be a momentous occasion.  For some kids, it happens when they are babies and they have no memory of it.  For others, it’s a birthday promise they’ve been counting down towards for years. My three year old is already begging for earrings but has to wait until the arbitrary age of seven (I’m such a mean mom).  Regardless of when the big moment happens, you want to make sure it’s done right.

Be sure to choose a clean and reputable place.  Your pediatrician might even offer it as we do at Spring Valley Pediatrics.  You’ll want to make sure the person poking a hole in your child’s ears is well trained, wears new disposable gloves, and uses equipment that is sterilized to decrease the chance of infection.

Be sure to choose the right earrings.  Since nickel is a main culprit of allergic reactions, stick to hypoallergenic materials like sterling silver or 14-, 18- or 24-karat gold.  At Spring Valley Pediatrics, our patients choose from a variety of earrings all made of 14-carat gold or surgical stainless steel.

Be sure to be up to date with vaccines.  Most pediatricians recommend your little one have received her third tetanus shot, typically given at the six-month-old well-visit, before any ear piercing.  We want to make sure this elective procedure carries as little risk to your child as possible.

Be sure to follow proper care of your piercing.  For the first six weeks after your ears are pierced, it is important to wash the ear lobe (while keeping the earring in) twice a day with soap and water.  We provide our patients with another cleaning solution to use in addition to soap and water twice a day. Turn the earrings, like winding a watch, twice a day as well.   After 6 weeks of keeping the original earrings in, you can replace them for other light stud earrings but avoid any heavy or dangling earrings for 4-6 months.  Also don’t leave your earrings out for more than 24 hours until your piercing is at least six months old – you don’t want those holes closing up!

Be sure to call your doctor if your new ear piercing is red, painful, or has discharge.  No matter how careful you are, infections can happen so be sure to be seen by your physician if things don’t seem right.

Happy piercing!

How to Help Your Children Avoid Insect Bites

Anyone who has spent a second in DC during the Summer knows that the mosquitos can be especially brutal (we are on a swamp after all). Don’t let these pesky bugs keep you and your family from enjoying time outside with these tips from Dr. Jessica Long.

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My kids are loving these long, sunny summer days and begging for some outdoor adventures.  However, if you are a true city girl like I am, the thought of leaving your concrete jungle and venturing into the grass and the trees may fill you with trepidation.  I do not like bugs and it greatly detracts from the nature time the rest of my family craves.  Plus, a new alert that West Nile positive mosquitos have been found in Ward 3 does little to calm my neurotic nature.  Obviously, I cannot prevent any and all insect encounters but there are many safe and effective ways to minimize my family’s exposure.

While complete avoidance of insects is not a realistic goal, we can be mindful of where we spend our time and what we wear.  Avoid areas with tall grass that ticks love to cling to as well as stagnant water that is a breeding ground for mosquitos.  When outside in the evenings when mosquitoes love to munch, choose long sleeves and pants that are light and breathable.  The same goes for hikes in the woods or tall grass to prevent ticks from attaching to your skin.  Be sure to do a “tick check” in the evenings when you’ve been outdoors (even your own backyard counts).  They especially like to hide in armpits, in and around ears, inside the belly button, back of the knees and between the legs, around the waist, and in your hair.

It is also a good idea to apply insect repellant to exposed skin and clothing. However, hitting the bug spray aisle of the store can be overwhelming.  There are so many options and ingredients!  Lotions, sprays, wipes, DEET, picardin – what should you choose?

The American Academy of Pediatrics and the Centers for Disease Control both give the thumbs up for 10-30% DEET in children as young as 2 months (keep the under 2 month babies away from insects completely). DEET has also been shown to be safe in pregnant and breastfeeding moms.  Another option is Picardin, a synthetic compound approved in the US in 2005 and protects about as well as 10% DEET.  There are also many repellants that contain essential oils such as citronella, cedar, soybean, and eucalyptus (the latter should be avoided in children under 3 years old).  While these are considered safe, they have to be reapplied frequently and long-term follow up studies are lacking.

Similar to sunscreen, whichever insect repellant you choose must be reapplied frequently.  10% DEET and products that function like it last about 2 hours while 30% DEET keeps you covered for up to 5 hours.  Choose the lowest concentration you need for adequate coverage; no need to go with 30% DEET if you are planning on playing in your backyard for an hour.

So now that you’re armed and ready to fight those insect bites, get out there and enjoy this gorgeous DC summer!  My family might even convince me to get out there, too.

How to Handle Separation Anxiety

It is heartbreaking to leave your child when he is upset. Read on for tips from Dr. Jessica Long on how to ease your child’s separation anxiety.

Nothing pulls at your heart strings like your child crying when you need to leave.  It makes you feel awful and, even if your little one recovers as soon as you are out of sight, makes you feel horribly guilty the entire time you are away.  Separation anxiety is a normal part of your child’s development but that does not make it any easier to endure.

Babies start to experience separation anxiety around the age of 4-7 months once they realize that you exist even when you are not right in front of them (this is known as “object permanence”).  They want you when you’re not there and are sad when you leave, even if it’s just to walk to the other room.  As our babies grow into toddlers, episodes of separation anxiety become less frequent but can be more intense (think crying, yelling, tantrums).  School-age children can even exhibit separation anxiety, especially with big changes like starting school or a new sibling in the house.  Thankfully though, it’s unusual for daily separation anxiety to continue in your school-age child. If it does, you should discuss it with your pediatrician.

So what’s a parent to do when you have to leave the house – now! – but you have a sobbing child clinging to your leg?  First off, no matter how tempting it is, don’t sneak out.  Your child needs to trust you and suddenly disappearing will only make her more fearful of your absences.  Instead, let her know that you are leaving and when you’ll be back in terms she’ll understand (“after you wake up from your nap” or “right before lunch”).  Just as importantly, keep that promise and be home when you say you will.  Develop a goodbye ritual that you use each time, to provide consistency, but keep it short.  Longer rituals may lead your child to fixate on the idea of you leaving.

Remember that practice makes perfect.  Being separated from a parent is important for your little one’s development, and it’s healthy for him to spend some time away from you.  Even having a friend, family member, or nanny provide child care for a few hours gives you the chance to practice your goodbye ritual and allows your child to experience special time with other trusted adults in his life.

Most importantly, separation anxiety is temporary.  Our children continue to grow, mature, and get used to new situations.  Stay loving and consistent in your goodbye routine and it will become easier and easier.

How To Handle Immunization Anxiety

As parents we all know that immunizations, although necessary, can be a source of anxiety for little ones (and for us!). Here are  Dr. Jessica Long‘s tips on how to keep our children calm during immunization visits.

I always hoped that, since I’m a pediatrician, my children would have no qualms about anything that happens at the doctor’s office. I was wrong. My children get as upset about shots, as fearful of a blood draw, and as manic about opening their mouths for a strep swab as the next kid. But shots don’t have to be a horrible experience for kids and parents alike. There are simple things we can do to calm our child, no matter her age, to make everything go a bit smoother.

Leading up to the doctor’s visit, your toddler or school-aged child may ask if it will hurt. Honesty is the best policy. Let him know that yes, it will hurt for a second, but it won’t be bad and you’re right there with him. Some kids like to role play beforehand, pretending to be the doctor giving shots to their parent or stuffed animal, which can make them more confident for the real thing.

At the doctor’s office, the first step in calming your child is checking in on your own mood. If you are relaxed that will rub off on your little one; if you’re stressed, that will too. How would you feel about getting a shot yourself? Probably not exactly excited about it, but also not too worried or afraid. You should feel that way about your child getting a shot. And your child will notice how you feel, and will tend to feel that way herself. Children are perceptive – pretending won’t help.

At the time of the shot, distraction can be very helpful. An infant may want to nurse, suck on a pacifier, or be skin to skin on a parent, all of which have been shown to reduce the stress of painful procedures in babies. An older child may want to hugged or cuddled, read a book, or even watch a favorite video on your phone. Encouraging your child to cough loudly right before and right after the shot has also been shown to reduce painful reactions in school aged kids and even middle schoolers (yes, they get scared, too).

Congratulate your child on being cooperative and brave, but don’t make too big a deal out of it Give her a high five, a hug or a cuddle to let her know you’re proud of her and then head out for a small reward. In our house we go for cake pops, and knowing there is a special treat waiting for my girls (and me!) at the end of a tough doctor’s visit puts everyone a little more at ease.

Strep Throat

We made it through flu season (fingers crossed), but what about the dreaded strep? Read on for advice from Dr. Jessica Long on how to handle this often painful infection.

Now that flu is leaving the D.C. area, it seems like strep throat has happily filled the void. If you have a school-aged child, chances are you have had at least one experience with strep throat. It’s almost a parenting rite of passage to get the “There is strep in the classroom” letter home from the teacher! Even though you hear about it all the time, what exactly is strep throat and why are pediatricians so quick to treat it with antibiotics?

Strep, short for streptococcus, comes in different forms but Group A Strep (aka streptococcus pyogenes or GAS for short) is the one that tends to infect the tonsils. The tonsils are a pair of soft tissue masses that are in the back of the throat. When they get infected, by either a virus or a bacteria, they can get larger, red, painful and sometimes even have pus on them. Though viruses are the main culprit of sore throats in kids, if your child continues to complain throughout the day of throat pain or has fever, belly pain, or a rash, it’s a good idea to see the pediatrician.

If your pediatrician wants to check if your child has strep throat, she will order a rapid strep test that can be done right there in the office. After a quick q-tip “tickle” of the tonsils, your doctor will have an answer in just a few minutes. The rapid strep test is good at checking to see if your child is infected but it misses a few people (it catches between 90-95% of people who have strep throat). Therefore, most physicians will also do a culture to see if strep grows from the swab over 24-48 hours. This extra test will make your pediatrician that much more confident that if the test is negative your child truly does not have strep throat.

We treat strep throat for a few reasons. First off, it makes kids feel better faster and who doesn’t want that? Also, after 24 hours of antibiotics your child is no longer contagious and can safely go back to school and activities without infecting friends and family. Plus, strep throat that goes untreated can lead to more serious infections such as an abscess of the tonsils, kidney problems, and even rheumatic heart disease. That’s why it’s important to take the full course of antibiotics if they are prescribed even though your child will feel back to normal in just a few days.

The biggest question on every parent’s mind is how to prevent this in the future? Unfortunately, that can be tough since strep throat can be spread a few days before a child has any symptoms. Throat infections are passed through the air by sneezing, coughing, or touching someone who has it, so remind your child to be vigilant about hand washing, to cough or sneeze into her elbow (not her hands!), not to share drinks and food, and to stay home from school when she doesn’t feel well.

Baby Proofing 101

Once your baby is mobile, it’s time to start making some changes around the house to protect your curious little one. Read on for tips from Dr. Jessica Long on best practices for baby-proofing.

There are a lot of ways parenthood changes us but one I did not expect was how drastically different our house would look. Never mind the scooters on the front porch, the chalk drawings on the sidewalk, or the toys strewn everywhere inside and out. There are more subtle differences I never would have guessed like covers on the outlets, gates on the stairs, and not a loose coin to be found. Baby-proofing your home is a huge but important endeavor and it involves changing habits and routines you never really knew you had.

How do you even start making your home safe for your little one who, at a very young age, can (and will) start reaching for things and sticking them in her mouth? Suddenly a benign water bottle lid becomes a potential choking hazard. The dog food bowl becomes your child’s most desired possession. And don’t get me started on how every electric cord in the house suddenly becomes a beacon of fun.

As you prepare to baby-proof, I recommend looking in each room in your house, ideally from the much lower viewpoint of your child, to see what potential dangers there are. There are obvious things like installing baby gates at the top and bottom of all stairs but also more subtle hazards like window blind cords that should be tucked out of reach. In bedrooms and living rooms, make sure furniture is secured to the wall so that your curious child does not accidentally topple it over when trying to pull up on it. The same goes for TVs, which are notorious for causing injuries to young children.

In kitchens and bathrooms, invest in strong cabinet and drawer locks so that curious hands do not find medications or cleaners. When possible, store toxic or poisonous substances up high as well as locked away to minimize the chances of your little one accidentally getting ahold of them. Outlets should be covered and electrical cords should be taped down or hidden behind furniture so as not tempt curious babies.

One of the big changes that needs to be made, and maintained over time, is keeping choking hazards out of your child’s reach. Gone are the days where you can toss loose change on the table without thinking or absent-mindedly leave batteries on the counter – both pose serious threats to your child. When ridding your space of choking hazards, use the toilet paper roll rule. If an item is small enough to fit through the cardboard tube, it should be placed out of reach of your child. While this is a routine that can take time to master, it will soon become second nature and ensures your child can crawl, walk, climb and explore in a safe space.

Once you’ve seemingly covered your house in bubble wrap, the next step is seeing what your child gets into. All the baby-proofing in the world doesn’t replace good adult supervision, and watching your child will reveal new hazards to abate Plus, every child is different, so while your first may never have looked at an outlet, your second may be found licking one (true story). You will likely continue to update and change your safety precautions as needed and as your child grows.

 

THE DREADED VIRUS – HAND FOOT AND MOUTH DISEASE

Now that school is back in session, germs are spreading and your children are bringing home all types of illnesses, one in particular you should watch out for is Hand Foot and Mouth disease, a viral illness that results in fever and a painful rashes. Dr. Jessica Long gives us the lowdown on this dreaded illness.

When we signed up for parenthood, none of us really knew what we were getting into. Which is probably a good thing because if we were warned about dealing with a sick child who had Hand, Foot, and Mouth disease we may have made a different decision (just kidding, sweet kids!).

If you haven’t been plagued by this viral illness yet, your time will eventually come. Nearly every child is struck by this rash during their early childhood. It is typically harmless and lasts about a week but boy does it make for sleepless nights and lots of phone calls and office visits from uncomfortable families.

Hand, Foot, and Mouth is most common during the summer and early Fall though enteroviruses, which cause it, can infect at any time of year – our practice is seeing a lot of it right now. Your child may feel run down and a bit unwell for a few days, perhaps with fever or less of an appetite. Then the rash will start popping up on their – you guessed it! – hands, feet, and in and around the mouth. Not all three areas will necessarily be affected and other spots, especially their buttocks, can be plagued with these tiny red blistery spots.

There is no quick fix for Hand, Foot, and Mouth disease. Keeping your little one hydrated is the main goal since kids often avoid eating and drinking due to the uncomfortable spots in their mouth. Giving some acetaminophen or ibuprofen may make them more willing to drink. Pedialyte popsicles are also lifesavers to soothe an aching mouth and get fluid in your sick child. If your child still doesn’t want to drink anything, chat with your pediatrician as there are prescription mouth washes that can be used to help combat the pain.

Even though your child may continue to shed the virus for weeks in respiratory droplets (like a runny nose or cough), most kids are no longer contagious once the red spots have crusted over, which takes about seven days. Your pediatrician will likely recommend that your child stay home until that happens and she is feeling better. To help prevent spreading Hand, Foot, and Mouth to others, wash hands frequently, clean and disinfect touched surfaces including toys, and avoid close contact such as kissing, hugging or sharing utensils and cups.

Most importantly, this too will pass. Just like lice, sleep regression, and that really annoying biting stage, Hand, Foot, and Mouth disease is another badge of honor we earn as parents. We really are super heroes.