Have a safe and happy Halloween

The 411 on the Flu

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It’s that time of year again…time to get your flu shot. With the kids back in school and freezing temps on the way, now’s the time to schedule your shot. Dr. Jessica Long gives us the lowdown on the flu and why it is so important to get vaccinated.

As a pediatrician, I see things through a different lens than the average parent. It’s a blessing and a curse. Back to school to me doesn’t just mean new clothes and backpacks – it means the swapping of germs with all your classmates. Grapes are tasty, nutritious choking hazards that must be cut into quarters. Monkey bars are fun and great for motor development but also keep emergency rooms in business. The long-awaited arrival of Fall means comfy sweaters and the rustle of fallen leaves…but also your flu shot is due! I can be such a killjoy, or so my husband says.

Flu peaks in the United States during December through March but we can see cases as early as September and as late as May. That’s what makes this time of year perfect for getting your annual flu vaccine since it takes two weeks to receive maximum protection from it. Just as in 2016, this year only the flu shot is available since the Flu Mist (the nose spray form of the vaccine) was not protecting people as much as we would like.

Avoiding contact with the flu virus is nearly impossible, so vaccination is the best way to ensure you do not get the flu this season. Flu spreads through droplets made when people cough, sneeze, or talk, making it very easy to share among your office, school or family. You can also get the flu by touching a surface or object that has the flu virus on it and then touching your own mouth, eyes or nose. In fact, the flu virus can live on a hard surface for 24 hours – gross!

Even though we all try to stay home and away from others when we are ill, you may have spread the flu before you were even sick! Most healthy adults can infect others with the flu one day before they have symptoms. People can remain infectious for 5-7 days after becoming sick. Some, like our young children, might be able to infect others for an even longer period of time.

Most people are familiar with the common symptoms of the flu (fever, cough, sore throat, stuffy nose, muscle aches, headache, and fatigue) but kids can also have vomiting and diarrhea. Our children are also more likely to develop “secondary infections” – a bacterial infection on top of the flu – such as an ear infection or pneumonia. And while we all know the flu is miserable, it’s easy to forget that for many of our friends and neighbors, especially infants and the elderly, it can be truly dangerous.

If all of this hasn’t convinced you to head over to your doctor’s office for the flu shot, remember that not only do you protect yourself with your vaccine but you also protect all of those important people around you from getting sick this flu season as well! Your kids will thank you for it!

Babies and Spit Up – When to See the Pediatrician

For many first-time parents, baby spit up can be a bit terrifying. There is a very fine line between what is “normal” and when you should seek help from your pediatrician.  Dr. Jessica Long helps to clear up some common spit up misconceptions…

spitup

When I found out I was pregnant with my first daughter, I daydreamed about lazy mornings cuddling with her, taking long walks together through our neighborhood, introducing her to all of my favorite childhood spots in DC, and of course all of the adorable clothes. What did not play a starring role in my motherhood fantasy was the amount of spit up that would end up on her, me, my husband, the dog, and really anything within a four foot diameter after she ate. Her spitting caused her no distress and certainly did not slow down her impressive weight gain but wow did it lead to a lot of laundry.

Spit up is an incredibly common baby phenomenon. In fact, more than half of babies younger than 3 months old spit up daily. For most babies, gastroesopahgeal reflux (GER) is a natural occurrence that, while annoying, causes no health problems and improves with time.   However, in some babies it may cause complications – in which case we call it GERD (gastroesophageal reflux disease) – and requires evaluation by your pediatrician.

For all of those parents out there with “happy spitters” who smile while you grab your tenth burp cloth of the morning, there are thankfully some simple things you can do to help reduce the amount of curdled milk you are scrubbing off the sofa.

First off, there’s only so much room in that tiny baby belly and if it gets overfilled with milk there is nowhere for it to go but out. Do your best to not overfeed your baby. Also, try to minimize gas in your baby’s belly so that, as a gas bubble escapes, it doesn’t bring up half the meal as well. Some babies need to take burp breaks in the middle of their feeding as well as at the end in order to not have a wet burp down your back shortly after eating.

While tummy time is important for motor development and can help to relieve gas, it is best to avoid it right after feeding. That extra pressure on the stomach is more likely to send its contents all over the living room rug. Holding your baby upright for 20-30 minutes after eating also helps to keep everything in her stomach right where it belongs.

Still spending more time with the laundry machine than enjoying that sweet social smile of your baby? It is important to have regular follow up with your pediatrician to ensure that gastroesophageal disease is ruled out. Talk with your pediatrician to see if diet changes would be helpful. Some breastfed babies may be sensitive to dairy or egg and having mom avoid these foods could cut down on spit ups. Similarly, a formula fed baby might prefer a hydrolyzed formula. Adding a small amount of oatmeal to bottle feedings has also been shown to help reduce the amount of spit up. However, chat with your baby’s doctor before altering anyone’s diet.

With spit up, time is the best remedy. As your child grows, spitting up will be less of an issue and your little one will be on to new and exciting problems such as desperately wanting to play with electrical outlets and finding every choking hazard accidentally left around your house. Parenthood is a journey and spit ups will soon be a distant memory. The overabundance of laundry in your home will unfortunately be an ongoing problem.

How to Introduce Peanuts to Children

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We all know that peanuts can be dangerous for children with peanut allergies, but when is the best time to begin introducing them to your child’s diet? Dr. Jessica Long gives us the lowdown on this tricky topic…

 

With two girls under the age of five, peanut butter is a staple in our house. It’s easy, delicious, and packs 8 grams of protein in a two tablespoon serving. However, for many families, peanuts are cause for real concern. Peanuts are the leading cause of food allergies in children and can cause serious allergic reactions and even anaphylaxis. For years, the medical community has been trying to figure out how best to prevent peanut allergy. Doctors used to advise parents to not expose their children to peanuts until they were at least two years old but that was not helping to decrease the number of people with allergies. Earlier this year, new recommendations came out in response to research showing that it’s actually early exposure, as opposed to late, that helps prevent peanut allergies.

So who do we now recommend try peanuts? Most healthy infants over the age of 4 months may benefit from early introduction of peanuts. However, some children may require allergy testing before trying peanuts so always discuss with your doctor before introducing new foods. For example, if your child has severe eczema or egg allergy, a peanut allergy test should first be done by 4-6 months old. Also, children with a strong family history of peanut allergy might need to see an allergist before trying peanut protein.

If your doctor gives the thumbs up for introducing peanuts to your baby, you can offer Bamba (a puff peanut product) or make your own thinned smooth peanut protein mixture. Combine two teaspoons of smooth peanut butter with two to three teaspoons of warm water or pureed baby food to make a perfect two gram serving which is the ideal amount for your little one.

The first feeding should be a small amount, just the tip of a teaspoon. Watch your infant for ten minutes to make sure there are no reactions such as hives, vomiting or nasal symptoms. If there are no reactions, continue to offer the rest of the 2 gram serving of peanut protein at your baby’s normal feeding pace.

Once your baby has successfully tried peanut protein, it is recommended that you offer two gram servings three or more times a week. If your infant develops any allergic symptoms within two hours of eating peanut protein, stop and contact your pediatrician. Remember to avoid whole nuts until kids are over 5 years old as well dollops of peanut butter until kids are over 4 years old due to choking concerns.

 

SCREEN TIME AND BABIES – ADVICE FROM A PEDIATRICIAN

We are all guilty of it…giving your child an iPad to get a small break during the day. Just how harmful is it? Keep reading for Spring Valley Pediatrics Dr. Jessica Long’s expert advice on how much (or how little) screen time is appropriate for our children.

iPad Baby

You are probably reading this on your phone, maybe catching a minute’s break during your baby’s afternoon nap or between answering emails. Texts, emails, adorable Instagram photos – there are plenty of reasons your phone is always within reach but what does it mean for your young child’s development?

We know that babies’ brains do a lot of growing and changing in the first years of life. From birth to two years old, a baby’s brain triples in size and is busy forming neural synapses (connections within the brain). Too little stimulation, as can happen to neglected children, causes the brain to under-develop. However, too much stimulation is also harmful to the maturing baby brain. Studies have shown that prolonged exposure to rapid image changes, like what is seen in children’s TV shows, during this critical period of brain development creates a mind that expects high levels of stimulation. This can lead to attention problems later in life; the more TV that is viewed before the age of 3, the more likely that child will have attention problems at age 7.

The American Academy of Pediatrics (AAP) recommends that, outside of video chatting with family, children under the age of 18 months have zero screen time. We know that children learn best through interacting with the people around them instead of with electronics. Exposing them to TV, tablets, and phones (including apps and shows that are meant to be educational) can actually cause children to speak later and use fewer words. Even having the TV on in the background, which many of us do when we are at home, can affect our baby’s language development. With the TV off, a parent speaks an average of 940 words per hour to a toddler. However, with background media on, the average is 170 words an hour, and important language tools such as facial expressions and body language are negatively affected.

So what is a busy parent, who deserves some down time scrolling through Facebook, to do? First, monitor your own use. When you are with your little one, put down your phone, turn off the TV, and give your child your undivided attention. Sing, read, and play with her. Make eye contact and use body language to communicate, all of which help her learn best.

Once your little one is 18-24 months old, the AAP gives the thumbs up to some screen time. Parents should choose high-quality programming and watch it with their child. Engaging your child in the viewing experience – asking questions, pointing things out, and helping him make connections to real life – make screen time more interactive.

I would be lying if I claimed to have never pulled out a tablet as a last resort on an airplane to calm a toddler throwing a tantrum. Every parent has been there, but do your best to avoid using screen time as an emotional pacifier. It’s important for your child to learn how to identify and handle strong emotions and to come up with activities to manage boredom or calm themselves down. The next time you are at a restaurant or in the doctor’s waiting room, let your child explore a new book, create a drawing with crayons, or play “I Spy” with you to pass the time instead of relying on a screen to keep her entertained. Added bonus – it gets you to put your electronics away, too, and I know I could benefit from some more unplugged time.

 

Carseat Tips – Is your child in the right one?

Read on for Dr. Long’s carseat guidelines to ensure a safe and fun summer of road trips for your family.

Summer is fast approaching and for many families that means lots of fun hours in the car on road trips. No parent would ever knowingly put their child’s safety at risk, but that is what often happens when we buckle our kids in the car. More than 70% of car seats are improperly installed and at least half of caregivers are not correctly securing children in their car seats. All of this greatly reduces the ability of car seats and booster seats to protect your child.

So what can parents do? First, make sure your child is in the right seat for her or his height and weight by reading the info below. Second, double check that your seat is properly installed. Safe Kids DC has sites throughout the city where they do checks most days of the week. Spring Valley Pediatrics hosted a free car seat check with Safe Kids DC in May and will be hosting another in September. Third, use the right seat in the right way every time you are in the car.

One of the most common questions we are asked as pediatricians is when a child can move to the next type of car seat or booster seat. As parents, we look forward to our children growing, maturing, and making it to the next milestone. However, with car seats it’s best to go slow. Instead of looking forward to graduating to the next safety seat, aim to keep your child in their current car seat for as long as they meet the manufacturer’s height and weight restrictions.

We find parents excitedly turn their child front-facing long before it is safe to do so. Staying rear facing for as long as possible – up to 35-50 lb in most convertible car seats – is 5 times safer for your child in a collision. Your tall two year old may look like her legs cannot comfortably fit rear facing but you would be surprised by how happily kids adjust their positions in their car seats.

Similarly, the jump from a booster seat to the regular seat is one every 5th grader is anxious to make. To check if your child is ready to retire car seats and booster seats forever, see if he passes these steps. Can he sit with his back against the vehicle’s seat, knees bent at the edge of the seat, and feet flat on the floor? Is the lap belt positioned over his thighs (not his belly) and the shoulder belt positioned across the shoulder and chest (not his neck or face)? Also importantly, can he sit properly with no slouching, moving around, leaning forward, or playing with the seatbelt? If so, you can consider ditching the booster forever but, as always, no need to rush things. They grow up fast enough.

Car seats do expire, typically six years from their manufacturing date, due to gradual breakdown of the materials and daily strain from installations and use – so be sure to check the date on the side or back of your car seat. You should also replace your safety seats if your car is in an accident, even if there is no visible damage to the car seat or your child was not riding in it at the time. Purchasing a new one is crucial to ensure your child continues to travel safely. Also, replace your car seat if there is obvious wear and tear – the straps are frayed or the harness doesn’t latch as well – since these are signs that it would not properly protect your child in an accident. As tempting as it is, never purchase a used car seat. There is no way to ensure that it is top condition and has never sustained damage in a car accident.

Still have questions? There is a lot to know about car seats and recommendations change as more medical and scientific data become available. Use your pediatrician as a guide and resource for how to keep your kids safe in all aspects of their life. We make it our job to help parents protect their little ones!

 

Infant CarseatThe Right Seat For Every Age


Birth to 12 months:
a rear-facing car seat is the perfect spot for your little one. Infant, convertible and 3-in-1 car seats are all options for safely securing your baby. Infant car seats (aka “bucket seats”) can be used up to the first year of life or until your baby outgrows the height and weight recommendations, whichever happens first. Convertible and 3-in-1 car seats can last longer but be sure to follow the manufacturer’s guidelines on height and weight requirements.

 

Convertible carseat

1 to 3
years:
your little one is still safest rear-facing. Most convertible and 3-in-1 car seats can still be used during this age. Switch your child to front-facing once she reaches the maximum height or weight limit for the car seat. Some convertible car seats can accommodate a child up to 80lbs in the front facing position so make sure you pick a color or pattern you adore because you’ll
be seeing it for years to come!

 

Combination Carseat


4 to 7 years old:
your school age child has likely grown to safely ride front-facing. Continue to use the five-point harness until they reach the height and weight restrictions of the seat. Combination seats (a hybrid car seat that can turn into a booster), convertible car seats, or 3-in-1 car seats should still accommodate your growing child.

Booster

 

 

8 to 12 years old: Though your child might seem so grown up, it is unlikely that he is ready to ditch safety seats altogether. A booster seat is best at this age. They come in many different shapes and sizes, with and without backs, and work with your car’s seatbelt to keep your child safe in the car.

 

13 and up: While the safest place in the car for your teen is in the back seat, a child of this age may legally sit in the front passenger seat.

 

Travel Consults

We now offer comprehensive Travel Consults. Please call to schedule an appointment and let us know where and when you will be traveling. When you come for your consult, we will discuss your plans and administer any vaccinations that you may need (including the Yellow Fever Vaccine).