Vomiting and/or Diarrhea

Vomiting and diarrhea viruses are not fun for anyone. Doctors refer to the most common cause of these symptoms as "viral gastroenteritis". Some kids just vomit, some kids just have diarrhea, and the most unlucky have both. 

Most of these illnesses do not need to be treated with medications (antibiotics can make it worse, since they also kill the good bacteria in your tummy), and anti-diarrheal medicines (like Imodium) can be harmful to children. The most important thing is to keep your child HYDRATED (more on that below). If you suspect your child has vomiting or diarrhea from food poisoning or any other type of foreign ingestion, please call poison control 1-800-222-1222, who are free and staffed with physicians 24-7!

How can you tell if your child is starting to get dehydrated?
- their mouth/lips seem dry
- they are urinating (peeing) a little less than usual
- they are thirsty

Now what?
You need to keep your child hydrated!
- A baby can continue to breast feed or take infant formula, if they are just a little dehydrated. If they vomit after every feeding, or are refusing the breast/bottle, then try to hydrate them with an Oral Rehydration Solution, like Pedialyte. Warning: the plain ones taste like salt water, so I suggest getting a few flavored ones and trying them out, to see which ones they will take. If they refuse the bottle completely, you can try feeding them via a syringe or spoon, giving small amounts every 15 minutes.
- A child who is getting electrolytes from food (such as chicken soup, or crackers, even if it's just a little bit) can hydrate with water. If they are not taking in any food, or if they are throwing up the food, please hydrate them with an ELECTROLYTE solution (aka Oral Rehydration Solution, aka ORS). You can buy them at most USA markets (under brand name Pedialyte, or generic versions), you can make your own by mixing 1 liter (5 cups) clean water with 6 level teaspoons (=2 tablespoons) sugar and 1/2 teaspoon salt. You can add a little bit of orange juice or a banana for potassium. Common substitutions are rice water, congee, green coconut water, or mixing gatorade with water (although I do not recommend doing this, since it is hard to get the right balance of electrolytes this way). If your child does not want to drink, try giving them sips every 15-30 minutes, or giving them the ORS/Pedialyte in frozen popsicle form.
- For every age, and everybody in the house, WASH YOUR HANDS A LOT to prevent spread/transmission of the stuff that gets you sick. Teach everyone to wash their hands in warm water, scrubbing for at least 20 seconds (2 rounds of the Happy Birthday song). Try and use real soap and water, instead of no-rinse hand sanitizers, since they do a better job at killing the tummy microbes.

But what if they keep vomiting?
- Let their tummy rest.
- Call your pediatrician, or go to the hospital, if they have signs of dehydration (see more below).
- Ask your pediatrician if your child is old enough and healthy enough for a medication against nausea/vomiting.
- Start with no food, but still give an electrolyte fluid (aka ORS above), for the first 12 hours.
- When they are ready/want to eat, give bland foods (e.g. the popular rice, toast, soup) and avoid foods that are fried, acidic, oily, or contain lactose.

But what if they have icky diarrhea?
- Change the diaper or bring them to the toilet frequently. Use a LOT of diaper cream to keep the area from getting chapped/sore. Put on a zinc cream (like the purple desitin) as if you are icing a cake - this acts as a barrier layer, to prevent acidic poop from sitting on the skin.
- Feed them binding foods, like rice.
- Sometimes the microbes that cause diarrhea, also cause a temporary lactose (the sugar in cow's milk) intolerance, so avoid lactose-containing stuff, like cow's milk and cheese. You usually have to do this for 2-4 weeks after the onset of the illness, until their GI system is back to normal.
- Try a children's probiotic with lactobacillus once per day, such as children's culturelle.

When my patients get sick this way, I often refer them to the great patient resources at UpToDate, such as this one on nausea and vomiting in children:
http://www.uptodate.com/contents/nausea-and-vomiting-in-infants-and-children-beyond-the-basics?detectedLanguage=en&source=search_result&search=patient+information&selectedTitle=7~150&provider=noProvider
or this one on diarrhea in children:
http://www.uptodate.com/contents/acute-diarrhea-in-children-beyond-the-basics?source=see_link

How can you tell if your child is dehydrated enough to warrant intervention (like an urgent care or ER), or at least a call to your pediatrician?
- they are not urinating (peeing)  often enough (every 4-6 hours for a baby, every 6-8 hours for a toddler/child, every 8-12 hours for an older child/adolescent)
- they are crying, but can not make tears
- they are an infant whose fontanel (soft spot on top of the head) is more sunken than usual
- eyes look very sunken

What are some other signs that I should call my pediatrician about, or head over to the local urgent care/ER?
- persistent high fever (above 102.5 F)
- any fever in an baby younger than 3 months old
- severe abdominal (tummy) pain
- abdominal pain that moves to the lower right side
- lethargy or decreased responsiveness
- bloody (red or black) or bright green (like pea soup) vomit or diarrhea
- diarrhea not improving after 1 week

Soon your baby will be back to enjoying (throwing) his food (c) 2013

The good news is that the gastroenteritis season is almost over, so hang in there. However, we are getting into cough and cold season, so see my August 2012 post for tips on that:
http://mommedicine.blogspot.com/2012/08/coughs-colds-and-croup.html)

Fun in the Sun:

Sunscreen Tips and Links

Before going out to have fun in the sun, you should apply sunscreen to yourself and your child. Reapply sunscreen every 2 hours, and after every time you get wet or sandy (rubbing the sunscreen off). Harmful UV rays come through clouds, so a cloudy day is no excuse to skip the screen.

SPF 30-50 are best. SPFs that are higher than that do not add significantly more protection.

The safest sunscreens are barrier sunscreens. These are sunscreens that use zinc oxide or titanium dioxide as the active ingredient, which sit on the skin to provide a shield from the sun. Since they are not absorbed systemically, I recommend using only these types of sunscreens* on infants (in addition to shielding clothing and hats).

Chemical sunscreens are those that contain chemicals which are absorbed into the skin to provide protection. These are newer, but still safe when used correctly. Some of the active ingredients in chemical sunscreens include, but are not limited to, octinoxate, octocryleme, oxybenzone. Most sunscreens on the market today use these, and there are many more options that kids like with these formulations, such as sprays, colors, and different textures. The best sunscreen is the one you can actually get on your child everyday. The aerosol spray sunscreen versions should only be used outside, in well ventilated areas, and below the neck, because they are meant to be sprayed evenly on the skin (you should see a layer of sunscreen forming), and not breathed in. They are a quick way to reapply sunscreen on kids at the beach or park, but can be avoided at home.

Fore more reading on sunscreen, see this post by two dermatologists who give their own advice, but geared towards adults, click here.

A lot of people are wondering about vitamin D. Although our skin can make vitamin D by being exposed to UVB light from the sun, the amount of sun it takes is variable by region and skin type, and enough sun to make enough vitamin D will also increase skin aging/wrinkles and cancer risks, so I still recommend using sunscreen, then getting vitamin D in your diet. For more information, see
http://www.vitamindcouncil.org/about-vitamin-d/how-do-i-get-the-vitamin-d-my-body-needs/

Do not use combination insect-repellent and sunscreen mixes. Insect repellents should not be applied more than once per day, and should not be applied to babies. For more information on insect repellents see here and here.

I used to link to the Environmental Working Group's sunscreen ratings, but their methodology has been ignoring science, and based on fear-mongering lately, so I stopped. For more information on that, see here and here.
EWG also warned against "nano particles" with no scientific basis. For information on them see this article from cancer.org.

*Here are some examples of sunscreens that use barrier (mineral) ingredients, in alphabetical order:
Aveeno Mineral Block
BabyGanics Cover-Up Baby Pure Mineral Sunscreen Stick
Banana Boat Natural Reflect Sunscreen
Burt's Bees Baby Bee Sunscreen
California Baby Sunscreen
Mustela Sun Cream and Sun Lotion
Neutrogena Baby Pure and Free

Here my son demonstrates proper beach attire with sunscreen (c) 2011

Immunization Information

There are a lot of great sites out in the world wide web that have information to help parents make an informed choice about vaccinations; however, unfortunately, there are also a lot of bogus sites that rely on anecdotes to promote myths, so I am including just a few links to help people find scientifically accurate information on vaccines:

My favorite book for vaccine information is "Vaccines and Your Child: Separating Fact from Fiction" by Paul Offit. It is short and covers all of the questions that parents frequently ask about immunizations. Here is the link to it on amazon:
http://www.amazon.com/Vaccines-Your-Child-Separating-Fiction/dp/0231153074/ref=sr_1_1?ie=UTF8&qid=1363372723&sr=8-1&keywords=offit

The Children's Hospital of Philadelphia has a wonderful Vaccine Education Center, which covers the same material as in Dr Offit's book (above), as well as videos, FAQ pages, and more.
http://www.chop.edu/service/vaccine-education-center/home.html
This is a great place to start if you want information on aluminum (which your child gets more of in breast milk than vaccines), formaldehyde (which our own bodies produce, and is also found naturally in things like pears), and other vaccine ingredients.
http://www.chop.edu/service/vaccine-education-center/vaccine-safety/vaccine-ingredients/

A great place to go once your child (or you) has gotten a vaccine and you have questions about it, or if you know of a specific vaccine that is coming up for your child, is the USA's Center for Disease Control. They put out "Vaccine Information Statements" on each vaccine that is routinely given in the USA:
http://www.cdc.gov/vaccines/pubs/vis/
They are also the best site to check out what vaccines you need for foreign travel:
http://wwwnc.cdc.gov/travel/page/vaccinations.htm
Remember to check out the site and make an appointment at a travel clinic at least 6 months before traveling to areas which may have diseases that are not in your home country.
The USA government also has a general vaccination information site:
http://www.vaccines.gov/

The U.S.A. has a vaccine adverse events reporting system (VAERS), but it allows anyone to "report" anything they likem without being the least bit accurate. Check out this great post on the subject:
http://momswhovax.blogspot.com/2011/10/incredible-hulk-vaccine-side-effect-or.html

If you have specific concerns about vaccines, or have heard some of the myths, please see the skeptcial raptor's blog, which covers each of the myths:
http://www.skepticalraptor.com/vaccine.html
Especially this post:
http://www.skepticalraptor.com/skepticalraptorblog.php/mmr-vaccines-do-not-cause-autism/

If you want to see what happens when a child does NOT get vaccines, check out Shot By Shot's videos:
http://shotbyshot.org/

If you are a visual learner and only have 5 minutes, check out this beautiful infographic on vaccines:
http://www.vaccinews.net/2012/09/infographic-a-brief-history-of-the-fight-to-save-lives/#
If you have more than 5 minutes, Vaccinews's blog is also a good site to learn more about vaccines.

A cute and very short blog post about the chicken pox vaccine:
http://mytwohats.com/2012/08/20/why-vaccinate-for-varicella/
In addition to her wonderful points, I would add that you should give your child the varicella vaccine because you do not want your child to suffer from shingles when they're older, as it is very painful and can cause disability. Shingles is caused by the varicella (chicken pox virus) living inside you. If you never get the chicken pox (disease), then you can not get shingles.

Here are some other good web sites:
The American Academy of Pediatrics: www.aap.org
National Network for Immunization Information: www.immunizationinfo.org
Every Child By Two: www.ecbt.org

My pinterest immunization board: http://pinterest.com/motek42/immunizations/

This is just a small list, and I recommend that you discuss any concerns with your pediatrician. Also note that some people can not get certain (or any) vaccines, and therefore, rely on herd immunity (their community being vaccinated) to protect them.

My beautiful, fully immunized, son (c) 2012

Due to the high number of antivax trolls trying to post spam, I am disabling comments for this post. Sorry!

A Basic Review of Eczema & A New Blankie

Eczema (also known as “atopic dermatitis”) is a skin condition where allergens or other irritants make your child’s skin itchy, red, rough, and/or flakey. Doctors sometimes refer to it as “an itch that rashes” because the scratching or rubbing usually comes before any changes in the skin. In its mildest form it is often just considered “sensitive skin”, but in its most severe form it can require hospitalization and serious drugs to alter a child’s immune system.

In order to prevent an eczema flare, or to relieve mild irritation, it is important to keep the skin moisturized, as well as avoiding “triggers”which the skin responds to by becoming inflamed. Common triggers are: chemicals, harsh soaps or cleaning products, perfumes/fragrances, dyes, synthetic fabrics (e.g. polyester), wool, sweat, dry air, stress, sudden temperature changes, and anything the child is allergic to (e.g. food allergies and/or pet dander).

How do you avoid so many things? For serious eczema, an allergist can help you identify specific triggers that make your child’s eczema worse. However, everybody can take some simple steps to help their child with sensitive skin:

1. Daily bath to clean the skin. Eczematous skin gets infected easily, since open areas take away your immune system’s biggest barrier. Use warm water (not too hot or cold), and bath briefly, since long baths can make the skin worse. Use soap-free cleansers (e.g. original Dove bar or Cetaphil). As soon as the child gets out of the bath, pat the skin dry (rubbing makes things worse) and cover it in a layer of moisturizer (ointments lock in the moisture best, which is why so many people love Aquaphor for their sensitive skin).
2. Always use dye-free, fragrance-free soaps and cleansers, especially for the laundry. Many people use Dreft detergent for their baby’s clothes, but this is full of chemicals. Run all of the baby’s laundry through an extra rinse cycle to be sure to get rid of any chemical residue.
3. Re-apply your moisturizer (e.g. Aquaphor) a few times a day.
4. Keepfingernails short to avoid scratching.
5. Many older children (and adults) with eczema report their symptoms worsen at night, so make sleeping conditions as comfortable as possible. A cool mist humidifiercan help keep the air cool and moist. Use distilled water in the humidifier, do not use any menthol or scented discs in it, and clean out the reservoir with vinegar every 3 days. Children age 2 and older may be helped by taking an antihistamine before bed (discuss this with your pediatrician before giving it to your child).

Babies have a larger surface area to body mass ratio then older kids/adults, and their skin is thinner. This makes them especially susceptible to irritants, and you want to avoid using medicated creams as much as possible, since more is absorbed into their system then in older children/adults. 

A mother whose baby has severe eczema created a blanket to help relieve her child’s skin irritation, and she gave me a blanket to try out. It is the Elli & Nooli Organic Cotton Pique Blanket (http://www.amazon.com/Loopiblanket-Organic-Blanket-Pacifire-Fastner/dp/B008MBMYZ8/ref=sr_1_2?s=baby-products&ie=UTF8&qid=1346005373&sr=1-2&keywords=elli+%26+nooli). 

I brought it to work to try with a few patients, and then brought it home to my toddler son. It is designed for infants, but since it is big enough to swaddle them comfortably, it is actually big enough (30” x 40”) to cover my toddler in bed (although he will soon outgrow it). This is now my son’s favorite blanket, and since giving it to him over a month ago, he insists on using it every night to sleep. He reports that it is “comfy”. The certified organic cotton means that it is less irritating than other fabrics, as well as being chemical-free and pesticide-free. The pique weave (tight weave forming raised mini squares all over) keeps air flowing under the blanket, and even allows some air exchange through the blanket. It keeps my child warm, without over-heating, so he is not sweating at night, despite living in a house with no air conditioner during a heat wave (for the past 2 weeks only, we are moving soon). Overall, I really like this blanket, and would recommend it for babies with sensitive skin.

Please note that although this post mentions many brands (e.g. Dove, Cetaphil, Aquaphor, Elli & Nooli), this is NOT a sponsored post, and I have no financial stake in any of these companies.

Coughs, Colds, and Croup

Even though it's a beautiful summer here in Southern California, we are still seeing some coughs, colds, and croup, so here are my tips to help keep your family comfortable as they clear their viruses:

Helping a child with nose congestion:

-          Use a nasal saline mist (such as Little Noses nasal saline mist) to spray moisture into each nostril and help clear her out. I like the mists more than the drops because you can hold the canister right below her nose and spray it in, without touching the canister to the actual nose, and without sticking anything directly up the nose. These are also sterile, so you don't have to worry about the water source.

-          Use a humidifier. Only put distilled or sterile water into it (not tap water). Clean it at least every 3 days. Do NOT use the menthol or eucalyptus discs/drops that come with some humidifiers.

-          If she suffers from allergies and is over age 4, you can use an over the counter antihistamine to help decongest her (e.g. children’s Benadryl). Under age 4: ask your pediatrician about these. Do NOT use the over the counter medications known as “decongestants” or “medicated cough syrups”, as these have been shown to have more risks than benefits in children under age 6 years old.

-          If he is very congested you can steam up your bathroom and sit in the bathroom with your child. Make sure the air is okay and the child does not have any access to the hot water. Never leave a child alone in the steam!
-    If you want to, you can use a vapor rub on the feet or chest of a child. It has not been proven to help or hurt. However, do not let the rub get near her nose or mouth! Vapor rub placed under the nose has been reported to cause wheezing in some children, and it is dangerous to ingest. Call poison control if your child eats any of this, or gets it in their eye 1-800-222-1222 (an important number to keep in your cell phone for emergencies).

-          Children under age 2 years usually can not blow their noses, so help decongest them (e.g. get the boogies out) by using a Nose Frida (http://www.fridababy.com/) which is a device you put in the nostril and use to literally suck the snot out. Sounds gross, but there is a filter (which needs to be changed every day) which prevents you from getting any snot in your mouth. You can do this before feeds and before sleep, or just as needed to clear out the mucus in your baby’s nose. I like this better than traditional nasal aspirators because it’s much easier to clean, is difficult to put it too far into the baby’s nose, and it gets a lot more of the snot out. The key to good suction is to hold the other nostril closed, when you suck out boogers from the first nostril (should take less than 1 second).

The Snot Sucker

Helping a child with a “wet” or “phlegmy” cough:

-          Do all of the above for nasal congestion plus the following:

-          Have her sleep propped up at 30 degrees so the mucus drains easily (if over 1 year of age).

-          Give children over age 1 year a big spoonful of honey twice a day. The honey has now been shown to help relieve cough symptoms in kids & help them sleep, in 2 published randomized control trials (scientific studies). The honey they used was NOT "raw", which can have dangerous bacteria in it.
-     Warm liquids, such as chamomile (caffeine-free) tea and lemon, or chicken soup, can help people feel better. 

-          Zinc may help shorten colds and soothe sore throats, but this has not been proven conclusively. You can get this in some non-medicated cough syrups, such as Zarbees (for over age 1 since it also contains honey), or in zinc lollipops (over age 2, observing child while they eat them) at CVS (I haven’t seen them anyplace else- let us know in the comments if you find them in other places). If he is over age 7 years you can give him the zinc cough drops that are available at all pharmacies.

Helping a child with a dry, barking, or croupy cough:

-          Do all of the above for nasal congestion & wet coughs plus the following:

-          Use a cool-mist humidifier. Use distilled/sterile water in it. Clean it at least every 3 days by rinsing out the water tank with distilled vinegar and then washing that out.

-          If the child is having a coughing fit, or breathing like Darth Vader, take him for a walk outside in the cool air, or hold him in front of an open freezer for a few minutes, to reduce the swelling in his throat. If that is not helping, call your pediatrician for immediate medical advice, or call 911 if he is actually having trouble breathing.

Check out other mom pediatrician blogs on the topic, such as this one from Dr. Stuppy:
http://pediatricpartners.blogspot.com/2013/12/but-snot-is-green-or-how-can-we-treat.html

Other Important Stuff:

-          If your child is wheezing, noisy breathing, breathing hard, breathing quickly, breathing with flared nostrils, or other signs/symptoms not mentioned, please call your pediatrician or 911, or take them to the ER immediately. This information is not intended to act as a substitution for speaking to your physician or using common sense!

-          If your child is breathing so hard that they have trouble walking or talking, or if their lips or fingernails turn blue, please call 911 for immediate medical assistance.

-          Some of the products listed above can be found on my pinterest health board: http://pinterest.com/motek42/kids-health/. I have not been paid to review any of these products and I do not get money from their sales- I am just letting you know what has worked in my experience.

Traveling with Children

Fortunately for us modern moms and dads, anywhere we want to go is just a plane, train, or automobile ride away. Despite the conveniences of modern transit, traveling with children remains a difficult endeavor. Here are a few tips to make your journey a little smoother:

1) Know your rights.
This sounds funny, but a lot has recently changed in U.S.A. airport security rules. For example children under 12 do not need to remove their shoes during screening. According to the TSA's website, you may carry as much juice and milk for toddlers as you "need until you reach your destination". The precise definition of how much you need varies by who is screening you at security.  During one trip with my then 1 year old, the security agent at LAX insisted that 3 small juice boxes was too much for a 5 hour flight, and threw all of our drinks away. I did not know enough to argue and instead I spent $$$ buying some non-organic, non-dilute juice for my child at the airport :( This also brings up the point to remember to be flexible, and give your self extra time for the unexpected.
For the latest information, check out the government's website:
http://www.tsa.gov/travelers/airtravel/children/index.shtm

2) Know your company.
Certain airlines and hotel chains are better at hosting children than others. Conversely, some airlines have recently banned children from first class on their flights, so don't expect an upgrade (or even friendly service) on those airlines. Malaysia Airlines is going to institute a "child free zone" even in their economy cabin on some flights. In general, European and Asian companies have been known to be friendlier to children on flights than USA airlines, often providing coloring books, special snacks, small toys, and other treats for families. Some airlines offer pre-boarding for families with infants and toddlers, while others have none. This may be more annoying than you think. When traveling with our then 2 year old, we had to wait until first class, business class, and everyone with a silver/gold card from the airline boarded (more than half of the passengers) before we were allowed to get on with a toddler, car seat, and hand luggage. Trying to get past the tiny aisle with people everywhere and a large car seat was not fun, and I think it disturbed the other passengers as well. Allowing us to board early, install the car seat and settle in would have prevented a lot of hassle for everyone. However, when we got to our destination we stayed at a hotel that provided us with squeaky bath toys and other amenities in the room that made us feel like family.
Here is a recent article from yahoo on the most family friendly airlines:
http://travel.yahoo.com/ideas/best-airlines-for-families.html

3) More tips just for flying with children:
- Try and book a flight with as few stops as possible, as take-off, landing, and boarding are the toughest times.

- Make sure you have assigned seats together in advance. Many companies have been separating families on flights, and then you rely on your fellow passengers to switch seats so you can sit together.

- I take our car seat when flying with my son, to make sure he is strapped in securely during our flight. This also ensures that he has a safe car seat for automobile travel when we arrive at our destination. It is also easier for him to fall asleep during the flight in his car seat, and more difficult for him to annoy other passengers by kicking them or climbing on the chairs. We use a GoGo Kidz Travelmate to turn the car seat into a stroller at the airport.

- To avoid pain from the changes in pressure in the ear during flights, teenagers and adults can chew gum or drink water to encourage swallowing, and thereby open up the eustachian tubes in their ears to relieve the pressure. For babies the best way to do this is breast (or formula) feeding. Breast (or formula) feeding has the added bonus of providing sugar to the infant, which is a natural pain reliever. For toddlers, diluted juice in a straw cup works well. Older children can suck on lollipops to get them swallowing (and happy and distracted by candy). Nasal sprays can also help relieve congestion and prevent pain during the flight, but speak to your pediatrician about this (salt water sprays can help babies with stuffy noses, while kids with ear infections or sinus problems may need a prescription nasal spray). If all this ear tube talk is confusing, check out the ear anatomy pics here:
http://pinterest.com/motek42/ear-infections/

- I recommend waiting as long as possible before flying with infants. The younger an infant is, the less developed their immune system, and the more likely they are to get sick. The air on airplanes is re-circulated so it is very easy to pick up germs from other travelers, even ones who are seated far away from you. Infants younger than 2 months old who catch an illness with fever may have to undergo extensive testing, including blood, urine, and spinal fluid exams if they get sick. I know this is not possible for all families, but waiting until your infant is 9 months or older can save you a lot of hassle and illness later on. In addition, the USA is currently experiencing a surge in measles cases, most of which can be traced to foreign travel- see these links for more information:
http://www.reuters.com/article/2012/04/19/usa-health-measles-idUSL2E8FJDSD20120419
http://wwwnc.cdc.gov/travel/page/measles-for-air-travelers.htm
And don't forget to check the CDC website, and make an appointment with your pediatrician at least 2 months prior to any foreign travel, so you can get medications and vaccinations for your trip.

4) Have your bags packed with items that will keep your child calm, quiet and comfortable. 
I prefer small, light items. If you are used to distracting your child with your phone or other electronic items, keep in mind that you will not be able to use them on take-off or landing, and they might run out of batteries on long car trips, so make sure to pack low-tech items as well. I recommend packing a carry-on or car bag with:

• baby wipes (good for cleaning up messes for kids of all ages)
• snacks
• your own sippy cups or bottles
• four more diapers than you think you need
• several different sizes of ziplock bags (for messes, soiled clothes, soiled diapers, and they are just generally handy to have)
• a medical bag (children's acetaminophen, children's ibuprofen, children's benadryl, bandaids)
• sunscreen (the sun through a car's windows can burn a child, and then sun through a plane's window has more radiation than down on the ground, so slather yourself and your child with sunscreen to avoid sunburns and -much later- skin cancer)
• lollipops for age 4 and above
• extra clothes (even for older children, as it's easy to get spilled-on during a flight or car trip, and you never know if, when, or where you'll get stuck)
• books
• re-usable stickers
• dry-erase crayons and board
• a soft blanket
• your child's lovey (favorite blankey, stuffed animal, or other comfort item). 

I've linked to a few of these items, as well as book suggestions, on pinterest:
http://pinterest.com/motek42/traveling-with-children/

This blog has many more great travel tips, and this link is for a funny story illustration why you shouldn't feel bad about that huge carry on with all of the extra supplies:
http://eatpackgo.com/pack/pack-diaper-ninja/

Traveling with children is a lot more stressful then traveling alone, but with patience, planning, and a large bag it can be a fabulous adventure.

Have any good tips or links of your own? Please tell us in the comments!

(photo of my son in his car seat, looking out of the airplane window, photo taken by me 2009 (c) )

Interviewing a Pediatrician

Recently, one of my friends asked me what questions she should ask when interviewing a prospective pediatrician, so I thought I'd share my answer with everyone:

1) What insurance do you take?
Of course, this is only important if you're using insurance. I know several families now that have health insurance for emergencies, but pay for general health maintenance out of their own pockets. This reduces their overall medical expenses (because they have a cheap insurance plan, only for emergencies), and allows them to see whatever doctor they like. These families usually use free clinics for vaccinations, or pay out of pocket. This only works if your family is healthy. If you choose the latter option, ask about visit prices instead.

2) What hours is the office open for well visits? For sick visits? When is your chosen primary pediatrician actually in the office during the week?
Keep in mind that the smaller the office, the less hours they are usually open. So if you want to do well visits at night or on weekends, you will probably have to go with a very large practice, and may be seeing a different doctor (or nurse practitioner) each time.

3) Who covers for your physician when they are not in the office, not on call at night, or they are on vacation?
For night call, is the person on the phone a physician from your practice, a physician from another practice, or a physician extender (NP or PA) or nurse?

4) Do you use electronic medical records?
These can reduce errors, and allow the physician on call (if they are a doctor from the same practice) to access your chart at night and on weekends, if needed.

5) Can I always get a same day sick visit appointment?

6) Who answers regular questions by phone during the day? What I mean by this one is, does your pediatrician call you back if it is not urgent? Does a nurse handle most questions about illnesses on the phone? Does another physician answer the phone when your physician is not available?

7) Are there any physician extenders (nurse practitioners or physician assistants)? Are they the ones to see you for same-day sick visits or phone calls, or will your physician or their partner see you?

8) Are there separate sick and well waiting rooms? Are there separate sick and well exam rooms?
This reduces the chance of your baby being exposed to a virus

9) What is your vaccine policy?
If the physician allows un-vaccinated children in their practice, consider that your baby (who is too young to be vaccinated for certain diseases) may be exposed to somebody in the waiting room with measles, chicken pox, etc...

10) How often do you see the baby for child for regular check-ups?
This can actually vary quite a bit between pediatricians for the first 3 years of a child's life. After that, your child is seen for an annual well check every year.

11) Do you have a website? Do you use email to communicate with patients?

12) What hospitals do you cover? Will your chosen primary physician be the one to see your baby everyday in the hospital (when they are born and if they are admitted later) or will one of the covering physicians see them?

13) What kind of parenting resources can you offer?

14) Where is the best place to park or closest public transportation stop?
I have found (at least in big cities, such as LA and NY), that the best place to park for my doctor appointments is often somewhere other than the valet parking in the medical building. The website or administrative assistants at your pediatrician office should be able to tell you the best (free) place to work, as well as help you get there by public transportation, if that's your preferred mode of transport.

That's all I can think of for now, but please leave your tips in the comments section!

[My son is too young to be your pediatrician right now, but isn't he cute? ;) (c) ]