Healthy Eating and the Immune System

You can probably feel it coming: A scratchy throat, a cough that just won’t quit and that tired, achy feeling. I work with families every day to guide them toward healthy choices that help children grow up stronger. One of the most common questions parents ask me throughout the winter months is, “How can I keep my children from catching a cold or the flu this season?” While warding off sickness requires a daily commitment to healthy choices beyond just nutrition – such as staying active and exercising, getting enough sleep and washing your hands regularly – eating a well-balanced, colorful diet can also help you avoid common pitfalls.

Channel your inner Bobby Flay or Julia Child

By including children in snack and meal prep, choosing healthy foods can be fun. Set up a make-your-own smoothie station for kids to invent new smoothie flavors using low-fat dairy yogurt and their favorite fruits and vegetables. Strawberries are loaded with vitamin C and are easy to grab from the frozen section of the grocery store. Or pretend to be a famous Italian chef, cooking up mini-pizzas made with whole grain English muffins or pita bread, sauce and low-fat cheese. Top with veggies like spinach for vitamin E or red bell pepper slices for vitamin A.

Turn water into a sweet treat

Water is the cornerstone of a healthy immune system. It transports nutrients and oxygen to cells throughout the body, and it carries away waste products and toxins. But getting children to drink the recommended amount of water each day – approximately 5 to 10 cups based on age – can be daunting. Turn up the flavor and make water a sweet treat by freezing strawberries, blueberries and other fruit into ice cubes or using an infuser.

Be on the lookout for these missing colors

Many families don’t have trouble getting enough starchy vegetables such as potatoes and corn, but as the U.S. Department of Agriculture’s MyPlate tool points out, we all need to focus on eating more dark green, red and orange vegetables. These veggies give us fiber, vitamins, minerals and other nutrients to keep our bodies and immune systems healthy. For example, dark green vegetables can provide vitamin K, folic acid, potassium and omega-3 fatty acids. Red and orange vegetables also can be great sources of powerful antioxidants, such as lycopene and beta carotene. Turn capturing these nutrients into an activity by making a veggie skewers workshop and encouraging kids to assemble the most colorful mix of vegetables possible.

Avoid chugging orange juice

Unfortunately, a mega-dose of a nutrient won’t have a magical effect on the immune system. If you don’t have deficiencies, there is no evidence that taking extra amounts of any vitamin will protect you. Instead, take small steps every day to keep your family healthy and make sure you’re getting the recommended servings of fruits and vegetables. It’s likely more enjoyable than chugging orange juice and will help keep your immune system strong.

Putting Your Baby To Sleep

Sudden Infant Death Syndrome or SIDS, is one of the leading causes of death in babies from 1 month to 1 year of age. Here is some advice on safe sleeping for your baby and possible risks leading to SIDS.

It is important for parents to know, particularly with infants under 4 months old, that bed-sharing is a factor in sudden infant death syndrome.

What’s the difference between co-sleeping and bed-sharing? 
Some people use them as synonyms but they are actually different. Co-sleeping is when the parent and baby are within sound sight, and/or touch. Bed sharing (sharing the same surface) is a subtype of co-sleeping. What we recommend is a type of co-sleeping within arm’s reach but on a separate surface.

How common is bed-sharing?

It is very common. If you look at surveys, they will tell you anywhere from 25 to 75 percent of parents bed share any time at night. That’s what people are telling us, but actually numbers are probably much higher.

Suppose parents balk at the idea of not having their infants in the bed with them at night – whether for bonding, convenience, or economics?

My goal is to make sure you have a child to bond with at the end of one year. The bottom line is this: Is it worth the risk to take that chance? Even if you are doing everything right, your baby is at five times the risk of dying when you bed-share.

You can also bond with your baby when you are awake. Bonding when everyone’s awake is probably actually more productive and more useful in the long run.

Safe sleeping tips

  • Always put baby on his/her back for sleep
  • Don’t smoke around the baby
  • Use a crib with a firm sleep surface and place it next to your bed
  • Remove loose or soft bedding including blankets, pillows, bumper pads and stuffed animals from where your baby is sleeping
  • Use proper sleep clothing such as blanket sleepers
  • Avoid bed sharing and do not place baby on any soft cushiony surfaces to sleep
  • Use a pacifier, which protects against SIDS
  • Don’t overheat the room and don’t overdress your baby
  • Breastfeed your baby. If you nurse while sitting in bed, when you’re ready to go to sleep, put your baby in his or her own crib.
  • Make sure anyone who watches or takes care of your baby knows sleep safety protocol recommendations that you’re following

Winter Tips

When temperatures dip and snowflakes begin to fall, I – like many – am eager for the chance to dive under some cozy, warm blankets and spend the day curled up on the couch. Yes, I do love those restful days, but I also know that staying active and exercising throughout the frosty, snow-filled months is just as important.

As a pediatric nurse practitioner, I encourage families to take small steps every day toward ensuring their children grow up healthy and strong. During the winter months, getting enough exercise is one of the first areas we tend to overlook, but it’s critically important for strengthening growing hearts and lungs and preventing obesity. Choosing outdoor activities also can help limit the spread of colds and flu germs, which easily spread through close proximity and in enclosed spaces.

Parents often have concerns about how to keep their children safe and healthy while still being active outside during the winter, so here’s a list of answers to commonly asked questions to guide the way. As always, for specific questions related to your child’s health, I encourage all parents to seek advice from their pediatricians.

1.      Is it ever too cold for kids to play outside?

In our region, generally the answer is no. If the temperature is above 10 degrees Fahrenheit, it is safe for children to play outside as long as they are bundled up appropriately to stay warm. Extremities – hands and feet – are particularly vulnerable to overexposure from cold temperatures and wind. Be sure to dress children in warm gloves or mittens, a hat and thick socks. Wool socks are preferable.

2.      Is it safe to take my young child or baby out into the cold?

Parents are often hesitant about taking babies outside into the cold. However, families can enjoy outdoor activities together as long as the child is dressed appropriately, such as bundled in a warm snowsuit. For very young babies, I also recommend that moms use wearable baby carriers so little ones can snuggle up against a mom’s body for additional warmth.

3.      What if my child has asthma? Should I still encourage him/her to play outside in the winter?

For families with children who have asthma, parents often are wary of physical activity – particularly in colder temperatures. All exercise is beneficial for these children. If you know that cold air can trigger your child’s asthma, using a scarf to loosely cover the mouth and nose can warm and moisturize the air the child breathes. If your child is having trouble with wheezing and other asthma symptoms, seek help from your healthcare provider so therapy is optimized and your child can enjoy playing outside.

4.      Do kids need a winter skin care regimen?

Keeping the skin moisturized and protected with a layer of thick, fragrance-free moisturizer can help prevent chapping and keep skin from drying out. Be sure to target vulnerable areas, such as hands and cheeks.

5.      Kids don’t always keep their gloves and mittens on.  How do I know if their skin is overexposed? What should I do?

The fear of frostbite or overexposure is something many parents worry about. A warning sign of overexposure is if the hands don’t return to their normal temperature and pinkish color upon returning inside. If this happens, parents should warm their child’s hands between their own hands or place them under warm, but not hot, water. If hands still don’t return to their normal temperature and color, seek medical attention.

6.      Should I be worried about winter sports injuries?

Parents should always ensure that their children are wearing well-fitting protective gear that each sport requires. One critical area of importance is preventing head injuries. Children should always wear a helmet while skiing and playing ice hockey. I recommend wearing a helmet during ice skating and sledding as well. If your child is in an incident involving a forceful blow to the head or body that results in rapid movement of the head, check for symptoms of concussion. Contrary to popular belief, a child does not have to lose consciousness to sustain a concussion. In fact, nine out of 10 children do not lose consciousness. Parents should watch for any change in their child’s behavior, thinking or physical function. A more detailed list of concussion symptoms can be found on the Children’s National website. If your child has any of these symptoms, seek medical care immediately.

7.      My child really doesn’t like to play outside in cold weather. What should I do?

The aversion to outdoor winter activities can be caused by a variety of factors. For example, a child’s motor skills could be slightly behind, which could deter the child from wanting to participate in complex group activities, such as skiing or ice skating. The advice I typically give is to match the activity with the child’s interests and make it a family affair. If your children see you exercising and enjoying colder temperatures, they are more likely to as well.

Does My Kd Need Antibiotics?

When your child is sick, it is without a doubt that you want to do everything that you can to help them feel better. However, it is important to understand that antibiotics are not always the answer. Antibiotics are strong medicines that may come with side effects and other risks that you might not be aware of. When a patient needs antibiotics, the potential benefits that the antibiotics will deliver outweigh these risks.

When is it appropriate for my child to receive antibiotics?

Most infections are caused by two kinds of germs: bacteria or viruses. Antibiotics can cure bacterial infections only. Some examples of bacterial infections are strep throat and some types of pneumonias. Some examples of viruses are the common cold, most coughs and the flu. Yellow or green mucus does not necessarily mean that your child has a bacterial infection; it is normal for mucus to get thick and change color during a viral cold. Using antibiotics for a virus will not cure the infection, help your child feel better or keep others from catching your child’s illness. Viral illnesses are typically self-limiting, meaning that your child can fight the infection without targeted medicine against the virus.

What’s the harm in giving antibiotics anyway, even if my child might not have a bacterial infection?

Antibiotics can cause some bacteria in your child’s body to become resistant, or unable to be killed with certain antibiotics. This can become a problem later for future potential infections and can also be spread to others. Generally speaking, many common infections are becoming resistant to antibiotics. An estimated 2 million illnesses and 23,000 deaths occur each year in the U.S. due to antibiotic-resistant infections. Overuse and misuse of antibiotics are main drivers of resistance, with an estimated greater than half of antibiotics being unnecessarily prescribed to children in doctor office settings for cough and cold illness.

Antibiotics can also cause side effects, such as diarrhea, nausea, skin sensitivity and even Clostridium difficile-associated diarrhea. These side effects and allergic reactions cause 1 out of 5 emergency department visits for adverse drug events and lead to 50,000 emergency department visits in children each year.

What should I do when my child is sick?

The Centers for Disease Control and Prevention (CDC) suggest three important questions to ask your healthcare provider when your child is sick:

  1. What is the best treatment for my child’s illness?
  2. What do I need to know about the antibiotics that you’re prescribing for my child today?
  3. What can I do to help my child feel better?

When your provider prescribes an antibiotic to treat a bacterial infection, be sure to ensure its use as directed. If your provider thinks that your child has a virus, symptom management with pain relievers, fever reducers, saline nasal spray or drops, warm compresses and increasing liquid intake should help your child on the road to recovery.

E-Cigarettes, Vaping and Teens

E-cigarettes are a growing concern because of their availability, addictiveness and attractiveness to teens. But what exactly are e-cigarettes and why are they so bad? And how should you talk to your kids about their potential dangers? Below are answers to some common questions many parents have about vaping, e-cigarettes and teens.

What are e-cigarettes?

Electronic Nicotine Delivery Systems (ENDS) – also known as e-cigarettes, personal vaporizers, vape pens, vaping devices, or by brand name, e.g., JUUL – are battery-powered devices that produce a vaporized mixture of liquid composed of flavorings (such as fruit, candy, peppermint or chocolate), chemicals and often nicotine that are inhaled by the user. The devices can resemble traditional tobacco products like cigarettes, but teens are more likely to use devices that pass as small common gadgets such as USB memory sticks or pens.

According to the American Academy of Pediatrics, e-cigarette use has sharply risen and is now the most commonly used nicotine product among youth. The vaping “epidemic” has infected 12 of every 100 high schoolers (who in 2017 endorsed use of an e-cigarette in the last 30 days), with use starting as young as 12 years old.

Why are e-cigarettes dangerous?

The harms from e-cigarettes come in at least three ways. First, the vapor itself contains toxic and carcinogenic chemicals and metals that harm the lungs short-term with inflammation (which may make youth more prone to pneumonia, asthma attacks and decreased sports endurance). Inhaling hot vapor also may temporarily cause dehydration and taste bud damage that results in decreased sense of taste or smell (“vaper’s tongue”), as well as nosebleeds. The long-term effects of vaping on the body are not yet fully known, so there is no known safe amount that can be recommended…even if it’s “nicotine-free.”

Second, the developing brain (up until age 25 years) is uniquely susceptible to nicotine. Even one inhalation of nicotine can alter the brain to crave more and start the cycle of vaping more often to get rid of unwanted nicotine withdrawal symptoms. Imagine what happens in the brains of teens who vape a whole JUUL pod per day (each pod contains about as much nicotine as a pack of cigarettes). If your family has a history of addictions, your teen is at higher risk of nicotine dependence when using ENDS.

The negative effects of nicotine on the body are cumulative and include increased blood pressure and heart rate and stomach ulcers. Youth may complain of heart racing, chest palpitations or abdominal pain, especially if they also consume caffeine from coffee, soda or energy drinks. Life threatening arrhythmias (abnormal heart rhythms) and heart disease may occur long-term.

Third, vaping poses risks to others. Accidental ingestion of the highly concentrated e-juice used to refill the e-cig devices is an increasing source of infant and child nicotine poisonings. While some e-cigarette devices have cartridges that are replaced as a whole, many have pods that require refilling with a dropper from a bottle of e-juice obtained online or from a vape shop. Adults should keep these products out of children’s reach. E-cigarettes that have substantial plumes of vapor also pose a health risk for bystanders who breathe in the polluted air. However, certain low-vapor devices are more popular with youth, e.g, JUUL, PHIX, and Suorin, possibly because fewer plumes facilitate undetected use on school grounds.

Although most youth hold negative views about traditional cigarette use that prevent them from uptake, they do not perceive harm in e-cigarette use. Unfortunately, kids who use e-cigarettes are more likely to transition to traditional cigarettes and suffer the better-known negative health consequences.

How do I talk to my teen about e-cigarettes?

It’s very important to communicate openly with your teen about e-cigarettes and vaping; ideally starting just before middle school. You can start a conversation with questions like “Do any of your friends use electronic cigarettes or vape?” Or “what are your thoughts about vaping?” Teens rarely identify themselves as “smokers” or “vapers” or “regular users.” One way to get around this is to ask them specific questions about behaviors, such as “Have you ever tried an e-cigarette?”

Teens respond better to specifics about the dangers of ENDS (see above), rather than being told “it’s bad” or “just say no.” Most young adults have a negative view of people who use traditional tobacco products, but that view doesn’t always transfer to e-cigarettes. By pointing out that e-cigarettes contain nicotine and still carry some of the same risks as other forms of tobacco, you can help them make that connection. You should also remind them that the contents of what they inhale may contain nicotine despite labeling, or may be spiked with cannabis extract without being able to tell (or smell).

You can also have a cigarette smoker in the family explain the challenges they’ve faced cutting down or quitting their nicotine addiction as a prevention message to youth. While adults already addicted to nicotine products may use ENDS as a harm-reduction or cessation strategy, it is important to point out that the use of ENDS by teens can lead to nicotine addiction since their brains are still developing.

If you don’t seem to be getting through to your teen, consider enlisting your pediatrician or adolescent medicine specialist to talk with them confidentially. Youth are more likely to engage in discussions about risk behaviors, like use of e-cigarettes, if they have time alone with their health care provider.

How can I tell if my teen is using e-cigarettes?

Unfortunately there is no easy way to tell if your teen is using e-cigarettes. Unlike traditional cigarettes, ENDS come in all shapes and sizes, may have small plumes of vapor that can be blown away discretely, and don’t have the odor associated with burning tobacco. It is definitely not a good idea to go through your child’s room or bag looking for e-cigarettes, cartridges, or containers of e-juice. Instead, opt for open and consistent communication, especially if you notice unfamiliar USB drives or parts in the trash bin. Warning signs that your child may be using nicotine products relate to the side effects, such as increased thirst or sudden avoidance of caffeinated products.

What should I do if my teen smokes e-cigarettes?

If your teen does smoke e-cigarettes, you should talk to them about their expectations. Ask them how often they think it’s okay to use cigarettes without long term health consequences. Then explain that vaping just once a week can easily increase to twice a week, then daily and eventually lead to addiction.

Emphasize that you want your teen to quit vaping, but don’t use commands, threats or ultimatums. Instead, ask your teen why they started using ENDS and what are the good and not-so good things about their use. Understanding what motivates them can help you address the situation and help them identify ways to cut down or stop. Once you set a quit date, co-develop a plan to help them distract themselves from cravings and have them write it all down. Encourage them to hang out with friends who don’t use ENDS or smoke cigarettes and practice how they might turn down offers to use by peers.

Your healthcare provider or school counselor can also provide support, or you can call 1-800-QUIT-NOW – a toll-free number operated by the National Cancer Institute that will connect you directly to your state’s tobacco Quitline. Quitlines offer free advice and counselling to teens and adults, information about nicotine replacement products, self-help materials and referrals to other cessation resources. Most teens should be able to quit nicotine use with the support of their family and friends, but your adolescent medicine specialist or pediatrician can help make decisions about whether to use nicotine replacement therapy


While growing up as a child, I remember that my favorite subject was recess, which had the benefit of unstructured playtime. This usually took the form of capture the flag, hide-and-seek and Simon Says with family and friends.

While these activities appeared only fun, they were also beneficial, contributing to my ability to think creatively, solve problems, recall facts quickly, work well with others and stay focused on goals of the group. Clinicians refer to this as executive functioning, and reference the social-emotional, cognitive and self-regulation skills that accompany play. I call it “having fun,” and often write prescriptions to help my pediatric patients reap its benefits.

The American Academy of Pediatrics agrees and recently released guidelines to encourage children of all ages to participate in 30 minutes of unstructured playtime, whether it’s at school or at home. The recommendations, published in the Pediatrics journal in advance of the 2018-19 school year, have compelled some school systems to extend recess time for children.

If your child doesn’t have recess and your family is short on time, the good news is that a 30-minute prescription for play doesn’t have to be consecutive. While 30 minutes is recommended, any amount of playtime counts.

Here are four ways to integrate playtime into your schedule at home:

Before school

1. At the bus stop or walking to school: If you walk your children to school or to the bus stop, use this time – whether it’s five minutes waiting for the bus to arrive or 10 minutes en route to school – to get creative. Come up with a tradition that’s fun for you and your child and engages their creativity. For example, try counting the different colors of changing leaves, which engages children in the learning process, instead of relying on rote memory skills. Or, implement an I Spy game of spotting animals, such as neighborhood deer, foxes, birds and cats, which makes this learning interactive. If you live in an urban area, identify clouds that take the shape of recognizable objects, from cars and flowers to pumpkins, monsters and planets.

2. On the school bus: If your child is in middle school or high school, they may use daily travel time to study or complete homework. This is a smart use of time, especially in advance of a big test or exam. However, if you notice they are overscheduled or entering a busy period of the school year, you can talk to them about the benefits of using that 20- to 30-minute bus ride on the way to school or on the way back from a sports game to connect with friends and have fun. We’re still studying the pathogenesis of our molecular wiring, but we find lower levels of cortisol, a stress hormone, following periods of play. This makes a packed schedule more manageable and is a valuable tool students can use throughout stressful periods. Another benefit of play is that it enhances curiosity, which then promotes memory and learning. This may make it easier to recall tricky calculus equations and historical dates in advance of a big history exam.

After school

3. After-school errands: Do you often stop at the grocery store on the way home from picking your child up from school or sports practice? If your child is younger, engage the same creative processes with analyzing objects in their physical environment in the grocery store. Count apples from the local display if you’re waiting in line or ask your child to identify the colors of the rainbow if you’re in the produce aisle. Find something they like – whether it’s the wheels on the cart, their favorite color or their favorite food– and encourage them to get creative and play. When you see your child play, you can encourage this behavior by smiling, playing with them or giving supportive nonverbal cues. This takes less than a minute but sends a message that you support the behavior.

4. Making dinner: The magic of play is that it can take place anywhere and in almost any environment. If your child is younger, pick up wooden spoons or spatulas as you’re making dinner and create conversations or narratives between the kitchen utensils. This will help pass time as you’re waiting for dinner – and introduce children to unusual conventions at an early age. Later in life, this unique paring and the ability to think outside of conventional standards has led to innovations in creating new medical devices, artificial intelligence systems and processes to help solve contemporary problems. It’s never too early to cultivate these skills in children.


Kids get skin rashes from time to time, so when your little one has red patches on their face, how do you know if it’s eczema or another skin condition such as heat rash, acne or hives? Here are four ways you can spot signs of eczema on your child.

Uncontrollable itching

Eczema is commonly known as the “itch that rashes.” It causes skin to dry and flake, which leads to a constant itchy feeling that’s uncomfortable.

If you notice that your child is scratching a scaly, red rash all day and night, that may be the first sign that he or she is suffering from eczema. Babies don’t know how to use their hands to scratch their skin, so they will rub against anything, including bed sheets, to relieve the painful feeling.

The itchiness can be so severe that your child may be fussy and have trouble sleeping. But scratching the affected area can make the rash worse, leading to a thick, brownish scab that can ooze with blood.

Location plays a big part

Babies from 1 month to 2 years old tend to get eczema on their cheeks (especially when they are drooling) and scalp. Older children will generally have it on the folds of their wrists, knees and ankles. If your child has a red, itchy and scaly rash that isn’t in a classic location for eczema, it could be allergic contact dermatitis, meaning they might be allergic to something they’re coming into contact with such as soap, shampoo or lotion.

It goes away and comes back

Most skin rashes go away within a few days or weeks, but eczema goes away for a short period of time and then reappears. Everyday elements in the environment like smoke, pollen, pet dander and fragrances can cause eczema to flare up.

The best way to prevent eczema flare ups is to use a thick, fragrance-free moisturizer at least twice a day over your child’s entire body.

Age matters

If your 12-year-old has never had eczema and suddenly has a dry and itchy rash, it’s less likely to be eczema since eczema usually starts at a young age. But if a baby starts to get dry itchy patches, eczema is most likely the culprit.

There are many skin rashes that are red and itchy, so if you’ve tried using moisturizers on your child’s skin and that isn’t working, you should see a dermatologist for a diagnosis.