This is a questions that we get asked often. So we wanted to take a moment and give you a little bit of background on diaper rashes and hopefully give you some good insight about this condition that many babies have. 

What is diaper rash?

A diaper rash is any rash that develops inside the diaper area. In mild cases, the skin might be red. In more severe cases, there may be painful open sores. It is usually seen around the groin and inside the folds of the upper thighs and buttocks. Miles cases clear up within 3 to 4 days with treatment. 

What causes diaper rash?

Over the years diaper rash has been blamed on many causes, such as teething, diet, and ammonia in the urine. However, we now believe it is caused by any of the following:

• Too much moisture
• Chafing or rubbing
• When urine, stools, or both touch the skin for long period of time 
• Yeast infections
• Bacterial infection
• Allergic reaction to diaper material

When skin stays wet for too long, it starts to bread down. When wet skin is rubbed, it also damages more easily. Moisture from the soiled diaper can harm you baby’s skin and make it more prone to chafing. When this happens, a diaper rash may develop. 

More than half of babies between 4 and 15 months of age develop diaper rash at least once in a 2-month period. Diaper rash occurs more often when:

• Babies get older-mostly between 8 to 10 months of age.
• Babies are not kept clean and dry.
• Babies have frequent  stools, especially when the stool stay in their diaper overnight. 
• Babies have diarrhea
• Babies begin to eat solid foods
• Babies are taking antibiotics or in nursing babies whose mothers are taking antibiotics. 

When to call the pediatrician?

Sometimes a diaper rashes need medical attention. Talk with your pediatrician if:

• The rash does not look like it’s going away or gets worse 2 to 3 days after treatment.
• The rash includes blisters or pus-filled sores. 
• Your baby is taking antibiotic and has a bright red rash with red spots at its edges. This might be a yeast infection.
• Your baby has a fever along with a rash.
• The rash is very painful. Your baby might have a skin condition called cellulitis. 

What can I do if my baby gets diaper rash?

If your baby has a diaper rash (and to prevent future diaper rashes) it’s important to keep the area as clean and dry as possible. Change wet or soiled diaper right away. This helps cut down how much moisture is on the skin.

• Gently clean the diaper with water and a soft washcloth. Disposable diaper wipes may also be used. Avoid wipes that contain alcohol and fragrance. Use soap and water only if the stool does not come off easily. If the rash is severe, use a squirt bottle of water so you can clean and rinse without rubbing. 
• Pat dry; do not rub. Allow the area to air-dry fully. 
• Apply a thick layer of protective ointment or cream (such as on that contains zinc a oxide or petroleum jelly). These ointments are usually are usually thick and pasty and do not have to be completely removed at the next diaper change. Remember, heavy scrubbing or burring will only damage the skin more. 
• Do not put the diaper on too tight, especially overnight. Keep the diaper loose so that the wet and soiled part does not rub against the skin as much.
• Use cream with steroids only if your pediatrician recommends them. They are rarely needed and may be harmful. 
• Check with your pediatrician if the rash a) has blisters or pus-filled sores; does not go away within 2 to 3 days; Gets worse.  

Many parents ask me if a cloth diaper is better than disposable diapers. Research suggests that diaper rashes are less common with the use of disposable diapers. 

However, what is more important than the type of diaper is how often it is changed. Whether you use cloth diapers, disposables, or both, always change diapers as needed to keep your baby clean, dry, and healthy. 

Written by Joanna Betancourt MD., FAAP. 

As you may be aware, in the past few months, we’ve seen an increase in pertussis cases, commonly known as “whooping cough,” in the McHenry County. Hundreds of cases had been reported.  

As a result, the IL Department of Public Health has issued the implementation of Tdap vaccination requirement for children entering the 6^th and 9^th grade this coming fall.  Students without proof of Tdap vaccination, or an approved medical or religious exemption on the file with the school, or an appointment to receive the Tdap shot during the school year will be subject to exclusion. 

If your child has not received the vaccine, we would encourage you to make an appointment with our office so that we can not only provide the necessary vaccinations, but we can also complete a full assessment of your child’s health. More importantly, a complete head-to-toe health exam may:

•  Find and treat health problems before they become serious.
•  Allow parents and children to ask questions about the child’s health.
• Help parents and children establish a relationship with a primary care physician or nurse practitioner.
• Help establish a healthy baseline to aid diagnosis when children become sick.
• Health help children stay healthy.

Keep in mind that Whooping cough is an extremely contagious disease and symptoms are similar to those of a cold, including runny nose, sneezing, low-grade fever and a cough that gradually worsens. Immunizations are the single most protective factor against pertussis.

Give us a call at 847-854-9402 at your earliest convenience so we can schedule that appointment soon.  And we thank you for entrusting us with the healthcare of your child. 

To read a FAQ, go to this link.

WOODSTOCK IL – Since McHenry County Department of Health (MCDH) first announced 8 cases  of pertussis or whooping cough on October 14, the outbreak has risen to 121 cases in 5 weeks ranging in age from 3 months to 37 years old in 13 communities. Twenty-nine (29) schools, from elementary, middle, high school and college age, have reported cases.  

With the upcoming Thanksgiving holiday when families travel to see loved ones, the potential to spread whooping cough to young and old alike is of real concern.    

MCDH urges residents to take precautions and protect family members through prevention, vaccination and complying with physician treatment regime.  

A 4th walk-in vaccination clinic has been scheduled for Thurs, December 1st, from 11am-1pm, at McHenry County College (in the Commons area), 8900 Northwest Highway, Crystal Lake. Dominick’s Pharmacy and primary care physicians also offer the vaccine.

The Centers for Disease Control and Prevention (CDC) stresses the importance of a pertussis booster for those aged 11 to 64 and those 65+ who are caregivers for young children.    

The cost of the vaccine at the December clinic is $50.  Medicaid is accepted for individuals aged 11-18; must present  Medicaid card. The vaccine is $15 for those aged 11-18 who are uninsured or underinsured, and uninsured adults aged 19 and older who meet income requirements. 

In addition, 11-18 year olds must  be accompanied by a parent; bring current vaccination record. High risk populations include  infants-young children (birth-5 years old) who may not be fully vaccinated, children who didn’t receive a booster shot, those who are immune compromised and older adults. 

Pertussis is highly contagious and easily spread from person to person through coughing and  sneezing.  Symptoms such as cough, runny nose, sneezing and low-grade fever can last several  weeks and lead to complications like pneumonia, encephalitis or pulmonary hypertension.   

Frequent hand washing, covering the mouth, coughing into tissues and staying home when ill are important  practices to limit the spread of infection.   Returning to school/work prior to completing the five (5) day  treatment regime could allow pertussis to spread. 

For more information on pertussis, visit www.mcdh.info or call MCDH at 815-334-451

As always, feel free to give us call should you have any questions at 847-854-9402

The Fall and Winter months see an influx of this viral illness and its telltale sign: the barking cough.

Here are pertinent key facts regarding croup along with measures you can take to help your little one feel better should they come down with it.

What is Croup?

• Croup is a viral illness causing inflammation of the voice box (larynx) and windpipe (trachea)
• The most common virus to cause croup is the parainfluenza virus
• croup is considered an upper airway infection
• Children ages 3 months to 3 years old are most commonly affected. It is rare to see a child over the age of 6 years old with croup.

What are the symptoms of Croup?

• The first symptoms of croup are similar to that of a common cold such as stuffy nose and fever.
• The fever is usually lower than 104 F
• After 1-2 days of cold symptoms, the telltale cough will appear
• This cough is characterized by its barking sound (like that of a barking seal).
• The cough is usually worse at night (of course it is!)
• The child usually also has a hoarse voice because of the inflammation of the larynx and vocal cords
• Most cases of croup are mild although the barking cough can sound quite scary especially in the middle of the night.
• Stridor which is a harsh and raspy sound when the child breathes in, is a more serious symptom and requires evaluation.
• The croupy cough usually peaks during the 2nd or 3rd night then gets better. The cold like symptoms may persist for a total of 7 days.

How can I treat Croup?

• Since croup is a viral infection, antibiotics are of no help.
• If your child wakes up at night with this barking cough, sit with your child in the bathroom while running a hot shower. After about 10-15 minutes of exposure to this warm steam, your child’s airway will become less inflamed and more clear.
• A cool mist humidifier in your child’s room will also help her breathe easier at night.
• Sometimes the cold night air will help reduce the airway inflammation.
• Be sure to treat your child’s fever with a fever reducer. This will make her a lot more comfortable
• Keep your child as calm and comfortable as possible. Crying makes this barking cough sound worse.
• Continue to offer clear liquids throughout the day to avoid dehydration
• Do not use cough syrups or antihistamines. They do not help children with croup.
• If your child is having difficulty breathing or has stridor, your child’s doctor may prescribe steroids.

When to call the Doctor

• Your child has stridor (the harsh and raspy sound made by taking a breath).
• Your child is having difficulty breathing
• Your child cannot talk because she cannot catch her breath
• Your child looks worried
• Your child appears very ill and sleepy
• Your child has a pale or bluish discoloration around her mouth
• Your child’s croupy cough does not seem to be getting better after the 3rd day
• Whenever in doubt, call your child’s doctor.

For the most part, most cases of croup are mild. Your child may return to school or daycare once the fever has resolved and your child is ready to participate in his daily activities. The best prevention for croup is diligent hand washing since croup is spread just like the common cold: droplet transmission and person to person contact.

Has Croup hit your household lately? Do you have any additional tips or stories to share regarding the treatment of croup?

Through surveillance measures, the McHenry County Department of Health has identified an increase of cases of bordetella pertussis in Cary-Grove High School. 

In 2010, according to the Centers for Disease Control and Prevention (CDC), 27,550 cases of pertussis (whooping cough) were reported in the U.S., but many more go undiagnosed and unreported.

There is an ongoing outbreak in the state of California with 9,143 cases reported in 2010 and 2,462 cases reported so far in 2011. Ten infant deaths have been reported in this outbreak. In the state of Illinois, 1,057 cases were reported in 2010.

Nine case of pertussis were reported to the McHenry County Department of Health in 2010 and 60 in 2009.

This notice is provided to alert you of treatment and prevention standards of bordetella pertussis. Through early action we are hoping to prevent a potentially large outbreak:

• Test patients that present with cold or cough symptoms
• Treat pertussis cases and provide prophylaxis for close contacts
• Patients with pertussis must be isolated from day care, school, work, and public gatherings until at least 5 days after the start of appropriate antibiotic therapy to limit further transmission.
  For more information visit http://www.cdc.gov/mmwr/pdf/rr/rr5414.pdf

Preventative measures

Coughing people of any age, including parents, siblings, and grandparents can have pertussis. When a person has cold symptoms or cough illness, they need to stay away from young infants as much as possible. Frequent hand washing and respiratory hygiene (covering coughs and sneezes with a tissue, and disposing of the soiled tissues) are also necessary to prevent further transmission.

Vaccinate with DTaP: All children should receive a series of DTaP at ages 2, 4, and 6 months, with boosters at ages 15-18 months and at 4-6 years. The fourth dose may be given as early as age 12 months if at least 6 months have elapsed since the third dose.

Vaccinate with Tdap: The recommendations for use of Tdap issued by ACIP at its October 2010 and February 2011 meetings;

Tdap can be given regardless of the interval since the last Td was given. There is NO need to wait 2–5 years to administer Tdap following a dose of Td.

Adolescents should receive a one-time dose of Tdap (instead of Td) at the 11–12-year-old visit.

Adolescents and adults younger than age 65 years who have not received a dose of Tdap, or for whom vaccine status is unknown, should be immunized as soon as feasible. (As stated above, Tdap can be administered regardless of interval since the previous Td dose.)

Adults age 65 years and older who have not previously received a dose of Tdap, and who have or anticipate having close contact with children younger than age 12 months (e.g., grandparents, other relatives, child care providers), should receive a one-time dose to protect infants. (As stated above, Tdap can be administered regardless of interval since the previous Td dose.)

Other adults 65 years and older who are not in contact with an infant, and who have not previously received a dose of Tdap, may receive a single dose of Tdap in place of a dose of Td.

Children ages 7–10 years who are not fully immunized against pertussis (i.e., did not complete a series of pertussis-containing vaccine before their seventh birthday) should receive a one-time dose of Tdap.

All healthcare workers, regardless of age, should receive a single dose of Tdap as soon as feasible if they have not previously received Tdap and regardless of the time since the last dose of Td.

The ACIP makes recommendations that differ from the FDA-approved package insert indications, and this is one of those instances. ACIP recommendations represent the standard of care for vaccination practice in the United States. In general, to determine recommendations for use, one should follow the recommendations of ACIP rather than the information in the package insert.

It is important at this time to report any Suspect, Probable, or Confirmed cases of Pertussis to the McHenry County Department of Health Communicable Disease Program.  Thank you for your cooperation and feel free to contact us with any of your questions at 815-334-4500

If you have any questions, please don't hesitate to give us a call at 847-854-9402

And even with all the knowledge obtained during medical school and pediatrics practice, it was hard to accept.

As an infant, and exclusively breastfed, our daughter developed cow's milk protein allergies that manifested as bloody stools and a severe rash at only 6 weeks of age. 

After a very tough time, she improved, but the rash was ongoing in the flexor areas of her arms and legs, particularly worse during her second spring. Her rash was ECZEMA, or ATOPIC DERMATITIS.  By 17 months of age, we started noticing occasional swelling around the eyes, so I took her to an allergy specialist. 

Our daughter underwent blood and skin allergy testing and was also diagnosed with mild egg allergies.  By age two, she got a cold and had some wheezing associated with it. It was winter and I knew many viruses that cause common colds, can make little kids wheeze.

So I treated her with Albuterol nebs for 1-2 days. I thought that she probably would not wheeze ever again. However, every spring and fall, she had mild wheezing episodes. We never needed to take her to the ER or admit her to the hospital. Everytime, she was fine after 3-4 days with the use of Albuterol. Her eczema was off and on and she was frequently stuffy and with dark circles under her eyes.

By age 4, I had to admit it, SHE HAD ASTHMA! Our daughter went through what is known as the ALLERGIC MARCH: starting with food allergies, advancing to eczema and allergic rhinitis and finally presenting as recurrent wheezing or ASTHMA. 

We were "lucky" though; her asthma was mild.

Until last year, when she developed about 3-4 "not as mild" asthma attacks. We had to add an oral steroids on 2 occasions. Last summer, she got a cough that lasted about 2 months despite several treatments that included anti-allergic meds, nasal sprays and antibiotics and again, she improved.

One evening in October of 2010, Alex complained of chest pain. She didn't have a cough or labored breathing. Of course I auscultated her and she was clear. I gave her an albuterol neb this time and  a steam inhalation.

She felt better...however, was not as playful.

I slept with her that night. Two hours after her neb, I felt her breathing deep and different. When I turned on the light, she was working hard to breath, her ribs were noticeable with the pulling of her abdominal and chest muscles to reach air, her lips were ashy and she was breathing heavily and faster. No cough, believe it or not. I followed the asthma action plan that was pre-established for her. She improved, but this was a very close call.

It was so obvious then that her asthma was slowly getting out of control! I just was thankful I decided to keep a close eye on her that night, because I would of not been able to hear her from my room.

Alex was immediately started on a preventive medication: an inhaled steroid she uses twice everyday religiously, before brushing her teeth. Since then, she has not had another asthma exacerbation.

She, of course, still gets colds and coughs, but recovers easily after 1-2 days. She has not missed a day of school since we started her "controller" medicine and I feel so much more confident she will be alright.

Asthma, No Small Condition.

Asthma is one of the nation’s most common and costly chronic conditions, affecting over 38 million Americans at some point in their lives. An estimated 8.6 million adults and 4.1 million children had an asthma attack in the past twelve months (2008 NHIS). The cost of asthma is estimated to be over $30 billion a year. Asthma can also be life threatening; more than 3,600 people die from asthma each year.

That is, about 9 people every day. Although much has been learned in recent years about asthma management and control, the information still needs to be put into sound public health practice. Managing asthma requires a long-term, comprehensive approach, including:

• Patient education
• Behavior changes
• Asthma trigger avoidance
• Pharmacological therapy, and
• Frequent medical follow-up.

In most cases, what causes an individual to develop asthma is unknown. The occurrence of asthma attacks, however, has been linked to:

• Exercise
• Respiratory infections
• Exposure to environmental factors such as allergens, tobacco smoke, and indoor and outdoor air pollution

A number of epidemiologic studies have reported associations between air pollution exposures and asthma. The association between ambient air particulate matter concentrations and asthma, including increased hospital admissions, is well documented.

Asthma Stats

An estimated 9.6 million children (13.1 percent) under the age of 18 and 24.4 million adults 18 and older (10.9 percent) had been diagnosed with asthma during their lifetimes.7,9   Current asthma prevalence is higher among children ages 17 years and younger (9.1 percent) than adults (7.3 percent).11   In 2007, asthma accounted for 3,447 deaths. In the United States, that’s more than 9 people every day. Unfortunately, one of our patients was part of these statistics in 2010.

Most children with asthma miss a significant number of school days due to asthma flares up during winter and spring. Parents also miss work days because they need to take care of their sick child, not to mention the burden of needed ER visits, hospitalizations , doctor's office visits, and long, sleepless, anxious nights.

Salud Pediatrics Asthma Clinic

In our effort to provide the best preventive health care, we would like to invite you and your child to participate in our Asthma Clinics on Thursday October 13 and Thursday October 20.

The purpose of these clinics is to prepare you and your child for the upcoming season by classifying his/her asthma and establishing an action plan so that the frequency and severity of asthma flare ups decrease.

During the Asthma Clinic we will provide:

• Identification of asthma triggers for your child.
• Classification of his/her current asthma. Even if your child has been well, asthma can strike anytime.... You need to be prepared!
• Establishment of a customized Asthma Action Plan that would empower you, the school staff or other care providers to take control of his/her asthma symptoms and act on time to avoid potential life  threatening complications.
• Introduce the use of a Peak Flow Meter so that you can objectively assess how your child is doing and how severe his/her symptoms are.
• Hands on training on the use of asthma medications, spacers, and nebulizer.
• Give needed prescriptions and pertinent refills.
• Flu vaccination and allergy testing for identification and control of triggers, if indicated.

Your participation in our clinic will be billed to your insurance company as a typical office visit.

Call us at (847)854-9402 to set an appointment on either of the 2 dates available.

Please bring with you all your child's asthma and allergy medications (inhalers, neb solutions, syrups, tablets, nasal sprays) and any aerochamber or spacer you have. 

We would like to partner with you so your child enjoys a healthy season.

Thank you for trusting the care of your children to us!

The mother of my 6-year old patient explained to me that her daughter always gets high fevers, especially when she is sick. Mom says she keeps on bringing her child in to see the pediatrician, but the doctor never seems to be concerned about it. Aren't fevers dangerous?

The short answer is that high fevers, in and of themselves, are not dangerous in normal children. The only fevers that are dangerous are those that occur with heavy exercise in hot conditions where the body’s fever control thermostat breaks down.

Fever is a symptom, not a disease. It is not the height of the fever that is of concern, but the nature of the illness causing the fever.

In the case of viral illnesses of childhood, the body will not allow a fever to get high enough to cause damage. Unfortunately, there is a “fever phobia” in America. Surveys of parents over the past 20 years have shown little change in it.

In fact, the American Academy of Pediatrics recently issued an updated clinical report titled “Fever and Antipyretic Use in Children” The Academy says it has issued the report to help pediatricians and primary care physicians (general practitioners) educate parents and families about fever and fever phobia.

This unreasonable fear of fever stems from the basic misconception I mentioned: that fever is a disease. It is not. It is the body’s response to an infection

Like most normal bodily responses, it has a purpose. Mild to moderate fevers actually promote the body’s defense against illness. Temperatures less that 100.5 F are not fever at all, they are NORMAL. Fever’s up to 102 F rarely makes kids sick and is often beneficial.

Most Pediatricians do not consider a fever “high” until it is 104 F. or greater. Even then, the disease causing the fever may not be serious at all. A lot depends on the age and clinical appearance of the child and other symptoms that might be present.

You must assess how the child appears; how he or she is acting; do they make eye contact? Are they drinking? Are they consolable? Therefore, if your child has a fever, it is always good to call your Pediatrician for advice. It is not good to be frightened or panic and run to an emergency room, since the vast majority of fevers are caused by common viral illness.

The only exception to this advice is in the very young infant.

 

If your child with fever is less than 3 months of age or appears very ill, however, then an immediate call is mandatory.

Dr. Lessin has been a practicing pediatrician for 30 years. He is a founding partner and serveD as both Medical Director and Director of Clinical Research at the Children’s Medical Group.

We stress the 2-hour limit to help prevent obesity. We warn about Facebook depression, exposure to violence and sex, cyberbullying and online predators. We talk about how texting can keep kids up at night and how video games can contribute to ADHD.

And although she continues to support this message, Dr. McCarthy says that when we just focus on the negative, parents and pediatricians may miss two important points which are: technology is not ALL bad and, as she puts it, for better or worse, digital media is here to stay.

If we are just negative, we may miss the opportunity to inform the discussion. Pediatricians may miss the opportunity to guide children and families in the best uses of technology. Someone else will step in and do it, someone who doesn’t understand child health and development the way pediatricians do. And kids aren’t going to want to talk to their parents about what they are doing online if they think that their parents’ only response will be disapproval.

 I like Dr. McCarthy’s call. She is challenging pediatricians (and parents as well), “to meet kids where they are” and start becoming more connected their world.

It’s hard to inform a discussion about something you don’t know about. So pediatricians and parents should explore the Web and see what’s out there. Do health searches; see what pops up. Find sites and applications that you like and can recommend. Talk to kids about how they use technology—learn from them. Check out Facebook and Twitter and YouTube. Consider using social media yourself.

With so many vitamin options available, choosing the right vitamin for your child can be a daunting task.  

Not all vitamins are all the same!  The age and health history of your child are important factors to consider. A premature infant will have different requirements than a healthy 2 year old.

My goal here is to give a sense of direction in the vitamin isle, but it is important to discuss individual needs with your doctor.

Often doctors will prescribe vitamins for your newborn, so that makes it much easier! Other times, they tell you the name of the vitamin to choose in the isle.  The vitamins your pediatrician recommends at this age is a little different depending on whether your breastfeeding your child or not.

Vitamins For Newborns

Vitamin K is very important in the newborn period but thankfully all babies get a vitamin K shot right at birth and the subsequent needs are met by breastmilk and formula. Breast-fed babies need extra vitamin D: 400 IU and iron supplement of ~ 11mg daily starting at 6 months.

Six Month Old

Typically, pediatricians will give D-visol (vitamin D) through 6 months of age, then switch to poly-vi-sol (multivitamin) with iron starting at 6 months, but some pediatricians opt to start the multivitamin from the start.  Either choice is fine.  All formulas are iron and vitamin fortified to contain at least the recommended daily amounts for the first year of life.  

12 Month Old

After the 1st birthday, life is completely different!  Your little baby is turning into a toddler and with it comes a whole new challenge: feeding.  We switch them from their vitamin fortified breastmilk or formula to whole milk and table foods.  

Toddlers

The tricky part is that toddlers are inherently picky!  They manage to get enough calories  through all of the “picking” of their food, but do they get enough vitamins and minerals?

Consider this: One cup of whole milk (about 8 oz) has only ¼ of the recommended daily allowance of vitamin D, ½ to 1/3 of the amount of calcium, and no iron.  This means that your child will need to drink 16- 32 oz (2-4 glasses) of milk to get all the vitamin D and calcium they need – but you would still need to consider their iron needs.  

Also, high volume of milk intake (more than 16 oz a day) can lead to anemia.  Translation: your mom was right that milk is good for you but there is too much of a good thing.

So, what to do? In general, all vitamins and minerals are important, but some are easier to get them to eat than others. We can focus on a few important ones:  vitamin D, calcium, iron, B vitamins, and folate.

• Iron is important in red blood cell formation and neurologic development among other things.  It is plentiful in meat, dark leafy green vegetables, beans, tofu, cereal and bread. 1-3 year olds need about 7mg per day, 4-18 year olds  about 10-12 mg per day except for menstruating adolescent girls who need about 15mg daily.   
• B vitamins are important for production of oxygen carrying cells and can be found in fish, poultry, meat, eggs, dairy, leafy green vegetables, beans/peas, breads and cereals.  B6 and B12 are fairly easy to get in the diet.  1-8 year olds need about 0.5 - 0.6 mg per day and teenagers need about 1.0-1.3 mg/day.  
• Calcium is  very important for growing bones.  Some sources of calcium include cheese, yogurt, orange juice, fortified breads and cereals, spinach, and salmon.  1-3 year olds need ~ 500 mg a day, 4-8 yo need ~ 800 mg a day. and  9-18 year olds need ~ 1,300 mg a day.
• Vitamin D is a tough one! The best source is the sun…but we spend most of our year bundled in sweaters, coats, scarves…you get the idea.  There are a few natural food sources: cod liver oil, salmon, mackerel, tuna, liver, and egg yolk.  My 3 year old definitely won’t eat liver.  Thankfully,  cereals and dairy are fortified.  The current recommendation for all age groups is a minimum of 400 IU daily.

After sorting through the vitamin isle, it seems that either Flintstones’ Complete – it is ½ tablet for 2-3 year olds and a full tablet for older than 4 years or Centrum Kids Complete Multivitamin are the best bet for toddlers and school age kids.  

Even still, they don’t provide 100% of the calcium and vitamin D in 2-3 year olds but they are pretty good for iron, B vitamins, and folate.  

A few words on Gummy vitamins…

Though they taste good and are probably easier to get your children to take, the vast majority I have seen fall short in providing the necessary daily nutrients.  Many contain ¼ to ½ the amount of vitamin D and 10% or less of the needed calcium;No gummies contain iron. Many have the minimum amount of B vitamins but less than the recommended folate. Each gummy does, however, contain about 3g of sugar.  If the serving size for your child is 2 gummies, giving them their vitamins is about the same as giving them a ¼ cup of soda!  

As a mother of four, bedtime can become a stressful part of my daily routine.  

Children have a gift when it comes to bedtime avoidance.

How many times have you heard these night time avoidance tricks: “one more book" "I need a glass of water," "I'm hungry!" "I think something is under my bed.” Just when you are sure they are tucked in, you turn and find them standing behind you or crawling into your bed.

This may or may not concern you, but it is important to understand that irregular sleep patterns can lead to “excessive daytime sleepiness.”  The AAP gives a great overview of this problem and ways to help nip it in the bud!
 

“Excessive daytime sleepiness (EDS) can be caused by insufficient sleep, fragmented sleep, or increased sleep drive. Although some sleepy children appear to have difficulty remaining awake, many sleepy children may exhibit hyperactivity, restlessness, poor concentration, impulsivity, aggressiveness, or irritability.”

Your child's problem may be related to fear.  Many children fear separation from the parents, they may be experiencing bullying from peers, a change in the family dynamics (sibling birth or a relative death) which can cause doubt and  uncertainty.  

Simple exposure to inappropriate media such as a scary movies, television shows or video games can lead to fearful thoughts.  Children's fears are real and need to be addressed.  The AAP has recommended some ways to assist your child in handling these fears:

• Acknowledge the child's fears: Children are still learning the difference between fantasy and reality.  So even though we understand monsters do not live under the bed children may still fear the monster exists.  
• Reassure them you will keep them safe: If a monster is under the bed, spray it with the miracle monster evaporator, check the closets,  or tell them the doors are locked with the special mommy lock that keep the monster's out.
• Empowerment stories: Go to your local library and get books on being scared, make sure it is age appropriate and read it with them.
• A night light: a simple night light helps keep the boogy man away.  When children can see there is nothing in the room they feel a little comfort in closing their eyes.

Fear or no fear children can manipulate any situation, and bedtime is no different.  When you are faced with an manipulative child you need to stay strong, hold your ground and keep a healthy bedtime routine.  Here are some tricks from the AAP on getting your child into bed and keeping them there!

• A bedtime routine should take less than 30 minutes, from brushing there teeth to saying goodnight.
• The child should have the parents undivided attention during this period.
• Activities should have a set length (ie: 2 books or 3 songs)
• When setting the limit you must stick to it (just one more book), when you give in once they will continue to ask for more.
• You must ignore request for more, arguing manipulation and encourages your child to continue to ask.
• Ensure them you will check in on the child within a few minutes and follow through, this is reassuring and gives them a sense of security.  But never allow them to get out of bed during that period.
• Positive reinforcement, stickers or an extra book the next night can give them incentive to stay in their beds through the night.

Try these helpful hints from the AAP and ask around, you may find friends and family with similar problems, more importantly some other helpful advice.