Dr. JJ's Travel Tips:
JJ Levenstein, MD, FAAP

Headed on a family getaway? Don't worry, traveling with your little ones doesn't guarantee meltdowns, especially if you are well prepared!

Here are a few simple, but tried-and-true basics to help ensure smooth sailing (flying, sailing, road tripping) in the future:

Before you travel, make sure your children's vaccinations are up to date; nothing stops people from traveling to loved ones (or loved places) – not even illness!

  • If you are travelling to international destinations, check with your healthcare provider about any special vaccines or precautions you must take about a month before taking off.
  • If your baby or child has had a cold or respiratory illness prior to flying, it's a good idea to have ears checked by your doctor prior to your trip, just to make sure flying will be comfortable.
  • If your child is on any medications, make sure you have enough for the duration of your trip, plus extra (in the event of spillage or delays).
  • If your baby is under 6 months of age, make sure that your friends/relatives at your destination site have had both flu vaccines and pertussis vaccine (TDaP)

Check online or call to make sure your flight hasn't been cancelled or delayed.

  • Arrive early at the airport – if it is naptime, find a quiet corner for your child to snooze while awaiting your flight. A rested child is a better traveler! If you have the ability to print out boarding passes prior to arriving at the airport, that streamlines your process.

Always pack comfort items for your baby or tot – a lovey, pacifier or blanket are essential.

  • For older children – always bring a couple of favorite books or a stuffed fuzzy friend. Remember to also bring extra diapers, formula/breast milk, and baby food (just make sure jars are 3.4 oz or less in volume) in the event your plane is held on the runway, diverted to another airport, or just delayed. With recent reports of terminal shutdowns and other unexpected events, your baby's stash of food is imperative!
  • Remember to pack some light snacks for your tots or older children.
  • Babies will do well with nursing or sucking on a bottle during take offs and landings; this will reduce discomfort associated with middle ear pressure changes.
  • Make sure you travel with pain reliever (acetaminophen or ibuprofen for older children) in the event that ascent or descent causes pain in your little one's ears

Current regulations permit a maximum size of 3.4 oz (100ml) bottles of creams, lotions, or gels as carry-on items. And no, this doesn't mean a half-empty 6 oz bottle or tube.I suggest you check www.tsa.gov the day prior to departure for the most up-to-date security information to avoid unnecessary delays at the security checkpoint.

  • Children like to be comfortable traveling, too! Their softest PJs are a better option than their most fussy outfit! Save that outfit for your destination.
  • If you're also traveling with a toddler, be sure to keep their shoes on when walking around the plane – unexpected injuries to little tootsies can be prevented.
  • If you're changing time zones, keep your child on his "home" time schedule until you arrive at your destination. Once at your destination, expect that for every hour time change you experience, your child will need a day to adjust. The same thing occurs on the return leg. Try your best to remember regular naps and a consistent place for your child to sleep. Ironically, keeping a baby up and missing naps usually results in very sleepless nights.
  • Make sure you have an approved carseat and safe sleep spot at your destination, otherwise travel with your carseat and a portable crib. If you are checking in your carseat, make sure it has a cover – otherwise stains and/or damages are likely to occur. Many hotels have cribs and other gear for wee ones. Check with the concierge and you may save yourself a lot of wear and tear (and extra baggage fees) as a result.

Most of all, travel leads us to those we love, so please, enjoy and cherish your time with family and friends.

Potty Training 101:
JJ Levenstein, MD, FAAP

Don't we all love it when our little ones make that leap from diapers to underwear…and yet, like breast feeding, this may not come so naturally to some kids.

Potty training involves a period of observation, action, followed by a plan to be successful.

When is it most successful?

  • Most girls will potty train fairly easily around 2, whereas boys may take a little longer(perhaps because language develops earlier (as a general average) in girls, and language is part of the preparatory checklist that needs to be intact before potty training can be accomplished)

What to do AHEAD of time?

  • From a preparatory standpoint, involve your child in YOUR pottying – ie let your tot pull toilet paper for you, flush the toilet, and even sit on their own potty next to you with a book. These imitative behaviors are key, but NEVER let your child see you strain or look as if you are in pain – you don't want them to witness what they then will think is a traumatic event.
  • Grabbing a few children's books about pottying, and incorporating them into your child's reading routine is a good idea – that way the characters they love in books (for my son, it was Elmo) already potty, and serve as beloved role models,/
  • Adjusting your tot's diet so that soft stools are the rule, rather than the exception. If your child has hard painful stools and/or suffers from chronic constipation, this is a situation that MUST be remedied for at least a couple of months BEFORE you start training. Stool must be soft enough to be "soft serve" in consistency, so when the urge hits, it's NEVER painful or difficult. Toddlers almost immediately associate that feeling with negativism, and start to withhold stool willfully – after about 2-3 days of doing this the stool in their rectums is so rock hard (from dehydrating in the "chamber") that it's impossible to cajole them into believing defecation will be pleasureable. Work on your child's diet, with the help of your pediatrician, in order to achieve soft, easy to pass stools. Your pediatrician likely will recommend fewer dairy products, more water, and diet rich in fiber and produce. Use his/her guidance to make sure your tot's diet is balanced, but potty-friendly.,/
  • Understand that you must DAY train a child successfully before expecting your tot to be successful at night – and often night dryness may not be achieved for 6-12 months after the days have been mastered. Realistic expectations of your child are a must!

How do I know if my child is ready? A few things absolutely need to be in place before you even try, and this way odds are you'll be successful…

  • Your child doesn't like the contents of his/her diaper – gestures like pointing at the diaper, asking/gesturing that it be taken off if wet or soiled indicate dislike. If your child is happy sitting in his warm wet one for prolonged periods, it's too early.
  • Your child can pull his/her pants down. Think about it – to be an independent "pottier", you should get the urge, take yourself to the bathroom, drop your drawers, and go. So this step is key from a motor readiness standpoint.
  • Language – having the ability to gesture and tell that he/she must go helps us get our tots to the pot on time.
  • SOFT stools are a regular
  • Neurologic readiness – ultimately, your child and his/her bladder need to be able to work with each other. How to know?
  • Your child awakes from naps dry
  • You witness several hours of bone dry diapers, then a flood of urine
  • Your child wakes up dry in the morning, then floods his/her diaper

Assuming ALL 5 elements above are in place (no matter what your child's age), what's the plan? This is the fun part!

  • Carve out a week to dedicate to helping your child learn to potty, and announce this to your child. Let your tot know that great things happen in the bathroom. Here's a suggested reward system:
  • Purchase stickers of your tot's favorite character/cartoon/obsession, and go to the store and purchase a few dozen small toys and characters, and then a few extra special goodies for the bribes (ok, let's call them incentives!). Developmentally, kids this age love rewards
  • Go to your local office supply store and grab a big posterboard and place it directly in front of the toilet where you plan to help your child potty
  • Just entering the bathroom gets them a sticker, sitting on the pot gets them 2, actually peeing gets them 3 stickers or a small prize, and pooping gets them a big prize.
  • Developmentally, the growth of this sticker board is a constant reminder of the rewards associated with the bathroom, as well as a reminder of success. Training with candy treats is "in one ear and out the other"….there is no concrete reward (and the candy idea is just wrong as a reward)>
  • Purchase a dozen pairs of underwear (not training pants or pullups) – this way if your child starts to go, your tot will FEEL the wetness (rather than it being absorbed by a pullup). They should be a little big/loose so that they are EASY to remove.
  • Make sure your training bathroom is well lit, warm, and that you have a step stool for climbing onto the toilet, but also a platform for putting little feet so your tot can have the physiologic support needed to "push" if pooping.
  • Place a potty seat over the regular toilet so your child doesn't feel as if he is "falling in"….and this seat gives his bum needed support to push when needed.
  • Have a kitchen timer, a stack of your child's favorite books, and a positive attitude. Now, let's go!

OK, what now? It's game day, and you are home with your child for a week to potty train.

  • We want to maximize success and getting there in time, so you little one can just wear underwear, a shirt and comfy shoes
  • Day 1: 2-3 hours of training time
  • Dress your child in the "game day uniform", inform him that if he needs to go before the timer rings, he should tell you, otherwise
  • Set your timer for every 30 minutes
  • Give your child frequent sips of water and fluids so that his bladder has something to work with!
  • Take your child to the potty when the timer dings
  • Reward him for entering the bathroom by having him proudly put up a sticker. Have him sit, and read a book with him for 5-10 minutes to relax him and give his bladder a chance to relax and empty. If no pee, put up another sticker for sitting and cooperating, praise him, pants up, out of the potty you go.
  • Repeat, every 30 minutes, and of course if he pees in the potty, it's a party (you can even throw in some party music if wanted) and extra rewards come.
  • If he urinates in his underwear, react in an "oh well, oops, let's try again mode"…clean him up, change his gear, and move on
  • After the 2 hour mark, ask if he wants to continue, and then go for another hour; then back to diapers.
  • Day 2: 3-5 hours
  • Day 3: 4-6 hours
  • Day 4: 6-8 hours
  • Day 5: all day, and diaper at night

If you get through the first week, just remember that once back in the "real world" of errands, driving in the car, seeing friends, going out, that your rhythm at home can't be duplicated once outside. So a few key points:

  • Try to have your tot potty before leaving home, and anytime a bathroom is nearby. Don't be surprised if there is a bit of reluctance in public restrooms or in the homes of others. The toilets are unfamiliar, the acoustics of flushing are loud, and the rooms may be a little cold. So be prepared for pushback, and offer a diaper if needed.
  • Don't let up on your child's diet, maximize drinking fluids while at home, but cut back a little when on the road to reduce the chances of accidents.
  • Pack extra clothes and underwear (and bring a few diapers) as likely there will be slips for a few weeks and NEVER punish your child for an accident. Praise his success, and be as blasé as possible about the accidents

Water Safety for All Ages:
JJ Levenstein, MD, FAAP

Drowning is the leading cause of unintentional death among children 1-4 years of age, and it is the second leading cause of death for children from 5-14 years old. Just last summer, 203 children died from drowning between Memorial Day and Labor day – and of those 143 of the victims were children younger than 5.

For every child that dies there are another 5 who receive emergency department care for nonfatal submersion injuries – half of those kids are admitted for further care – and some end up with severe brain damage leading to long-term disabilities.

Not surprisingly, the warm states (Texas, Florida, California) lead the pack in seasonal drownings, as there are generally more pools/capita and more people in those states. But all states are affected!

70% of African American children can't swim and are 3 times more likely to drown than Caucasian children. 60% of Hispanic, and 40% of white children cannot swim.

The main factors that affect drowning risk are lack of swimming ability, lack of barriers to prevent unsupervised water access, lack of close supervision while swimming, location, failure to wear life jackets, alcohol use and seizure disorders.

Young children and toddlers are especially vulnerable to drowning. With that in mind, the Consumer Product Safety Commission, the CDC, and other advocacy organizations emphasize the following safety steps:

  • Fence all pools, on ALL sides -fences should be at least 4 feet high, and be self latching/locking
  • A 4-sided isolation fence (separating the pool area from the house and yard) reduces a child's risk of drowning 83% compared to 3-sided property-line fencing.
  • MOST CHILDREN AGES 1-4 DROWN IN A HOME SWIMMING POOL
  • As children get older, more drownings occur in natural water settings.
  • 88% of those drowning in boating deaths weren't wearing life vests!
  • Stay close to children in the water
  • NEVER LEAVE A CHILD UNATTENDED IN A POOL OR SPA
  • When infants or toddlers are by a pool, stay within an ARMS' reach
  • ALWAYS WATCH YOUR CHILDREN CLOSELY AROUND ALL BODIES OF WATER, that includes ponds, play pools and streams. Little children and babies can drown in as little as one inch of water
  • Be alert, and not distracted
  • Be alert, and not distracted
  • Avoid alcohol or other substances while supervising children
  • Don't engage in other activities (phone, internet, reading, outdoor chores, or activities far from the water). Give children 100% of your attention
  • If you have to leave the pool, even for a moment, take your child(ren) with you
  • DESIGNATE A WATER WATCHER TO SUPERVISE CHILDREN IN THE POOL OR SPA – alternate taking turns every 15 minutes with other adults at the pool or event.
  • Teach children how to SWIM make sure that ADULTS SUPERVISING CHILDREN IN THE WATER ALSO KNOW HOW TO SWIM
  • New data suggests that early swim training may actually lower drowning rates in children under the age of 4. Since there is no evidence that such training can do harm, the American Academy of Pediatrics has revised its position.
  • For years, the AAP had recommended against swimming lessons for children between the ages of 1 and 3 years old. Its position was that children so young were not developmentally ready, and that lessons could give parents a false sense of security and take away a child's natural fear of the water.
  • LEARN how to perform CPR on children and adults. This should be on the TOP of your list when you either have children or build a pool!
  • Make sure your pool and spa drain covers comply with federal safety standards to avoid entrapment.
  • Educate your children not to play around, or sit on pool or spa drains
  • Unless bodies of water are gated or locked, remove water from tubs, portable baby pools and buckets after use.
  • If you have a pool, install a door alarm, a window alarm or both to alerg you if a child wanders into the pool area unsupervised
  • Many drownings occur in neighbor's pools, as little ones toddle in through open gates and have access to unprotected water
  • A child who knows how to swim may not necessarily be WATER SAFE! Why?
  • Every child has a different amount of stamina for floating/treading water, and may panic if feeling vulnerable in the water, or fatigue and not be able to maintain flotation
  • Kids need to know to swim in areas designated for swimming only - open water and river currents, ocean undertow and changing weather can drastically increase risk
  • Most importantly - Teach children to swim with a BUDDY from the get go. From the start, teach children to NEVER go near or in the water without an adult present.,/
  • Don't rely on swimming aids (noodles, water wings) – they are toys, not flotation devices. Use approved life vests until your child learns to swim CONFIDENTLY
  • IF YOUR CHILD IS AROUND A NATURAL BODY OF WATER, MAKE HIM WEAR A LIFE VEST, EVEN IF HE KNOWS HOW TO SWIM. THEY SHOULD BE USED FOR WEAKER SWIMMERS AROUND POOLS
  • Children need to know that pools and spas are OFF LIMITS until an adult gives the go-ahead!

Back To Sleep – The Safe Way:
JJ Levenstein, MD, FAAP

There are two important interventions that you, as a new parent, can employ, to help reduce that chances that sleep is a hazard for your baby. The first is knowing how to provide the safest sleep space, and the second is creating a safe sleep environment in order to prevent Sudden Infant Death Syndrome (SIDS).

Startling, but true, a study published by Pediatrics in March 2011 revealed that 26 children/day under the age of 2 years are injured in their cribs, playpens and bassinets – that adds up to 10,000 injuries/year. Because these injuries raised many red flags, the Consumer Products Safety Commission published new safety standards for cribs in December 2010. Here are the most important recommendations brought forth:

  • Eliminating drop sided cribs
  • Improving the structural integrity of crib slats and mattress bases
  • Elimination of wood screws from key structural elements
  • Improved labeling and instructions

A safe sleep environment should include the following:

  • Adequate ventilation for baby (to help prevent SIDS)
  • Visual access for parents to see into the crib
  • Crib slats that minimize entrapment of body parts
  • Side walls tall enough to prevent climbing out
  • Reduced toe holds
  • Elimination of drop sides
  • Less falls
  • Less limbs trapped when loose
  • A crib mattress made for that crib
  • Must be firm
  • Tight fit to reduce entrapment – less than 2 fingers between mattress and sides
  • NO CRIB BUMPERS OR SLEEP POSITIONERS
  • Deaths and near deaths have occurred due to suffocation risk
  • Injuries and fractures have occurred with limbs caught between bumpers and side slats
  • NEVER use a feather mattress or lofty mattress pad
  • NEVER put pillows, toys, blankets or quilts in a baby's crib

What should be in a crib? BARE IS BEST

  • A fitted sheet
  • Baby
  • Sleep Sack (cooler weather), light PJs for warmer weather
  • Swaddle only until 2 months, if needed

If a co-sleeper is used, what should be in that?

  • A fitted sheet
  • Baby
  • Sleep Sack (cooler weather), light PJs for warmer weather
  • Swaddle only until 2 months, if needed

What are other tips for creating a safe-as-possible sleeping environment?

  • Purchase a crib manufactured after June 2011 if possible
  • Assemble the crib precisely – using all parts, and following manufacturer's directions
  • Purchase a mattress made specifically for the crib
  • Use ONLY a fitted sheet on the mattress
  • Never place a crib near a window, or near drapery or shade cords
  • All electrical cords should be at least 3 feet away from the crib
  • Avoid cribs with finials or knobs – baby's clothing can get caught and lead to potential strangulation

WHAT is SIDS?

SIDS is the sudden unexpected death of an infant, under 12 months of age, with onset of the fatal episodes apparently occurring during sleep, that remains unexplained after a thorough investigation, including complete autopsy and review of the circumstances of death and clinical history.

WHAT IS IMPORTANT TO KNOW:

  • Peak incidence at 2.5-4 months
  • More cases in fall and winter,
  • African American babies at greater risk
  • It is the most common cause of sudden infant death between the ages of 1 month – 1 year
  • Cannot be predicted in infants prior to death

WHY DOES IT HAPPEN?

  • Baby suffers from asphyxia/lack of oxygen, if face down or entrapped
  • Brain receives less blood flow
  • Baby fails to arouse and lift head to turn and improve breathing
  • Baby's cardiovascular regulation is very immature in the first 3-6 month, so physiologic responses are immature and don't function optimally
  • Autopsy studies have shown decreased serotonin and serotonin binding activity in the brainstems of babies dying from SIDS vs. other conditions

WHAT ARE THE RISK FACTORS:

  • Side or prone sleeping position
  • Since "back to sleep" has become standard in the US – SIDS rates have fallen from 1/600 babies to 1/2400
  • In prone sleeping position babies actually have a GREATER risk of aspirating stomach contents than when on their backs
  • Babies placed PRONE after being routine back sleepers are 20x greater risk for SIDS (note to grandparents/caregivers who think they know more)

AAP NOW RECOMMENDS:

  • Room-sharing without bed-sharing is recommended
  • ALL babies should sleep in the parents' room, near the parent's bed, in a crib. This is the safest, and is safer than bed-sharing.
  • Room Sharing REDUCES SIDS RISK BY 50% and is most likely to prevent suffocation, strangulation, and entrapment that might occur when infant is sleeping in an adult bed
  • Breastfeeding is recommended
  • The protective effect of breastfeeding increases with exclusivity. However ANY breastfeeding has been shown to be more protective against SIDS than no breastfeeding
  • Infants brought to bed for breastfeeding should return to a separate crib
  • Breastfeeding rates are NO DIFFERENT between those who room-share or bed-share
  • Do not bed-share if parents smoke cigarettes or if the parents' arousal is depressed (alcohol, drugs, sleep deprived (4 hours sleep the night before)
  • Avoid smoke exposure during pregnancy and after birth. Both maternal smoking during pregnancy and smoke in the infant's environment after birth are MAJOR risk factors for SIDS
  • Smoking increases SIDS risk x 21
  • Keep soft objects and loose bedding out of the crib to reduce the risk of SIDS, suffocation, entrapment, and strangulation
  • Offer a pacifier during sleep
  • Avoid overheating
  • Avoid alcohol, and drug exposure
  • Avoid commercial devices claiming to prevent SIDS
  • Infants should be fully immunized
  • Health care professionals, and nursery/NICU staffs should endorse the SIDS risk reduction recommendations from birth.

SO THE BEST WAY TO REDUCE CHANCES OF INJURY AND SIDS IS TO FOLLOW THIS BASIC GUIDELINE:

SUPINE (on the back)

ALONE (no bedsharing)

FIRM MATTRESS

EMPTY CRIB (except for baby, of course)

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