Trusted Pediatric Health Tips at Your Fingertips
Parenting Comes With Questions. We’ve Got Answers.
Dr. Epstein’s handouts offer easy-to-follow guidance on everything from current pediatric topics to common concerns like managing fever, feeding practices, and head colds. All this compassionate guidance is drawn from years of experience as a pediatric specialist, and as a parent. Our blog is here, too, with thoughtful takes on the questions that matter most. Explore at your pace, and feel free to call us if you’d like more details.
Visit by Visit Teaching
Visit Schedule
Nutrition
Behavior
Illnesses
Health Maintenance
Immunizations are Safe and Effective
Immunizations are Safe and Effective
Vaccines have protected children against serious childhood illnesses with remarkable effectiveness and safety for many decades. Unfortunately, many parents have been confused and worried by rumors claiming to warn about dangers inherent in routine childhood vaccinations. News reports in print and on television are frequently misleading or inaccurate. This handout describes the facts.
Visit by Visit Teaching
At each check-up, there I things I like my patients to know. You will receive a copy of the appropriate handouts at each visit. But if you like to be prepared, you’re welcome to anticipate the information by browsing the handouts below.
One Month
After-Hours Emergency Policy
We try our best to provide 24 hour a day availability for our patients who have emergencies. We feel that this is an important part of our practice. However, if you call us after hours, please keep in mind that you are calling our personal telephone number, not an answering service. We depend on the judgment of our patients as to what constitutes an emergency. We reserve the hours after the office closes for emergencies only
Car Seats
Most parents are now aware of the laws in each state mandating infant seats that are rear facing until the child is one year old and at least 20 pounds. Most parents are also aware that their children are safest if they continue to use a car seat during the toddler years; this is also required in many states. And since 2011, the AAP has recommended that children stay in rear-facing seats until they turn 2.
Obesity Prevention in Infants
We are all concerned about the worsening epidemic of obesity in children. Here are some simple suggestions that may help combat our society’s obesity-prone lifestyles.
Two Months
Dr. Epstein’s Book Suggestions
My wife and I began reading to Hannah when she was only a few weeks old, and she quickly learned to enjoy books. We discovered that choosing books was a matter of holding the adults’ interest as much as the child’s! Choose books that YOU like reading out loud.
Immunizations are Safe and Effective
Vaccines have protected children against serious childhood illnesses with remarkable effectiveness and safety for many decades. Unfortunately, many parents have been confused and worried by rumors claiming to warn about dangers inherent in routine childhood vaccinations. News reports in print and on television are frequently misleading or inaccurate. This handout describes the facts.
Four Months
Sleep Advice for Babies
A newborn infant’s sleep pattern is very irregular. Fortunately, infants will always get enough sleep over a day’s time, regardless of the pattern. So the goal is to maximize the parents’ sleep. It is better for children if their parents are well-rested!
Starting Solids
Parents of newborns will receive much advice about feeding from well-meaning people. Unfortunately, much of this advice is more complicated than necessary. In fact, starting solids is quite easy and fun! It should not be a source of stress or panic for parents.
Six Months
Spoiling
Small infants can learn “spoiled” behavior at just a few months of age. So it’s important to demonstrate predictable, consistent parenting from the start. With small infants, the dilemma usually presents itself when the infant cries to be picked up, or to be fed. Years ago, families solved the dilemma by feeding on a strict schedule, or by not picking babies up when they cried. This does prevent spoiling, but I think it’s better to teach a baby to trust that its needs will be met rapidly.
Nine Months
The Word “No”
After the age of 9 months or so, most infants can learn the meaning of the word, “no.” Here’s how it plays out:
The infant sees an object that attracts her, but that she should not have. She reaches for the object; but her parent says, “No!” Then the child draws away, looks right at the parent, grins, then reaches again for the object!
Twelve Months
Responsibility
At a certain age, a typical child will say: “Guess what, Mom, Dad? I’ve decided that you can’t tell me what to do anymore. I know what I want to do, and that’s what I’m going to do. See you later, bye!” Many parents will respond by saying: “No, sorry. I’m the parent, and you are the kid, and I’m going to tell you what to do, and I expect your cooperation.”
Fifteen Months
Responsibility
At a certain age, a typical child will say: “Guess what, Mom, Dad? I’ve decided that you can’t tell me what to do anymore. I know what I want to do, and that’s what I’m going to do. See you later, bye!” Many parents will respond by saying: “No, sorry. I’m the parent, and you are the kid, and I’m going to tell you what to do, and I expect your cooperation.”
Visit Schedule
Usual Visit Schedule
Open the handout to view the time table for your newborn – 21 years old with recommended vaccines.
Visit Schedule (For children started on Pentacel® Vaccine)
Open the handout to view the time table for your newborn started on Pentacel® Vaccine – 21 years old with recommended vaccines.
Nutrition
Here are my best answers to your questions about feeding and eating. Remember that the most important principle is to teach your children to trust their own appetites, rather than trying to win feeding battles.
Artificial Sweeteners for Kids?
Are diet sodas and snacks with artificial sweeteners safe for children? There is probably not much immediate harm; there is no definite proof of medical disease of any sort in children to be caused by artificial sweeteners, except for an occasional allergic reaction. But I don’t see a need for it.
Calcium and Milk
Children need calcium for proper bone growth, but many children do not receive sufficient calcium in their diet. The Institute of Medicine has recently increased its recommendations for calcium in children’s’ diets:
Calorie Count Spreadsheet
Please write down EVERY food or drink your child eats in three 24-hour days. You don’t need to track 3 days in a row, but all intake in each full 24 hour period must be charted.
Eating Habits
In many American families, parents and children struggle over meals. Often, the children do not want to eat what is on the table. The parents, fearing for the children’s health, will try to make the child’s eating an issue. If the battle escalates, meal time becomes no fun for anyone at the table.
Infant Feeding Peanuts
A new study suggests that giving infants peanuts might reduce their rate of peanut allergy.
Here’s a 2018 statement from the AAP:
Study: Feeding peanut to high-risk infants may reduce allergy rate
by Scott H. Sicherer, M.D., FAAP
Newborn Instructions Bottle
You may safely use any commercially available formula. (Generic or store-brand formulas are perfectly acceptable, and much less expensive.) Use a formula “with iron.” Start with 1-2 oz. and slowly increase as the baby wants. Trust your baby’s appetite! Do not impose a schedule, but you may feed as often as the baby desires. During the day, don’t let the baby nap for longer than 2 ½ hours between feeds; wake the baby for feeds if needed. But you can let the baby sleep at night, while you are asleep.
Newborn Instructions Nursing
I recommend that you feed whenever the baby is hungry. Teach your baby that you trust his appetite! Your baby should nurse at least 8 to 12 times in a 24 hour period. Some of these feedings may be clustered very close together, even 1-2 hours. During the day, don’t let the baby nap for longer than 2 ½ hours between feeds; wake the baby for feeds if needed. But you can let the baby sleep at night, while you are asleep. The baby does not need water. Cereal and solid food is not generally started until 4-6 months of age.
Nutrition, Lifestyle, and Weight Gain
The lifestyle habits that parents teach and role-model for their children have immediate benefits for improved behavior and health. And children are likely to continue good habits as adults (even after they’re beyond the parents’ direct influence), if they are accustomed to healthy habits from an early age.
Obesity Prevention in Infants
We are all concerned about the worsening epidemic of obesity in children. Here are some simple suggestions that may help combat our society’s obesity-prone lifestyles.
Pacifiers and Breastfeeding
Pacifiers might be OK while breastfeeding. Breastfeeding mothers have been told for many years that pacifiers should be avoided, because of a fear that they might interfere with breastfeeding. Now, a review article in the AMA’s pediatrics journal (April 2009) reassures us that pacifiers may be okay for breastfed babies, after all.
Behavior
Behavior for infants
Here you can find advice to help guide your infant’s behavior patterns. Your baby’s behavior will seem “normal” now. But it will help guide the child’s growth and development later if you can use discipline techniques now that teach effective decision-making skills.
Sleep Advice for Babies
A newborn infant’s sleep pattern is very irregular. Fortunately, infants will always get enough sleep over a day’s time, regardless of the pattern. So the goal is to maximize the parents’ sleep. It is better for children if their parents are well-rested!
Spoiling
Small infants can learn “spoiled” behavior at just a few months of age. So it’s important to demonstrate predictable, consistent parenting from the start. With small infants, the dilemma usually presents itself when the infant cries to be picked up, or to be fed. Years ago, families solved the dilemma by feeding on a strict schedule, or by not picking babies up when they cried. This does prevent spoiling, but I think it’s better to teach a baby to trust that its needs will be met rapidly.
The Word “No”
After the age of 9 months or so, most infants can learn the meaning of the word, “no.” Here’s how it plays out:
The infant sees an object that attracts her, but that she should not have. She reaches for the object; but her parent says, “No!” Then the child draws away, looks right at the parent, grins, then reaches again for the object!
Behavior for children
Look here for advice about guiding older children’s behavior. Even if your child’s activity and behavior seem “normal”, it will help guide the child’s growth and development later if you can use discipline techniques now that teach effective decision-making skills.
Bed Wetting
Most children are potty trained during the daytime well before the age that they become dry at night. Children older than 4 years old who still wear pull-ups in the daytime are uncommon. But children who require pull-ups at night until age 6, or even older, are not unusual.
Responsibility
At a certain age, a typical child will say: “Guess what, Mom, Dad? I’ve decided that you can’t tell me what to do anymore. I know what I want to do, and that’s what I’m going to do. See you later, bye!” Many parents will respond by saying: “No, sorry. I’m the parent, and you are the kid, and I’m going to tell you what to do, and I expect your cooperation.”
Television and Screen Time
American children watch, on average, over 25 hours of TV per week from preschool through high school. This may not be good for them. Childhood obesity rates are doubled for kids who watch over two hours per day; reading scores start to drop as kids watch over 3 hours per day.
TV Allowance
These tickets may be used as an allowance. Perhaps 15 tickets may be given to your child every Sunday night, or 2 tickets each morning. The tickets may be stored in a jar, in the child’s room.
TV and movies do influence behavior
Do you believe that the magazines, movies and TV shows your kids watch don’t influence your kids’ behavior? Think again! Children and teens copy the behaviors they see in the movies and on TV, according to research.
ADHD
ADHD (Attention Deficit Hyperactivity Disorder)
ADHD is a common problem in children. Estimates are that 5% to 8% of all school children have some degree of ADHD. Also, 30% to 50% of children with ADHD have learning disabilities in addition to their attention problems. For many (but not all) children with ADHD, there are clear familial tendencies towards distractibility and attention problems.
ADHD Vanderbilt Scale – Parent
Please rate your child’s performance, at home and during play, on the following symptom list. I would also be grateful for any WRITTEN comments you would like to make.
ADHD Vanderbilt Scale – Teacher
Please rate the above student’s performance in your class on the following symptom list. The form should take about 10 or 15 minutes to complete. I would also be grateful for any WRITTEN comments you might like to make.
ADHD: Letter to Teacher
The parents of your student, , have asked me to evaluate him/her for the possibility of an attention problem. It will be quite helpful for me to know your observations about school performance. I will find your written professional opinion to be more helpful than preprinted rating scales.
Illnesses
Office policies
After-Hours Emergency Policy
We try our best to provide 24 hour a day availability for our patients who have emergencies. We feel that this is an important part of our practice. However, if you call us after hours, please keep in mind that you are calling our personal telephone number, not an answering service. We depend on the judgment of our patients as to what constitutes an emergency. We reserve the hours after the office closes for emergencies only
Medicines
Amoxicillin Rash
The most common reaction to amoxicillin is a red bumpy rash. We call it an “amoxicillin reaction” or an “Amoxil reaction” (named for the original “brand” of amoxicillin). Do you see little red raised bumps, like mosquito bites, all over the trunk or limbs? It may look very dramatic, but it probably doesn’t itch or bother the child. It usually starts about 5-7 days after the amoxicillin was begun; it fades after a few days with no treatment, even if the amoxicillin is continued.
Antibiotics and Drug Resistance
Bacterial infections are treated with antibiotics. If your child contracts an ear infection, strep throat, sinusitis, or a chest infection, amoxicillin or another antibiotic should clear it up.
Illness at any age
Asthma Action Plan
This document outlines an Asthma Action Plan for a student, detailing medication protocols and emergency procedures.
Asthma Handout
This handout will help you understand your child’s asthma. Asthma is a long-term condition, but usually it is completely controllable. It will be helpful to know: what asthma is, how to treat attacks, what to expect over time, and some preventative measures.
Eczema
Children often develop dry patches on their skin. Usually this is not due to food allergies, but is due simply to the skin drying out. In susceptible children, the dry skin becomes inflamed, thickened, and itchy. The child may worsen the rash by scratching. Dry indoor air, cold outdoor wind, and hot baths may also worsen eczema in winter.
Fever
Your child will have a fever several times during childhood. Usually, fever is due to a virus or other self-limited illness. However, it is not always easy to tell whether a child’s fever is due to a more serious illness. The best clue is the child’s level of activity; a child who seems playful, even if a little less so than usual, is less likely to have something serious, even if the thermometer records a high fever. If you are concerned, please do not hesitate to call.
Gastroenteritis
Vomiting with diarrhea (gastroenteritis) is a common illness. Most cases of vomiting are caused by one of several viruses infecting the intestinal tract. Typically, a child with gastroenteritis will vomit for several hours, sometimes up to a day before stopping; and then diarrhea will ensue, often lasting several days.
Lacerations and Stitches
Caring for your wound after staples or stitches removal is important to prevent inflammation, minimize the risk of infection, and promote healing.
Nosebleeds
Nosebleeds are not usually dangerous, but they are messy and alarming. In order to stop the bleeding, a clot must form. The quickest way is to have the child sit calmly, with the head tilted slightly forward (as if looking at the floor at the far end of the room). Pinch both nostrils closed, and hold them closed for 10 minutes or longer, while the child breathes through his mouth.
Seizure
If you think your child is having a convulsion, here are steps on what to do next.
Tick Bites and Lyme Disease
Ticks and Lyme Disease can be scary, but Lyme Disease is preventable and curable. Here’s how we approach ticks, and Lyme Disease.
Upper Respiratory Infections (URI)
Head colds make us miserable, but they do go away on their own. For comfort, you may use a vaporizer or humidifier in the child’s room. There are several varieties; all work well. You do not need to put anything in the water (unless the steam vaporizer instructions require salts to make it work). Steam vaporizers may work a little better than a cold-mist humidifier, but you must watch that your small child does not get scalded by getting too close to the steam.
Illnesses in Infants
Colic
Lots of experts give advice about how to care for fussy babies. There are special medicines (such as Mylicon), special formulas, and home remedies galore. (Could someone please tell me what “gripe water” actually contains?) But most babies who cry a lot don’t have “colic.” I haven’t made this diagnosis more than 2 or 3 times in my 30+ year career. There is usually some other explanation for a baby’s fussiness.
Constipation in Infants
Small infants can become constipated. If your baby’s stools are dry hard pellets, or if they’re large, firm and painful, then he might be constipated. Surprisingly, the frequency of the infant’s bowel movements are not very important, as long as they are soft. Some infants make a bowel movement only once every few days; if the baby is otherwise healthy, then this is probably normal.
Diaper Rash
A baby can develop a rash under the diaper for a number of reasons. Diaper rash is usually a straightforward problem that can be cleared up easily, if the correct cause is found. Round irritated erosions might be caused by skin bacteria. Antibiotic ointment (triple antibiotic, bacitracin, or Neosporin® non-prescription) applied 3 times a day usually clears this up quickly; you can safely try this as a home remedy.
Gastro-Esophageal Reflux
Many babies spit up occasionally with feeds. If weight gain is good, the baby eats eagerly and seems satisfied after feeding, and the baby is cheerful and sleeping well, then I am not usually concerned.
Jaundice
All babies become jaundiced in the first few days after birth. Usually, the infant remains healthy, or at worst becomes a bit sleepy for a couple of days. But occasionally the jaundice can become a concern.
Umbilical Cord Care
How should you take care of your newborn’s umbilical cord? Conflicting instructions confuse new parents. But proper care is not difficult. The most important technique is to expose the base of the cord. If the base is not exposed to air, then bacteria can thrive in the wet, low oxygen environment; this may lead to infection.
Illnesses in Older Children
Acne
Acne is so common that sometimes we tend to ignore it. But it’s worth treating, early and completely. It can lead to social problems and even low self esteem. Untreated acne can cause permanent facial scars, which may lead to social problems as an adult. But acne treatment is very easy in most cases.
Concussion
We know that a head injury may result in a concussion. Typical symptoms of a mild concussion may include headache, vomiting, sensitivity to light and noise, mental confusion, crankiness or irritability, loss of attention, and loss of short-term memory.
Constipation in Older Children
Sometimes children develop a pattern of stool withholding, which results in chronic constipation. If a child develops a pattern of avoiding stooling, either because of painful bowel movements or because of control battles with parents, the stool can become dry, hard, and packed in the colon. Even if the child then begins to stool daily, the “pipe line” may remain full. Crampy abdominal pain can be the result. This is generally a behavioral problem, rather than a medical or dietary problem.
Environmental Allergen Control
Allergy season is here! Many households have one or more members with allergy problems. There are many easy things you can do to keep your house free of allergens, and reduce the need for medications
Head Lice
The idea of head lice makes us recoil. Of course, they don’t carry disease or cause symptoms beyond a little itching. But I don’t want them – and neither does anyone else! The social detriment of head lice is the most important reason to treat them.
Health Maintenance
Here are some tips about safety and illness prevention.
Autism Programs
Comprehensive evaluation, treatment and coordination for children with Autism Spectrum Disorder. Behavioral counseling services, and ABA (Applied Behavior Analysis)
Autism Screening
We now realize that 1 in 150 children has an autism spectrum disorder. So finding and starting treatment for these children is worth our attention.
Car Seats
Most parents are now aware of the laws in each state mandating infant seats that are rear facing until the child is one year old and at least 20 pounds. Most parents are also aware that their children are safest if they continue to use a car seat during the toddler years; this is also required in many states. And since 2011, the AAP has recommended that children stay in rear-facing seats until they turn 2.
Care of New Ear Piercings
Clean the earlobes or cartilage, front and back, three times a day with Hydrogen Peroxide. Gently rock the studs back and forth as you clean. Do not remove the studs for 4-6 weeks! After cleaning, you may apply a small amount of antibiotic ointment, such as Neosporin, front and back, to reduce the chance of infection.
Cavity Prevention
Tooth decay is the most common chronic disease in children: it’s 5 times more common than asthma. Brushing is important, of course. But there are many other things you can do to keep your kids cavity-free. The big news is that the AAP now recommends that children see a dentist regularly, starting around the 1st birthday.
Color Blindness
Are you worried that your child might be color blind? Kids usually begin to identify colors by age 3 or 4. A 4 year old child who can identify some but not all colors might be normal, but it’s worth knowing if he has a physical impairment in recognizing colors. He’ll be frustrated if the adults try to teach him something that he might be physically incapable of learning!
Ear Wax
Ear wax (cerumen) generally does not pose a medical problem, even if the amount seems excessive. Excessive ear wax does not cause middle ear infections, and is only rarely involved in swimmer’s ear. It is unusual for excessive ear wax to cause hearing problems in children (although this is a more common problem in adults). So there’s usually not much medical reason for parents to clean their children’s ears, though the wax may be unattractive.
Flu Vaccine
Get your flu shot as soon as it’s available. There’s no value to waiting later in the season. It takes 6-8 weeks for the immunity from a flu vaccine to develop; and we can’t predict when the first wave of influenza will arrive – sometimes it’s as early as October.
Fluoride Supplementation
Tooth decay is caused by mouth bacteria growing on tooth surfaces. The best defenses against cavities are to brush and floss twice a day, starting when the first baby tooth erupts; to visit the dentist twice a year, starting after the 3rd birthday; and to take the recommended amounts of fluoride supplementation.
PPD: Mantoux Tuberculin Skin Test
The tuberculin skin test (PPD) can show if a person has been exposed to tuberculosis (TB) germs. These germs can cause you to feel sick with TB disease, or remain in your body and not make you feel sick. When the germ doesn’t cause you to feel sick, it’s called latent tuberculosis infection; you feel fine and you cannot spread the germ to others; but there is a risk that you will become more sick with TB over time. The PPD is a skin test, not an immunization.
Referrals to Specialists
We can help you choose an appropriate specialist. Here are some people with whom I have worked closely in the past. These lists are certainly not exclusive; if you find a doctor that is not on this list whom you are considering consulting, we encourage you to call to ask our experience with him/her. There are many other excellent specialists available in our area.
If your insurance plan requires a referral to see a specialist, we can call the insurance company for you. First, make the appointment with the specialist’s office. Then, call us to ask for the referral.
For insurance referrals, please provide us with the name of the specialist, the date of your appointment, and the medical condition that needs evaluation. Completing the referral is a time-consuming process, so please give us several days to complete it.
Autism Programs
Comprehensive evaluation, treatment and coordination for children with Autism Spectrum Disorder. Behavioral counseling services, and ABA (Applied Behavior Analysis)
Car Seats
Most parents are now aware of the laws in each state mandating infant seats that are rear facing until the child is one year old and at least 20 pounds. Most parents are also aware that their children are safest if they continue to use a car seat during the toddler years; this is also required in many states. And since 2011, the AAP has recommended that children stay in rear-facing seats until they turn 2.