Polar Vortex, Toddler Sleep, Baby on the Way – PediaCast 422

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  • It’s winter in Ohio and the Polar Vortex is here! This week we cover cold-weather safety, including tips for preventing, recognizing and treating frostbite and hypothermia. We also answer a pair of listener questions on toddler sleep problems and preparing young siblings for the arrival of a new baby. We hope you can join us!

Topics

  • Polar Vortex
  • Frostbite
  • Hypothermia
  • Toddler Sleep Problems
  • Preparing Sibling for New Baby

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Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick:  Hello, everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It is Episode 422 for January 30th, 2019. We're calling this one "Polar Vortex, Toddler Sleep, and Baby on the Way."

I want to welcome everyone to the program. We have lots to cover today including answers to a couple of your questions which relate to toddler's sleeping problems. And in particular, what can parents do when their toddlers want to sleep with them in mom and dad's bed but this results in a poor night sleep for the parent?

0:01:16

And toddler tantrums occur when mom or dad tries to put the little one back in bed. How can you make peace at night and encourage everyone to get a good night sleep? I have some ideas for you, so we will cover that. 

And then we have another listener question related to bringing home a new baby, so brand newborn baby from the hospital, when you already have a toddler at home. How can you prepare your toddler for the big event which is sure to rock his or her world? Because when a new baby comes home, your toddler's behavior is likely to change in a number of ways, some for the good, some for the bad.

So what changes can you anticipate and what is a parent to do when toddler drama occurs? Or more importantly, how can you minimize the drama through some prevention efforts?

0:02:09

By the way, both of these scenarios, toddler sleeping problems and welcoming a new baby into the home, they're common concerns as families grow. And we'll talk through these issues which I think will answer questions for many more people than those who asks the actual questions. So stay tuned for all of that.

Before we get to our listener questions though, it is winter here in Ohio and actually in the entire United States, which normally means cold weather, but it is particularly cold right now. And in fact, as I sit here in Columbus, we are under a windchill warning. Current temperature is -2 with a windchill of -34. And that is cold schools close today. Even the Ohio State University cancelled classes and activities. And this isn't even the worst of it. It's much worst Chicago and up above that, in Minneapolis. 

0:03:10

So really, really frigid weather. And it's funny because when I planned this show last week and the topics we were going to cover, my intent was still to cover frostbite and hypothermia. I had no idea it would be this cold. So as it turns out, it all worked out in terms of our editorial calendar and scheduling things because we hit it right at the right time.

So as I mentioned with this frigid temperature, we do become concern about things like frostbite and hypothermia especially if kids want to spend time outdoors sledding, and skiing, and snowboarding, making snowman, engaging in snowball fights. Although that's just with normal winter weather, we want to avoid frostbite and hypothermia while you're doing those things. 

When it gets to be this cold with windchill in -30s or lower, really, you don't want to be outside doing any of those things because any exposed skin can have frostbite happen very quickly.

0:04:12

So sort of the prevention efforts that I'm going to talk about bit later in the program is really geared toward when it's 15 outside and a windchill of, okay, maybe 12, just a tiny breeze. So when it gets to be the polar vortex kind of cold, just stay indoors. That's the best advice. But we'll talk you through frostbite and hypothermia.

We covered those things last year. This is one of those topics important enough to review each and every year, kind of like lawnmower injuries and water safety in the summer. Sorry, folks, you're going to hear about seasonal conditions that are preventable year after year because we forget the rules in the off-season and some kids suffer because of our parental forgetfulness. 

So we'll cover cold weather rules once again, again, with normal cold weather, not this extreme stuff. And remind you how to keep your kids safe while they are exploring the great outdoors in the northern climates.

0:05:09

If you live in the south and you experienced mild winters. Although for what I hear, Florida has been in the 40s the last few days, okay? They're having a heatwave today. It's expected to be in the 50s. 

Or maybe in the southern hemisphere. We have lots of listeners in Australia, New Zealand. It's summer for you right now. So, please bear with us as we provide important safety messaging or go ahead and fast forward to our answers to listener question segment. That would be fine as well.

Speaking of listener questions, sometimes listeners just write in to say hi or to make an observation. They don't really have a question, rather something is on their mind. And I love when you do that. 

So I want to take a moment and read a note that came in from one of your fellow listeners. This is from Alexis in Upland, California and San Antonio, Texas. Apparently, she commutes back and forth between these two cities. I'm guessing between home and school.

0:06:04

Alexis says, "Hello. I subscribed to you podcast, both PediaCast and PediaCast CME, over the last year and have really enjoyed the content. As a third year medical student interested in pediatrics, I wanted to say thank you for your podcast New Year's Resolution to go back to the basics of pediatrics, especially since the podcast app feed doesn't have the earlier episodes where these topics were likely covered. I'm excited to learn and hopefully do well in my pediatric clerkship rotation. I'm open to other helpful resources you may like to share as well. Thanks again, Alexis."

Well, thanks for writing in, Alexis. So, folks, this is a future pediatrician who tunes in to PediaCast and our Continuing Medical Education podcast, PediaCast CME, which is also available wherever podcasts are found. And she is using our content to supplement her formal medical training, which is great. In fact, many of the pediatric residents here at Nationwide Children's Hospital listen to PediaCast episodes to partially fulfill their required hours of self-directed medical education.

0:07:11

And I'm talking about this podcast for parents. So even though we don't offer formal Category 1 CME Credit for these episodes like we do for the PediaCast CME episodes, our residency program acknowledges that the evidence-based educational nature of this program. And they recognize that and they allow pediatric residents to use those for official education credit within the pediatric residency training program.

So why am I making a big deal about this? There are couple of really good reasons. First, there are pediatric residents from children's hospital across the country who tune in to PediaCast episodes. I know this because I've talked to many of you and I want to get the word out that your training program is likely to allow you to count your time listening to PediaCast against your required educational hours, even though this particular program does not offer formal accredited Category 1 CME.

0:08:10

So still, we cover lots of pediatric topics. We do not dumb down the science and yet we attempt to present the material in a way that parents can understand, which is a very useful skill for the practicing pediatrician.

So if you are a pediatric resident and you listen to these episodes of PediaCast and you're not at Nationwide Children's Hospital, because we already know this count for you, ask your program director if you can count the time listening against your required educational hours. And let them know that the residents at Nationwide Children's are allowed to do this. 

Also, let your fellow residents know about this opportunity. We produce 29 of these episodes with an average link of about an hour each in 2018. So that's a significant number of hours of free pediatric education. And if your program director has any questions about PediaCast and the credit that we offer our pediatric residents here at Nationwide Children's, please have them reach out to me to the Contact page of pediacast.org.

0:09:11

The second reason I bring this up, moms and dads in the audience, this should give you some confidence that you are hearing trustworthy information on PediaCast as we answer your questions, cover pediatric news, and interview pediatric and parenting experts. PediaCast is where it's at if you're interested in evidence-based best parenting and pediatric practices.

And that's a nugget you can share with your friends, family, neighbors, co-workers, anyone with kids or anyone who takes care of kids including daycare workers, babysitters, teachers, coaches, and your child's medical provider. And let them know the show is free. It is produced with moms and dads in mind and yet it rises to the level of recognized pediatric education for medical students and residents. I think that's an important distinction.

Now, Alexis asked about other pediatric educational resources and I wanted to share some of my favorites with her and with all of you.

0:10:05

I always recommend healthychildren.org from the American Academy of Pediatrics. They have terrific stuff there. And just a huge encyclopedia of pediatric knowledge in written format.

Now, in terms of podcasts, PedsCases is another podcast that's been around for a while. That one is produced in Toronto and they're created specifically for medical students in Canada and in fact used as part of the pediatric curriculum of several Canadian medical schools. Dr. Peter Gill is one of the leads on that project.

The Baby Doctor Mamas which I've mentioned on this program before, they are terrific. They're a couple of neonatologists who also have young babies at home, Dr. Diana and Dr. Joanna. They're based out of The Children's Hospital of Philadelphia. And they produce a podcast for parents with young babies at home. 

Las Doctoras Recomiendan, a Spanish-speaking podcast for parents. That one is highly recommended especially if you speak Spanish. 

0:11:05

Primary Care Perspectives is another podcast out of what we call CHOP, The Children's Hospital of Philadelphia. This one hosted by Dr. Katie Lockwood with the target audience of primary care pediatricians. That's another great one. 

The Pediatric Hospital Medicine podcast hosted by Dr. Tony Tarchichi in Pittsburgh is another fabulous resource, as is the Pediatric Emergency Medicine Playbook, which is a podcast hosted by Dr. Tim at UCLA.

I know all of these folks, by the way, not to be a namedropper or anything, but those of us producing pediatric podcasts were a tight-knit group and we've collaborated on a few projects together. So as great as PediaCast is, I highly recommend that one to the top of my list, but there are plenty of other terrific pediatric resources for moms and dads and pediatricians and pediatric residents, and medical students as we all learn together in an evidence-based fashion. 

By the way, I'll include links to all of those in the Show Notes for this Episode 422 over at pediacast.org.

0:12:05

Thanks, Alexis, for writing in and giving me the opportunity to promote pediatric education by way of podcast.

All right, let's move on with a couple of quick items of business. First, don't forget PediaCast is on social media. We're on Facebook, Twitter, and Instagram. And I just love when you connect with us in those places. We try to make it easy to share the show with your own online audience. 

And in addition to promoting the podcast and letting you know what we're talking about each week here from the PediaCast studio, we also try to include helpful information. We curate articles from around the country, blog post from other pediatricians, what's the mainstream media talking about as it relates to pediatrics and parenting and especially put those out on Facebook and Twitter. 

Instagram, a little more personal, what's going on in my family's life, what's happening, look inside the studio when we record, what's happening with family vacations. And just recently, we went to a Panic! at the Disco concert. That was a lot of fun with my son and my wife. And so we put pictures like that on Instagram and love to connect with you there. And if you follow me on Instagram, I'm likely to follow you back because I like to see what's happening in your family's life as well.

0:13:16

Don't forget you can also use the Contact page over at pediacast.org if you would like to suggest a topic for the program or you have a question you like to ask me. Or want direct us in the direction of a particular news article or even a journal article, please, let us know. And easy to do over at the pediacast.org Contact page.

Also I want to remind you the information presented in every episode of this program is for general, educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you have a concern about your child's health, be sure to call your doctor and arrange a face-to-face interview and hands-on physical examination.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at pediacast.org.

Let's take a quick break and then I will be back to talk more about the polar vortex, frostbite, hypothermia, toddler sleep and the baby on the way. That's all coming up right after this.

0:14:13

[Music]

Dr. Mike Patrick: All right, first up, we're going to talk about frostbite. And frostbite, as its simplest, is an injury that's caused by freezing of the skin and the underlying tissues. So they get too cold. And it's going to be most common occur on areas of skin that are kind of distant from your core. So your core body temperature is where you're the warmest. And so the farther you get out from your core, the less heat that's in your bloodstream, so to speak. 

0:15:15

And also, these are the same areas that are less likely to be well covered. So we're talking about things like fingers, and toes, your nose, your ears, your cheeks, your chin. So again, things that are kind of distant from the middle and tend to be exposed.

Now, freezing can still occur even if it's not exposed. So you can have skin that is covered by gloves, and clothes, and shoes and if it's cold enough, that skin starts to freeze, then you're going to still have a problem with frostbite. Now, how quickly this occur is really dependent on the temperature but also the wind because remember, wind is going to serve to kind of sweep away your heat.

0:16:02

When your in wind, heat comes up to the surface of the skin and goes into the air. And if that air then is blown away, now you got cold air again that your skin can heat and so you don't have a thermal layer. And when you're exposed to wind, that just takes the heat away and really quicken this whole process.

Now, in terms of concrete numbers, it ends up being that if you're out and it's 0 degrees Fahrenheit with a windspeed of 15 miles an hour, so that's a -19 windchill, then you can expect to start to have frostbite after about 30 minutes of exposure, about 30 minutes.

But as wind chills go lower, we would expect that to happen quicker. So right now, we are in the midst of this polar vortex here in Central Ohio and our windchill as I speak are currently -34 degrees Fahrenheit. So it's going to be quicker than 30 minutes of exposure. In fact, probably more on the range of 10 to 15 minutes of exposure that you could potentially start to have symptoms of frostbite.

0:17:11

Kids, by the way, are in increased risk of getting frostbite because of their behavior, for one. They need an advocate. They're less likely to be appropriately bundled. They make poor decisions in terms of staying outside too long, you know, "Things start to feel numb but they don't hurt, so I'm going to continue to play and have fun." And so they can get themselves into trouble just based on behavior.

But they're are also somewhat, especially the younger ones are really dependent on adult supervising them in terms of getting them bundled up appropriately and really watching them and getting them inside if there could become a problem.

Now in terms of symptoms of frostbite, we can really define three levels of frostbite. So the most mild form of this is going to be what we call frostnip.

0:18:02

So frostnip is it's just a nip, not quite a bite. It's the beginning stages of too much cold on the skin. And it is uncomfortable if you've been outside for a little bit and it's really cold. Your fingers are exposed. You don't have gloves on. Your finger starts to hurt and then that pain progresses to numbness. We see the skin looking kind of reddish as the blood vessels dilate. You're really trying to get blood to the region in order to warm it up but the problem is when you dilate those blood vessels, the skin turns red. There's more blood there.

But also your skin serves as a radiator and if it's windy, it's still taking that heat away, which ultimately can lead to hypothermia which we're going to talk about next. But your skin looks a little red. And then, when you rewarm it and we'll talk about the best practices for rewarming, that can lead to feeling painful again, like it did before it went numb. However, that pain and tingling last a little bit longer because despite you warming it up, it still persists for a little while afterward. We do see good recovery from frostnip.

0:19:18

Also, while it's really cold, you may be clumsy because your tactile sensation, your nerves or feeling and there can be a little bit of muscle impairment as the muscles underneath the skin get cold. And so you kind of fumble with things because you're just a little clumsy in moving especially your fingers. So that would be frostnip, which is the first stage of frostbite. 

The next stage would be what we would call superficial frostbite. It's really just the outer layers of skin that start to actually freeze. And in this case, the skin is not red anymore. It actually turns kind of white or pale color. Your skin may actually feel to you that like area is warm. So it goes from feeling numb to feeling warm. 

0:20:08

And that can be a sign of some serious damage beginning because the nerves are damaged and the warm sensors start to fire even though you're not warm. So if you get the sensation or the perception that your skin feels warm after it's gone numb, that's a sign of a more serious damage, along with the skin looking white or pale. 

Much more clumsiness. Because your sensation is impaired, there's more muscle impairment in terms of moving.

And then rewarming starts again to make it hurt. And in this case, it can feel like hot or burning, like you've got a burn, and then swelling. And then blisters can appear usually in about 12 to 36 hours. So the blisters are not immediate but fluid-filled blisters occur with that superficial frostbite and again about 12 to 36 hours out.

So it's kind of like a thermal burn, like you burnt yourself with something hot. Except in this case, you're sort of burning yourself, so to speak, with being too cold. And again, you get those blisters.

0:21:15

And then, deep or severe frostbite is when you basically are going to freeze all the way throughout the entire skin. And in this case, the skin now goes from being kind of pale and white to being more of a bluish gray color. Very disconcerting, like, "This is not what my skin is supposed to look like." 

You lose all sensation. So you go from that numbness to feeling warm, to not feeling anything at all. And then the muscles and joints may not only be weak, they may just not work as the muscles and joints are damaged.

And then, in this case, rewarming leads to large blisters, but they can take 24 to 48 hours to develop. And then the tissue dies, kind of like a third degree or full thickness burn, kind of that black hard look to it which will most likely need surgical intervention at that point. So the superficial frostbite's more like a second degree burn, and the deep frostbite would end up being a third degree burn.

0:22:15

So how do you diagnose this? Pretty easy, history and physical. You have a history of being exposed to cold temperatures. You go through those symptoms, "This is what the skin looks like." So that's pretty straightforward.

And then, treatment of all of these things, first and foremost is to rewarm the skin. But you want to do this so in a way that does not burn the skin, so you want a warm water bath. And you want someone around who does not have a frostbite injury, their skin is normal. Have them feel what that warm water bath feels like, just to make sure that it's not too hot.

And then you submerge the area. It's a little harder to do if it's an ear or a nose but you could still do a warm wash rag. And you'd want to do that for about 15 to 30 minutes. 

Of course, it's going to hurt, and so oral pain medication with Ibuprofen or acetaminophen or Tylenol is going to be a good idea. 

0:23:15 

And then, if it just the frostnip, so it's just with a little numb. And now it hurts a little, but after the warm water bath, things are pretty much back to normal, we're good. But if the skin had turn pale or white or blisters appear, you do want to seek medical attention for that. Don't wait for the blisters to appear. If it's pale or white or, of course, a gray color, then you would want to seek medical attention right away.

And then, we worry about a skin infection because if you do get the blistering and just like with the thermal burn from too hot, one of the things you really worry about then is outer layer of skin bacteria that normally live on all of our skin invading that damage skin and causing an infection.

0:24:01

So you might need an antibiotic if there's any evidence of skin infection associated with the resolving frostbite. So that would be something that would need to be medically managed. 

And then, you may need a surgical management for what we'd call debridement or the blisters. You may need to trim that skin off and do burn dressings, watch for infection. 

And then, especially with the deep frostbite, yeah, you may need things like skin grafts just you would like you would for severe burns. This can be and sometimes folks lose fingers or lose toes because of the frostbite. So this can be serious and if it's anything more than frostnip, you definitely want to seek medical attention for that. 

Now, in terms of prevention, pay attention to environmental conditions when there's a polar vortex and a windchill warning and the wind chills -30s, 40s or 50s and lower, then stay indoors. There's really not much you can do in terms of preventing this if you're outside for any length of time even with gloves and hat on. You want to make sure if it's extreme weather that you stay indoors. And that's why schools and such are canceled.

0:25:11

Now, if it is not quite those drastic conditions and you going to go outside and you going to do some fun winter activities like skiing, and snowboarding, and sledding, and making snowman, and building snow forts, and snowball fights and those sorts of things, you just want to make sure you dress for the weather. Thermals layers, thin layers, but multiple layers, you trap warm air as you get dress indoors and that provides a nice insulation. And then, of course, coats, and gloves, and hats, and gaiters, and scarves, socks, appropriate shoes, and you really dress for the weather.

And then, everyone should know the symptoms including young kids and then act to rewarm at the earliest signs. But you will need to supervise and advocate for your kids as I mentioned at the beginning, especially the younger ones. Don't let them be out there too long. They're likely to say, "Oh no, I'm fine. I'm fine. I'm fine." Especially during that numb stage, they may feel funny but it's not particularly uncomfortable, but that precedes worsening of it. So you do want to make sure that you are supervising and advocating for your children.

0:26:18

By the way, we do have a blogpost if you like some of these information in written form, Frostbite: Symptoms, Treatment and Prevention at the 700 Children's Blog. And I will put a link to that in the Show Notes for this episode over at pediacast.org. It's Episode 422 is the one that you want to look for, and you'll find a link, again, to that blogpost.

All right, let's turn our attention to hypothermia which is the other thing we worry about when the temperatures drop and you're outside for any length of time.

And hypothermia really is just a condition in which your body is losing heat faster than it can produce heat. And it produces heat through metabolic activities, your cells are doing stuff and part of the by-product of that is you're creating heat. You're also shivering when you start to get colds, so your muscles shivering can generate heat. And, of course, then also behavior, when you feel chilly, you cover up with a blanket. And so your behavior also plays a role in terms of heating up your body. 

0:27:20

But with hypothermia, despite all of those things going on, you still lose heat faster than you can produce it or create it. And by definition, we talked about fever a couple of weeks ago and sort of  "normal" body temperature is 98.6. But we don't really call it a fever until 100.4 degrees Fahrenheit. And likewise, we wouldn't call it hypothermia until you are at 95 degrees Fahrenheit or below. So the technical definition of hypothermia is again a core body temperature of 95 degrees Fahrenheit or lower. 

And this whole process of your body losing heat is going to depend on just like with frostbite in the skin freezing. It's going to depend on what the temperature is that you're exposed to. Wind, because again, wind blowing across the skin is going to take heat away. And even if your body heat radiates sort of out through your clothing which is more difficult to do when you're layered, but if that heat does go to the outside, again that wind blows it away and then your body heat, because heat tends to move outward.

0:28:32

And this is the kind of thing that is why wind feel so good when you're really hot, sort of the opposite thing. You're trying to dissipate heat and having wind, you sweat, and then the wind causes your sweat to sort of evaporate and takes the heat with it. And so in the case of cooling, when you're overheated, you want to lose that heat. But in this case, you want to keep the heat and the wind is serving to dissipate it. 

And so, the combination of temperature and then wind really makes a difference. And that's why we pay attention to wind chills like we talked about with frostbite.

0:29:10

Now, the other thing that kind of plays a role in this is water. So when you are wet, the water also takes your body heat, heats that water up and then again, you're losing that heat. And so when you're wet, you're going to cool down the inside of your body even quicker. 

Now, another important thing with hypothermia is that kids are in an increased risk. And just like we talked about with frostbite, they're in an increased risk because they tend to take more chances, maybe make some decisions that aren't so great. Maybe they didn't bundle up really well. They stay out too long. They're having fun. Or they get themselves into a situation where they need help and help is not available to them.

And so, it's going to be really important that you supervise your kids in terms of getting them dressed warmly and layers and covered up with hats and gloves and scarves and all those things. And then you want to also make sure that they're not out too long.

0:30:08

But the other thing that put kids at risk, and this is a little different than frostbite, is that their skin surface area compared to their mass is larger. So kids have more skin compared to how much they weigh. And your skin is acting as a radiator, again, you lose heat through the skin. And so, if your proportion of skin is greater, that does put you at an increased risk of developing hypothermia.

So kids do have an increased risk. The elderly also have an increased risk. They tend to have less fat under their skin. They can have some issues with temperature regulation. They may not sense it being this cold. They may not be able to communicate that they're feeling cold. Or they maybe wheelchair bound and not able to move to get out of the cold. 

And so it is going to be important, not only for you to advocate for your kids when there's cold weather like this, but also the elderly as well because they are also at an increased risk of hypothermia.

0:31:04

And then alcohol use and drug use, those go along with judgment problems. And staying out too long, you may pass out in the cold. 

When you do use alcohol on other drugs, you get some vasodilation. So your blood vessels dilate, become larger. You have more blood flow to the skin and you get rosy cheeks when you've been drinking too much. And so that vasodilation again increase blood flow to the skin which allows the heat to leave through the skin. 

And then also, there's a diminished ability to shiver when you've been drinking alcohol, which can also lead to more lower body temperature. And hypothermia is more of a risk because you're unable to shiver.

Now, in terms of symptoms of hypothermia, shivering is certainly one of them. You can also have some slurred speech, muscles aren't working quite as well, including the muscles involved with talking, with the way that your mouth and your tongue move. 

You also then can get some cognitive dysfunction. So your brain isn't working quite as well. You can have confusion, drowsiness, memory loss, and then ultimately loss of consciousness, then you're not able to get in to where it's warm.

0:32:14

And then, there's also cardiovascular effects, so your heart and your blood vessels and your breathing, also. You slow down your breathing, your heart slows down in the cold. And then, ultimately, you can have a cardiac arrest where your heart stops because it's so cold, and then you can die from that. So certainly, hypothermia is life threatening. 

This is something else again, diagnosis is pretty easy based on history physical. You have a history of exposure, and you have all the signs of hypothermia and your core body temperature is 95 degrees or less, fairly easy thing to diagnose.

And then, in terms of treatment of hypothermia, one, you want to get them warm. And so, get out of the cold. We talked about water being an issue, so if there's any wet clothing, snow that's melting as you go indoors and now that's wet, you want to get that wet clothing off. 

Increase the ambient temperature. So the temperature of the room should be warmer. Of course, use blanket. You can use warm drinks in order to warm up. 

0:33:12

And these are things that you can do on your own, as long as you do not have the brain issues or the heart and lung issues. If you're just shivering and cold and have some slurred speech, warm up and get out of the cold. Get the wet clothing off. Turn up the thermostat, use some blankets, drink some warm tea, and warm yourself back up.

But if they do those things but if there are any brain issues, so again confusion, drowsiness, memory loss, history of loss and consciousness with this, slow breathing. It's a little harder to tell if someone's heart speeding slower but usually if there's a heart and lung problems, there's going to be brain problems as well. So anything, or if you do notice that they seem not to be breathing very well or you are a medical person and you listen and their heart's beating pretty slow, you're going to call 911 for sure and seek medical attention if those things are happening.

0:34:08

In terms of medical treatment of hypothermia, like if you do end up at a hospital, of course, they're going to do the same things. The room that 
you're in, they're going to increase the temperature as much as they can, use blankets. 

There are other techniques that can be used in an emergency department like warm IV fluids. You can do blood rewarming. You can give someone humidified oxygen that is warmed. So there's warm moisture being put into the oxygen that can help to heat them up.

And then, ultimately, you can put warm fluid into the chest or into the stomach cavities. We call that peritoneal or chest lavage where you put warm water in and then suck it back out and that can help to rewarm someone who's too cold. 

So again, you want to seek medical attention, 911 if necessary, if there's any brain issues, so again, cognitive dysfunction, confusion, those sorts of things or evidence of the heart or lungs being involved.

0:35:08

In terms of prevention of hypothermia, it's realty a lot like prevention of frostbite. Pay attention to environmental conditions, dress for the weather. Again, if there's windchill warnings and a polar vortex like there are right now where it's -34 degrees wind chills as I speak, stay indoors. Don't go outside.

But if you have to go out or now we're talking regular winter weather and your kids want to go outside and have some fun, again, thermals, lots of thin layers to get warm air trapped in between coat, gloves, hat, gaiters, scarves, socks, appropriate shoes, all those things. And then know the symptoms of hypothermia and act to rewarm at the earliest signs. Again, remove those wet clothes when you get to a warm place, that's really important.

And perhaps most important of all, supervise and advocate for your kids. Make sure to dress warm. Make sure someone is checking in on them that help is available. Don't just send them off into the neighborhood. Maybe this is a great opportunity for you to dress up warm and have those fun outdoor activities with your kids because if you're getting cold, you can be sure they're getting cold. Even if they don't say so, then you can get them into where it's a little warmer.

0:36:15

We do have a blogpost to help you out with this sort of thing. It's called How To Be Prepared for Cold Weather Emergencies. That will be a good one to read for yourself and to share in your social media channels. It's on the 700 Children's Blog and I'll put a link to it in the Show Notes for this Episode 422 over at pediacast.org.

[Music]

0:37:04

Dr. Mike Patrick: We have a pair of the listener questions for you this week. Both of them pertain to toddlers. This first one is from JL in West Virginia. JL says, "Hey, Dr. Mike, every night, my four-year-old daughter sneaks into our bed several hours after we lay her down in her bed. She falls asleep with a song and a story and likes to hold our ear. She sleeps for a few hours in her bed and gets up and comes to ours. We are so tired that it is tough to put her back in her bed and when I've tried, she protests and we end up taking her back to our bed. Are we harming her by letting her sleep with us? Will she outgrow this behavior? 

"I am particularly concern about my two-year old son who's a great sleeper and sleeps on his own in his bed all night. But I'm afraid he'll catch on to what's happening and want to join his sister in our bed. Or worse, that he feels like we're playing favorites by letting his sister sleep with us. Just wanted your thoughts."

Thanks for the question, JL. This is a common dilemma that a lot of parents face. And I want to preface this by saying that there is not one answer that works for everyone, all right?

0:38:09

I mean, other than safe sleep, there are no hard and fast rules here because this is going to get better. I mean, 14-year-olds typically don't want to sleep with mom or dad. So it is something that's going to get better with time. The question is how do you deal with it, when do you deal with it? And other than safety, you really have to consider the needs of your family and what is going to work in a practical way.

Now again, safe sleep, babies who have trouble rolling on their own or would have trouble getting out of the way of a dangerous situation, those kids, you're going to want to make sure that they are sleeping in a safe environment, which just remember the ABCs, alone, on their back, and in a crib. 

Alone just means that no co-sleeping with a little babies because you can roll over on them, I've seen it happen, and cause suffocation. 

0:39:07

You also want to make sure they're alone, meaning no blankets, no toys, no teddy bears, no pillows, no bumpers on the crib, just a mattress with a flat sheet that's tuck in all around. And then your baby can be in warm clothes if need be but nothing else, because you don't want them to suffocate and it does happen.

On their back because we know that babies on their back are less likely to die from SIDS. This is especially important for kids who are younger than 69 months, kind of in that range. And then in a crib, really or at least you could say a container. You want it to be something safe that they can lie flat in but still move around. So you don't want them buckled into something. 

You don't want them in an old crib. The slats are too big and they can get their head or a leg or an armed trap. 

You want to make sure that you have the latest devices. The crib is going to be best, or a bassinet or Pack 'n Play.

0:40:06

And if you want that to be in your room and so you're sleeping next to them, that's fine. There's also baby boxes. In some Scandinavian countries, they have a box that's the same purpose. Again, they're not strapped in and they're in a safe environment that's their on, but then they can be either on the bed in their box or on the floor next to the bed. 

But again, you want that to be fairly good size and something that they can move around in, but also tall enough that once they get to the point that they can pull themselves up to stand, that they're not able to get out of that.

So the ABCs of safe sleep in the young babies, that's a little bit of a different story. So we're talking toddlers here and toddlers sleeping with mom and dad. And really you do have to pay attention to the family needs and what's going to work with you. If you are a single mom, there may be some comfort with sleeping with your toddler and your toddler being there with you. I totally understand that.

0:41:07

On the other hand, this can become quite an issue because if you're not getting a good night sleep as a parent and this is happening night after night after night, you get to the point where sleep deprivation really does affect your parenting. And so, this becomes a real issue that you do need to address. It's a common problem. 

Many kids have trouble settling down for the night. They can be light sleepers. Many kids are social. They want to be with you. They don't want to miss any of the action. So these are all things that are very common.

On the other hand, there's a lot of kids also like your two-year old who they put themselves to bed, they go to sleep, they sleep really well, they sleep all night. And that's just them. And in my own family, we have both of these. My daughter was like your daughter. She was the older one. 

And my son was younger and he did exactly, JL, just like you, when they were these age, exactly the same. My son would just lay down, go to sleep. If he was tired, he'd put himself to bed and he'd sleep through the night and not a bother. 

0:42:10

Where my daughter, ah boy, just wanted to talk to you, wanted you in her room, wanted to sleep in your room, all of these things. So it's common and both of these scenarios even in my own home once upon a time. 

So what can you do? Well, first, you wanted just make bed time easier. So for a lot of parents, the trouble really starts when it's time for bed. And you do get into these rituals of, "Now, you got to read three books" and, "You got to tell this story," and "I got to hold on to your ear." And whatever it is, it's these rituals that just get longer and longer.

So you do want to scale back on those. Instituting a calming bedtime routine, even dimming the lights an hour or two before bed time can be helpful. Getting into the pajamas, or if you take the bath every night, and then into the pajamas. So to have a calming soothing routine that happens the same time every night that's predictable. 

0:43:13

And then, I would also be sort of flexible in your expectations. And what I mean by that is ideally, when it's bed time, you read the bedtime story and you want the light out and your child in their bed and go to sleep while we go do some adulting. Because it's our only chance during the day to actually have that happen. 

And so, but you may need to be a little flexible and give up some of those things at least in the beginning. Maybe the reading time is, "We'll read you one book and then you can read some books on your own with the dimmer light on, no screens but a dimmer light on, but you have to stay in your room." And then at that time and hopefully just bank on them getting sleepy and putting themselves down.

0:44:00

And then, once you're at that stage where now, "Okay, we're staying in our room. We're not coming down to the living room every five minutes but we're staying in our room," then you may be in a position where the next step is to, "Okay, now, the light has to be off." Or you could say, "You can stay in your room with the light on. You could read a book but in such and such a time, that lights going to go out and it has to stay out." But you may have to take it back one step at a time.

And the other useful thing with this, and I know I've talked about this before on this program, is to set up a sticker chart. Have some positive reinforcement, "If you did stay in your room, you're doing all the things that we're asking you to do, we read one story, then you read a couple books," things are going as plan. 

Again, be flexible in your plan but spell it out. And if things are going well, your child gets a sticker the next morning on the sticker chart. You may have to do something like three strikes, you're out. "You can get a drink of water, come down, call on us but you only get two times or we're going to put a little x on your sticker chart. You get the three the next morning, you don't get a sticker."

0:45:04

And then, you have five stickers. Maybe in the beginning, you have two stickers, you earn something. It could be an activity, it could be a little toy. You really get creative. It could be anything that really motivate your child to want so that they'll earn those stickers. And then increase it. Say, "Well, it's going to be a little bit of a bigger price. So it can be two stickers now. It's got to be five stickers." And just play the game. Kids love games and sticker charts typically work pretty well for that. And be flexible and creative with it.

But you should not be the factor that helps them get to sleep, okay? They should be able to get sleep on their own without them holding on to your ear. Don't read to them until they fall asleep. They should be able to sooth themselves and get to sleep on their own because you need to go downstairs and start to have some alone time for yourself.

0:45:58

Now, in terms of them getting up during the night, that's a little bit more difficult because you want to get to the point where you're getting a good night sleep. One thing that we did that worked for us is to say, "If you get up in the middle of the night, you cannot sleep in our bed." We did not have a king size bed, we had a queen, and my daughter was a flip flap sleeper. She was all over the bed and you'd wake up and her feet would be in your face. And so that's just not going to work out. So no sleeping in mom and dad's bed.

Now again, for you, that might be okay, especially if you're a single parent with the big bed. But for us, that just wasn't going to work out. So again, there's not one rule for everybody. 

But this is what we did that works. When we were kind in these ruts of this happening, we'll put a sleeping bag on the floor next to our bed and say, "Don't wake us up. But if you wake up in the middle of the night and you want to come in here, this is where you can sleep, on the sleeping bag."

0:47:06

And there were nights when you might even start sleeping in there, especially if it was on the weekend or there's something else going on, or they don't feel well, kind of special time. And so, we got to the point where there would be intermittent time periods where my daughter would come in, sleep on the sleeping bag next to our bed, just wanted to be in a different place and be around other people and so I get that.

On the other hand, for your family, again, it may not work. For your family, maybe you and your spouse need as much alone time as you can get all night long, I don't know. And so toddlers coming in to your room is just not going to be a good thing, and so don't do it for you. But one kind of middle-of-the-road thing that I think can work is sleeping on the floor next to your bed rather than in your bed, "That's allowed. In the bed, not allowed." 

And again, because as parents, we need a good night sleep too and we're going to be a better parent the next day if we get a full night sleep.

0:48:05

So what about the two-year-old? I would just be thankful that he's an easy deep sleeper and hopefully it will stay that way. But I do agree with you, he should be allowed to do whatever her sister can do, which is another reason to set some boundaries now. So that you don't have that issue with both of them in your bed if that's not going to work out for you. You may end up with sleeping bag on each side of your bed, I don't know. Or maybe they want to share sleeping bag.

So that's something to consider. But again, I'm not saying, "Oh, you have to do it this way." But the only thing I'm saying you have to do is those little babies, the ABCs of safe sleep. Despite what you read on the internet, I would continue to recommend that all babies, young babies, again, we're talking last than six to nine months old should be sleeping alone on their back in a crib or other safe flat container.

So thanks, JL, from West Virginia for asking the question. I really do appreciate it.

0:49:02

Next stop is Megan from Birmingham, Alabama. And Megan says, "Hi, Dr. Mike. I really enjoy your show. I recommend it to many friends because I value the information and advice you provide to parents and because it is evidence-based. I also appreciate that you tackle a wide variety of parenting topics and that regardless of their child's age, parents can gain knowledge from every episode.

My husband and I are parents of an adorable two-year-old daughter. We are also expecting our second daughter this spring. We want to prepare our firstborn as much as possible for her new sister and want to prevent sibling rivalry as much as we can. What age appropriate interventions do you recommend to help us prepare her for this new arrival? Thank you, Dr. Mike, I look forward to your next episode. Best, Megan."

Megan in Alabama, thanks so much for writing in. This is another one of those questions that really will pertain to lots of families out there. 

The first thing is I would manage your own expectations of how this is going to go. Your two-year-old's world is going to be rocked no matter how much you prepare. And you can expect some behavioral problems and a little bit of development regression. Maybe your two-year-old didn't have a pacifier anymore, didn't have any thumb sucking, was really well potty-trained. They may backtrack a little bit on some of those things.

0:50:23

So approach that with a little bit of empathy. I mean, when they were an only child, they were really the center of your attention for as long as they can remember. And having a new baby coming to the house is really going to change that center of attention to some degree. And so have some empathy for that. 

I mean, put yourself in their shoes and realize it's going to get better. Having the baby in the house will soon become the new normal, but for a while, there may be some many problems that even preparing in the best way possible is still going to be there.

So don't be too discouraged or too disappointed with those. Just understand it, have some empathy for it and realize that things will get better.

0:51:11

But there are some things you can do to sort of lessen the drama, so to speak. And the first one is before baby arrives, you definitely want to prepare for that arrival. Talk about it. If they ask you questions, answer them honestly and realistically in an age-appropriate way. 

Playing with baby dolls beforehand, doing some role play and changing the baby's diaper and feeding the baby. It's nap time for the baby and just the baby doll play. Even with boys, it can be fun and helpful. 

Picture books about new babies coming home, looking at pictures of families where there is a toddler and a baby present like, "Hey, this is our family now without the baby, but the baby is coming soon. And so this is what our family will look like."

So talking about it, sort of normalizing the fact that this baby is coming and what it's going to be like and talking about it. And again, books, and pictures, and role playing with dolls, I think these are all things that will be helpful.

0:52:11

Also shop and prepare together. So as you're putting the nursery together, take your two-year-old shopping with you and pick out some things. Maybe even give your two-year-old ownership or something. Whether it's, "You get to pick the outfit that the baby is going to come home in. That's exciting. Or what baby blanket we're going to wrap the baby when he or she comes home." Or maybe it's, "You get to pick which side of the nursery you want the crib to be on."

Again, it's going to be different for each family. But let them help your family get ready and give them some ownership and something. 

And then your older sibling hopefully will be able to visit the baby in the hospital. That's an exciting trip. And maybe even bring a gift for the baby. Just make it an exciting adventure your child's a part of it. And then continue to include the older sibling as part of this process even after the baby comes home but not too much.

0:53:08

You want to give the older siblings some responsibility that they'll enjoy. Maybe it's helping change diapers which may not be the actual thing. But like, "Hey, go get me a new diaper. Once this one all folded up, put it in the garbage bin or the diaper pail." Or help with laundry. Something that they're interested.

But you don't want to force them into too much work. It should be fun. You don't want resentment like, "Oh, before the baby came, I didn't have to do any of these chores. And suddenly, I have to do all the stuff I don't want to do." Make it more of a game and fun but put them to work so that they feel some responsibility in a fun way.

And emphasize that role of the big brother or a big sister. That's going to be really important. Talk about that, what can they do to help with the baby and they're acting like a big brother and big sister or big brother shirt. Things to just really emphasize that role I think is helpful.

0:54:06

And great way to incorporate your child into reading. It's great for babies to hear books and so you can all read together. That's a lot of fun. If it's a picture book and the toddlers not quite ready to read the words, they can make up the stories and point to the pictures and make up a story for the baby, and that can be fun as well.

The other big piece of advice that I have is to maintain protected time for the older sibling. Have regular dates with your toddler with mom or dad or get a babysitter for the infant and go out and do something fun. I mean, really still even though at home kind of the new norm is that your toddler is not the center of attention anymore, sometimes make them the center of attention on a regular basis. Do something fun. Choose an activity that your toddler loves, make it special. It's important because it is a big change and your toddler is still going to want to feel like to some degree that they are still the center of your world at times.

0:55:12

And then, the other thing is watch for behavioral cues that the toddler is feeling left out and then anticipate when they're going to have a meltdown. And maybe meet their needs before a big problem arises. Maybe think about the rules of your house where can you get a little lax. Now you also want to be consistent but where can we maybe change the rules a little bit to help when your toddler suddenly, they want to do something. It's always been, "You can't do this." As long as it's not a safety issue, maybe this is an area where you could be laxed a little bit. 

It's hard because there's so many specific examples that one could give but just off the top of my head, "You have to clean up all your toys after you're done playing in the playroom," let's say. And your child is getting cranky and, "Do I really have to clean this up? It's going to be dinner time," maybe let the toy stay.

0:56:16

If you can prevent meltdown and that meltdown is really not about the toys being out. The meltdown is because they feel a little bit neglected and so they are pushing their feelings on to this chore that they normally had, maybe we could back off on that a little bit. So again, that's just one quick example what exactly is happening.

What are causing the meltdowns in your house and could you do something and maybe change the rules a little bit? Again, we don't want to compromise safety but change things in order to give the older child a little bit of leeway as we understand that, "Hey, this could be a problem."

Now, in terms of sibling rivalry and this is more of an issue as the baby gets older and can rival back, I always encourage cooperative play among siblings. Again, especially as the baby gets older, role-playing games, finding activities that you can enjoy together, playing with blocks and little toy cars and building with Legos.

0:57:19

And again, things that are safe and age appropriate but embrace the creativity, de-emphasize screens, what can they play with their hands and then put things together and role playing and do some fun stuff. And encourage them to do that together. And I think that oftentimes helps as compared to when each is off doing their own thing. 

I mean, yes, there's going to be arguments. There's going to be conflict. It's all a normal part of growing up. 

If you want some suggestions on what sort of creative fun things that kids can do cooperatively, and you sort of forget from your own childhood all the things that you did and if you're like me and you grew up before screens were everywhere and there's lots of things that we used to do, there is a great book by Pam Lobley. 

And I interviewed her about her book in PediaCast Episode 382. And I'll put a link to that in the Show Notes for this Episode 422 over at pediacast.org.

0:58:19

But The Do-Nothing Summer was Pam's idea of just taking your kids out of all, and these are school-aged kids, and just taking them out of activities just for the summer. We're not going to go to camp. We're not going to have swimming lessons or music lessons. We're going to do nothing over the summer except play and just have fun.

And she's in, it was a remarkable experiment for her family, really kind of change their lens on life a bit. They didn't do it every summer after that. They weren't involved again the next summer.

But it really helped them in terms of just relaxing and unplugging and it was very therapeutic for their family. And she's got some terrific ideas on what kids can do when they're doing nothing. Because when you're doing nothing, you really are doing something. It's just you're not doing the scheduled things that you have to do. It's more like the fun stuff.

0:59:10

The book is called Why Can't We Just Play? What I Did When I Realized My Kids Were Way Too Busy. That's the name of the book. And I'll put a link to the book and also the episode of PediaCast where I talked to the author. That was PediaCast Episode 382, author Pam Lobley. And I'll put that in the Show Notes for this Episode 422 over pediacast.org so you can find that easily.

So Megan from Birmingham, Alabama, thank you so much for your question.

[Music]

1:00:08

Dr. Mike Patrick: We are back with just enough time to say thanks to all of you for taking time out of your day and making PediaCast a part of it. I really do appreciate that.

Don't forget, you can find us in all sorts of places. So I'm not sure how you came across PediaCast for this particular episode, but you can subscribe to the podcast. We're on the Apple podcast app, in iTunes, Google Play, iHeartRadio, Spotify, most mobile podcast apps. Really, wherever podcasts are found, you should be able to find us.

Then there's the landing site pediacast.org. You'll find our entire archive and past programs, so 422 of them at this point. Also Show Notes for each episode with all of the links that we talked about, transcripts for the episodes if you'd rather read through the material. Our Terms of Use Agreement is there. Very important that you take peek of that and the Contact page if you'd like to ask a question of your own or suggest a topic or point us on the direction of a news article or a journal article, I always appreciate of those things.

1:01:04

We're also a part of the Parents On-Demand Network which you can find at parentsondemand.com. It's a collection of podcasts for moms and dads. That collection includes PediaCast along with many other terrific podcasts for parents, including the Messy Bun Girls podcast with your hosts, Lauren and Jocelyn. They're two hardworking moms with a show that is very real and a flat out fun listen. 

In their words, they created the podcast to drown out the negative noise of the world. They say we need more voices of encouragement and love and oh, yeah, we should have some laughs too. The Messy Bun Girls podcast is for all the dishwashers, taxi drivers, therapists, personal chefs, stylists, and shoppers out there. In other words, all you moms. 

So be sure to check out the Messy Bun Girls podcast. And I'll put a link to it in the Show Notes for this Episode 422 over at pediacast.org.

1:01:58

Also, reviews are very helpful wherever you listen. Please consider taking some time out in writing a review for the program. Always appreciate that. And then we love when you connect with us on Facebook, Twitter, and Instagram. Again, Facebook and Twitter, we're going to promote the current episode, let you know what we're talking about each and every week. 

Also, we take some episodes from the archive and promote those as well. Especially if they're topical seasonal kind of things, evergreen material, as we like to call it, but stuff that you can still get some use out of, still relevant, and up to date and based on evidence.

And then, we also share lots of news articles through Facebook and Twitter, just current topics that are going on like the measles outbreaks that you're hearing about. Or there's really an explosion of the use of Juul, for example. Teen vaping has became a very serious problem that is affecting a lot of high school students. And so we talked what's going on in relationship to that as well.

1:03:00

So just the things that relate to pediatrics and parenting that are out there in the mainstream media. We try to collect the best information and share that with you as well on a daily basis. And that's all shared through Facebook and Twitter.

Also, on Instagram, a little more personal there, what's going on in our family's life, a little peek inside the studio. I also do some movie reviews. Our family sees a lot of movies together and when we see movies, even if it's not kids-related movies, just any movie really, we try to put that on Instagram and I have a little reading system. Very brief, believe me. It is not really professional, to be honest. It's just my own opinions on what I think about the movie and I rate it. 

So you can check that out on Instagram. Facebook, Twitter, Instagram, you just want to search for PediaCast and you can find this very easily.

We also appreciate when you share the show with others and let your family, your friends, your neighbors, co-workers, babysitters, anyone who has kids or takes care of children and that, of course, would include your child's pediatric healthcare provider. Please let them know about PediaCast so they can share the show with the other families and their patients that they take care of.

1:04:11

And while you have their ear, let them know we do have a program for them as well. Of course, a lot of pediatric providers listen to this program, but we also do PediaCast CME. The CME stands for Continuing Medical Education. It's similar to this program. We turn up the science a couple notches and we offer free Category 1 Continuing Medical Education Credit for those who listen. Shows and details are available at the landing site for that program which is pediacastcme.org.

Those are also available just like the show in the Apple podcast, iTunes, Google Play, iHeartRadio, Spotify and most mobile podcasts apps. Simply search for PediaCast CME.

Thanks again for stopping by and until next time. This is Dr. Mike saying stay safe, stay health and stay warm and stay involved with your kids. So long, everybody.

[Music]

1:05:17

Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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