Continuity of Care

As a pediatrician now in my 27th year of practice, I can’t tell you how important it is to have continuity of care for your child. It is truly an honor for me to take care of children from those very first days after birth until they are done with college!   

Over time, I get to know both the child as well as the parents and family as a whole, and this allows me to be an even better pediatrician. Each family has its own set of values, and I respect and admire the individuality and devotion that our Brooklyn parents have for their children.

When it comes to a medical condition or illness or anything that might be worrying you about your child, continuity of care, and knowing that your pediatrician will be there for you for the long-haul, as well as on a daily basis, is crucial.  As we navigate both the emotional and medical well-being of children nowadays, I am always available as someone who has seen over 10,000 kids and spent 36 years working with children in a variety of settings to be there for you, guiding and navigating with you.   

I am available every day for your child for both in person, same day sick visits as well as virtual/video visits for both medical and behavioral or developmental issues. In addition to the scheduled yearly preventative well-child exams, setting aside time and allowing  us to form meaningful connections as we navigate obstacles, big and small, allows us to form a plan and make sure we are not neglecting an important issue.    When there is a fever or rash, that is getting worse or ongoing medical condition that just isn’t getting better, you want to know you can connect with your pediatrician instead of having to go to an urgent care and receiving unnecessary antibiotics or x-rays. There are situations where an urgent care is necessary, but having a true medical home for your family can actually lead to better outcomes and less unneeded interventions.  Indeed, the seasoned pediatrician will know when to worry and when and how to safely reassure.

It is by definition concerning if your child has a high fever and only with a hands-on physical exam can we truly get to the bottom of diagnosing which type of germ or infection - viral or bacterial - is causing this high fever. But whether it is an acute illness or a problem coming up in school with behavior or focus, or a developmental issue in your toddler, it is so important knowing that your pediatrician is there for you every day, saving slots and time for same day issues.

Although I have just started my role as Pediatric Clinical Director of the NYU Cobble Hill center, I have been thrilled and impressed with the level of support, efficiency and customer service provided by our amazing pediatric staff. If you will be  joining us from another medical institution, please be aware that all of the medical records in the epic EMR system will transfer seamlessly at your first appointment and you do not need to do anything beforehand to request medical records - they will appear in your medical chart here at NYU.   You can call 929-455-2500 or my chart us, or go on the NYU website to set up a same-day visit, in person or by video for any concerns that you have, or to schedule that next check up!    I look forward to seeing you soon and serving as an important part of your child’s team, celebrating them as they grow, and keeping them healthy!   

Communicating with your Doctor

We are there for you - 24/7/365! We pride ourselves on being available, and providing sound medical advice, as well as aiming for excellent customer service! Let’s get a behind the scenes look at the doctor’s office, so you can utilize the best ways to approach different questions and concerns.

We are a group of pediatricians all working together as a team, but in general you have one “main” doctor who will see your child for all general well-child check-ups and most if not all urgent, or same day sick visits. When messaging your doctor, remember that we need to follow strict HIPPA compliancy, and not give any medical advice in any format that isn’t password protected and part of your child’s electronic medical record, so we can’t text or email about any medical concern. Calling remains a very efficient way to contact us, and we get all phone messages in our inbox as alerts in real time and become part of your child’s chart. The phone number for the practice is 929.455.2500. We have all our pediatricians here from 830-5/530 during the week and we have Saturday mornings at NYU Slope Pediatrics at 60 8th avenue between Berkeley and Union, between 9-12, to see newborns and same day sick visits.

After hours, we are on call 24/7 and the excellent pediatric nurses are the ones fielding the initial calls, and giving advice, triaging, and troubleshooting for sick children or urgent matters. We will be available for same day sick visits the next morning, or there are times where an urgent care or pediatric ED visit is needed especially if there is respiratory distress.

Normal office hours are the time to call with any medication refills or appointment requests or questions regarding ongoing pediatric issues. During the day you will have the full staff here at work, accessing your child’s medical chart, and giving thorough advice. At night, we are home with the family, and not logged into the electronic medical record system, but we are indeed available by phone if there is a medical emergency or new acute illness or accident that arises.

We cover for each other during times where a doctor may be out on vacation or starting their day later or ending earlier, so someone should always get back to you the same day, but unfortunately, not always the same hour. We are almost always in the room with a patient doing a check-up or seeing a child or baby that may be sick, so we can’t leave the room to answer a call, but we will get back to you as soon as we can. We save same-day sick visit slots so try to call earlier in the day, after 8am to make a same-day slot for an in person or video visit when appropriate. We also have an amazing Emergency Department here at NYU Cobble Hill just in case we need them.

I wouldn’t email to our general NYU email, as this isn’t answered as quickly, and NYU and the HIPPA privacy laws require all medical advice to be part of the child’s chart and in a secure server. My chart messages can attach a picture, and yet we can’t diagnose and treat by one pic – so it’s best to schedule a video visit or an in person visit so we can work together to diagnose and treat any necessary condition. Often an in person visit is best for proper physical exams, but we have been very happy with telehealth with certain conditions like rashes, or making a plan regarding how to approach the first day or two of fever or a mild illness, or dig and and explore a behavioral issue, or sleep regression.

You should sign up for my chart for your child, so that you can message a non-urgent question any time. After hours or on the weekend, my chart isn’t checked, so just call if you are worried, and someone will get back to you. My chart activation is best done while you are here, but it can be done on the phone. Once you have my chart active, you can also arrange for telehealth video visits for behavioral or developmental concerns or phone consults and schedule your next check up.

All forms can be done – for school and daycare and whatever else you need. Just tell us while you are here for the physical exam and we can generate a school or daycare form, or my chart message us and we can attach the form back in the my chart app. We usually can get back forms in a few days.

There are regularly scheduled well-child check-ups, and at times a sick visit is needed, but remember that we also welcome a follow up phone consult, or video or in person visit for any issue that is not getting better, including problems with sleep, nutrition or development. We are all honored to be part of your team, for up to 21 years!

Baby to Big Kid: Transitions

Baby to Big Kid!

My wife still calls our 8 year-old “our baby”.  Just picking her up and giving her the biggest hug in the world is a great feeling!   Of course our 11 year old (going on 15) will have no part of that anymore!   Once we get past those first few months of sleep deprivation, I think most of us are thrilled and overwhelmed with joy as we watch these little guys develop and flourish.  To think that a 9 month old has true feelings, thoughts, a personality, and a strong will or even major attitude is astonishing, and down-right fun!  I too wish they could all stay that age in a sense!  But just as the newborn transition happens around 3 months, the “baby to big kid” transition may begin as early as 9 months.   Let’s go over some of those transitions together, remembering all the while, that it is the parent and family that makes these decisions on exactly when we transition and how we do it.  The pediatrician is there for you for guidance and support, but not to “tell you exactly what to do and exactly when to do it”.  Since I have seen over 10,000 kids in these 23 years, I hope to share my experiences and observations regarding these magical, and at times stressful transitions.

Sleep transitions

Hopefully by 9 months old, you have established a nice bed time routine, and your child is giving you a nice stretch of uninterrupted sleep.  I took 3 hours to write my thoughts on sleep, so feel free to peak at that when needed.   Now try hard not to go backwards!  Sometimes the back molars can interrupt sleep, and now they not only can scream louder, but some pull to a stand in their crib, and even call out for mama or dada, and can wake up the entire neighborhood!  But that doesn’t mean they need to feed, or are truly hungry, so try to keep your stretch of sleep without feeding. Every single 9 month old can give you 10-11 hours of sleep (sometimes you’ll get the magical 12) without needing any calories.  Indeed some very intense habits can form at this age, so really think about if you want to spend an hour rocking them to bed, or bringing them in your bed, or even going to them.  You are not just making the decision for the night – you may be digging a hole for many months if you “reinforce the waking”.  There are no “wrong” decisions, but just remember, it only gets harder later to break habits. 

Naps are really different for each child, but we often have transitioned from 3 naps to 2 by now, and the next transition from 2 to 1 is most often from 15-18 months, but there is no right or wrong.   Your baby should be getting around 12-14 hours of sleep, but there is a lot of flexibility in timing of naps.   Most lose their naps by 3 years old, so enjoy them while you can!

Milk

From 9-12 months hopefully you are opening up the choices in terms of solids, and your baby is enjoying eating.  Before a year we can give breastmilk and/or formula, but it is safe to give yogurt and cheese.  As long as the yogurt and cheese is well tolerated, there is no chance your baby will be allergic to milk.  We wait until 1 years old to offer straight cow’s milk.   It should be full fat as they need the natural fat until 2 years old, at which point you can give 2%, but don’t have to.   Some people prefer not to give cow’s milk, but the other sources (almond, coconut, oat, soy etc.) of calcium and vitamin D are not full fat, and I feel very comfortable using cow’s milk, and do prefer organic if possible.  You can indeed keep nursing for a long time, and if you want you can continue on from baby formula to toddler’s formula. 

The goal is to get around 16-24 ounces of milk past a year.  This is a sum of all the types of milk or dairy, so breastmilk counts as well as cheese or yogurt.  It isn’t easy to count the exact ounces.  Some need to cut their total milk intake – such as a baby who was getting 4 bottles of 8 ounces of formula, or 32 ounces total.  And some kids just don’t like the idea of cold milk, and you have to push, or keep trying.   I would set 12 ounces as an absolute minimum, and I like even older kids to get adequate sources of calcium and vitamin D. 

For a “behavioral acceptance” many mix the new cow’s milk with breastmilk or formula to get them used to it.  You can warm it still, but really don’t have to.  You can gradually increase the ratio of the cow’s milk over a few weeks, but this is for taste and acceptance, and not necessary if your baby likes the milk from the start.   You also will start to transition from the milk being a full meal, to it being part of a meal.  It shouldn’t be milk then bed, but more of milk, then the night-time routine, and remember to brush the teeth after!

Bottle to Cup

A little baby simply can’t learn how to use a sippy cup or big kid cup – so a baby bottle is fine.

As they get more and more teeth, the soft nipple bottle can make the front teeth come out, and increase your chances of an overbite, or braces in the future.  So as they get towards a year, it is nice to practice using the sippy cups or straws, and start to think about losing the bottle.  As kids get older they can indeed develop strong habits and associations, and so I really try to lose the bottle by 13-15 months latest.  The longer you wait, the harder it is, so start practicing by a year, and then insist on losing the bottle at some point, even if your child has always associated milk with sleep.  Many kids accept the water in a cup, but not the milk, but you still have to play your card at some point, or it will continue past 2 years old and will be even more of a battle then. 

Some go “cold turkey” or pretend to misplace the bottle.  Some gift it to a new baby they know who needs it.  And some do a gradual decrease in frequency.  You know your child best, so see what seems to fit best, but do “choose that battle” at some point.    

If they absolutely refuse to drink milk in the cup, there will be a temporary decrease in dairy, so increase yogurt and cheese, or make creative smoothies to sneak it in.  It isn’t wrong to use another source of milk, such as almond, or oat, or pea milk, but they are lower in fats, so I aim to get back to the cow’s milk in due time.  I also would aim to lose the pacifier in the similar fashion – as you see fit, but as close to a year as possible.  This also can become a very stubborn habit to break, and older kids will be even more resistant to losing it for sleep. 

Water

Water is safe to give after 6 months.  It has no calories, so you really don’t need to give much, unless there are hard stools/constipation.  Even on a hot day, the milk can keep them hydrated and helps them grow more than water.  But by 8 or 9 months old the option of having a sippy cup or bottle during a walk in the park is a nice and practical option.  It is also nice to practice using a sippy cup, straw, or big kid 360 cup.   There is no maximum amount of water past 8 or 9 months old, but make sure they are getting enough of their milk.  

Daycares?

This is such a complex topic, and really is 100 percent a decision made by the family, but allow me help if I can.  The first step is see if you like the daycare, and their philosophy.   There are many excellent ones in the area, but I don’t have a list or preference as it is so dependent on other factors.  For sure, a young baby who goes to daycare will see more germs, and yet we hope most of those are self-limiting viruses.  All daycares say that a child with a fever must go home, but the day before or the day after, the kids are still contagious, so even if the staff washes their hands, the more kids there are, the more chances of germs.  Each germ will boost your child’s immunity, but nobody wants to catch a strong germ like pneumonia or the croup.  Most kids who start daycare young make it through the first winter just fine, and then are in a sense stronger, or more equipped for the next winter. 

There are indeed benefits or socialization and being with other kids, but I don’t think that becomes a real reason to send a child to daycare until they are 2.5-3.   So I appreciate the social benefits of daycare and all group classes, but I would not say you need to send a child to daycare to learn social skills. 

Of course any child would love to be with their family, but please don’t feel guilty if you do need to return to work quickly and need to get care for your baby.  It’s a very tricky balance indeed.  But your baby will feel all your love when you are with them. 

Crib to Bed

There is no place safer than their crib, so keep them in there for as long as you can!  But please don’t let them climb out either!  I have seen kids as young as 17 months climb out of the crib, so of course lower it down as low as it goes once they are pulling to a stand.  But if you think that they are lifting that leg over the top, and can fall out from the crib, it is time for the transition to a big boy bed.   That leads to a host of other concerns regarding safety, and them coming out of their room, so please safety proof everything as best as you can. 

Brushing the Teeth:

I write about oral health separately, but please do remember to take the teeth seriously.  I have seen cavities and even the need to remove teeth, so please brush them twice a day every day after the first and last meal, even if your child resists.  The dentists want to see you by 12 months, but if you are brushing well and don’t see any yellow spots, perhaps it is ok to wait until 18 or even 24 months, but please know these teeth can get cavities, so do your best job brushing with a  real brush and fluoride free baby toothpaste. 

The Attitude!

I truly love the 9 month old, as they are so full of life and energy!  There are learning how to express themselves even if they don’t have any true words.  They are feisty and intense!  They can indeed start to have mini melt-downs or even give us some good ol’ attitude!  Don’t worry, this is all part of good development, but certainly it can make these transitions more difficult.  

Choosing your battles:

Remember that you know your child best, and you know how and when it’s bests to choose your battle.  There is no absolute wrong or right.  Why do we give cow’s milk at a year, but not a week before?  Why is it safe to use sun screen at 6 months old (see my blog on “summer safety”) but not at 5 and a half months?  When do we go from 2 naps to 1, or lose the pacifier.  There is no absolute formula of success, but our advice is indeed based on evidence-based medicine as well as our experience.  But as a fellow parent, I know it just ain’t always that easy to make these transitions!  So take all my advice with a grain of salt, but do your best to help your baby to transition from a little baby to a healthy beautiful (and no doubt intense) big kid!

Empowering and Supporting Parents

I started working with children in 1986.  I always knew I would spend my life working with children, and have done so in a variety of fields.  I was a daycare and camp counsellor, a tutor, an umpire for little leagues, and a clinical researcher studying topics such as infant cognitive development and ADHD.   Those years were filled with significant learning experiences, and enabled me to really get to know children and their diversity, as well as their joys, passions, and boundless energy!   I am honored to be a pediatrician for over 23 years now, caring for children medically and holistically, sharing stories, empathizing  and supporting parents.  

In the old days, there just wasn’t as much pressure to do this parenting thing perfectly, but nowadays there are so many philosophies and models, that there is a tendency to feel like you are not doing a good job, or may not be doing things “right”.   

The most important thing you can do is give your child unconditional love.  They need undying support and smiles.  They need nutrition, warmth and hugs.  You are providing a base, a backbone, as well as a platform to jump from and explore the world and flourish.   So please never feel like you are not a good parent if you haven’t cracked the code of a newborn, or if there isn’t a set schedule of naps yet.  In the moment, these things feel like the most important thing in the world, and no one should minimize the stress of a crying baby who despite all your efforts won’t sleep.  But we need to keep it in perspective and rejoice if our kids are healthy, and gear up for the real stresses when they get older and venture into the world without us!  Some say, “Little kids, little problems, and big kids, big problems!”   Well, that doesn’t help at 2am when your little one is fussy and screaming – because in that moment it does feel like it’s the most stressful thing in the world.  And as someone who has worked with children of all ages for so long, and as a fellow parent, I would like to help you through all moments of stress.  I would like to help find “the answer” to the stress and solve the problem.  But of course, it isn’t always that easy.

I can tell you one thing about children for sure – they are each unique individuals.  And so are we!  Each parent has their own set of morals, values and ways they aim to parent.   Each one of us views subjects such as daily routines, nap schedules, discipline and nutrition differently.  So the dynamic between two different parents, each raised differently, and each with their own opinions, feelings, goals and aspirations can be quite complex.  Oh yes, and then we throw in their baby who is developing their own personality,  and playing their own card, and things can get quite intense and complex! 

I look at my role as a general pediatrician as encompassing a lot of areas.  As opposed to a neurosurgeon, who we would look to for one thing – just fix the problem – the pediatrician is indeed there for more than just the treatment of fever or illnesses.  But that is absolutely our main job, or priority – guarding, preserving and nurturing the medical and physical health of your child.  When it comes to things like fevers,  asthma, rashes, screening for developmental delays, monitoring growth charts, strep throats, accident prevention, and figuring out which set of clinical symptoms to worry about, versus  which will get better with time, I think the pediatrician may actually in a sense take the lead.   I always “shift gears” when I am worried about a child’s medical condition, and whether it’s doing a thorough physical exam, or medical testing such as blood tests, images, or arranging for consultations with specialists, I can assure you that you’ll see me truly “go to bat” for your child, and you won’t see me rest until things get better.  

When it comes to giving general parenting advice, on hot topics such as scheduling a baby’s routine, choosing when to travel, teething, starting solids, and the all-important questions of sleep, I have spent over 20 hours organizing my thoughts and writing everything I know and feel about these hot topics.  I create, fine-tune, manage and pay for that “bulletin board” – my website – as a method of communication.  It is me sharing all of my thoughts, instead of trying to give a quick summary or overview.  I aim to share everything I have researched, the true evidence-based scientific results of studies,  as well as sharing my experiences over these 32 years of working with children.  I detail my thoughts and go over options and approaches in more detail than may be plausible or practical during a typical pediatric well-child time slot.   I never want it to feel like we don’t have time to discuss these hot topics, but I have found that often these topics may take more than an hour to dissect all the medical research, what a parent has heard or read, and conflicting opinions or models.  Indeed, there are entire books over 100 pages written on nutrition and sleep in children!  I try to share my advice and perhaps nudge you in a certain direction, but I feel very strongly that each family needs to make their own decisions when it comes to many of these parenting topics. 

There are many reasons I try to empower and support parents to make these decisions.  First of all, despite what you hear from one or two friends, there is no right or wrong in many cases.  There is no one way to get your child to sleep, or one fail proof method to avoid a picky eater.  Each child is different, and each parent is different, and I really think no medical professional should tell a parent what to do a 2am in their own home.  I think we can all have inclinations of what we would like to do…but in that moment in the middle of the night, you have to do what you think is best, and not feel like a doctor told you that you were wrong if you decided to go to your baby and hold or feed them.   I think crossing those roads as a couple is a learning experience, and one that can take weeks or months to work through and find the best approach. Only you and your family can decide on these and many other important topics, such as what time is the second nap, or the third meal, and when to go to a daycare, or should we hire a specific nanny.  I wish there was a simple answer or one that was clearly best, but there are so many factors to consider.   

There are indeed times where there is a developmental, or even medical basis to my advice, but the truth is, many of these hot topics have a lot of flexibility to them, and I don’t want to overstep my boundaries and actually tell one family “how to do it”.   You see, every single 4 month old is so different.  Different in their stages of development, different in the amount of ounces or calories they may consume, in the hours of sleep they may get, and different in the parents that they have.  Websites and blogs will tell you when your child is going on a growth spurt, or how many ounces they need in a day – but this just isn’t necessarily true for any one child.   

My feelings are that parents and not pediatricians, should dictate their child’s ideal bed time, nap schedule  and exactly what to do at midnight, when a beautiful healthy baby is crying, and the question is should you go to your baby, or let them work it out, or even cry it out.   I offer guidance and my thoughts on nutrition, but there is no exact right or wrong in terms of when exactly to give the first solid food and whether it is avocado or cereal, and if cereal, which kind type of grain is the healthiest.  I give a lot of advice about how I view nutrition, but I feel strongly that as a medical doctor I should not take the power away from a parent to make those important decisions, as long as they are all safe options.

The moment that a scientific study makes something proven to help the health of a child, I promise I’ll “play my card” stronger.  But when it comes to these important, intense, even stressful parenting decisions, I’ll go the extra step and give you guidelines, on how I view teething, starting solids and sleep.  I’ll share my experience, my research, and my guidance.  But they are only my general thoughts, and they are not “the rules”.  They are based on evidence-based medicine, coupled with my plethora of face-to-face interactions.  It isn’t my two daughters I am basing my advice on – it is having over 100,000 child-doctor interactions or “visits” over these 23 years – and hearing from parents the trials and tribulations of different models, and what worked and what didn’t work.  

So please never feel as if I don’t want to hear more about the difficulties about establishing a good nap schedule, or about how a 4 month old fights their sleep or seems to regress.  I know about it, and I write a good amount of “parenting” advice on my website.  I share all my feelings, thoughts and some guidance. But I have to respect, empower, or shift the decision back to the parents I work with as I respect your decisions so much.  I have heard of practices that tell you exactly “how to do it” and enforce certain “rules” of sleep training or potty training.  And since that really doesn’t feel right to me as a person, I just won’t be that kind of a doctor.   I’ll always be there for my families, and you will see me switch gears and lead the charge 100% when there is something medical going on.  But I hope it’s ok that I’ll listen, and certainly empathize, but not always tell you how I would do something, or pretend to have the one correct approach or quick fix, when there is no true right or wrong answer.  

Please remember you are doing a great job, and giving your child an absolutely wonderful childhood.  

I respect your right to decide what is best for your child, and I respect the individuality of each child, and in turn each family.  

And I am honored to be part of that team!       

When I cry, you absolutely must come to me! Don’t listen to Dr. Gilgoff!!!

Potty Training

Potty Training 101

    I really think we should keep tabs on how many diapers we change!  When these guys are teenagers with attitude, we should just keep reminding them of just how much we did for them!  It is indeed a major celebration for every parent when we can convince these strong-minded toddlers that the coolest thing in the world is indeed to sit on that throne and say bye-bye to diapers.  

    I really believe that each child is so unique, and the truth is that in this particular endeavor, the parents feelings and attitude matter a lot as well.  There are so many new and groovy books that are written nowadays, and I don’t discourage you from reading them as some have really fun and novel ways of approaching this sometimes stressful process.  But after working with children for over 31 years, I hope to offer you some general pointers that just may help.

    I think parenting is a lot about choosing your battles.  And although I want you to scream when something is dangerous, and really make them brush their teeth, I just don’t think you can force them to poop on the potty.   So I would begin by saying that this process is almost 100% child-led.  This idea of a naked boot camp weekend, and by Monday Johnny is full potty trained just doesn’t work in most cases.  When Johnny was just about all ready, a stronger nudge might done the trick, but if children really don’t want to use the potty, they will often play their card, rebel, hold it in, and get constipated.  Constipation is actually a very common and sometimes chronic problem.  It becomes intensely behavioral, but it starts with a physical feeling that is annoying and painful, and then your little guy says, “I am just not going to go!”  And then things get worse.  

    So please always avoid or at least help with constipation, especially around these potty training months.  Keep it soft and flowing, and that at least will prevent an obstacle and give you the best chance to have your little one keep an open mind about the process.

    As it is really child-led, some people wait, and literally don’t even discuss the idea of the potty.  And that is ok!  I mean no pediatrician should tell a parent when to potty train.   I think each interaction is a delicate and unique balance, and I want both child and parent to go at their own pace.  But in most cases, the child around 15-18 months is actually becoming more aware of their bodily functions.  They may make certain faces after they go, or point to their diaper as if to tell you they just went.  Well, this may be called the first step!  I think potty training is like driving a stick shift car.  Your child is controlling the speed at which they will be willing to drive, and you are unfortunately often stuck in first gear for a long time!

    But if your child is showing signs they are willing to go into the next gears, then you should be ready to help them shift gears and allow the car to drive a bit faster!  When your child is first showing interest, or at least a willingness, you should get that first potty, and just make it oh so cool!

    You can decorate the potty with stickers, and perhaps save special activities that you do, whether it’s reading a book, playing a quick game, or telling a fun made-up story while they sit on the potty.  No actual result is needed, but you are celebrating their willingness to sit and befriend the potty.  Of course, the moment they resist or show a fear, just take a break.  Change something up, and try again.  I like the ideas of sticker charts, and reading books about potty training, or watching videos, but don’t use all of your tricks before they seem more ready.  Indeed it can take a full year before they are willing to feel the urge, hold it in, run to the potty and do their business!

    Many like to take the portable potties on the go, just to keep things consistent.  Try to keep it as light-hearted and without pressure.  You just don’t want them to rebel and develop an aversion to it.   You’ll see them go in spurts, where things seem like they are really getting closer, and then it will lag or slow down for a few weeks.  In many cases, it takes them seeing a buddy or cousin who can do it.  And all of a sudden they just decide they want to go for it!

It honestly runs the full gamut, where some kids are full trained at 2, but many are still not fully trained by 3.  

    In some cultures they find a way to read the child’s cues and faces so well, that the child can be trained closer to 9-12 months old!  But this is really the parent training themselves to read the baby, and doesn’t fully mean the child will go on their own when fully mobile.

There are of course the stubborn ones, and often these kids are the incredibly intelligent and super strong minded ones, who refuse to use the potty until 4, but this is not common.  

For most, number one is easier, and number two comes later.  Many will still wear a pull up at night for a full year more, or until around 4.  I aim for daytime control first, and really don’t push the night time - let that come naturally.  

    Sticker charts and even M&M’s are all fair game when it comes to convincing these guys.  I say don’t push, but a little nudge is fine.  You plant the seeds, water and nurture it gently, and it will grow I promise.  They won’t go to college in diapers! 

    So explore your feelings on it, as you count too!  And be sincere.  Don’t just follow one specific book or model - follow your heart.  This is just one of many stages where your child wants to feel your true support and encouragement, and not see your stress or feel like a failure.  So keep it light and fun and keep the faith!  It will happen…when they are ready.

Hey Gav...you doing poop on the potty yet?

Flu Vaccine

FLU VACCINE

All of the pediatricians here agree that the flu shot is very important and worth getting.  Influenza can be a severe infection, especially in young children, those with asthma or other medical conditions.   It is not just a cold – it is much worse, and can lead to hospitalization and severe complications.  Each year, children in the United States and abroad die from influenza infections, so even if the shot is not always effective, it is worth attempting to decrease the risk of this potentially dangerous disease.

The flu shot is safe and can’t cause the flu. It is completely inactive, and can’t make someone sick.  It can cause fever or localized muscle pain that night, but it has nothing to do with colds or getting sick weeks or months later.  It is specifically trying to prevent the influenza strains, but can’t lead to more or less “colds” from other cold viruses.   It is not 100% effective, but helps to prevent or lessen the effect of the flu in most cases.  

The nasal flu spray is not an option this year, unfortunately, as studies showed it was not be effective for the current circulating strains.  We won’t have any at all this year.  

Flu shot is safe and effective starting at 6 months old.

We recommend that all adults caring for a baby (family, nannies etc) get their flu vaccines.

 We give flu shots from September until May, but the earlier in the season, the better.  

If your check-up/physical exam is up to date, you can just call to schedule a shot-only visit with us.    

The first time you get a flu shot, you need a booster a month later, but then every future season, you only need one.  You need a new flu shot each winter!

Getting any shot or giving any medicine is not an easy decision.  But after seeing the effects of influenza on young children for over 21 years, I have learned to respect and fear the flu!  My daughters get it each year, and I think yours should as well!

Summer Safety

I just love it when it gets warm here!  Flowers blooming, birds chirping and getting darker later! Unfortunately there are also some scary things that can happen to our little ones during spring and summer – so let’s go over a few pointers and guiding principles to keep your little ones safe and smiling. 

Sun

Maybe we have swung too far in sun avoidance.  Some experts actually want us to get a bit more natural sun, and Vitamin D levels can get pretty low even in kids.  Nonetheless, especially with the little ones, I think it’s best to aim to avoid most sun, and allow for the incidental sun.  Any time we know we are going to be outside, we should put sunscreen on all over a good 15 minutes before leaving the house.  Use a good kid’s brand, and not one with parabens.   An excellent source for looking at all the potential toxins in creams and sunscreens can be found at the environmental working group (ewg.org).  I really trust them, and they will list and rank all the brands out there.  You can’t go wrong with California Baby, Blue Lizard, Badger, and Babyganics, but there are a ton of excellent brands for kids.  Remember to reapply every 2-3 hours and sooner if they get wet. 

If you do get a sunburn, usually it will be mild, and you can use over the counter moisturizers such as vanicream, cerave for baby, or aquaphor, but if there is blistering and skin breakdown it is time to see the doctor. 

Bug bites

Summer in Brooklyn can be absolutely treacherous when it comes to mosquitos.  We try organic natural bug sprays, and these critters laugh at us.  It feels horrible when our little ones get bitten up, but almost always they will get better on their own, so in most cases there is no medical concern.  Any time you get a bite, it can swell, and some kids have a huge reaction to bites.  You can use Benadryl (check drgilgoff.com for proper doses according to their weight), liquid after-bite preparations, hydrocortisone 1% or calamine lotion for their comfort. 

Some bites cause actual infections – spreading redness and even pus – so see your doctor if any bite is getting worse and spreading.  Taking pictures can help show the progression, but it can be tricky!  Some bites are not infected, but are actually large, red, and tender – and those are actually the same signs of a cellulitis or abscess – types of skin infections.  So if you are worried, it’s best to come in for a same day visit to catch a potential infection early.

Zika virus is a work in progress in terms of our knowledge and recommendations, but as of 2017, we really don’t see much to worry about in terms of serious effects on a healthy child.  If you are pregnant it can be a different story, and there are updates every week or two in terms of prevention and testing, so check out the www.cdc.gov website for the latest info.  West Nile Virus is so scary, but is quite rare, and if your child has that illness they become very sick and weak, so see your doctor if you have concerns about that.  We do worry about our little ones so much – so I can’t tell you NOT to worry about these rare diseases with each mosquito bite.  In other countries they have malaria and other diseases to think about each day.  But luckily those are very very rare over here, and there is nothing you can do with each individual bite to prevent the mosquito from having West Nile or Zika or not, so it’s safe to just watch and wait and assume it isn’t anything serious. 

The organic child bug spray is the safest to use, but as kids get older ,and stop putting everything in their mouth, it is safe to try a low strength of DEET, especially if it is only on the clothes and not the skin.  Certain times or locations are also just asking for trouble – like at dusk on a humid day, or being near a body of water.  But it seems in Brooklyn you just can’t avoid getting attacked no matter where you go!

Not all that bites are mosquito bites – so remember to see your doctor if the bites are literally all over or spreading or don’t look like mosquito bites.  We continue to see patients with bed bugs, fleas and scabies, so come and see us for any rash that looks like it is spreading and getting worse.

Water Safety

This is an area where every parent is aware and cognizant of the risks, but I fear we don’t all take it serious enough.  The risk of drowning is so enormous with our little ones.  Even a bath could be a huge risk, but certainly a pool or large body of water is a set up for a disaster.  There are few summer scenes more enjoyable than hundreds of kids at the pool or beach, but please always take the proper precautions to ensure your child is 100% supervised, and this is even after they have aced all their swim lessons and have the independence of a teenager in their soul.  Children should never be unattended near any body of water.

Having your little newborn in your arms in a pool or ocean can be fun for a minute, but don’t let them ingest the water.  There have been some very scary stories about secondary drowning, but that is luckily extremely rare, and children get water in their mouth all the time.  If there was a significant ingestion of water, along with choking or the need for resuscitation, of course come see us immediately.   We usually say 6 months is a safe age for swimming classes. 

For some, the chemicals used can irritate the skin, or get those eyes red, but in general, there is nothing more fun for our kids than 8 hours in a pool!  So get out there, be safe and enjoy the summer!

Please see may article on lyme disease for more information on tick bites and testing and prevention of this condition.