If your child is healthy, a cough of any duration can be safely evaluated and treated at your pediatrician’s office. Yes, I realize that if you are up in the middle of the night, the urge to do something about it in that moment — and the worry as a parent — are nudging you to grab your keys and head to the nearest emergency room. But I want you to know that in otherwise healthy children who are breathing well, there actually isn’t much ER physicians can do. You’re better off getting whatever little rest you can get at home, reaching for the honey if your child is older than one, and making an appointment in the morning.

The same goes for most fevers. In children who are older than three months and are otherwise well — no dehydration, trouble breathing, or underlying medical conditions — the pediatrician’s office (and not the emergency room) is the best place to evaluate a fever. Though most fevers in young children are due to a viral illness and resolve on their own, primary care pediatricians are also equipped to evaluate for other common causes of fever, such as ear infections, strep throat, and urinary tract infections.

When children are seen in the office, we are also able to take a stepwise approach. For example, if you come in early during an illness, we can always see you back in a few days for fevers that have not gone away and do additional testing then. This approach is tough to do through an emergency room.

Another conversation that is perfect for the primary care office: viral testing, and whether it’s even needed. Following the COVID-19 pandemic, “testing” became a common word in our vocabulary, and many daycares and schools required it regularly for what felt like an eternity. As a result, many of us want to know which virus is causing our ailments- even when that may not change how you or your child is treated. As primary care physicians, we want to talk through the need for these viral tests with you, in the calm of our offices.

I’ll end with two important caveats to the case I’ve made until now. First, if you are worried, we are worried. Emergency rooms and the physicians, nurses, and staff who work there are dedicated professionals ready to help who will not turn you away. And second, there’s no medical advice or compilation of tips that can replace your parental intuition. If something doesn’t feel right and you believe your child needs to be evaluated right now, grab those keys and head on over to the nearest ER.

 Editor’s note: Dr. Edith Bracho-Sanchez is a practicing pediatrician at Columbia University Irving Medical Center, co-founder of Informada, a contributing editor to SheKnows, and a mom to an active toddler.

Before you go, grab these all-natural remedies to relieve your child’s cold symptoms:

Brittany Mahomes discovered her son Bronze’s peanut allergy in one of the scariest ways, when she rushed the then-8-month-old to the hospital in August. Now, Mahomes is opening up about how food allergies are impacting their family life, including daughter Sterling and husband Patrick Mahomes, and why she’s passionate about speaking out about the cause.

“We recently found out my son Bronze has a severe peanut allergy, which led to a scary trip to the ER,” Mahomes told People recently, describing it as “one of the most terrifying days of my life.” Fortunately, she continued, “he was OK, but I’ve had to cope with this new way of living and ensure my family is safe inside the home and out.”

The family had been aware of two-year-old Sterling’s allergies said “since she was an infant,” the Kansas City Current co-owner said, adding that she’s now “hyper-aware of what food and drinks we have in our household.”

“I can relate to all moms and families out there that are dealing with children with severe food allergies,” Mahomes went on, acknowledging that “the holiday season is extremely difficult when gatherings and activities revolve around food.”

To show her support, Mahomes is partnering with plant-based nutrition brand OWYN to support the Food Allergy Research & Education (FARE) organization. Both Mahomes and the brand have pledged to match donations up to $100,000 to kick off the organization’s fundraising initiative, the “I Can” Campaign.

Through the campaign, Mahomes says, she hopes “to inspire change within the food allergy community,” adding that it’s “so special to be able to help these people and reassure them that they are not alone.”

It’s a worthy goal, because food allergies impact more people than you might realize. “During the first year of life, up to 10 percent of all infants have been reported to have developed an allergic reaction to a food,” Dr. Ama Alexis, an infectious disease allergy and immunology physician for children, previously told SheKnows. Many children grow out of their allergy, “but peanuts, tree nuts, fish, and shellfish may persist for life.” Allergic reactions can vary widely, including hives, redness, or itchiness; swelling of the yes, ears, lips, tongue, or throat; vomiting or diarrhea; and coughing or wheezing. Alexis also explained that most reactions show up “within minutes,” but can occur up to two hours after ingesting the product.

For the Mahomes family, dealing with Bronze’s food allergy means being more aware and mindful of what the kids are eating and what products are present in the house. Mahomes said she likes OWYN for that reason, as the brand provides “clean, delicious protein shakes that I know are safe to be around our kids,” she explains. Most of all, Mahomes says, “I want Sterling and Bronze to grow up having a healthy relationship with food.” As a mom, she adds, her goal is to “ensure they feel safe and informed in case of emergency. We are learning so much.”

Before you go, shop these products to help your kids’ cold and flu symptoms:

Watch the recap of SK Conversations: Parents’ Playbook for Pediatric Pain Management where our panel of medical experts shared how to navigate your child’s recovery plan. We explored today’s leading non-opioid pain management options and how to prioritize your child’s safety while effectively managing pain. You will walk away with invaluable advice on how to be your child’s best advocate.

The Experts

Dr. Stone and Dr. Sethi are consultants of Pacira BioSciences, Inc.

Dr. Mona Stone

Dr. Mona Stone is not only an esteemed oral and maxillofacial surgeon practicing full-scope surgery, but she is also a public speaker, activist, philanthropist, and the co-founder of the grassroots organization Real Heroes Need Masks.

After receiving her dental degree from the University of Missouri-Kansas City, she went on to do a year of internship at Truman Medical Center and then a residency in Oral and Maxillofacial Surgery at Broward General Medical Center.

Dr. Stone practices the full scope of the specialty, including maxillofacial pathology, dentoalveolar surgery, implant surgery, maxillofacial reconstruction, microvascular surgery, facial cosmetic surgery, and trauma surgery. She is also an attending surgeon at Baylor Medical Center Grapevine, Irving, and at Methodist Hospital.

Dr. Paul Sethi

Dr. Paul Sethi is a board-certified orthopedic surgeon specializing in sports medicine conditions of the elbow, knee, and shoulder. He is a leading research physician who speaks at academic and instructional medical conferences in the U.S. and abroad. His research on surgical advances in his specialty is regularly published in leading medical journals, including the Journal for Shoulder and Elbow Surgery, Arthroscopy, and the Journal of the American Academy for Orthopedic Surgery.

He also collaborates with outside companies for education and research purposes and to develop medical procedures on the shoulder, elbow, and knee. Dr. Sethi is a member of the prestigious American Shoulder and Elbow Society and the American Academy of Orthopedic Surgeons. He also serves as President of the ONS Foundation for Clinical Research and Education (ONSF).

For more information on EXPAREL, please visit www.EXPAREL.com/safety. 

Indication

EXPAREL^® (bupivacaine liposome injectable suspension) is indicated for single-dose infiltration in patients aged 6 years and older to produce postsurgical local analgesia and in adults as an interscalene brachial plexus nerve block to produce postsurgical regional analgesia. Safety and efficacy have not been established in other nerve blocks.

Important Safety Information

EXPAREL should not be used in obstetrical paracervical block anesthesia.

In studies in adults where EXPAREL was injected into a wound, the most common side effects were nausea, constipation, and vomiting.

In studies in adults where EXPAREL was injected near a nerve, the most common side effects were nausea, fever, and constipation.

In the study where EXPAREL was given to children, the most common side effects were nausea, vomiting, constipation, low blood pressure, low number of red blood cells, muscle twitching, blurred vision, itching, and rapid heartbeat.

EXPAREL can cause a temporary loss of feeling and/or loss of muscle movement. How much and how long the loss of feeling and/or muscle movement depends on where and how much of EXPAREL was injected and may last for up to 5 days.

EXPAREL is not recommended to be used in patients younger than 6 years old for injection into the wound, for patients younger than 18 years old for injection near a nerve, and/or in pregnant women.

Tell your healthcare provider if you or your child has liver disease, since this may affect how the active ingredient (bupivacaine) in EXPAREL is eliminated from the body.

EXPAREL should not be injected into the spine, joints, or veins.

The active ingredient in EXPAREL can affect the nervous system and the cardiovascular system; may cause an allergic reaction; may cause damage if injected into the joints; and can cause a rare blood disorder.

FOR MORE INFORMATION, PLEASE VISIT www.EXPAREL.com or CALL 1-855-793-9727. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-108

The study, published in JAMA Network Open, found that COVID transmission within child care centers was low overall and that children who did get infected at a child care center had a low chance of passing it to parents, siblings, and other people in their households. In other words, child care centers aren’t likely to be COVID superspreader locations.

To find those conclusions, researchers followed 83 children across 11 child care settings in two cities, along with all of their household contacts (comprising 118 adults and 16 children) and their 21 total child care providers. For a year, the researchers tracked the health of all participants, which included weekly PCR tests, symptom diaries, and optional baseline and end-of-study blood testing for the COVID virus. They also received weekly reports from the child care center directors detailing the number of COVID cases at the centers. From this data, researchers were able to determine the incidence of the virus at the child care centers, transmission patterns, and secondary attack rates (aka the number of cases occurring among contacts of an infected person).

The data showed that the virus transmission rate within the child care centers was only about two to three percent, compared to the 50 percent household transmission rate for children (which jumped up to 67 percent for adults). In addition, only 17 percent of household infections came from children who picked up COVID at child care centers, and only 1 in 20 symptomatic children at the child care centers ended up testing positive for the virus.

While that might be a relief to hear, it’s worth noting that the study was small and observed child care centers that served “relatively high-income families” with a high vaccine rate, the researchers noted. More research is necessary before the conclusions can be generalized, but the findings are striking nonetheless, especially for parents who may be nervous to send their kids to daycare while COVID hospitalizations are rising, per CDC data.

The study authors wrote that their findings do suggest potential changes to the current testing and isolation recommendations for COVID in child care centers. “While it’s crucial to remain vigilant in our efforts to manage the spread of SARS-CoV-2, it seems that prioritizing testing and extended exclusion periods for children in child care centers may not be the most practical approach,” study co-author Andrew Hashikawa, MD, clinical professor of emergency medicine at the University of Michigan, said in a press release. “It can place undue financial burden on families from frequent testing, result in missed work, and hinder children’s critical access to quality care and education,” he explained.

That said, it’s still important for parents to keep their kids and families up to date on COVID vaccines, especially given the high household transmission rates found in the study. And for now, the current CDC guidelines are the ones to follow. They state that kids with respiratory symptoms (think: congestion, runny nose, sore throat) get tested and stay home if they test positive. If they’re symptom-free and testing negative, you can at least breathe a sigh of relief when you drop them off at daycare tomorrow, knowing they may not be as likely to pick up COVID there as we once thought.

We recommend these products for soothing your child’s cold symptoms this season:

The study, published in JAMA Pediatrics, found that nearly 1 in 5 children and preteens now take melatonin for sleep, and some parents frequently give the supplement to preschoolers.

“We hope this paper raises awareness for parents and clinicians, and sounds the alarm for the scientific community,” said lead author Lauren Hartstein, PhD, a postdoctoral fellow in the Sleep and Development Lab at the University of Colorado at Boulder, per a CU Boulder press release. “We are not saying that melatonin is necessarily harmful to children. But much more research needs to be done before we can state with confidence that it is safe for kids to be taking long-term.”

In the study, researchers surveyed about 1,000 parents in the first half of 2023 about the use of melatonin among their kids. They found that over 18 percent of children ages 5 to 9 had been given melatonin in the last 30 days. The number went up to 19.4 percent among preteens ages 10 to 13, and hovered at nearly 6 percent among preschoolers ages 1 to 4.

The study also found that those kids had been taking melatonin for a while. Among preschoolers, the median length of time taking melatonin was a year; for kids from 5 to 9, 18 months; and for kids 10 to 13, 21 months.

The issue, Dr. Hartstein explained, is that melatonin isn’t regulated in the US (and is actually banned for over-the-counter use in countries the UK, the European Union, Japan, Australia, and Canada). As a result, research has found that the amount of melatonin advertised on products isn’t always accurate. A 2017 study of 31 melatonin supplements in Canada (before OTC use was banned) found that the melatonin content varied from containing 83 percent less than advertised to 478 percent (!) more than advertised.

In other words, when it comes to melatonin supplements, “parents may not actually know what they are giving to their children,” Dr. Hartstein stated. That’s a serious issue, especially when you consider that melatonin overdoses in US kids have skyrocketed in the last decade, increasing by 530 percent between 2012 and 2021, according to a 2022 CDC study. In 2022, the American Academy of Sleep Medicine (AASM) issued new guidelines around the supplement’s use in kids, recommending that parents talk to a doctor before giving children melatonin.

Melatonin for kids “is almost never a first-line treatment,” said study co-author Julie Boergers, a psychologist and pediatric sleep specialist at Rhode Island Hospital and the Alpert Medical School of Brown University, in the press release. “Although it’s typically well-tolerated, whenever we’re using any kind of medication or supplement in a young, developing body we want to exercise caution.“

Melatonin might seem like an easy fix for kids’ sleep issues, but it may just be masking the issue instead of addressing the root of it, Dr. Hartstein noted. “If this many kids are taking melatonin, that suggests there are a lot of underlying sleep issues out there that need to be addressed.” The AASM guidelines agree with her, stating that many sleep problems “can be better managed with a change in schedules, habits, or behaviors rather than taking melatonin.”

So what does that mean for your kids? If they’re having trouble getting to sleep, go back to reinforcing that good ol’ bedtime routine — bath or shower, brush teeth, lower the lights, shut down the screens, pull out a book, whatever helps your kid relax and wind down. Stick to that scheduled, familiar bedtime as much as possible to help them stay on track.

When your child is having sleep issues, the frustration is real. They’re tired and cranky, you’re tired and cranky, and you just want them to sleep. If tweaking their schedule or routine isn’t working or your child’s sleep problems are chronic, make sure to talk to your doctor or pediatrician before reaching in the medicine cabinet. Melatonin works, but it comes with potential risks and a lack of regulation, so it’s a good idea to try other fixes first.

Before you go, check out these natural products that can help soothe your child’s cold:

At home and in my work, I am determined to help children develop a healthy relationship with both food and with their bodies. Here are a few things I recommend for parents looking to do the same. 

DO: Address your own “stuff.” 

Many of us grew up with complicated relationships with food. I personally started “dieting” and working on “improving my body” at age 14, and I know my experience is far from rare. In order to be effective role models and leaders in our homes, it is important we give ourselves the space to reflect on and heal our own relationship with food. That includes our views on different foods, on different bodies, and on how much worth we attach to people’s appearance, including our own.

DON’T: Talk about bodies.

Some of us do this without thinking, but it is a good practice to avoid talking about your own body as well as the bodies of others — whether that be strangers, family members, or your children. Don’t comment on physical appearance, whether it’s to praise or to shame. Simple, seemingly benign comments such as “You look good! Did you lose weight?” are quickly internalized by children. Instead, praise qualities unrelated to appearance, such as effort, curiosity, kindness, and persistence.

DO: Gather, talk, and celebrate around food.

A meal is supposed to be a social activity. Food is a way to connect, to gather, and even to pass down tradition and culture, especially around the holidays. It is as much an activity as it is fuel. Involve children in planning, in the preparation, and in the meal itself. Starting at an early age, children are eager to be involved in conversation and to mimic parents’ behavior. Put away the phones and iPads, take a deep breath, and enjoy each other’s company.

DON’T: Label food. 

Attaching the labels “good,” “bad,” “healthy,” or “junk” to different foods is counterproductive and can make children feel they themselves are “good” or “bad” based on the food choices they have made. Offer variety, try your best to offer balanced meals, and do not judge children by labeling their choices. 

DO: Check in about unrealistic expectations and negative messages. 

Given the pervasiveness of diet culture, kids will inevitably be exposed to negative messages about food and sometimes even their bodies. Check in often and listen carefully for changing attitudes. In the preteen and early teen years, I also recommend supervising social media use, with a focus on teaching social media literacy and helping kids understand what is real vs not.

DON’T: Expect perfection. 

Leave room for mistakes. Even when we have done the necessary work of disentangling our own complicated relationships with food, many of us are parenting at the same time we are healing. Mistakes will happen, and they will be powerful opportunities to sit down and talk with your children about your values as a family.

Editor’s note: Dr. Edith Bracho-Sanchez is a practicing pediatrician at Columbia University Irving Medical Center, co-founder of Informada, a contributing editor to SheKnows, and a mom to an active toddler.

Before you go, check out these quotes that’ll help you develop a healthy attitude around food:

During her speech at the Shaping Us National Symposium at The Design Museum in London, she couldn’t help but happily gush over his school activity, per OK.

“Louis’ class, they came back with a feelings wheel — it’s really good. These are 5 or 6-year-olds and going with names or pictures of a color that represents how they feel that day, so there is a real keenness in school particularly to get involved in conversations,” Kate said. “It’s actually helping continuity across the board and then how does that feed into you, with your mental health — it’s same conversation, so to be able to find a bit of framework to talk about this, is very important.”

It’s no secret that the Princess of Wales is all about early childhood development and care, but highlighting this game-changing mental health activity shows how much people are ready to help their kids learn about how to navigate the world.

In an article for the American Psychological Association, experts discussed how teaching your kids to name and recognize their emotions can help in the long run. And per the Gottman Institute, you can start teaching your kids emotions as early as their toddler years, so by the time they reach childhood, they will be “more likely to develop and use appropriate emotion regulation skills to deal with difficult feelings.”

William and Kate: A Royal Love Story by Christopher Andersen

Image: Gallery Books

Prince William and Kate Middleton’s life as parents and husband and wife has been well documented over the course of their marriage. But when royal fans go back long before the couple’s 2011 nuptials, they find a love story with twists and turns. Christopher Andersen’s William and Kate: A Royal Love Story chronicles the couple’s early days in college, through their breakups, and finally to their memorable engagement. This is a must-have addition to any royal fan’s bookshelf.

Before you go, click here to see more photos of Prince William & Kate Middleton through the years.

The study, published today in Environmental Health Perspectives, looked at a particular marker of infant reproductive development called anogenital distance, aka the length of the distance between genitals and anus. Previous studies have shown that shorter anogenital distance among adults might be related to hormone levels, semen quality and fertility in men, while both longer and shorter anogenital distance is associated with reproductive disorders in women.

Anogenital distance is also used as a marker in animal studies to find the developmental toxicity of pollutants. The researchers in the new study wanted to find out if the same pollutant relationship existed in humans, with potentially serious implications for reproductive health.

The researchers in this study used anogenital distance data from an ongoing study, The Infant Developmental and Environment Study, which involves pregnant women and their children in four major US cities. They used anogenital distance measured at birth and, for boys, at one year, and compared it to levels of pollutants measured in areas where the study’s participants lived during pregnancy.

Looking at both of these measures, the researchers found a clear connection. They saw that higher pollution levels during certain key periods of pregnancy correlated to shorter anogenital distance at birth. Specifically, higher exposure to pollutants at the end of the first trimester, when the male fetus usually receives a higher amount of hormones, was linked to a shorter anogenital length at birth. Higher pollutant exposure during the period known as “mini-puberty,” an early-infancy period when hormone production is also high, was also linked to shorter anogenital distance at age one for male babies.

So which pollutants were the issue? The researchers specifically looked at levels of nitrogen dioxide and fine particulate matter, aka PM2.5. This refers to particle pollution that measures 2.5 micrometers or smaller, released by burning wood and/or fossil fuels like gasoline, oil, and diesel.

PM2.5 is a kind of “trojan horse,” as it can carry endocrine disruptors like cadmium and lead, said Emily Barrett, PhD, lead author of the study and professor of environmental and occupational health, in a press release from Rutgers. “When these disruptors interfere with the body’s hormones, the result could be lifelong impacts on our health, from cancer risks to impaired ability to conceive a child,” she explained.

The conclusion, researchers wrote in the study, was that exposure to these pollutants “during critical pre- and postnatal windows may disrupt reproductive development,” though they noted that more research is needed to confirm the results and explain exactly how they occurred.

“These findings suggest air pollution may interfere with normal hormone activity during critical periods of prenatal and early infant development, and we suspect that disruption may have long-term consequences for reproductive health,” said Dr. Barrett.

The discovery is yet more proof that air pollution is doing damage to our health far beyond coughing and sore throats, and another reason to look towards cleaner fuel sources in the future beyond oil and gas.

Before you go, check out these must-have items to get you through pregnancy and bed rest:

When you’re a parent with a sick child, time is of the essence. You want answers and a solution ASAP. But scheduling an appointment with your pediatrician (or a specialist) can take days or even weeks, and if you try to call, you might be waiting on hold for half an hour. This is an issue that telehealth has been working to solve for the last few years in adult healthcare, but now it’s coming for pediatric healthcare as well, through a company called Summer Health.

This pediatric telehealth company launched in 2022, billing itself as the “first nationwide healthcare entity to offer text-based pediatric care.” Through Summer Health, parents can send a text and connect to their care team within 15 minutes for a message-based appointment.

There are no phone or video calls required, which can be key for busy parents who can’t step away from work or caregiving to take a call. Parents can also send photos and videos through the chat, and doctors can send out prescriptions to local pharmacies as needed.

Summer Health

Buy Now $20

---

Up to this point, Summer Health has provided access to vetted providers for urgent care (fever, rashes, infections, etc.) and specialty care (think sleep, nutrition, and lactation). Today, the company announced an expansion of its services into primary care through its new Everyday Care portal. Like a primary pediatric practice, each family on Summer Health will be assigned a lead pediatrician and medical team. The families will get 24/7, “unlimited access” to this team and any specialists, Summer Health said in a statement.

Summer Health describes the expansion as a way to provide “a holistic approach to care” and deepen relationships between parents and their care team, “who will have a complete understanding of the health of their children and remain available at all hours of the day.” And when they say 24/7 access, they mean it; while Summer Health aims to respond to all texts within 15 minutes, the company’s FAQ notes that the “national average wait time” comes to about 3 minutes.

Chelsea Clinton, a mom of two herself, invested in Summer Health last year and told Fortune in a recent interview that any caregiver “should have access to excellent advice in a timely fashion.” The writer and health advocate noted, “We have more phones in our country than we have people, and we have many examples of text-based platforms being particularly valuable to parents.”

And Summer Health’s services come at an affordable price, especially compared to the cost of a doctor’s appointment or urgent care visit. An account with Summer Health costs $20 per month for a monthly subscription, or $16 per month for yearly. All children in your household are covered under the same subscription.

It’s a solid option if you often find yourself frantically googling your kid’s symptoms, comparing their rashes or scrapes to scary photos online, then wondering how accurate that search engine info really is. Instead of Dr. Google, you can text an actual doctor or specialist and get information you know you can trust. For more information on Summer Health or to sign up for a subscription, check out the company’s website.

Before you go, check out these natural products to treat your kid’s cold:

That’s where a dad in a recent Reddit AITA post is getting some heat. He took to Reddit after a family disagreement that has to do with his daughter’s period pain, and whether he should have a say in whether the pain is bad enough for her to stay home from school or not. The daughter and mom both want to know his opinion; he doesn’t want to give it. Feeling confused? Redditors are too.

It’s a nuanced post with multiple rounds of edits already, and over 2.6k comments and votes (and counting). So what’s the issue and — most importantly — where does Reddit stand? Is this dad trying to avoid mansplaining and giving opinions on something he’s never experienced? Or is he just trying to get out of a tough conversation? Let’s break it down.