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Parents Need to Know is a newsletter written by Craig Collison, MD, pediatrician with Mount Nittany Physician Group.
Raising polite preschoolers

Preschool years are the prime time to emphasize etiquette. Three- and four-year-olds have an insatiable desire to learn, master new skills and please those around them. Although children that age may seem too young to follow certain rules, the first steps they take into the world of good manners will eventually translate into their ability to handle social situations with confidence, as well as respecting the needs and feelings of others. Keep in mind that this is a gradual process, and you will have to continually remind and teach this for years to come. Here are eight ways to get started:

Establish basic standards: It is important to set clear limits about considerate behavior just like you do for safety issues. “We knock before entering a room when the door is closed” should be discussed just like “We don’t cross the street without holding hands.” Before children can develop their own conscience, they need to learn how to regulate their behavior on the basis of how you as a parent discipline them.

Talk about values in concrete terms: Use simple language that your child can understand. If you consistently demonstrate the link between respect and behavior, your child will think that’s how he should want to act and be treated. You might say, “It’s good to be quiet when someone else is speaking,” or “It’s wrong to hit anyone, even when you are angry.”

Emphasize empathy: Because children of this age are just starting to be able to identify with other people, preschoolers are not instinctively considerate. To make your child more aware of others’ feelings, point out when people do something helpful or thoughtful, and talk about how their actions make you feel. You can also use books or movies to encourage empathy. When you read about Cinderella, talk about how sad Cinderella is because her step-sisters are mean to her.

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Smart snacking for back to school

The new school year has started, and it’s the perfect time for parents to think about how to pack school lunches with creative, healthy options. I recently read a story in Medical News Today with some great advice and tips worth sharing.

Dr. Joel Lavine, chief of pediatric gastroenterology at NewYork-Presbyterian/Morgan Stanley Children's Hospital, reminded parents that you don’t have to completely cut back on snacks and sugars to ensure that your child eats a well-balanced meal. “Kids can still get the sugars they crave from low-fat snacks and fruits, while parents are satisfied with the nutritional content," he explained.

In addition to finding healthy food choices, some parents face the challenge of providing meals for their children with digestive conditions such as Crohn's disease or irritable bowel syndrome. "Try to avoid sending trigger foods," said Dr. Aliza B. Solomon, a pediatric gastroenterologist at NewYork-Presbyterian/Komansky Center for Children's Health. "For someone with active Crohn's disease, this might mean avoiding high fiber food or fresh fruit. Children with irritable bowel should avoid foods with polyols, such as sorbitol and xylitol, often found in sugar-free gum, which can lead to bloating."

Nutritionists at NewYork-Presbyterian Hospital offer more tips on making your kids' lunches healthier:

  • Salty Snack Substitutions. Instead of packing potato chips or pretzels, which have no benefits, try air-popped popcorn (with a little sea salt and olive oil). This provides fiber as well as healthy fat, while providing less sodium than most processed chips and pretzels.
  • Food Allergy Alternatives. For kids with peanut allergies who like their PB&J, try a sunflower seed puree or even a yellow pea puree product available on the market.
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Warts are prevalent but usually resolve on their own

An interesting study by the Leiden University Medical Center in The Netherlands examined the prevalence of warts and how many of them went away on their own in the span of 15 months. We still treat warts, especially in painful areas, but if they don’t bother the child, I am a proponent of leaving them alone. We are always happy to see your child and assess the need for treatment (or not) with warts.

Researchers examined the natural course of cutaneous warts and treatment decisions among primary school children and found a high prevalence of warts, half of which resolved within one year despite any treatment.

In the study of 1,099 Dutch children aged 4 to 12 years, researchers found 33 percent of children had cutaneous warts at baseline. One-half of the children found to have warts were free of warts one year later, despite any treatment.

Resolution rates were higher among younger children and children with non-Caucasian skin type. During the 15-month follow-up, 38 percent of children and their parents decided to treat the warts, a decision that was more likely when warts were bigger and bothersome. Eighteen percent used over-the counter treatment only, 15 percent used a family physician-provided treatment only and 5 percent used both.

The authors expect these findings to be useful in the process of shared decision making with parents and children. They conclude parents and family physicians should weigh the benign natural course, the adverse effects of treatments and the costs on the one hand, and the effectiveness of treatments and the risk of spreading untreated warts on the other.

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Chest pain in children isn’t usually from the heart
  Chest pain  

Chest pain is something that scares everyone. Fortunately in children, the pain is usually caused by something other than the heart. A study by Boston Children’s Hospital looks at that complaint and found that we typically see that chest pain in children usually comes from musculoskeletal or gastrointestinal issues. This is very reassuring for all of us who take care of children.

The multi-institutional study, led by cardiologists throughout New England and published recently in Pediatrics, was conducted using a unique quality improvement methodology called Standardized Clinical Assessment and Management Plans (SCAMPS). It found that chest pain in children, rarely caused by heart disease, can be effectively evaluated in the ambulatory setting using minimal resources, even across a diverse patient population.  

"Previous research has shown that children referred for chest pain infrequently leads to a diagnosis of a cardiac condition, and yet, we continue to see referrals at very high rate," says the study's senior author David R. Fulton, MD, chief of outpatient cardiac services at Boston Children's Hospital.

In fact, one study found that among 3,700 children and young adults, ages 7 to 22, who were evaluated for chest pain in the outpatient clinics at Boston Children's from 2000 to 2009, only one percent were found to have a cardiac cause.1 The researchers also found that the patient testing involved with those visits was quite disparate - from extensive to minimal.

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Mount Nittany Health names Kristina Taylor-Porter, MA, executive director of Children’s Advocacy Center
  Kristina Taylor-Porter  
Photo provided by The Indiana Gazette

Mount Nittany Health is pleased to announce the appointment of Kristina Taylor-Porter, MA, to executive director of the Children’s Advocacy Center. In her role as executive director, she will oversee and direct the management of the Children’s Advocacy Center to ensure that children are the first and main priority of the facility every single day. In addition, Taylor-Porter will serve as the Children’s Advocacy Center representative in building relationships with agencies and organizations that are essential to the well-being of children who have been abused, witnessed abuse or are at risk of abuse or neglect.

“I am very pleased with the hire of Kristina as executive director for the Children’s Advocacy Center,” said Steve Brown, FACHE, president and CEO, Mount Nittany Health. “As the region’s health leader, it is Mount Nittany Health’s responsibility to protect the most vulnerable, and I am confident that she will do a tremendous job to help the children in our community.”

Taylor-Porter has most recently served as executive director and forensic interviewer for The CARE Center of Indiana County. She earned a bachelor’s and master’s degree in sociology from the Indiana University of Pennsylvania, and serves on multiple committees, both locally and statewide, including chair to the development committee for the PA Chapter of Children’s Advocacy Centers and Multidisciplinary Teams.

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Recent product recalls

Here are just a few of the recent product recalls announced by the U.S. Consumer Product Safety Commission (CPSC). For the most up-to-date recall information, please visit and click on the Recalls tab from the home page.

Name of product: Children’s one-piece footed pajamas by The Children’s Place

Hazard: The footed pajamas fail to meet the federal flammability standard for children’s sleepwear, posing a burn hazard to children. The garments are being recalled, because they do not meet the tight-fitting sizing requirements.

Incidents/Injuries: No injuries have been reported.

Description: This recall involves three styles of The Children’s Place bunny-themed one-piece cotton footed pajamas. One style is pink with dark pink bunnies and a ruffle at the neck. It was sold in size 9-12 months. This style has a sewn-in label at the side seam with both 2158 and one or more of the following numbers: 042521, 042523, 042571, 042572, 042774 or 042816. The other two styles are both blue/green with bunnies on the feet and bunny print fabric. They were sold in sizes 9-12 months, 12-18 months, 18-24 months, 2T and 3T. One style has bunnies with eyeglasses. The other has bunnies and yellow chicks. Both styles have a sewn-in label at the side seam with both 2598 and one or more of the following numbers: 030647, 030779, 038826, 670409, 670602, 670603 or 945210. “Made with love by PLACE” with a heart outline is printed at the neck of the pajamas. 

Sold exclusively at: The Children’s Place stores nationwide and online at from January 2012 through May 2013 for about $15

Manufactured in: China

Remedy: Consumers should immediately take the recalled pajamas away from children and return them to any The Children’s Place store for a full refund.

Consumer contact: Contact The Children’s Place toll-free at 877.752.2387 between 9:00 am and 5:00 pm ET Monday through Friday, or go online at and click on Customer Service for more information.

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