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Holiday Tips

November 26, 2019 by  
Filed under Uncategorized

By Susan Shor

With holidays here already, life becomes more frenetic. Many people thrive on the excitement, family, parties, and big meals, but children who have autism, sensory issues, or just plain need routine, this time of year can add extra strain.

Here are a few things to keep in mind to maintain your holiday joy and also give your children what they need.

1. They aren’t doing it on purpose.

This seems so obvious, but it’s not. I know. When you are running around, listening to honking horns, or trying to organize a meal for 16 and your child is acting out, remember that acting out is a symptom of something they can’t express or don’t even understand is bothering them. As a parent with a sensitive child, you have to stay preternaturally calm (I know, so hard) and play detective.

2. Give them plenty of warning.

Don’t spring things on them. Let them know what’s happening ahead of time. Be as detailed as you can. Make a visual schedule, if they like that. Then check items off together. Consider a seating chart.

3. Build in downtime.

Your child is not insulting you or anyone else if they need to leave the table or the big family celebration. Even adults sometimes need to get away from the fray. Build breaks into your schedule. Make sure you let your child know that excusing themselves to go to a quiet, safe place is OK. Develop a signal that you can use if you feel your child needs a break, but hasn’t yet realized that. Remember, children are not that self-aware. Transitions during meals or before and after them make for good times for a child to slip away for a few minutes without it becoming a fuss.

4. Assign your child a job

Sometimes, being involved and busy helps. Your child can focus on a task and feel proud of an accomplishment. Try to make the task a familiar one instead of adding something new during a stressful time. What chores or tasks does your child do regularly? If they clear their plate after dinner, consider asking them to help with that job. Practice with family meals beforehand.

5. If you’re a guest: Ask for accommodations

No, you can’t expect the world to revolve around your child, but you can  explain what your child needs and accomplish some of what is on this list anyway. If you are staying local, can you bring your child over to practice and set up a safe space? Even if you are traveling (a different set of issues I will tackle later), see if you can get a heads up on the schedule or pictures of the holiday setup. Any preparation you can give your child will help.

6. Remember … things happen

No matter how prepared you are, no matter how much everyone understands and loves your children, something may go wrong. The hardest thing you will have to do is learn this: Don’t sweat it. You and your children are doing the best you can and the people who love you know that. You are probably harder on yourself than any of them will ever be.

Now relax and enjoy the holidays.

Helping Your Child When They’re Struggling At School

November 13, 2019 by  
Filed under Uncategorized

Throughout their educational lives, children encounter challenges, but if your kid is suffering from serious or sustained behavioral or learning problems then you need to intervene and help them get back into the habit of learning. Here are some of the best ways you can support your child through this tough period and work with them to make education fun.

Figure out what kind of help they need

Just as there are many different types of child and learning, there are also many different ways that children can be helped if they struggle with their learning. Work out what your child is struggling with by talking to their teachers so that you can help them to get the proper assistance they need to get back into learning and growing as a person.

Work with a therapist to get to the root of the problem

For those children displaying more serious behavioral issues, find a child therapist who can help you figure out if there is a more serious mental health problem causing your child’s struggle, or if they simply need more support in certain areas of their learning. It’s important that you completely understand what’s going on before you try to fix it, so work with your child’s therapist to understand the problems they have and work out a solution.

Explore different educational options

If you feel that your child’s current school is not giving them the support they need, then do some research on other schools where they could flourish. Look out for schools with smaller class sizes and a greater focus on individual progression, such as the Arizona charter schools offered by the Academies of Math and Science. Establishments such as the Tucson Charter School and the Phoenix Charter School offer exceptional teachers, cutting-edge facilities and a focus on using the best teaching techniques available, so you’ll know that your child is in safe hands.

Give them support at home

A child’s home life can have a serious effect on their learning, so try to give them as much stability and tranquility as possible when they return from school. Try your best to create a safe and cozy space for your child to do their homework in, and make them a routine so that they get into the habit of studying and then relaxing. Try not to make them feel like a failure for struggling at school, and instead offer them a supportive space in which they feel able to open up and improve their performance.

The most important thing to remember when you’re trying to help a child who’s struggling at school is not to panic or get angry with them. Even if you don’t think they’re putting a lot of effort into learning, there may be a problem that needs addressing, so don’t be unkind to your child or they’ll come to resent you as well as learning. Instead, be patient and understanding so that your child can get back to excelling as soon as possible.

Get a Good Flight’s Sleep the Next Time You Travel

November 6, 2019 by  
Filed under Uncategorized

By Nilong Vyas, MD

For many people, getting sound sleep on an airplane flight is as elusive as seeing a unicorn. For this reason, airlines have spent millions of dollars developing their on-flight sleep environments to help their passengers get some shut-eye on long flights. Still, many passengers turn to medications because they’re available over the counter and are considered an easy fix. However, with a little planning before your flight, it’s possible to have a “good flight’s sleep” without turning to a pill.

First, it’s important to do your research and determine how many time zones you’ll be traveling through and what the time will be when you arrive at your destination. Plan to either sleep or be awake at your destination based on its time zone. For example, when traveling east to India from the United States, many flights arrive during the new country’s morning time. In this case, it’s important to sleep on the flight so you can be awake “with the natives” upon landing. In order to do that, provide yourself with the most ideal sleep environment possible. You may have to go to sleep before your body is ready to sleep. In that scenario, bring along a great eye mask that doesn’t allow any light to enter your eyes and is soft to wear and doesn’t get caught in your hair. Find a great set of noise-canceling headphones because they will drown out the excess noise that is common on planes and will also allow you to listen to quiet music, white noise, or guided meditation through your phone or device to help lull you to sleep. Finally, pack your favorite pj’s and a warm shawl or blanket and make sure to change into them once you board the plane. Being comfortable and at a comfortable temperature will help you get to sleep.

Even if you are unable to fall asleep on the plane, try to rest during the flight. Stay away from alcoholic beverages and drink plenty of water instead to stay hydrated. Finally, limit electronics because the blue light they emit from their screens will stimulate your retinas and cause wakefulness.

When you arrive at your destination, if it’s daytime, make sure that you get lots of light stimulation, either from sunlight or artificial light. This will keep your body from producing sleep-inducing melatonin. Try not to nap during the day, and get to sleep that night at a reasonable time (when the “natives” would be sleeping), which will get your sleep cycle back on track.

Happy sleep and safe travels!

About the Author: Nilong Vyas, MD, is a mom of two children and the founder and owner of Sleepless in NOLA sleep consulting, in New Orleans, Louisiana.

Sleep Better, Starting Tonight

October 22, 2019 by  
Filed under Uncategorized

By Nilong Vyas, MD

In our hard-driving culture, sleep is often seen as a sign of weakness, and some people even brag about how little sleep they get each night as if it’s a badge of honor. Yet there is no question that we need adequate sleep to perform at our best. What’s more, lack of sleep increases the risk of chronic diseases such as dementia and heart disease.

Even if you’re convinced of the benefits of a good night’s slumber, you might still find yourself struggling to fall asleep—and waking up feeling tired and groggy the next morning. If getting a restful night’s sleep has been a challenge for you, try the following tips.

  • Evaluate your bedroom. Create a cool, comfortable, and dark sleep environment that is free of clutter and noise.
  • Eliminate caffeine after noon, if possible.
  • Turn off all screens at least an hour before bedtime. If that is not possible, use a blue light filter device on your screen to diminish the blue light emitted. Blue light can stimulate your retinas and cause wakefulness.
  • If you’re having difficulty sleeping, don’t try to force yourself to fall asleep. It is best to get out of bed, move around, and journal or read a book. Then try to get back to sleep once you’re feeling sleepy again. This process may take up to an hour and a half.
  • Aim for achieving seven to eight hours of sleep per night.
  • Finally, prioritize sleep just as you would nutrition and exercise. The overall health impacts are truly great.

About the Author: Nilong Vyas, MD, is a mom of two children and the founder and owner of Sleepless in NOLA sleep consulting, in New Orleans, Louisiana.

What Your Sleep Position Says about You

September 24, 2019 by  
Filed under Uncategorized

By Nilong Vyas, MD

Sleep is essential not only for healthy development but also for the maintenance of health. Most people are not getting enough sleep as it is, so in my opinion, any sleep position that allows you to get adequate sleep is the ideal position for you. If a particular position isn’t allowing for good-quality, restful sleep, then you should seek out a better position. Or if you are waking in pain or experiencing cramping in
an extremity such as an arm or leg after a full night’s sleep, it’s time to evaluate your sleep position.

What’s the absolute best sleep position? Unfortunately, research to answer this question reveals contradictory information, and the benefits of certain positions vary based on what is going on with an individual. For example, if you’re experiencing neck pain, back sleeping may help to eliminate that issue. However, if you suffer from sleep apnea, back sleeping is not helpful and can even be harmful. But most often, it has been shown that sleeping on your left side in the fetal position is the ideal sleeping position for most people. When you sleep on
your left side, it allows your body’s organs to better eliminate the waste in the intestines as well as promotes better blood flow through the major blood vessel in the body, the vena cava. This is also a good position if you suffer from neck pain or snore. Further, even though the body looks symmetrical on the outside, this isn’t the case on the inside. The heart, spleen, and stomach are all on the left side of the body, and because the aorta (the main blood vessel of the heart) arches over the left side of the heart, sleeping on your left side eliminates the possible congestion that can be created by sleeping on your right side. So sleeping on the left is better for your heart. Finally, sleeping on your left side levels off the acidic juices in your stomach and prevents the potential for reflux that can happen if you are a stomach sleeper.

Interestingly, your preferred sleep position can say a lot about your personality type. Stomach sleepers are known to be playful and free-spirited, but they can also experience chronic neck and back pain from this position, so they might want to consider a side-lying position. Back sleepers tend to be the strong and silent type, but as they get older, they may have difficulties with snoring or sleep apnea. However, back sleeping does help those with reflux and helps maintain the neutrality of the spine. The fetal position sleeper is known to be soft on the inside and hard on the outside. This may be the perfect “balance” of personality as it has been shown to be the best sleeping position for most people.

So what personality trait are you, and what sleep position do you fall into? And would you be willing to try it a different way tonight? If so, you may wake up feeling like a whole new person.

About the Author: Nilong Vyas, MD, is a mom of two children and the founder and owner of Sleepless in NOLA sleep consulting, in New Orleans, Louisiana.

Get Ready for Fall Allergies Because They’re Headed Your Way

September 23, 2019 by  
Filed under Uncategorized

A few simple tips will keep you sneeze- and wheeze-free this fall

 

By Sonal R. Patel, MD

 

The arrival of autumn can mean the return to bad allergy symptoms, but there is good news: If you start planning now, your allergy symptoms will likely be much less severe, and you’ll be able to enjoy the beauty the fall season brings. With a bit of preparation, you won’t get hit as hard with sneezing, a runny nose, and itchy eyes when fall allergies descend with full force. It’s a matter of planning ahead for what you know is coming based on your past experiences.

 

Here are four tips from the American College of Allergy, Asthma, and Immunology to help you keep fall allergy symptoms from ruining hayrides and your enjoyment of the changing leaves.

 

  1. Don’t confuse lingering warm temps with summer. The coming of fall doesn’t automatically mean cool weather. Unseasonably warm weather for longer periods of time is no longer a rare occurrence. Mild temperatures along with rain can promote plant and pollen growth, while wind accompanying rainfall can stir pollen and mold into the air, heightening symptoms for fall allergy sufferers. Because fall allergies may start earlier and last longer, it’s important to begin taking your allergy medications at least two weeks before your symptoms normally start. And don’t stop your medications until pollen counts have been down for about two weeks—usually after the first frost. 

 

  1. Beautiful leaves + mold = misery. Those autumn leaves may be gorgeous, but once they’ve fallen, they begin to gather mold. And mold is an allergen that thrives in fall. In addition to leaves, mold can be found anywhere there is water—including in your backyard, in a field of uncut grass, and in clogged gutters. If you are allergic to mold, the key to reducing it is moisture control. Be sure to clear standing water anywhere you find it. You can also help ward off mold by cleaning gutters regularly and keeping your home’s humidity level below 60 percent.

 

  1. Don’t let back to school mean back to allergies. If your child suddenly seems to have a constant runny nose, itchy eyes, a cough, and sneezing, they could be dealing with allergens in their classroom. Kids can be allergic to dust in the classroom, or there might be pollen coming in through open windows. And don’t forget about mold—often found in bathrooms and locker rooms—as well as dander from pets that other kids may bring in on clothing and backpacks. If your child seems to have symptoms that came on around the time school started, make an appointment with an allergist. An allergist can set your child on the right track, for the long term, to handle their allergies or asthma.

 

  1. Dodge pollen to dodge symptoms. Whether it’s ragweed, which is fall’s most prominent pollen, or another type, keeping pollen out of your life means fewer allergy symptoms. Some simple “housekeeping” tips can help. When you come in from outside, make sure pollen doesn’t come with you. Leave your shoes at the door and throw your clothes in the washing machine. Shower and wash your hair in the evening before bed so you’re not sleeping with pollen and getting it on your pillow and in your nose. Keep your windows closed and run the A/C in both your home and your car. Monitor pollen and mold counts online so you can determine when it’s best to stay inside.

 

If allergy symptoms are getting in the way of doing the things you want to do, see an allergist. An allergist can help treat your symptoms and help you get your life on track. For more information about controlling fall allergies and asthma, visit AllergyAndAsthmaRelief.org or MyAllergyMD.com. 

 

About the Author: Sonal R. Patel, MD, is a mom of twin daughters and an allergist with Huntington Asthma and Allergy Center in Pasadena, California. She is double board-certified in allergy-clinical immunology and pediatrics. She is the coauthor of The Mommy MD Guide to Twins, Triplets, and More. You can find her on Twitter @TMommyMD.

Don’t Let Back to School Mean Back to Allergy and Asthma Symptoms

September 11, 2019 by  
Filed under Uncategorized

Prepare now so your child eases into a symptom-free year

By Sonal R. Patel, MD

For kids with allergies and asthma, summer break from school can also mean a break from their symptoms. When school starts up again in the fall, classrooms are often filled with allergy triggers kids don’t face at home, causing a return of allergy and asthma symptoms parents haven’t seen in their kids since school let out for the summer.

In the fall, I see an increase in kids’ visits to my practice for allergies and asthma. And hospitals experience what’s known as the September Spike because kids who have been off asthma controller medications for the summer start experiencing flare-ups in the fall. When kids return to school, they’re exposed to different allergens—in the classroom, out on the playing fields, and in the school cafeteria—many that they probably haven’t run into all summer. In addition, it’s ragweed season, and for kids who are allergic, it’s a terrible time of year.

Below are five tips to help children steer clear of fall allergies so they can focus on classwork and school activities rather than suffering from runny noses, headaches, and asthma attacks.

  • Find an allergist, find relief. Well before your child heads into the classroom, make an appointment to see a board-certified allergist. Your allergist will create an allergy action plan for your child by identifying triggers your child may run into and helping them understand what causes their symptoms. Children with asthma who are under the care of an allergist have a 77 percent reduction in lost time from school, and an allergist can set your child on the right track, for the long term, to handle their allergies or asthma.
  • Identify potential problems at school. Sometimes parents must act as detectives to root out asthma and allergy triggers at school. Does the school have new carpeting? Sometimes volatile organic compounds (known as VOCs) can result from new carpeting and cause wheezing and sneezing. Are there open windows where pollen can drift into the classroom? Is there a class pet that might be causing allergies? How about mold in the bathrooms? Potential triggers should be discussed with the teacher and school administrators so they can take action to help ease symptoms.
  • Get everyone out on the field! Children who have asthma or allergies should still be able to play any sport they choose as long as they follow their allergist’s advice. While playground games, physical education class, and after-school sports can all trigger exercise-induced bronchoconstriction (EIB), if your child’s asthma is under control, they should be able to participate. Asthma symptoms during exercise may indicate poorly controlled asthma. Make sure coaches and physical education teachers know what to do in case of an asthma-related event.
  • Consult an allergist to confirm a food allergy. Parents are sometimes given misinformation about food allergies thanks to home tests and unreliable sources. About 5 to 8 percent of children have diagnosed food allergies, and it’s important to work with an allergist to arrive at the diagnosis. If your child does have a food allergy, make sure the school is fully informed. Work with your allergist and school staff to create an action plan that lists the foods your child is allergic to, what treatment needs to be given, and emergency contact information.
  • Prep your child. Make sure you’ve discussed how to handle emergencies with your child. No matter what state you live in, your child has the right to carry and use asthma and anaphylaxis medications at school. Children who are at risk of anaphylaxis should have auto-injected epinephrine available to prevent this severe, life-threatening reaction caused by allergies to certain foods or insect stings. Be sure your child and school staff know how to use emergency medications.

A board-certified allergist is the specialist best trained to treat your child’s allergies or asthma. Work with the allergist to make sure that your child’s allergy medications are appropriate for their height and weight, their asthma action plan is up-to-date, and symptoms are under control.

To ensure you’re fully prepared for the fall, contact your allergist. If you need help locating one, use the “Find an Allergist” feature on the American College of Allergy, Asthma, and Immunology’s website (ACAAI.org/locate-an-allergist). You can also visit MyAllergyMD.com for more information.

About the Author: Sonal R. Patel, MD, is a mom of twin daughters and an allergist with Huntington Asthma and Allergy Center in Pasadena, California. She is double board-certified in allergy-clinical immunology and pediatrics. She is the coauthor of The Mommy MD Guide to Twins, Triplets, and More. You can find her on Twitter @TMommyMD.

Read every parenting book out there, then throw them all out the window!

March 1, 2019 by  
Filed under Uncategorized

By Sonal R. Patel, MD

There’s a certain lure to self-help books—especially if you’re anything like me. I’m always on the quest for more knowledge; I’m the perpetual student.

I’m constantly either looking for ways to better myself, or looking for ways to do things better or faster. In other words, a shortcut!

I am embarrassed to admit this, but I’ve read almost every popular parenting book out there. Heck, I’ve even coauthored a surviving twins guide! And before I was a parent, I read many self-help books on dating, better communication, how to improve my career, etc.

Well, by read, I don’t mean that I actually read all of the books from cover to cover. I usually skim through them, or read only particular chapters of interest or those that I feel will be of benefit to me.

What I’ve come to realize is that there’s no magic solution to parenting. There’s no hack.

Parenting is a work in progress. It’s an evolution of ourselves and our children.

Some parenting techniques require both parents (and often grandparents) to consistently apply them for them to be able to work. Some techniques are more rigorous than others. Some are too lax for my parenting style; some are too rigid. But I like picking up a few key ideas from each book. You have to know your own temperament and your child’s. You have to constantly adjust. Needs change as situations change and as your child’s development changes. Know your child, and know yourself so that you can anticipate problems and set boundaries, but adjust them when you need to.

No one tells you how hard parenting is going to be! No single self-help book can help you hack parenting. It’s a work in progress for all of us.

PS: My current favorite is Weird Parenting Wins by Hillary Frank of the podcast The Longest Shortest Time.

About the Author: Sonal R. Patel, MD, is a mom of twin daughters and an allergist with Huntington Asthma and Allergy Center in Pasadena, California. She is double board-certified in allergy-clinical immunology and pediatrics. She is the coauthor of The Mommy MD Guide to Twins, Triplets, and More. You can find her on Twitter @TMommyMD.

Fans + Sleep = ?   

January 24, 2019 by  
Filed under Uncategorized

By Nilong Vyas, MD

As a Pediatric Sleep Consultant, I recommend the use of a fan or sound machine when a child is learning to sleep through the night. A fan can drown out noises that may cause wakefulness such as cars going by, pets in the home, other siblings as well as a multitude of things that may wake a child and can prove to be advantageous in those situations. However, once the child is sleeping through the night for at least a period of 1-2 months, my recommendation is to start working to eliminate the fan or sound machine (white noise machine) by decreasing the intensity of the sound every few days until it is no longer in use. Once the sound machine has been eliminated, if certain situations arise, for example, thunderstorms, fireworks, or traveling with the child, the temporary use of a sound machine is beneficial. Again, when that situation has resolved, use of the sound machine can be terminated as well but kept handy for certain necessary situations.

The primary disadvantage of sleeping with a fan or sound machine is that most people (adults as well as children) get used to having that sound present and then can no longer sleep without that sound. So much so that if the power goes out or something interferes with the sound, such as when traveling, it can inhibit sleep when that white noise terminates. App creators and developers have tapped into that market, however, and have created apps as well as travel fans that one can take with them anywhere and have any time in order to recreate that white noise (whether it’s a fan sound, a/c sound, airplane sound or even waves) in order to help one fall asleep. Although helpful, the use of many of these devices is dependent on electricity and another prop that if it were to fail, can cause loss of sleep. It is my preference and advice to eliminate the need and dependence on the white noise so that one can sleep without it. My husband is one of those addicted to the sound of a fan and has strong connections to that sound and sleep. So much so that when we were traveling to Europe for our honeymoon (before the era of cell phones and apps), and the room did not have an A/C or a fan, he had to leave the water running in the bathroom in order to recreate that sound to be able to sleep!

The use of an actual fan can be beneficial for infants or children in that it creates airflow in the room. If that is necessary, it is best to use a fan that does not make noise so they don’t become dependent on that sound in order to sleep. The advantage of a fan or sound machine is for those that live in noisy environments where the sounds are out of one’s control. For example, if you live in a noisy apartment building or have to travel for work and the sleep routine is constantly affected, a fan can provide a reassuring hum that helps drown out extraneous noises and allows one to fall into a deep slumber.  Make sure in those situations that you have ample batteries for your device or chargers, and you pack the device before the travel takes place.

The health risk fans can pose is when they are not cleaned properly. Whether it’s a ceiling fan or a table fan, the blades need to be cleaned regularly. Dust can collect on the blades and when in motion, that dust can be blown around and possibly inhaled and cause respiratory issues. The same concern exists for air conditioners as far as the sound it creates and the dependency it can potentially create for some in that they can only sleep with the sound of the cooling fan blowing. In addition, the filters need to be replaced often, in order to maintain a unit that works efficiently as well as one that does not cause mold or dust buildup in the room or house.

Many people prefer to be on the cooler side when sleeping, down to 60-70 degrees. For those that like it cool when they sleep and absolutely need the air condition, again, it’s best to use a unit that does not make too much noise or keep the fan portion off so the cooling benefits can still be met but without the sound association.

About the author: Nilong Vyas, MD, is the president and CEO of Sleepless in NOLA, in New Orleans.

Sleepless in Seattle? Or Philadelphia? Or New York?

January 23, 2019 by  
Filed under Uncategorized

By Nilong Vyas, MD

Here’s how to solve sleep problems while traveling.

Insomnia can be a critical issue when traveling, when you need to be somewhere important and need to be rested; or mentally prepared for a meeting at work the next day. Most people reach for the quick fix of an over the counter pill such as melatonin, ZzzQuil, or prescription medications like Ambien. These remedies work, but they have many negative side effects, including dependence on these meds in order to be capable of falling asleep.

Melatonin works well. It’s useful when traveling across time zones to help you increase the amount of natural melatonin that is released in the body based on its circadian rhythm that may be out of sync since landing in a new time zone. It helps with sleep initiation (as one is falling asleep) but not the continuation of sleep (keeping one sleeping through the night). That is when a medicine such as ZzzQuil can be beneficial because it can help with the initiation of sleep and also maintenance of sleep. Like melatonin, Ambien helps you get to sleep but not necessarily stay asleep if awoken in the middle of the night.

The active ingredient in ZzzQuil is diphenhydramine HCl, an antihistamine whose side effect is to cause sleepiness. But there are multiple inactive ingredients such as various artificial color combinations, high fructose corn syrup, and alcohol. Melatonin pills mostly have melatonin unless it is a flavored tablet with other additives such as lavender or mint. Ambien (active substance zolpidem tartrate), however, has lots of additional additives such as colloidal silicon dioxide, hypromellose, microcrystalline cellulose, and polyethylene glycol, to name a few. These may cause sensitivity or reaction in some in addition to not fully assisting in fixing the insomnia.

My preference, as a sleep consultant, is to advise the use of non-consumable sleep aids that don’t have a risk of dependency such as blackout curtains, sound machines, blue-light restriction devices, and a soothing sleep environment. These tools can be used anywhere and everywhere to allow one to fall asleep easier by creating a proper environment for sleep. If there are situations in which these tools are not available or accessible, it is fine to use a medicinal sleep aid as long as it is used for a very short period of time (over the course of a weekend of travel). Also, if having a bout of insomnia that is atypical, using one of the medicinal sleep aids described above is acceptable, again for a short period of time.

When good sleep habits are not used and one comes to rely on medicinal sleep aids, the dependency grows and it is then hard to go back to simple sleep aids such as good sleep hygiene.

About the author: Nilong Vyas, MD, is the president and CEO of Sleepless in NOLA, in New Orleans.

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The information on MommyMDGuides.com is not intended to replace the diagnosis, treatment, and services of a physician. Always consult your physician or child care expert if you have any questions concerning your family's health. For severe or life-threatening conditions, seek immediate medical attention.