Bedwetters Anonymous

You know what’s great? That my 8 year old is not totally stressed out that she is still an occasional bed wetter. It happens to her about once every six months, and the way I’ve explained it to her is that she gets into such a deep sleep that she doesn’t even realize that it is happening until it does. She’ll tell me by saying, “Mom, I was in a really deep sleep last night....” And I know what’s coming.

Benign bed wetting is fairly common and can make kids quite anxious and avoid sleepovers and other situations where this might happen. When talking to patients & parents about this topic I think it’s important to get out of the way IMMEDIATELY actual physical causes of bedwetting—like urinary tract infections. Medical causes do happen, as do psychological ones—like a significant life change for a child— a new sibling, parent divorce, move, or other transition. And these are all important. But once these causes have been considered, then you’re back to my 8 year old, a random, occasional bedwetter.

Some kids wet the bed very regularly and there are some strategies that can be really helpful to aid in decreasing the number of sheets washed per week, such as:
• Limiting fluids by mouth after 6pm
• Waking them up for a bathroom trip once in the middle of the night
• Even trying out one of those bedwetting alarms can help make families’ lives much easier when they are dealing with this.

Older kids do NOT want to sleep in a pull up so I really recommending trial and error of some of the other strategies to help kids manage. One pediatrician colleague told me “kids won’t go to college as bedwetters” and I’ve repeated this over and over to try and reassure people far and wide that it’s simply a matter of time before it’ll all be in the rear view mirror.

Occasional bed wetting does seem to run in families, and most kids totally outgrow it by the time they are teenagers. For the “rare” or “occasional” crowd, I generally suggest NOT MAKING A BIG DEAL ABOUT IT. At all. I can guarantee that kids are never happy that it happens so there’s really no need to pile on here. The less anxiety, the better.

If you’re reading this and have experience in this area, I hope you’ll comment and share what you know; what has worked and what hasn’t. If you’re new to this gig I really suggest trying the “deep sleep” explanation: it shifts any and all blame from the child and puts it into some perspective for them. I’ve known kids who wet their beds up until 12 or 13 years old. They’re in college now, and you know what? They’re fine. And sleeping in a dry bed each night.

Christina Johns, MD, MEd is the Senior Medical Advisor at PM Pediatrics. As a parent, pediatrician and pediatric emergency physician with a master’s in education, she shares her own expertise, plus the wealth of knowledge from our highly skilled staff, with patients and families everywhere.


Follow Dr. Christina online for everyday health tips, insightful articles and more.

PM Pediatrics: Now Open in Annapolis
Festival at Riva Shopping Center

PM Pediatrics is the specialized urgent care just for kids from cradle through college. Open every day until midnight, the practice’s kid-friendly themed offices are staffed by Pediatric Emergency Specialists and feature on-site digital X-ray and lab. PM Pediatrics treats a broad array of illnesses and injuries – from earaches, fevers, infections and abdominal pain to dehydration, asthma, fractures and wounds requiring stitches. The result is the highest quality after-hours pediatric care, delivered with comfort and convenience to both patients and their parents. To learn more about PM Pediatrics’ services, visit


High-Risk Holiday Season Scenarios – Tips for Keeping Your Family Safe

Article written by: Samuel M. Libber, MD, Annapolis Pediatrics

The holidays are times of great joy, celebration, and sharing with family and friends. Our routines shift, our day-to-day patterns change, and life takes on a different pace. To a child, however, these changes can expose them to a number of risks both inside and outside of the house. Taking a few moments to remind ourselves of these risks may pay gigantic dividends....and maybe even save a life.

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According to the Centers for Disease Control, transportation-related accidents rate highest in terms of risk to children. Motor vehicle accidents, in particular, are the most problematic. At holiday time, long car trips, drivers impaired by alcohol or sleeplessness, crowded roads, and poor weather conditions present hazards to kids and their families. Heightened defensive driving, proper seat-belt and car seat use, frequent breaks, and timing trips to avoid high-risk scenarios will all help to lower these risks.

Household injuries, such as falls and burns, also pose threat to kids (and their family members). While celebrating, adults may temporarily let their guard down when supervising their children. Kids can easily fall, harming themselves and potentially requiring emergency care. Candles, electric fixtures, and lit fireplaces can be especially intriguing to small children and can lead to contact burns, scalds, and fires.

Be careful, too, about ingestions. Little children may find their way into bottles of brightly colored pills lying on tables or countertops, or in purses left open from visiting family and friends. In only a short time, a child may consume enough to have a serious or even fatal ingestion. Watch out for mistletoe and holly, both of which have potentially disastrous effects when consumed. Poinsettias have had a bad rap, which has been largely disproven for humans...although not necessarily for pets.

Enjoy your holidays and treasure the time with your family and friends, but remember to be mindful of potential hazards. You will thank yourself for the extra few minutes you take to prevent possible mishaps from happening. Happy---and safe---holidays!


For over 60 years, Annapolis Pediatrics has provided superior healthcare to infants, children, adolescents, and young adults in Annapolis and the surrounding communities. In some cases, we have cared for three generations of families. We strive to provide high quality medical care, from excellent clinical care to a positive customer experience for our patients and their parents.

We have over 30 physicians and nurse practitioners in 5 locations: Annapolis, Crofton, Edgewater, Severna Park, and Kent Island. We also offer M-F walk-in hours at our Annapolis office for short sick visits.

For more tips and information from your local pediatrician, visit us at:

Be Still My Beating Heart: 5 explanations for an elevated pulse that you should know

Today I want to talk about some vital signs. These are important, right; they’re VITAL. And we need to have them all working (fairly) smoothly in concert to remain vertical, so I think it’s fair to give them some attention. Most of the time at work, before I even go into a room to examine a patient, I take a look at the vital signs as a way to frame up my assessment.

Let’s first say what the vital signs are:
• Temperature
• Pulse (or heart rate)
• Respiratory rate
• Blood pressure
• Weight

One thing that I want everyone to know is that normal vital signs are different for different ages.

Kind of like in the animal kingdom, where little animals like hummingbirds have usual heart rates of over 200 beats per minute and elephants have rates of 40 per minute: the larger the creature gets, the slower the heart rate is. Same deal in humans. A heart rate of 145 in a baby is perfectly normal, but when I see that number for a teenager I get very concerned, or at least need a reasonable explanation for it.

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Temperature and weight get addressed a lot, don’t they?

Between fever and obesity, many a blog has been written. Respiratory rate is a vital sign that usually makes itself known when there’s a problem: it’s hard NOT to notice when a child is in true respiratory distress. They’re breathing so fast that their chest and abdominal muscles are visibly moving in and out, and they can barely feed (baby) or speak (older child) due to that rapid respiratory rate. Blood pressure is a squirrely one in children: high blood pressure in kids is relatively uncommon, but as the childhood obesity epidemic grows, we are starting see more of it. See how vital signs interrelate?

Let’s get back to pulse.

That’s the number of times the heart beats in a minute. What I want to focus on today is on the heart rate, and specifically, a fast heart rate. The 25 cent word for this is tachycardia (pronounced ta-kick-ard-ee-uh), and it always gets my attention. I’m happy to say that most of the time in pediatrics it is easily explained by reasons OTHER than the heart, but that doesn’t diminish its importance. There are FIVE key reasons for the heart rate to be elevated in kids (adults too, for that matter):

1. Fever

Elevation of the body temperature alone causes the heart rate to increase. The chemicals in our cells that are associated with inflammation (due to whatever cause: infection, auto-immune reactions, etc.) produce a cascade of reactions that ultimately elevate our body temperature “set point”, and that’s why we have fever that hangs on until a fever-reducer medicine is given (acetaminophen or ibuprofen) or the infectious or inflammatory process goes away. Along with those chemical reactions come an increase in pulse, as the heart does its job to help pump along all the infection fighting inflammatory cells in the blood to the rest of the body where they are needed. Thanks, heart, for pitching in and doing your job.

2. Exercise

When we exercise, our muscles need more oxygen to keep going, and as such, the heart rate increases to make sure the oxygen delivery is adequate. Simple as that. As we get better conditioned our muscles “process” oxygen more efficiently and that’s why athletes have lower resting heart rates. Totally normal.

3. Dehydration

When the body is low on fluids, the circulating volume of blood and plasma in your body decreases, and this causes the heart to pump faster in order to get that smaller amount of oxygenated blood to the other organs and tissues where’s it’s needed. Refer to the animal analogy from earlier: the smaller the body, the less volume reserve the body has. That’s why babies get dehydrated quicker than older kids. And it’s one of the MOST common reasons that the heart rate goes up. Again, thanks heart. See #1.

4. Actual heart problems

Kids can get abnormal heart rhythms, called dysrhythmias (diss-rith-mee-uhs...25 cents!) that cause the heart rate to increase. These are typically quite dramatic; I’ve had families say that they could see their child’s heart beating rapidly underneath their shirt from across the room! It’s not unusual for a rapid heart rate due to an actual cardiac cause to yield markedly high heart rates of over 200 beats per minute (BPM), compared to only moderately elevated heart rates due to other causes. Needless to say, a heart rate elevated over 200 BPM in ANY age group warrants an immediate and emergent evaluation, usually with heart monitoring and an ECG (electrocardiogram) tracing. I’m not gonna thank the heart for this one, since it needs to straighten up and act right.

5. Poisons/Toxins/Medicines

Special shout out to THE most common medicine for causing kids to feel like their hearts are thumping away: ALBUTEROL, the friendly neighborhood wheezing medicine. Available in nebulizer or inhaler form, this medicine, while doing a beautiful job dilating and opening up the constricted airways, also has a direct effect on the heart to speed up the rate. In children, this is usually not a big deal and it goes away on its own after a bit of time, but it can be very annoying and distracting. I’ll take it temporarily though, if it means that breathing improves.

Other substances can cause the heart rate to increase: cocaine (yep, I’ve seen it in kids), and one that we always need to keep in the back of our mind- accidental ingestion of an adult family member’s medication. This happens more than we all think, even with our best intentions of keeping medicines away from children. Make sure you have the Poison Center’s phone number handy: 800.222.1222. Those folks are fantastic, and are available 24/7.

This list covers most of the important highlights of what goes through my mind when I see a child with an elevated heart rate. As you can probably conclude from a few of the points above, not every child who comes in with the complaint of “heart palpitations” needs a fancy ECG or X-ray. What they DO need is a full set of vital signs (and maybe a repeat set or two, to catch any potential discrepancies during the first set) and a thorough assessment by a solid clinician to determine the most likely cause. And now that YOU have some insight into what could be the explanation, you’ll be able to follow along the rationale without a stressful increase in YOUR heart rate as well.

Pulse check!

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Christina Johns, MD, MEd is the Senior Medical Advisor at PM Pediatrics. As a parent, pediatrician and pediatric emergency physician with a master’s in education, she shares her own expertise, plus the wealth of knowledge from our highly skilled staff, with patients and families everywhere.

Follow Dr. Christina online for everyday health tips, insightful articles and more.



Learn About Hearth and Home in Early Maryland at Historic St. Mary's City

Sponsored Editorial Courtesy of Historic St. Mary's City

HearthandHome1What did it take to get through the winter 350 years ago? Forget a quick trip to the store—you needed enough food to last until the next harvest, a secure shelter that would keep out the elements, and clothes to keep you warm. At "Hearth and Home in Early Maryland", today’s families can explore the skills that allowed Maryland’s first citizens to weather the cold. Hearth and Home will take place on November 28 and 29, from 11 a.m. until 4 p.m. at Historic St. Mary’s City (HSMC).

Discover the 17th-century version of a refrigerator. Help put our gardens “to bed” for the cold months and assist as we tighten up our fences. See what’s cooking at each living history site – explore open hearths, food preservation, and more!   Watch the trial of John Salter, pig thief, and consider what it took to preserve the peace in early Maryland.  Lend a hand grinding corn, churning butter, and maybe stir a pot or two.   Take home a free colonial recipe book and try some old-style cooking at home. HearthHomeGrindcorn web

Hearth and Home in Early Maryland offers a welcome opportunity for family and visitors to get out of the house after Thanksgiving.  All will gain a new appreciation for the comforts of our homes, and the convenience of modern appliances, utilities, and grocery stores!   HearthandHome3

Begin your visit at the HSMC Visitor Center at 18751 Hogaboom Lane, St. Mary’s City.  Admission is $10 for adults, $9 seniors, $6 students, and free for those under 6 years and Friends members.  Bring a non-perishable food item for the Southern Maryland Food Bank and save $1! 

For more information, call 240-895-4990, 800-SMC-1634, or visit

A Homework Survival Guide for Kids


 A Homework Survival Guide for Kids with ADHD (or anyone who is tired of sitting!)

So your child comes home with homework; all day long they have been encouraged to sit still and be quiet and now you have to coerce your child to do the same. Quite often bribery, threats or even tears ensue. Well no more…here are some multi-sensory ideas to ease the pain.

An interesting thing to consider is that a major difference between the top performing education system (Finland) and ours, is the amount of time spent taking a break and moving around.  Finland gives students approximately 75 minutes of recess daily, while many of our schools allow just 27 minutes of free time to move a day (this is outrageous but a discussion for another day). SO, building movement into homework kills so many birds with one stone; your child gets to move and using their whole body (multi-sensory learning) helps accelerate learning.

Need to work on spelling words?
Spell words out loud while:

  • Bouncing a tennis ball
  • Playing balloon volleyball
  • Playing catch
  • Swinging
  • Jumping rope (Coupling a rhythmical movement with a memorization task actually improves recall)

Have ‘read aloud’ each night?

Read aloud while walking around the room. At every comma, you stop walking and pause in the reading for one second before resuming walking and reading. At every period, exclamation point, or question mark, you stop and pause in the reading for two seconds before resuming. (You can add other movements or features when you encounter different types of punctuation. Here the kids can become very imaginative!)*

Working on skip counting?

  • Jump while counting on the trampoline
  • Swinging while counting on a swing
  • Choreograph a short dance routine that includes simple moves and count on the beat!
  • Use chalk to make a big number line on the sidewalk or driveway. Do addition and subtraction by walking the line.

Silence is overrated!

How about some ’thinking’ music in the background? Choose carefully.  Rhythmical drumbeats are very calming and organizing, and helps maintain attention.  Some classical strings can tap into higher level thinking skills.  DO NOT put on music with an irregular beat (this promotes inattention and distractibility).

Take it outside

How about interspersing answering some homework questions with 5 minute intervals on the playground/swing-set.  Use a timer so you can stay on track.

Switch up the seat

As long as you are armed with a clipboard who says you need to sit on a chair and work at a table?  Dig out an exercise ball and gently bounce while working through the worksheet. Lie on the floor propped up on elbows, or, my favorite for the serious mover is standing on a balance board and completing the assignment.

Heavy work

The most organizing and attention inducing activities are those that involve resistive or compressing actions on our major joints, simply put, pushing and pulling activities.  These could include climbing a rope, ladder or cargo net, tackling the monkey bars, wheelbarrow walks, tug-of-war, push-of-war, riding a bike.  These activities would be excellent to incorporate into homework time.

For personalized strategies to manage ADHD, and Sensory Processing Disorders at home, in school or in the community please call Katie on 240-421-3154 or visit us at   

Katie Ryzhikov M.S.,OTR/L is the owner of Blossom Pediatric Occupational Therapy which specializes in Sensory Integration therapy for children with ADHD, fine and gross motor delays and Autism Spectrum disorders


Content provided by Blossom Pediatric Occupational Therapy


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Upcoming Events Inside Pages

Mon Jan 22, 2018 @12:00AM
Beauty and the Beast, Annapolis
Mon Jan 22, 2018 @12:00AM
Tales of Beatrix Potter, Glen Echo
Mon Jan 22, 2018 @11:00AM
Drum Circle, Baltimore
Mon Jan 22, 2018 @ 3:00PM
Musical Instrument Petting Zoo
Mon Jan 22, 2018 @ 6:30PM
Making Ice Cream, Prince Frederick
Tue Jan 23, 2018 @12:00AM
Beauty and the Beast, Annapolis
Tue Jan 23, 2018 @12:00AM
Mini Golf, Baltimore
Tue Jan 23, 2018 @12:00AM
Tales of Beatrix Potter, Glen Echo
Tue Jan 23, 2018 @11:00AM
Kids Club: English Muffin Pizzas, Annapolis
Wed Jan 24, 2018 @12:00AM
Beauty and the Beast, Annapolis