- Head lice/ Sklice co-pay coupon
- Should you give tylenol before the shots? / vaccine reaction discussion
- Skin fold irritations
- HAND FOOT MOUTH (and butt) VIRUS
- Tips for giving medication
- Strep Throat
- The Poop series: Chapter #1 Baby poop
- Anaphylaxis/Do you need an epipen?
- Nurse Judy' Blog
- Pinworms (ugh)
Friday, October 23, 2020
Adjusting to the time shift I am quite certain that it will happen. Forty eight hours or so before the official directive to set our clocks back, I will glance at a clock somewhere in my house and do a double take, “What? It is only 9 o'clock? It feels so much later!” Sandy will laugh and we will know that he ‘got me yet again’. There are so many clocks to adjust in our houses these days between the clocks in the cars, microwaves, coffee makers, etc. Some adjust automatically, but for the others, in our family it is Sandy’s job to make the changes, and for all of the years that we have been together, it has been his habit to start the process several days ahead of time. Even though I should know better, invariably there will be the moment I look at a clock and get confused and caught off guard. Indeed, twice a year the powers that be have decided that we need to adjust our times either one hour backwards or forwards. Some people love it and others hate it, but unless the law changes, or you live in Hawaii or Arizona, it is something most of us need to deal with. In general, for most adults, other than a tiny bit of lag, a one hour time shift is a no big deal. However it is quite the thing when you have a baby who is already waking up at 6 am. If you don’t make a bit of effort in advance, the ‘Fall Back’ means the babies are now awake at 5am (shudder!) With a little bit of planning, the following tips should make it a bit easier for you. Before we tackle the time shift, let's review some sleep basics. There are many different approaches to helping your kids sleep well, but here are the cornerstones. Getting enough sleep is essential, not only for the health of your child, but for the sake of your own sanity. If your child has the ability to do some self soothing, everything will be easier on you. It is never too early to start paying attention to this. Even if they are only able to doze off without having a nipple in their mouth or by having you actively rocking them once a day, consider that a win. Create a routine and strong sleep association, such as a special song, massage or snuggle. Make the environment conducive to good sleep. People tend to sleep better in cool dark rooms. Babies are no exception. A perfect temp is somewhere around the 68 degree range. See what you can do to keep the room dark. Consider the use of a Hepa filter or white noise machine. Hopefully once your little one weighs more than 14 pounds, they are giving you a good stretch at night and are on somewhat of a regular schedule. This is not something I count on for babies who are younger than 4 or 5 months. For you newer parents, take a deep breath, you need to be patient for just a bit longer. Babies still need to be feeding at night for the first several months. This phase will pass. Even though the young ones don’t usually have a real schedule in place yet, and it is normal for them to be feeding during the night, self soothing, sleep associations and a good environment are still very important, trust me! If you start good habits early, you will tilt the odds in your favor for getting a good nights sleep sooner than later. Once your baby is routinely sleeping through the night, the sleep goal should be that they stay in bed roughly 11 hours after bedtime. If bedtime is 7:30pm, the ideal wake up time would be 6:30 am (I see some of you rolling your eyes at the concept of 6:30 am being considered ideal. Someday you will be able to sleep in again, just not right now.) The simplest way to adjust to the new time zone is to do it gradually. I would suggest starting a week or so earlier and every night, move the bedtime 10 minutes earlier. This fall, the official time to change the clocks is 2am, Sunday, November 1st, but most people (except Sandy) change the clocks on Saturday night. For toddlers and preschool kids, many parents end up purchasing a toddler clock or someway that the kids can see so they know when they are allowed out of bed in the morning. If they get up earlier, for the big kids, calmly walk them back to their room, but with the infants, you can do the check in and pat them. Pam from Sweet Dreams suggests not switching your clocks until you actually wake up on Sunday morning. I tend to agree with her, but I would add that being conscious of the “extra hour” can be a fun thing to do with your kids. For the grown ups, make sure you each get an hour of being off duty. Spend it doing something just for yourself, maybe a bubble bath, or some meditation or go for a run. It is your hour. Your partner gets one as well. For the kids, ask them how they would like to spend their hour. I want to make one more point about the early waking. When my sisters and I were young, my mom was the first one up. She loved the dawn. Sometimes it was because it was the only time she could claim quiet time before the rest of us woke up, but there was something about it that called to her. The reason that this lifestyle worked for her was because whenever she could, she also went to sleep early. Many of us get a second wind in the evenings and enjoy some adult time once the kids are in bed, but if you are routinely exhausted in the morning, it might be worth the effort to put your kids schedule on the back burner for the moment and take a look at your own. Sleep needs vary. How much do you tend to get? How much do you think you need? If you are running at a steady deficit, this is going to start taking a toll on every aspect of your life. Much of the time it is simply about making better choices. Yes, I am saying that perhaps you should stop binge watching whatever series you are following, or put down candy crush and get into bed! If you have trouble falling asleep, make sure your iron and vitamin D levels are within normal limits. When your kids have grown and you are retired, you can sleep in as late as you wish. The years with young kids in the house are fleeting. Most kids are early birds. See if you can train yourself to embrace this, or at least not look at it as torture. If life offered the option of going back in time, I wouldn’t rule out a 6 am encounter with my babies Enjoy your extra hour! I hope your kids behave. You are on your own with your pets......
Posted by Nurse Judy at 1:48 PM
Friday, October 16, 2020
Happy Birthday to Frida the Lamp As many of you know, Sandy and I spent 2 months last year wandering around Europe by train and by foot. Knowing what we now know, I am so grateful that we traveled while we could. We packed extremely sparingly. We each had one small rolling suitcase and shared one smalI backpack that we took turns wearing (meaning I had it 5% of the time and Sandy had it the other 95%) I found that packing cubes were essential (Sandy found them useless). My suitcase was like an intricate puzzle. Things just fit exactly. There wasn’t a spare micro inch for anything else. We didn’t do much shopping, because we simply couldn’t fit anything extra. I joked that every time I used a Q-Tip there was a tiny bit more room in my suitcase. Because we were doing so much walking, we were grateful that we were able to manage traveling so lightly. Typically we would simply have to manage our stuff from the train station to whatever lodging we had chosen. Finding lodging that was walking distance to the train station location was always a consideration when selecting our hotel, or AirBnB. It was amazing how much walking we did. We ended up taking a total of 3 cabs/ubers the entire 2 months! A bit over the midway point in our trip we were in the lovely city of Florence. Our daughter Lauren and her husband Adam had been in Italy several months earlier. She had a favor to ask. While they were there she had fallen in love with a lamp that she saw in a cute little store. It wasn’t cheap. She wavered for several days and couldn’t stop thinking about it. Adam strongly encouraged her to just buy it, and finally Lauren agreed. On their last day, they returned to the store and to their great dismay found that it was closed. How many of you have had the item that “got away”, you were in a store eyeing something, but decided for whatever reason not to buy it and the moment was lost? For Sandy and me, it was a clock. If you live in the Bay Area, you might have seen it. Many years ago, a quirky store in Sausalito had several amazing clocks in their window. These were large clocks with gold wire mechanical figures climbing and moving about throughout. We were both enthralled. It wasn’t so much that they were expensive, but they were also big, and we weren’t even sure where we could put it. One day we were over in Sausalito and saw that the store was going out of business. The one clock left was on sale; should we finally get it? We gave ourselves a night to think about it. When we went back the next day it was gone. The store was shuttered. Of course now that we had lost our chance, we really wanted it even more. We did an internet search putting in all the keywords that might help us, but we never saw anything quite like it. We were out of luck. We still look for it! Whenever we pass an antique shop we pop in to see if ‘Our Clock” is there. So, when Lauren told us about the lamp, we understood. She insisted that she would want to reimburse us, but could we go by and purchase one of the lamps for her? She remembered exactly where the store was. We went to the store and immediately understood why she was charmed. It turns out that there were dozens of these wonderful lamps. They were figures holding umbrella lamp shades. Each one was wearing something different and was holding a different colored umbrella. They all had names. They were all unique. We connected with Lauren over WhatsApp, explained to the puzzled shop owners what we were doing, and wandered through the store showing her all of the options. It is easy to take for granted how easy it is to communicate these days. When I traveled as a teenager my poor mom had to wait weeks for the airmail letters to get through. Lauren ended up choosing the lamp named Frida. We started the process of buying it but when we got to the shipping option we were shocked to find that the shipping cost was almost as high as the cost of the lamp. We did some searching around to see what all the options were. The lamps were NOT available for purchase in the US and there was no way to ship it without paying exorbitant costs. We updated Lauren and she sighed and told us to never mind. Sandy and I thought about it overnight and both of us came to the same conclusion. We would get it and just carry it with us. The store did a magnificent job creating a little handle on the large box and we were on our way. Did I mention “large box’? The lamp was taller than my suitcase. So, as mommies and daddies will do for their kids, we schlepped this large lamp with us for the rest of our travels. If this lamp had her own passport, it would be an impressive one, When we were lucky, Frida got her own seat on the train. During our last night in Amsterdam, for some reason we were upgraded to a 4 bedroom suite (the benefit of traveling off season); Frida the lamp got her own room! On our flight home, she was too large to take on as a carryon, but we were amused that she was literally the first thing to appear on the baggage carousel. Friday now lives happily shedding some light on Lauren’s piano. It is hard to fathom that it was almost exactly a year ago that we got her. It feels like just moments have past, while at the same time it could be a century ago. Many of my posts and stories have a lesson to be gleaned. Hmmmm, not sure what the lesson from this one is. Maybe.. When you see something super special, if you can afford it, don’t let it get away. There are usually more regrets from passing it by, then buying it. OR A bit of short term schlepping is absolutely worth the long term pleasure. OR When we are all are able to travel once again, packing cubes are great! (except for Sandy, but I think more people agree with me!)
Posted by Nurse Judy at 9:26 AM
Friday, October 9, 2020
Teething symptoms and remedies: Dos and Don'ts Normal infants have 20 primary (baby) teeth which have started to develop in the womb. The teeth start to erupt through the gums around 6 months of age. The baby teeth are then shed at various times throughout childhood. At the end of this post, you will find a chart with the normal range of ages when most teeth start to come and go. Occasionally, I have a patient that doesn’t seem to like to follow rules, ignores the charts and does things their own way. I know of one baby who was born with teeth! Another started out with the upper canines and looked like a little vampire. As you can imagine, those parents were so happy when the rest of the teeth popped through. There is some heredity involved. If one of the parents was very early or late it is possible for the baby to follow suit. If you are lucky enough to have the option, check with grandma to see if she remembers anything special about your teething pattern! It is rare for teeth to actually make an appearance before 4 months. Once in a while parents will notice a smooth round white bud on a baby’s gum. This is a little benign cyst called an Epstein Pearl. It is not a tooth and it usually goes away without causing any bother. Many parents think of teething as something they are only dealing with for their young infants. Think again. If your 6 year old is going through an extremely grumpy phase, or has a mysterious bout of mild, clear congestion that has been hanging on for a few weeks, take a feel in the back of the mouth and see if those first permanent molars are starting to pop through. Once your child reached the age of 21, all 32 of the permanent teeth have usually erupted and they can no longer blame their grumpiness on teething. Just like the timing varies, the symptoms may also vary greatly from child to child and even from tooth to tooth. By far, the most common first teeth are the ones in the bottom middle (and they are so cute once they come through). Take your clean finger and run it along your baby’s gum. If the tooth is imminent you may feel that the area of the affected gum feels soft and boggy. Let's talk about the symptoms. Many healthcare providers and dentists dispute that there is any real relationship between teething and any of the symptoms below, but I have been an advice nurse for a long, long (long) time. I speak to parents of teething babies all of the time, and I maintain that I see a connection. Fussiness: Teething is uncomfortable. Most parents report that the babies seem fussier than usual right before a tooth pops through. Do what you can to relieve symptoms, but if your baby is inconsolable (screaming with NO break) for more than 30 minutes and there is nothing you can do to calm them down, please call to have them checked. That would be an extreme reaction and we want to see if there is something else going on. Drooling: Drooling starts weeks and weeks before you actually see a tooth pop through. Many kids will get a drool rash on their chins and cheeks. There are several products that I find quite useful for this. Clean off the area with Cetaphil cleanser (no water needed, apply with a cotton ball and wipe off). Follow it up with aquaphor or cerave ointment (which you can use multiple times throughout the day). Gnawing/biting: Biting on things will feel great to the baby; not so good to your nipples if you are nursing. If your baby starts biting you during feedings I recommend a loud “ouch!!” and immediately remove them from the breast. Most babies can be trained to stop this. Remember that you want to make the association mildly unpleasant so that they will stop the habit quickly. Biting = loud yell and loss of breast! If you are too gentle some babies will think it is quite amusing and will continue to bite at will. Poor Sleeping: If your little one is miserable, this is not the time for sleep training. I would go in quietly and try one of the teething remedies listed below. If you are going through a rough patch remember that parents should take shifts. Give yourselves each a few hours where you are off duty. There is no reason for both of you to be up all night. If you have the option, it is often best for the NON-breastfeeding parent to go in, unless it is time for a feeding. This is a slippery slope; I would try not to feed for comfort throughout the night. Bleeding/bruised gums: It is not unusual to have a little bit of bleeding on the gums. Once in a while you may also see a purple/bluish bruise on the gums right before a tooth breaks through. This will usually resolve without any intervention although something cold will feel soothing. Mildly elevated body temperature: Most dentists will remind you that teething does not cause an actual fever, but I commonly see it associated with an elevated temperature. If a fever goes higher than 100.5 I am not likely to blame it on teething. Any fever that is lasting more than three days is worth a call to the doctor's office to check in. Loose stools: You will likely get differing opinions on whether or not teething can be the cause of loose stools and again; I will state here that I see it all the time. Some folks speculate that swallowing all that saliva and drool might be the reason. Regardless, I do think there is a link. If you have a baby with loose stools, you want to go with the bland, starchy diet and make sure they are on probiotics. Breast milk is safe, but other milk-based products may aggravate the situation. Rashes: If your child has sensitive skin and/or eczema sometimes, you might notice that the general rashiness flares up during active teething. Congestion: Many young teething kids seem to have a clear runny nose and congestion. This can last for weeks and weeks. Sometimes it causes a post nasal drip that in turn causes a little hacking cough. Ear tugging: When kids are working on some of the upper teeth they tend to poke and play with their ears. Uh oh, many of these symptoms are the same thing we look out for if we suspect an ear infection. Even though teething may well be the cause, if I have a patient who is very fussy, feverish, and is having trouble sleeping, I am likely going to want to have someone take a peek in those ears. It is worth having an arsenal of tools at the ready for dealing with the months of teething that you have ahead of you. Chinese herbs: These are a great place to start. A very safe pediatric herbal tincture called Tender Teeth can be obtained at The Acupuncture Den, a family practice located in Noe Valley. Please contact Dr. Den to arrange a pick-up or mail delivery if you’re not in San Francisco. Beyond just the herbs, our local acupuncturist can offer relief with acupuncture and/or non-needle techniques. Many parents report babies taking a long and deep nap after a treatment! Cool teething rings: make sure they are made out of a safe material. Do not tie any teething rings around your baby's neck. Strangulation is a real risk! Frozen washcloth: Wet half of a washcloth and put it in the fridge or freezer. The baby will be able to hold the dry half and chomp happily on the frozen side. For an interesting twist, consider soaking the washcloth in chamomile tea before chilling it. Distraction: There is nothing as nice as a body massage and a warm bath by a calm singing parent. Homeopathic drops: The ones I am most familiar with are Camilia by the Boiron company. Click the Boiron link for a coupon. Orajel’s new formula is also safe. https://www.orajel.com/en/products/child-oral-care/orajel-non-medicated-cooling-gels-for-teething. The older formula which actually numbed the gums was recalled years ago due to safety issues. Make sure you read the labels carefully to make sure that it is Benzocaine free Feeding bags (baby safe feeder, or sassy teething feeder): If your baby has had some solid foods introduced, these feeding bags are great for teething relief. Add a cold hunk of fruit or veggie (pick a food that they have been introduced to already so that you don’t need to worry about any odd reactions) and let them gnaw away happily. With the mesh bag you don’t need to worry about them breaking off a piece that could be a choking hazard. You can find these bags online pretty easily. You can also fill one of the bags with a frozen ‘Milksicle'.Take 3 or 4 ounces of breastmilk, or formula, and combine it with some fruit, like banana, pear or mango. Puree until very smooth and stick it into an ice cube container. Pop out a frozen cube and add to the mesh feeding bag. Spa in your mouth - cool cucumbers of course! This is for kids who have proven themselves to be able to handle actual pieces of food, but for your toddlers who are cutting teeth, these might be a hit. Peel the cucumber, slice into circles, get rid of the seeds. Put the cucumber circles in a bowl in the fridge to keep cool. Teething Tube I actually just learned about these little gizmos from Pam of Sweetdreams infant care. She tells me that her grandson loves this, and it was very helpful getting him through the teething process Chew beads: I have had multiple parents tell me that these beads seemed to help but there is valid concern about these being a potential choking hazard. If Grandma feels strongly about using these, I have no objection as long as you have checked carefully for safety (nothing that can get loose) and are actively watching the baby while they chew on them. These should never be in a crib. I worry about strangulation with any necklace. Brandy/alcohol: Ask great grandma what she used to do for teething and she may tell you that she used to put whiskey or brandy on the baby’s gums. Obviously giving our babies alcohol is not something that most doctors would suggest today, but I actually wouldn’t worry if you caught grandma rubbing some directly on the gums. It probably does help. Some folks also say that rubbing pure vanilla extract on the gums is an effective home remedy. That may be from the alcohol content (I am referring to a tiny amount applied topically, no swigging booze!) Acetaminophen (Tylenol) and Advil (Ibuprofen) are useful but I prefer not to overuse them. Make sure you are using the proper dose. Start with the other approaches first. If possible, I would prefer to keep these as remedies for night time use only. Tylenol and Advil are quite safe but if they are used for a long period of time they can be stressful to the liver and kidneys. If you find that you have gone more than 5 nights where you are depending on these meds to keep your child comfortable, give your doctor's office a call to see if you need to make sure that nothing else is going on. DO NOT USE Any product that contains Benzocaine or Belladonna!! Once your child has teeth, it is especially important to keep bottles out of the crib. Milk has sugar and can cause tooth decay if a baby sleeps with a bottle in their mouth. It is never too early to start brushing the teeth. Let's get your baby in good dental habits. It is important to use a soft toothbrush and non abrasive toothpaste. The current recommendation is to use fluoride toothpaste; just a teeny bit the size of a grain of rice. Once they have a mouthful of teeth it makes sense to start shopping for a pediatric dentist that you can establish a relationship with. This will come in handy if you have any tooth questions or mouth injuries. Your next task is to figure out what the going rate for the tooth fairy is! I can’t help you there. Wishing you easy teething!
Posted by Nurse Judy at 9:55 AM
Friday, October 2, 2020
This week's topic Your Family Tree/ How far back can you trace? When Lauren was in 4th grade, her class was given an assignment. Pick a grandparent or great grandparent who immigrated to this country. Where did they come from? What was their story? Lauren ended up picking one of her great grandmothers, Mollie Kivowitz, but the project got me thinking. I was curious to trace all of the branches to highlight each of the ancestors who made the courageous journey to a new life in America. Sandy and the girls bought me a family tree program for Chanukah that year and I went to work. As part of my search I sent letters to relatives and talked to older aunts and uncles trying to get as much information as I could. I was very fortunate to find relatives from different branches who had already done a lot of family tree legwork and were willing to share. In the process I made wonderful connections with long lost relatives. Some branches are easier to find information on than others. For one thing, a name like Smith is going to be a lot tougher than one like Kivowitz. There are other factors. My paternal grandfather, Asher Isaacs, came from a family that had the distinction of being the only family in America at that time that could claim having 8 members (including my grandfather) who were members of the Phi Beta Kappa honor society. That branch was almost too easy, since there are actually multiple books written about them. Other branches take quite a bit more digging and the information is going to be based on a combination of stories that were passed down along with census searches. It is easier than it used to be. A lot of this stuff is online. Here is an assignment to all of you. If you are blessed enough to have people to ask, capture this information while you can. See what you can find out! On my mom’s side I have a second cousin who is a popular comedian/late night talk show host. Mom would tell stories about sitting on the porch with her first cousin and doing the routine catching up on kids. “Lauren got the starring role in her high school play” "Seth is hosting the Whitehouse Correspondents' Dinner" Um. My father's side is peppered with people that were known to have the 'second sight' and includes his first cousin Dr. Brian Weiss, MD, an author who has written extensively about past life regression therapy ( brianweiss.com/ ) (No, I don’t have a familiar relationship with either of my famous relatives.) Simply writing the names down in a family tree program doesn’t necessarily bring their stories to life. During my search, I was able to capture a lot, but so much has been lost to time. I am grateful for whatever stories have been captured and sad at all of those that are beyond my reach. After my mom died, when we were at the family house sorting through old letters, I came across a pile of correspondence between my mom’s parents. These were love letters, filled with personality and pet names; sweet and funny treasures, but they left me thinking. I wonder how Flora and Asher met? How is it that I didn’t know that story? The loss of my mom pierced through me with the realization that there was no one left to ask. Some little piece of my brain nudged me to do an internet search. Amazing, there it was! Back in 1987, the Pittsburgh chapter of the National Council of Jewish Women did an oral history project. My grandmother was interviewed! She was 86 at the time. There are 4 sections of the interview, each 30 minutes, that are online. In the first section she gives me the answer I was seeking. She tells the story of how she met my grandfather! I felt like the universe had given me a gift. I just listened to these again this week as I was getting my daily steps. The first sounds of her voice still get me choked up, but then I get swept up in her stories. Make this effort for your children and their legacy. How far can you go back? Some families can’t trace back too far, others can go back many generations. Celebrate the remarkable mix of cultures and DNA that have combined to create you and any offspring that you might have. Don’t be afraid of the moonshiners or the proverbial black sheep that are on your tree. They all led to this moment in time. Time passes and opportunities are fleeting. Talk to your older relatives! They will likely love telling you their tales!
Posted by Nurse Judy at 10:55 AM
Friday, September 25, 2020
I wrote my first post about loss back in 2015. I updated it in 2017 when I was dealing with the loss of my mom Ruth Ann. The same week that my mom died, I was still working at Noe Valley Pediatrics. We lost a young patient one day and a young mother the next. Both were sudden and unexpected. Those were tragedies. An 86 year old woman, who was able to peacefully pass away in her own bed with her family around her is not. As I noted in the intro to my post: My mom was pretty amazing. She was a force of good. She routinely wrote thank you letters to strangers who were kind and good at their jobs. She actively reached out to lonely friends, family, and acquaintances to let them know that someone was thinking of them. She was the second mom to all of my childhood friends. She was the kindergarten teacher who remained beloved by all of her students. She was incredibly charitable. I was incredibly blessed with both of my parents. A wise friend once shared a theory with me that the world is like a scale that is a precarious balance between good and evil. The smallest act of kindness might be the essential spark that is making the difference in tipping the scale in the right direction. It is going to take a lot of kindness and good deeds to make up for her loss. This week we lost another Ruth. My Oath team was on a zoom meeting together when the news came through. We sat in stunned silence as the emotions slammed through us. Children all over the world watched their parents weep and mourn. Talk to them. Teach them. May her memory be a blessing and may all people recognize and embrace her legacy that all people should be treated with equal rights and respect. This week's topic Dealing with loss/helping your child cope Laughter/Crying/Happiness/Sadness. Life is such a balance. Assuming you are lucky enough to have people, pets, or even objects that you care about, then dealing with loss is inevitable. If you have a child, you need to be prepared to know how to approach the subject. Parents, it may be helpful to ask yourselves the following questions: How do you, yourself deal with loss? What do you believe? Some folks have a deep faith that there is “More to it than this,” and others think that “this is it.” Are you comfortable sharing your belief system with your children? How do you find comfort? What can your friends and family do for you when you are grieving? Do you need hugs or space?? There is not one simple approach for every person, child, or family. My mother-in-law liked to say that there is no right or wrong way to grieve. There are no rules. It is important to be supportive of the different paths that people take. There are also many cultural factors that may impact the situation. The routine losses that the families deal with most often are the passing of a grandparent or beloved family pet. Those are the lucky ones. An anticipated loss is no less devastating, but this is the cycle of life that is sad but not shocking. Others are flattened by the loss of a partner, friend, sibling, child. If your family is hit with a loss, sudden or anticipated, unless we are talking about a goldfish, likely the death is hitting you just as hard, if not harder, than it is impacting your child, though don’t minimize the loss of that goldfish as a valuable opportunity for ritual and conversation. (My husband managed to delay the "goldfish conversation" several times with a visit to the "open till midnight fish store" where Goldie was replaced several times with no one the wiser!) Parents don’t usually have the luxury of collapse. How do you help your child when you yourself are dealing with all the grief? There are factors to keep in mind for each age that you are dealing with. ages 2-4 generally don’t grasp the concept of death as permanent ages 4-7 may feel responsible for the death because of their thoughts, actions, or lack of action age 7-11 just starting to see death as something irreversible over 11 has a better understanding about the loss Not to make light of the subject, but here is a classic family anecdote: When Lauren was between 3 or 4, she went through a phase of obsessing over several musicals and movies that were centered around orphans. Annie and Disney's The Rescuers are ones that come to mind, but I know there were others. One day she asked, “what is an orphan?” We discussed that an orphan was someone who didn’t have any parents. We immediately went on to say that she was very lucky that she had both mommy and daddy, but if in the very unlikely event that anything ever happened to both of us, her aunt and uncle, Barbara and Richard, would be her guardians. She was quiet for a moment and then said, “ I better get their phone number.” Hmmmm. Do's and Don't s Do NOT say that an animal was “put to sleep” or use any phrase that can confuse your child. The words “passed away” are also fairly passive and confusing. They might wonder if that could happen to them at any time. Do NOT lie. Find a way to convey truth that you are comfortable with. Your child will know that you are very upset. Shielding them from honesty and communication is not doing them a favor. It is okay to be sad. It is okay to cry. Find a ritual that you feel comfortable embracing. Take comfort in happy memories. Celebrate the life of the one you lost! Tell wonderful stories. Don’t be afraid to laugh. Honor the memories with kind gestures. Finding a good therapist to help you or your child give you coping tools is often a good idea. Check to make sure that the therapist has experience dealing with bereavement issues. Books and stories can be an excellent launching off point for discussions. If you can’t come to terms with how you feel about death, you might be able to turn the spotlight away from you with lines like: “Some people believe…” “Other people think……” In my search for further local resources I reached out to my old friend Dr. Nancy Iverson. Nancy has not only written several published articles about the grieving process, but has been involved in facilitating various support groups for many years. She pointed me towards Josie’s Place. (It was a bit of a treasure hunt.) This is a small but wonderful center here in San Francisco that offers support groups and other services for families and children who have experienced loss. Josie’s Place: Info@josiesplace.org 415-513-6343 Groups meet in the Inner Sunset For children over the age of 7 www.josiesplace.org If you scroll down to the bottom of the home page on their website in the "Articles on Grief/Grief Resources" tab, Pat Murphy, the director has cobbled together a list of other local resources that might be useful. Janet Jaskula, RN, MS, A pediatric hospice nurse, also shared her list of resources: The Heart and the Bottle This is a great book about what loss and grief can do if one does not deal with it. Kids and adults. "Fall of Freddie the Leaf" by Leo Buscaglia "Velveteen Rabbit" by Margery Williams "There is a Rainbow Behind Every Dark Cloud" written by a group of children with leukemia who attended The Center for Attitudinal Healing. A Lion in the House Movie that follows several children and teens and their families through illness and loss, grief and death. Though not all of the kids in the film die, they are certainly affected by their illnesses and loss of their "normal" childhood and teen years. The Giving Tree Shel Silverstein. Or check out this newer version that I quite prefer! https://www.topherpayne.com/giving-tree For parents, check out the the website of Barbara Karnes. Barbara Karnes is the author of "Gone From My Sight." She has some excellent combo coloring/story books about loss for kids. Dr. Nancy Iverson recommends the book: "Never Too Young to Know" by Phyllis Rolfe Silverman The very helpful children's librarian Liesel Harris-Boundy at the San Francisco Public Library West Portal Branch did some research for me and came up with some good choices for kids. Scroll down to the end of the post for her list. ****************************************************************** I saw the following gem circulating around the internet and it resonated with me. I thought it worth sharing. Someone put out a post asking for help dealing with grief. This answer was the response from a fellow in his late 70s: I'm old. What that means is that I've survived (so far) and a lot of people I've known and loved did not. I've lost friends, best friends, acquaintances, co-workers, grandparents, mom, relatives, teachers, mentors, students, neighbors, and a host of other folks. I have no children, and I can't imagine the pain it must be to lose a child. But here's my two cents... I wish I could say you get used to people dying. But I never did. I don't want to. It tears a hole through me whenever somebody I love dies, no matter the circumstances. But I don't want it to "not matter". I don't want it to be something that just passes. My scars are a testament to the love and the relationship that I had for and with that person. And if the scar is deep, so was the love. So be it. Scars are a testament to life. Scars are a testament that I can love deeply and live deeply and be cut, or even gouged, and that I can heal and continue to live and continue to love. And the scar tissue is stronger than the original flesh ever was. Scars are a testament to life. Scars are only ugly to people who can't see. As for grief, you'll find it comes in waves. When the ship is first wrecked, you're drowning, with wreckage all around you. Everything floating around you reminds you of the beauty and the magnificence of the ship that was, and is no more. And all you can do is float. You find some piece of the wreckage and you hang on for a while. Maybe it's some physical thing. Maybe it's a happy memory or a photograph. Maybe it's a person who is also floating. For a while, all you can do is float. Stay alive. In the beginning, the waves are 100 feet tall and crash over you without mercy. They come 10 seconds apart and don't even give you time to catch your breath. All you can do is hang on and float. After a while, maybe weeks, maybe months, you'll find the waves are still 100 feet tall, but they come further apart. When they come, they still crash all over you and wipe you out. But in between, you can breathe, you can function. You never know what's going to trigger the grief. It might be a song, a picture, a street intersection, the smell of a cup of coffee. It can be just about anything...and the wave comes crashing. But in between waves, there is life. Somewhere down the line, and it's different for everybody, you find that the waves are only 80 feet tall. Or 50 feet tall. And while they still come, they come further apart. You can see them coming. An anniversary, a birthday, or Christmas, or landing at O'Hare. You can see it coming, for the most part, and prepare yourself. And when it washes over you, you know that somehow you will, again, come out the other side. Soaking wet, sputtering, still hanging on to some tiny piece of the wreckage, but you'll come out. Take it from an old guy. The waves never stop coming, and somehow you don't really want them to. But you learn that you'll survive them. And other waves will come. And you'll survive them too. If you're lucky, you'll have lots of scars from lots of loves. And lots of shipwrecks. ******************************************************************** Liesel Harris-Boundy's recommended reading list: Life Is Like the Wind by Shona Innes - 2014 Written by a clinical child psychologist, Barron's "A Big Hug" series offers a gentle and direct approach to the emotional issues that children face. This book introduces the concept of death to young readers by likening life to the ever-moving wind. My Life Changed A Journal for Coping With Loss & Grief by Amy Dennison - 2003 Parenting Through Crisis Helping Kids in Times of Loss, Grief, and Change by Barbara Coloroso - 2001 Missing Mommy by Rebecca Cobb - 2013 Ben's Flying Flowers by Inger M. Maier - 2012 Emily introduces her younger brother, Ben, to butterflies, which he calls "flying flowers," and when his illness makes him too weak to go see them she draws him pictures, but after his death she no longer wants to draw happy things. Includes note to parents. Harry & Hopper by Margaret Wild - 2011 Harry is devastated when he returns home from school to find that his beloved dog, Hopper, will no longer be there to greet him. The Blue House Dog by Deborah Blumenthal - 2010 A boy whose beloved dog has died, and a dog whose owner also died, find each other and slowly begin to trust one another. Always by My Side by Susan Kerner - 2013 A rhyming story written to help children understand that a dad's love is forever. Even if they grow up without his presence in their lives. Rabbityness by Jo Empson - 2012 Rabbit enjoys doing rabbity things, but he also loves un-rabbity things! When Rabbit suddenly disappears, no one knows where he has gone. His friends are desolate. But, as it turns out, Rabbit has left behind some very special gifts for them, to help them discover their own unrabbity talents! Rabbityness celebrates individuality, encourages the creativity in everyone and positively introduces children to dealing with loss of any kind. The Scar by Charlotte Moundlic. When his mother dies, a little boy is angry at his loss but does everything he can to hold onto the memory of her scent, her voice, and the special things she did for him, even as he tries to help his father and grandmother cope. Remembering Crystal by Sebastian Loth - 2010 Zelda the goose learns about death and loss when her turtle friend Crystal disappears from the garden one day. A Path of Stars By Anne Sibley O'Brien - 2012 A refugee from Cambodia, Dara's beloved grandmother is grief-stricken when she learns her brother has died, and it is up to Dara to try and heal her. I Remember Miss Perry by Pat Brisson - 2006 When his teacher, Miss Perry, is killed in a car accident, Stevie and his elementary school classmates take turns sharing memories of her, especially her fondest wish for each day.
Posted by Nurse Judy at 9:22 AM
Friday, September 18, 2020
This evening ushers in the holiday Rosh Hashana, which is the Jewish New Year. I think everyone is ready for a fresh start! There is so much going on around us! I am taking a break from things like poor air quality and viruses and simply telling a story this week. This week's topic A strange but true story about a pair of socks Serendipity? Coincidence? All I can tell you is that odd things happen more than you would think to me and my family. My husband for years tried to find explanations that made sense, but he finally gave up. Here is one such tale. The mysterious socks Social media is a mixed bag. I try to avoid the political spats and focus more on the sweet updates from family and friends (admittedly I don’t always succeed.) One of the more enjoyable aspects of Facebook is the memories that surface. Just this week a memory popped up from 2013 about a pair of socks. I had forgotten all about it. It was such a strange story that I have no way of explaining it. I can only promise you that Sandy the skeptic bore witness to it. When we moved out to San Francisco back in 1985, I made it clear that moving to the west coast was contingent on me going back to visit my family in Pittsburgh several times a year. Sandy was very supportive of this. The big brick house where I grew up in the actual Mister Rogers Neighborhood of Squirrel Hill became a second home to my kids as they regularly came back with me to visit family. As the kids got older, they still made it their business to get back there, but they no longer were able to come with me on every visit. On that August visit seven years ago, I had gone solo. The house had several stories and somehow, much to my mom’s dismay, was a magnet for “stuff”. My childhood home and it’s various collections are featured in many of my posts over the years. Aside from the generations of letters, photos and treasures, new and odd things had a way of appearing. My mom had taken the term barnacle and used it to describe things that somehow took root in a place where they had no business being. That empty container of hand sanitizer in your house that has been sitting on it’s side, on the coffee table for several weeks, and somehow looks like it belongs there...that’s a barnacle. During this particular visit, my mom had asked a favor. Somehow the set of steps going from the second floor up to the attic had amassed a collection of stuff. Would we be kind enough to go through it and clear the area? She had someone coming to do some work on the third floor and has been asking for people to get the steps clear. My visits were often her catalyst to getting things done. My sister, my niece (who lived up on the third floor) and I started our sorting. Here was a copy of the Pittsburgh Post Gazette with Lauren and I on the cover, the day after the Loma Prieta earthquake. Here were piles of clothes to go to the thrift store; here were some books. Piles were made. Keep it, toss it, donate it. We were making good progress. At the bottom of a bunch of clothes was one sock. It had a distinct embroidered pattern and I recognized it as mine. “Hey that sock is one of mine.” This was August, sandal weather in Pittsburgh. My best guess is that this sock got separated from its mate (as socks do) during a laundry during my last visit, which in this case was December. That is a good definition of a barnacle. The sock had somehow taken root on the steps and folks just stepped around it. But for now, I stuck it in my suitcase. I spent a week in Pittsburgh and then stopped for a few days in Denver to visit one of my best friends. The day before I was heading home I spoke to Sandy for what was a fairly routine call. “I miss you very much and can’t wait to have you home. There are fresh sheets on the bed, and I cleaned the house from top to bottom...it would be nice if the house could stay neat for at least a day once you are home.” (As an side, there is of course a reason why he had to ask me that; I am not the neat one in our relationship!) “Yes dear.” I got home to a truly spick and span house. I brought my suitcase up to our bedroom, and plopped it on the bed. Before I even opened it, I turned around and saw that on my dresser was a single sock. Yes. It was the mate of the lone sock in my suitcase. I picked it up in a bit of shock and yelled “Why is this sock here?” Sandy looked puzzled. “I have no idea, I didn’t put it there, I straightened up everywhere, maybe Alana put it there." As soon as Alana came home that afternoon I waved the sock in her face. ”Where did this sock come from?” “Gee Mom, it is nice to see you too!, I have no idea where that sock came from. It has been hot out and I haven’t worn socks for awhile." I opened up the suitcase and pulled out the matching sock to show them. This sock had been sitting on a step in Pittsburgh for months and months and somehow its mate was waiting for it. If you are waiting for me to follow up with an explanation, I have none. I will say that if I knew I had one wish, it likely would not have been to find a missing sock. There is a follow up. The socks were clearly special. On my next trip to Vegas I brought them along. Yes I got a straight flush at the poker table and the slot machines smiled at me a bit more than they usually do. When we came home and did the laundry, only one of the socks came out. Somehow I think it will turn up again. Is this my strangest story? Probably not. What is yours?
Posted by Nurse Judy at 9:52 AM
Friday, September 4, 2020
West Nile Virus/ Mosquito Information West Nile Virus has been detected in the Bay Area. It is 2020; this should not be a surprise to anyone. What else is coming our way? Oh yes, that asteroid right around election day... Even if they weren’t carrying any diseases, I hate mosquitoes. Yes I am aware that they are part of nature's vast food chain but that doesn't stop my loathing. For the record, it is a mutual dislike and fortunately I rarely get bitten. The rest of my family, both of my daughters in particular, are tasty targets, and are feasted on when given the opportunity. Of all the mosquito-borne illnesses, the West Nile virus is the one that has gotten the most local media coverage lately. It is thought to have originated in Africa (hence the name.) It has spread throughout the world and it was first detected in this country in 1999. Unfortunately we now have it in most states, including California. Mosquitoes get this virus from feeding on infected birds and then transmit it to humans. Humans are referred to as "dead end hosts"; they get the virus from being bitten by the infected insect, but then can not spread it to each other. It is possible that it can be transmitted from blood transfusions, pregnancy or breastfeeding but there are no known cases of infants who have gotten seriously ill from these transmissions. The good news is that most of the time it is actually not such a big deal. Children under 5 seem to be at relatively low risk for getting terribly ill, and folks over 50 seem to get hit the hardest. It can be found year round but seems to peak in late summer/early fall. 80% of folks who get WNV have no idea that they are infected and feel perfectly fine. There are probably thousands of cases that go under the radar since we would never consider testing if someone is only showing mild symptoms of a mystery illness. The unfortunate other 20% of infected folks may have fever, joint pain, muscle weakness, stiff neck, diarrhea, vomiting, swollen glands, photo-phobia rash on the trunk. Not everyone will have every symptom. Most people showing these mild to moderate symptoms will recover completely, although there are reports that some of these folks can remain fatigued and achy for several weeks. 1% of infected people can get more serious neurological complications including encephalitis and meningitis. It can be fatal for those with serious cases. People with troubled immune systems are at the greatest risk. The incubation period is usually between 2-14 days after the bite from an infected mosquito (most commonly 2-6 days.) There is, alas, no treatment beyond supportive care. It is thought that most people who have fought off the illness end up with some level of immunity. Keep in mind that any severe headache-fever-stiff neck combination always needs to be evaluated right away. If West Nile virus is suspected there are blood tests that can help with the diagnosis. Since there is no vaccination at this point, and no treatment, the key is prevention. Of course right now with Covid circulating, any fever is something that we pay attention to, but if there have been recent mosquito bites, make sure you report those as part of the relevant history. Prevention is the key when it comes to dealing with mosquitoes. Make sure that you have intact screens on all windows. If you are getting bites, check for holes or cracks where the insects might be getting in. Get rid of any standing water that is around your house; do a double check to make sure there are no pots, bird baths...etc. that are places where mosquitoes can breed. The larvae are dependent on water for breeding. Unfortunately just dumping out the water might not be good enough because it won’t dislodge the larvae that might be attached to the side. You really need to give a good scrub. Check out Mosquito bits and mosquito dunks. You can add these to any water features to keep the mosquitoes from breeding. There tends to be increased mosquito activity during dusk and dawn so that is when most of the biting happens. This seems to be true for the mosquitoes who carry West Nile Virus, not as much for Zika. Try to wear (keep your child covered with) long pants/ long sleeves etc. Light colored clothing is recommended. If you are going into a heavy mosquito area use bug spray on exposed skin and clothing. Mosquito repellent works only on the surface to which it is applied directly. Experiments have shown that they will actually bite skin only four centimeters away from where the repellent is applied, so wristbands or just spraying clothing does not offer full protection. Some bug experts would rather that you avoid the traditional electric bug zappers. The violet light may be irresistible to some flying insects, (and that zap is such a satisfying noise), but mosquitoes are actually not attracted to the light. Some of the innocent and beneficial insects are the ones getting fried. Mosquitoes don’t like fans! The nasty insects are lightweight enough that a good breeze may make it hard for them to zoom in on their target. The Off! Clip on has some folks who swear by it. If you are looking for an alternative to the DEET, it might be worth giving it a try (perhaps it is the fan aspect that makes it work…) If you are seeing mosquitoes around your house, San Francisco's Environmental Health Department will send an inspector to investigate (415-252-3805.) They will check the area around your home (including sewers) to see if they can find any breeding areas. Alas, long sleeves alone aren’t going to do the trick if you are out in a buggy area. There are plenty of natural products on the market that claim to be repellents, ranging from Vitamin B to catnip. Most of these are generally safe, but unfortunately the scientific studies show that they are mostly ineffective. We have the luxury in the Bay Area of not having some of the more notorious mosquitoes, so the bites are mostly an aggravation rather than a health risk. If you are in San Francisco, it is not a big deal to give something a try to see how it works on your family members. However, If you are traveling to an area where there are more dangerous mosquitoes, I would stick with the strong stuff. No kidding around. The EPA has five registered insect repellents. DEET is likely the most well known option. It is the only product labeled safe for infants as young as 2 months old. It comes in different concentrations. The concentration of DEET in a product indicates how long the product will be effective. A higher concentration does not mean that the product will work better; It means that it will be effective for a longer period of time. Therefore, products containing lower concentrations of DEET may need to be reapplied, depending on the length of time a person is outdoors. Oil of Lemon Eucalyptus is considered one of the least toxic options but interestingly, the age recommendation for it is for 3 years and older.(Natural lemon eucalyptus oil is not the same as Oil of Lemon Eucalyptus) Some people are sensitive to the smell of this, it is worth sniffing it before you buy it. Picaridin is odorless and is approved for children 6 months (recently lowered from 2 years) and older. Dr. Anne especially likes the Sawyer product. Avon Skin so Soft Bug Guard PLUS IR3535 Insect Repellent has been around for years but seems to be more commercially available than it used to be (also for over 6 months of age.) It comes in a highly rated product that combines Avon Skin So Soft and an SPF 30 sunscreen Bite Blocker is a botanical formula that claims to provide protection for up to 8 hours. The reviews mention a strong odor, but otherwise it gets a high rating. Before applying anything topical to the skin for the first time, do a little test patch on the skin to make sure there is no sensitivity before you widely spritz or wipe on any of these products. You will need to read the labels to see how often you need to reapply. Avoid contact with eyes and keep all of these safely away from kids. I would also be cautious about getting any insect repellents on the hands, especially if your child is young enough that those hands are going into the mouth a lot. If you are also using sunscreen, apply sunscreen first and insect repellent second. All of the EPA recommendations are considered safe, and they are clearly better than getting bitten, but at the same time, let’s use them wisely. The EPA has created the following tool to help you find the proper product for you needs EPA guide to finding the right repellent Some products are more effective than others for certain types of mosquitoes, so the product you choose might depend on where you are going and what you might be most at risk for. Trusting that someday we will be able to move around the globe again, it is always good to check in at https://wwwnc.cdc.gov/travel prior to any travel. DEALING WITH A BITE If the prevention has failed the most important thing is to treat the itching. Scratching at a bite will make it worse. There is a product called a mosquito zapper that some folks find useful. Young kids might be startled from the noise, but others claim that it is great for minimizing the reaction if you use it quickly. Over the counter hydrocortisone cream probably works the best, but other topical treatments can include calamine lotion, or mixing up a paste of baking soda with a bit of water. A cold black tea bag compress can also be very soothing. Black tea contains tannins, which seem to help. Some kids can have enormous reactions. Eyes and ears can be remarkably swollen. Topical treatment won’t be enough for these. Give a dose of Zyrtec or Benadryl right away. Scroll to the bottom for dosing info. If the antihistamine doesn’t make a difference or if there is fever or severe discomfort, those kids need to be evaluated by a doctor. If your little one is getting bitten, check the bedroom carefully. Look at the mattress and all the corners of the room; bites could be from spiders, fleas or other culprits. Zyrtec Dosage Chart The dose of cetirizine depends on age: · 6 - 12 months of age: 2.5 mg given once daily (maximum dose 5 mg daily) · 12 - 24 months of age: 2.5 given once or twice daily (maximum dose 5 mg daily) · 2 - 6 years of age: 2.5 - 5 mg given once daily (maximum dose 5 mg daily) · Over 6 years of age: 5 - 10 mg given once daily (maximum dose 10 mg daily) Zyrtec comes in a 1mg/ml solution (so 2.5 mg = 2.5 ml). There is also a 10mg/ml oral drops preparation (so 5 mg is 1/2 ml). Make sure you check the strength of the solution. Benadryl dosage will be the same volume as your Tylenol dose. The liquid says for children 4 and over; we still use it for our younger patients who need it. Benadryl makes most kids sleepy but can have the opposite effect. If you are interested, Here is some current info on some of the mosquito borne illnesses that have been in the headlines the most in the past year or so. West Nile Virus https://www.cdc.gov/westnile/ If you see any dead birds, give them a wide berth and report them to 1-877-968-2473 (WNV -BIRD) or online at http://westnile.ca.gov/ That website also will give you the up to date numbers on how many West Nile virus cases there are in California, county by county. It is updated weekly. Zika https://www.cdc.gov/zika/index.html Chikungunya https://www.cdc.gov/chikungunya/ Here are some bonus facts about mosquitoes: Both males and females make that awful whining noise, but only the females bite humans. Mosquitoes are especially attracted to people who drink beer. Mosquitoes love the smell of sweaty feet. Mosquitoes can sense CO2 from up to 75 feet away. Mosquitoes only fly as fast as 1-1½ miles per hour. Some blood types may be tastier than others. O seems to be the favorite, A the least. B lands somewhere in the middle. Mosquitoes love pregnant women (regardless of their blood type) possibly because they emit a little extra CO2.
Posted by Nurse Judy at 11:11 AM