Friday, January 12, 2018

Building and Protecting your immune system

Topic of the Week:
Building and Protecting your immune system

This is the season to focus on boosting your immune system. I have had multiple requests to address this topic in a post.
One of the blessings of working at Noe Valley pediatrics is that although we are a western medicine, science based practice, the advice nurse team is allowed to stray off the rigid telephone triage guidelines that most advice nurses must adhere to. My patients over the years have been on the receiving end of advice from me that includes some more natural or holistic suggestions.

This post in particular strays way off the basic western medicine path and includes a combination of conventional wisdom, with some anecdotal remedies shared with me by healers from a variety of modalities. Some of the things that I suggest can be found as my husband laughingly describes it, down the “placebo aisle” of the local drugstore, but as we are in the full throes of a variety of illnesses, many of my patients are ready to try anything.

My kids grew up with my husband's grandma’s recipe fondly referred to as Muggala Guggala, (see below for recipe*) I imagine many families have their own health rituals. As long as you are not ignoring a condition that warrants medication such as asthma inhalers or antibiotics, there is little harm in exploring some natural options. Who knows, you might find something that helps.

Good Hand Washing is the cornerstone to staying well.


If you were out and about in a crowd of sniffling,coughing people make sure you scrub up and change your clothes as soon as you get home.

Getting enough sleep is essential. If kids seem tired, you might need to start the bedtime routine a bit earlier. If you are interested in really finding out more about the actual quality of your child’s sleep, Knit Health is an interesting, reasonable option.

For older kids and adults make sure you limit the screen time for at least an hour before going to bed. Most experts suggest longer than that, but I accept that it often isn’t that realistic. (For the record, binge watching Game of Thrones right before bed is NOT a good idea.)

Nutrition
Make sure you and your kids are getting enough Vitamin D. Many folks have vitamin D levels that are significantly below where they should be and would benefit from a daily supplement .

Make sure you are getting enough Iron. Magnesium, iron and vitamin D are all connected to sleep as well as to a healthy immune system. (Magnesium also helps with pooping.)

I don’t love to binge on most vitamins, but a multi that has A and C is especially important during the cold and cough season. Check out Ester C. This is an exclusive form of vitamin C that is designed to give round the clock immune support. Sandra Roddy Adams, my chiropractor, gives this a big thumbs up.

Zinc is an important cold fighter and some studies show that it can decrease the duration of a cold by 50%.
Zicam lozenges are what I like. I actually think that the generic orange flavor tastes the best. These work better if you catch it early! With any zinc product it might be best to take with something in your stomach to avoid nausea. Kids need to be old enough to safely take a lozenge or chews


I asked my cousin Sam, who is a retired family practice physician if he had any favorite supplements. Echinacea,
ginger,garlic,myrhh, cayenne, vitamin C, vitamin B6 and bioflavanoids all made his list. For the grown ups out there, he recommended a Source Naturals Wellness Formula that has a lot of the good stuff in one capsule.

More and more studies are finding that having a healthy gut is essential to the immune system. My friend Sari is a craniosacral therapist in Arizona. When I reached out to pick her brain about this post she concurred with me that more and more studies are finding that having a healthy gut is essential to the immune system.

Probiotics are good for any age

Oil of oregano is thought to be a great immune booster. I would recommend this for grown ups or kids over 6 who are very cooperative, It has a very strong taste and causes some oregano burps but can work pretty well


Omega 3 are mostly found from eating fish, but most people probably don’t get as much as they should. This supplement makes it to most of the lists as a worthy supplement.


Local honey has antioxidants and is thought to be helpful for the immune system. Dr. Anne was the one who added this to the list. She actually adds honey to her coffee! I tried it and it isn’t bad. Hey, working in this office gives us a lot of exposure to everything that is going around. We will try anything!
Remember that infants under one year should NOT eat honey

Chinese Medicine - Dr Schwanke started using Chinese herbs in our office many years ago, but only carry a limited line that we use for ear infections and congestion. We are fortunate to have the creator of those formulas right in the neighborhood at the Chinese Medicine Works. It is important that any Chinese medicine comes from a reputable source. I like the gentle warriors brand because it is made locally


It might be worth exploring some herbs if you or your kids keep getting sick.

My amazing friend Anita is an acupuncturist in Colorado.
She encourages warming foods for her patients. These keep the internal temperature up. Viruses prefer the cold environment. She suggests that drinks be room temperature or warm/hot. Don’t add ice to drinks. Use warming spices and herbs such as garlic, cinnamon and cloves.
Soup is always good! Here is a bonus Acupressure point good for boosting the immune system: acupressure point stomach 36

Herbs and Homeopathy
Sambuccol is at the top of my list when it comes to my personal self care. This is an elderberry base, fairly widely available that has some scientific studies backing up it’s immune boosting properties. (Even Sandy doesn’t scoff at this one.) I start taking these the moment that I feel the scratchy throat feeling that makes me worried that I am starting to come down with something.The earlier you start this, the better it works. The bottle says for children over 2. The UK version gives the dosage for over 1.



These are homeopathic sprinkles that I refer to as fairy dust.
I don’t understand homeopathy, but many folks swear by these. I take a tube every time I fly. Sandy tried to figure out what’s in them and the only ingredient he recognized was duck liver.

This herb is on many folks list of remedies. The studies have been mixed as to whether or not it works. Make sure you are a label reader when getting this supplement



Reflexology
My friend Oran is a wonderful healer who lives in Israel. Both of my daughters had moments during their travels there when they showed up on her doorstep with various illnesses and she nursed them right back to health. She has the ‘No White’ rule when people are sick. No white sugar, No White Flour and No Dairy. All of those can contribute to inflammation.
She also shared something that I confess I had never heard of. She suggests cutting an onion in half and leaving it on a plate right near the head of the bed.

Environment
It is very important to avoid secondhand smoke. If you are someplace where the air is dry, or in SF you have turned the heat on, consider using a humidifier at night. Make sure you keep it clean and turn it off during the day. Running it 24/7 can create a mold situation.

It is fairly common for parents to call us, incredibly frustrated when their kids seem be sick all the time. It makes sense when you think about it. If they are depleted from illness number one, when illness number two comes around they are more vulnerable. Everyone is being exposed to so much this season. I have patients who actually have more than one illness at a time. RSV and Flu together seems to be a popular combination at the moment. Unfortunately most viral syndromes simply take time. Antibiotics are NOT useful for a virus.

If you are stuck in a cycle of catching one thing after another and the above suggestions haven’t helped, explore your options and see if you can keep your child out of daycare for a week or so. Sometimes that break makes a big difference.
Don’t forget to swap out the toothbrush or put it in the dishwasher.

* Muggala Guggala - 1 cup milk, 1 Tbsp of butter, 2 Tbsp honey - heated in a saucepan.

PS Mama Jaime chimed in to share that she has found that Thrive Market is a good place to get many of these supplements at a good price.



Friday, January 5, 2018

Tummy Bugs 101 (2018)

Topic of the Week:
Tummy bugs 101/dealing with diarrhea and vomiting

By far most of the tummy bugs that we see are caused by a virus. Time will generally take care of these. The typical symptoms are vomiting, loose stools and sometimes fever. Not everyone has every symptom. Vomiting without the loose stools could also indicate something else going on, like strep throat, a urinary tract infection, an ear infection or even appendicitis. When the diarrhea comes along, the good news is that it usually signals that we can narrow our attention to some type of tummy issue. The bad news of course is that when the patient is losing fluids from both ends, dehydration now becomes more of a concern. I also don’t want to minimize how miserable it is when you are in the full throes of an acute GI episode and don’t know whether to sit on the toilet or kneel at it.

If your baby is under two months old and you suspect that they have a tummy bug, we will want to monitor them closely. Young babies can get dehydrated much more easily than a larger child.

If you are breastfeeding, smaller more frequent feeding will often be much easier for the baby to keep down. Of course it is not always easy to know what's up. Many babies spit up on a regular basis daily and normal baby poop is very liquidy. But, if you are worried, they are spitting up more than normal, and have increased fussiness I would suggest getting them evaluated. For a young infant, watery/clear stool would also get my antenna up. With a dehydrated infant, the fontanel (soft spot) may appear more sunken, and they will be significantly sleepier or fussier than usual. If they are nursing well, and peeing fine that is very reassuring.

With any age, the main focus for someone suffering from a tummy bug should be hydration. It is okay and even expected for the patient to have less of an appetite for food for a few days. Unless the person is extremely slender, we are not too worried with a bit of weight loss. Most folks will gain it right back up when this passes. Don’t stress about the food intake. Pushing food will likely just aggravate the situation if they aren’t ready. We just need to make sure that they are getting adequate fluids.

Start by giving clear fluids (breastmilk is fine you have it.) Because we lose lots of electrolytes when we vomit or have diarrhea, it is best to replace the fluids with something that replaces the electrolytes as well. Water is not your best choice.There are products on the market that are specially formulated for this purpose.

Pedialyte is the classic brand that has been around for many years.. There are Pedialyte popsicles that are terrific for older kids. They recently improved the flavor quite a bit, which has improved compliance. It still has a mild soapy taste so not everyone will take it. There is also product out there called Drip Drop that some folks feel tastes a little better. The exercise drinks like Gatorade are another option but have more sugar than the Pedialyte. Consider keeping a Pedialyte product on hand so that you are prepared if a tummy bug strikes. Pedialyte now comes in a little tube of powder that you mix yourself. I would have it as part of your travel emergency kit as well.

I don’t have any hard and fast rules about fluid amounts. Electrolytes are the better choice, but you have to do the best you can if they simply refuse those. Try some diluted juice, coconut water, ginger ale, or colas that have lost some of the fizz . Whatever they are agreeing to drink, I typically wait at least ten minutes after they have thrown up before I offer anything.Think of a drip irrigation system. If all you can get in there is a dropper full, that’s okay! Get that fluid in, drop by drop, ice chip by ice chip. Do the best you can.

If they are thirsty, don’t let them guzzle. Stick with an ounce at a time. If you have a tiny tea set, or a fancy shot glass, those are fun ways to measure small amounts. You can have a star chart for the reluctant drinkers.

Please note, so that you don’t freak out, right before someone is going to vomit, it is normal for them to look quite miserable. Some kids get very pale and shaky. Some folks actually look greenish. Once they throw up, most of the time they feel a bit better and the color normalizes.

If your child has an elevated temperature as part of this illness, a tepid bath can help get the fever down. If the bath hasn’t done the trick, the fever is over 101, and your child is miserable it is worth giving some fever reducing medicine. Ibuprofen tends to be a bit harder on the stomach so I would choose acetaminophen (Tylenol) when I have an illness that includes tummy symptoms. Another advantage to the Tylenol is that it comes in suppository form, so it is more easily tolerated by a vomiting kid. Dosage chart

How to assess hydration

If your child is running around and has good energy, I am usually not too concerned. There is a big difference between subdued and lethargic. Some kids are well hydrated but still feel lousy and are quieter than usual. We can call them subdued. If you have a kid with big juicy tears and lots of drool, they are probably not terribly dehydrated. The body doesn’t waste the fluid.

On the other hand, a dehydrated child is lethargic. They do not want to play. The urine is more concentrated (darker and smellier) and way less frequent. Their mouth feels dry. Their breath might be stinky (of course if they have been vomiting that is probably a given.) Their skin may be dry. Normally if you pinch up a bit of skin on the wrist, it will immediately correct itself. If someone is dry, it may remain up in the pinch for a moment.

If they are refusing fluids or can't keep down anything, you need to check in with your doctor’s office. If they are vomiting up bile (bright green) that is another signal that their tank is really on empty and they need a little help turning things around. These are the kids that sometimes get carried into our office draped over their parent’s shoulder.

If I am giving phone advice, and it sounds like a child is dehydrated,I am usually going to skip the office visit. If the child is lethargic and you have been attempting small amounts of fluids and failing, then a trip to the emergency room is appropriate. Once there your child may get some IV fluids which often perk them right up.

Most of the time the ER is not necessary. Frequent but tiny amounts of fluids is a remarkably effective approach. Generally the vomiting is the first thing to ease. If they remain nauseated, there is a magic pill called Zofran. This is an effective but strong medication. We don’t like to give it without an office visit, to make sure we are not ignoring an underlying cause that needs treatment.

Once your child has started keeping down fluids, it is okay to advance the diet if they are interested in food. More often than not, we expect the stools to continue to be looser than normal for a bit longer. Trust your kids to some extent. I find that most of the time they crave the foods that their bodies can handle. If you have an outlier asking for a hotdog, follow your instincts and say no.

Bland starchy foods are your best bet. I suggest a modified BRAT diet. Bananas, rice, applesauce, crackers, toast, potato, pasta, boiled chicken and watermelon are all okay.
I find that folks have a quicker time getting over this if they avoid dairy (some folks can stay on yogurt and tolerate that fine).

In my experience, getting started with probiotics right away is the key to getting over this quickly. We need to get the gut healthy again so that it can tolerate a normal diet and the good bacteria in the probiotics is critical to this.

There are plenty of good brands out there. One of my favorites is Florajen for kids which you can get from the Noe Valley or Diamond Heights Walgreen’s. It is kept in the back in the refrigerator, but there is no prescription needed. Baby Jarro Dophilus (Whole Foods or health food stores) is another brand that we have had success with. If you have a trusted brand on hand, it is fine to stick with that.

One of the most common calls to our advice nurse team is when a patient seemed like they were improving and have had a bit of a relapse. This is usually caused by advancing the diet a little too quickly (especially dairy.) You may need them dairy free for a week before things return to normal. Yes, this includes cheese....

If your child is keeping food down but has loose stools, I have had great success using the Similac expert care for Diarrhea (it used to be called Isomil DF) It is difficult to find this locally. Amazon might be your best bet. For older kids, I still use this soy based formula as the base for a smoothie:

   -   Similac DF or other Soy based formula
   -   Banana
   -   Frozen yogurt (if not tolerating dairy, find a non dairy alternative)

Mix the ingredients in a blender. This smoothie is usually easily accepted, well tolerated and helps form up the stool. Watch out that it doesn’t do too good of a job. We don’t want to let the poop get hard.

What if it isn’t a virus?
If you or your child has fever, chills, bloody diarrhea and vomiting, that could be food poisoning. The most common culprits are Salmonella, Shigella and Campylobacter. Sometimes the symptoms might not show up for a few days, making it hard to identify the source.

Even though many of those illnesses are self limiting, getting seen is a good idea. We may send a stool sample to the lab to check for a bacterial stool culture. There are special containers required for this. You can get those from the office or the lab. Mom or dad, it is your job to get the poop into the specimen container and to the lab (thank you for your understanding.)

If you or your child are just back from travel or camping and has awful gassy, incredibly stinky stools, we should make sure that you don’t have giardia or some other parasite. If that is a possibility, we would send another type of stool sample to the lab that requires a different set of specialized containers. This is called an O&P (ova and parasites.) As opposed to many of the other tummy issues, these do not usually resolve without help of some medication. If you have a pet with loose poops, that can be an important clue.

With any ongoing tummy issue it is important to get some routine weigh ins.

Many times tummy pain is from constipationGas pains tend to be sharp and intermittent. Any steady abdominal pain that is lasting more than several hours should be evaluated.

With anything poop related, often defense is your best offense. Wash your hands!!!

Friday, December 29, 2017

They put WHAT in their mouth?


They put WHAT in their mouth?

Holiday seasons are especially challenging for childproofing. Christmas trees, presents, wrapping paper…..It is hard to stay vigilant 24/7. We usually get some pretty interesting calls this time of year.

Kids like to explore. Many times this involves sticking things where they don't belong.
Being fairly oral critters, most of the time the object they are handling gets placed in the mouth. When this happens there are two passages that it might go down.

If it goes into the esophagus it hopefully will make its way down into the stomach, through the intestines and then get pooped out.

If something was swallowed, here are things to consider:

Is it stuck?
How does the child look? Are they able to take a sip of water? Can they swallow just fine? Is their breathing relatively normal?

If something has gotten stuck in the esophagus they will look uncomfortable, There will be frequent coughing and throat clearing going on. You will know that something is amiss. This will necessitate a visit to the ER.

Is it poisonous?

If you have any doubt about that, call the poison control center


Is it potentially germ laden?
We get calls about kids eating things that are pretty disgusting. Young infants are the most vulnerable, but usually don’t have the dexterity to actually get something into their mouth without some help. Once they have mastered the hand/mouth coordination skill, they are old enough that a normal healthy gut has good bacteria that can be somewhat protective. If whatever it is that they ingested is going to cause trouble, symptoms will usually show up with tummy aches, vomiting and loose stools within a day or so. Persistent tummy upset will usually warrant a stool test to help us figure out what the culprit is.

Is it a battery?
Any battery can be trouble, but button batteries can be a tremendous hazard because they can be easily swallowed and they seem to be everywhere these days. Several years ago I got a call from a mom of 15 month old twins. There they were, sitting on the floor with mom's pedometer right in between them. It was open and the battery was gone. Because of the uncertainty involved, we did have to send them to get x-rays. Indeed there it was, that little battery, sitting in the stomach of one of the kids. In this case it passed safely, but if a battery gets stuck anywhere on the way it can cause a dangerous amount of damage. Please know where all the button batteries are in all of your little gadgets and make sure that your kids have no access to them. Keep a strict inventory and perhaps stick a piece of duct tape across any battery compartments.

Other objects that you need to be wary of are magnets. I am not talking about the little letters that you may have on your fridge. The ones that cause concern are the industrial strength magnets that you may find in some "grown up" toys like buckyballs or jewelry.
If more than one of those get swallowed it can wreak havoc on the intestines and be deadly. Keep them away from your kids!

Is it sharp?
If it is something that has a point or sharp edge, keep an extra close eye on your child. Make sure the tummy stays nice and soft. If your child seems to have a rigid painful belly, they will need to be seen right away. Keep an eye on the stools. Any dark, tarry poop or bright red blood would be a reason to get immediate help.
One of the sharpest things that we were keeping an eye out for some years ago was one of a Grandma's one carat diamond stud earrings. That passed through and was retrieved with no harm at all to the swallower (Grandma didn't want it back; it was reunited with the mate and is in a safe deposit box waiting until the little girl is 18.)

Most of the time, it is simply a matter of watching for the whatever it was to pass through. I have seen all sorts of stuff get swallowed and pooped out without incident. I think I have seen enough change to put a kid through college. Most coins smaller than a quarter go through fairly easily.

Let's encourage a quick passage! Increase the amounts of fluids that your child drinks. Perhaps add prunes. If your child is old enough that they are beyond simple pureed food, consider giving some corn kernels (You won't see that in any textbook). Have you figured it out yet? For those of you who need this spelled out, corn kernels are usually fairly recognizable after they have been pooped out. They can act as a marker. Corn can help you track the transit time.

If your child is old enough to know better and seems inclined to continue to put non food items in their mouth, this might be a condition known as Pica. Pica is the persistent eating of substances such as dirt or paint that have no nutritional value. This is worth pointing out to your doctor. There might be a nutritional deficit or something else going on.

If the object goes into the trachea it may block the airway and you have a choking situation on your hands or it could get aspirated into the lungs. Neither is good. Your child will clearly be having breathing difficulties if this has happened. They will likely have a color change is they are fully obstructed. If someone is obstructed, they can not speak or make sounds. Of course with any emergency you should call 911, but it is my hope that all parents and caregivers are trained to do a choking rescue.

To avoid this happening on your watch, it is SO important to keep little items away from the young kids. Anything that can fit into a toilet paper tube is too small for an infant or young child to be handling. Food pieces should be soft or cut into long strips rather than round pieces.
Encourage safe eating: sitting instead of running around, chewing and swallowing rather than shoving in wads of food. Parents, please model good behavior!

Dr Kaplan advises that a rule of thumb to keep in mind is that the size of your child's airway is about the same diameter of their pinky finger or ear canal. That is pretty small!
All parents should be able to do a choking rescue!







Friday, December 22, 2017

Will the real Santa please stand up! 2017

Topic of the Week:
Talking to your child about Santa


Over the years several parents have asked me to weigh in on the ‘Santa discussion.’ What is the best way to keep the magic alive while not endangering the trust that is so important in any relationship?

For this general discussion, we can put Santa into the fine company of the Tooth Fairy and the Easter Bunny, but it is safe to say that Santa is usually the member of this trio that has the most emotional connection.

Let me preface this post by saying that I think it is essential to be honest with people in your lives. You don’t need to knock them over the head with the truth, but if they ask a question and press for an answer, please don’t lie.

In my Jewish family, the girls never gave too much thought to the man in the red hat or the giant bunny, but we did get routine visits from the tooth fairy every time the girls lost a tooth. When I started writing this, I checked in with my grown girls to see if they remembered any feeling of betrayal when they realized that it was daddy sneaking the money under the pillow.

Lauren tried hard to remember. She vaguely recalls that she figured it out reasonably early, but played along for several years. She wanted to make sure that the gravy train didn’t dry up. Alana says that she was too busy trying to figure out if monsters were real or not (thanks to having a big sister who teased her by making strange noises in the middle of the night) to worry too much about the Tooth Fairy.

For the young kids who ask if the mythical creature is real, you might deflect the questions fairly easily without telling a falsehood if you want to extend the magic for another year.
A simple,“What do you think?” works pretty well. Or, “It is fun to believe in magic sometimes and Santa is part of the holiday magic”

Keep in mind that once your child gets to kindergarten believing that Santa is actually going to try to fit down your chimney, rather than the ‘spirit of the holiday magic,' they might be in for a shocking disappointment when they learn the truth. There are lots of kids at school eager to share the cold hard facts with your innocent child. It is much better if this discussion comes from you before your kids find out a harder way.

I spoke to several people who recounted that they believed in Santa with all of their hearts and were completely heartbroken when they learned the truth.They felt deceived. One person told me that finding the truth was the moment they stopped believing in all magic. How sad!
Letting them know the truth gently doesn’t have to be a negative experience.

For older kids, I love a good story. Many stories start with an element of historical truth:

“Once upon a time in a far off country there was a man named Nicholas. He loved to do good things for other people. What was special about him is that when he gave people presents or did nice things, he didn’t do it because he wanted something in return. He simply wanted to do good things. Lots of times he did it in secret and no one even knew who did something nice for them. Maybe this Nicholas was big and jolly and had a white beard.He became known as Santa Claus. Santa is a symbol of love and magic and hope and happiness. He teaches children how to believe in something that they can’t see or touch. I am on his holiday kindness team and now you can be too. Really little children might believe that there is one Santa who manages to be everywhere at once. Big kids like you get to know the secret. Team Santa is all the big kids and grown ups who want to help make other people happy. “

Perhaps take the opportunity to help your child be an active member of this awesome team; an initiation of sorts. Is there someone in your life that seems like they need a little kindness? What could you do for them. Is there a little gift that might make a difference? Plotting a secret kindness is the thing that wonderful lasting holiday memories are made of.

PS: The photo on Santa's Lap should be voluntary. If your child isn't eager to go sit on a strange guy's lap, please don't force them.

Friday, December 15, 2017

Essential equipment 2017

Topic of the Week:
Essential Equipment


Essential equipment 2017
"stuff" that may make parents life easier

How old are my kids? They are so old that they slept on their tummies in cushy little cribs surrounded by tons of stuffed animals. They survived their early years without a cell phone or ipad to play with. The cell phone that I did have was as large as a briefcase and needed to be plugged into the car cigarette lighter for power. The baby swing that we owned was wound up with a crank. If you are a grandparent reading this, you are nodding as you remember the model that I am talking about. The babies loved it and would be lulled into a contented relaxed state for several minutes of clickety click, clickety clack. Then alas it would wind down and need to be cranked up again. This was a noisy process that more likely than not would wake the sleeping baby who had just nodded off.
Parents of young children have a much wider variety of “parenting hacks” to choose from. There are plenty of new things constantly coming onto the market that parents will refer to as “game changers”. These are the item that really make things feel more manageable. The following products are not personal endorsements; I am simply sharing wisdom from others that may be useful to my patients and readers. This is the third year that I am doing this post. Every year I have added more items. Thanks to all of you who have chimed in.

Having a safe place where where your baby can comfortably hang out is essential.
.
For the Crib:
  • Dr. Hurd suggests that all of her patients invest in a simple crib wedge. Having them on a comfy 45 degree angle is especially important for babies with digestion issues or any congestion.
  • Dr. Anne has several parents who absolutely love the Snoo Bed.This is not cheap, but it was created by Dr. Karp who wrote the Happiest Baby on the Block series. It might be cheaper than several nights of night nurses!

  • One of our patients Amy (mama of twins) told me aboutwonder bumpersThese are one of those “why didn’t I think of that” products

Putting them down outside of a crib

  • Dr. Anne likes the Boppy newborn lounger


  • Some of Dr. Hurd’s favorites are:



  • Diane, a mom of twins passed along a tip. “When I started asking other twin parents which products I should buy two of, at least 5 people told me I should get two fisher price rock and plays (with auto rock). They were all correct. The rock and plays are amazing. When my girls are a little bit congested (which has happened a lot in the first 6 weeks of life), the incline helps them sleep better. And on those challenging nights where they are both fussy, I can put them each in a rocker and turn them on and they can rock gently for hours. Make sure to buy the one with the auto rock option, because the regular one you have to rock manually”

  • If you don’t mind a manual version, You can rock this Fisher Price rocker with your foot (never run out of batteries.) One of the nice things about this is that it is reasonably priced and can transition to be used as your kids grow.

  • For kids over 4 months, my husband Sandy says I can’t leave the doorway jumpers off the list. Our daughter Lauren absolutely loved hers and would bounce and twirl in that thing in rhythm to music.These of course only work if you have sturdy door jambs. With any carrier or swing, use your common sense and don’t keep the babies in there for ridiculous stretches of time.

  • Thanks to Nurse Lainey for telling me about the DockaTot This product has some big fans


Blankets and Swaddles

  • Many parents and Dr. Anne all really like the Merlin Sleepsuitto help with the transition out of the swaddle around 3 months

  • My niece Lena says that the swaddle blankets with velcro were really useful. These give the option of snugging the arms tight while leaving the feet free to be strapped into a bouncer.




  • Wherever they are hanging out, Dr. Anne also suggests checking out the Summer Infant Snuzzler Infant Support for Car Seats and Strollers- this is terrific for small newborns or babies having a having a hard time transitioning to bassinet in first month.

For some of our toddlers and preschool kids working on their sleeping skills, thanks to Tila for sharing the sleeper heroAfter she told me about it, I have passed this tip along and many parents have called it a difference maker

Please never leave kids unattended. Just this week I had a call involving a baby not fully strapped into a little bouncer who managed to flop himself forward and bonk his head (he’s fine.)
Don’t put carriers up on a high surface. Trust me, they manage to fall. You don’t want to be the person calling me about that. This is more dangerous if there is a toddler or large dog that can 'help' the baby get knocked over.



  • Once the babies are over 4 months old, Noe Valley Pediatrics' Lily relied on her infantino flip advanced convertible baby carrier

  • For the babies who are starting to take their first steps, Nurse Lainey loves to recommend Little balance box

Food related

This is especially helpful for a family with twins who are mixing larger quantities of formula at a time



You can wipe it clean and it cuts down on messes

  • My super adorable neighbor and patient Sean loved his Zo li sippy cup. His mom Sara says she tried a bunch before they found this winner and that it helped them transition away from the bottle. (Welcome to baby Kate, Sean’s new sister!)


Other Random tips

My lovely patients Rita and Ricardo spend a recent date night trying to brainstorm for me. They reminisced and thought about the most essential baby equipment (especially the first time around). Here's their list:

  • For the tall parents out there -- the Uppa Baby stroller line is great.They have the Uppa Baby Vista and the Uppa Baby G-Lite strollers and both are great for Riccardo (who is 6'8').

Other parents let me know about

  • The Frenchie Mother towell - is a towel that velcros around mom or dad's neck and makes it easier for you to take the baby out of the bathtub (and keep you dry at the same time.) So simple but such a good invention!

Thanks Caroline for letting me know about another towel suggestion: I have a pretty random suggestion for essential equipment, but it made my life so much easier that now it’s my go-to gift for new parents. I absolutely loved my apron towel. Especially when Jack was a squirmy, wet baby. It made me feel so much more comfortable bathing him by myself.
You clip the towel around your neck before the bath, and after the bath you just pick up the baby to your chest and flip the hood up.


  • Mama Regan let me know about the Oogie bear, little scoop for removing little boogies

  • Noe Valley Pediatrics Eileen reminded me that this list isn't complete without the nose frida or other nasal aspirator. Having one of those is a must have for every parent


I couldn’t do a post like this without checking in with Jennifer of Hint Mama. She sent along the following tips





Clive’s mom Kylie says favorite toy as infant and now great distracter in car seat is baby Einstein take along tunes.


(Bells and whistles are fine and entertaining. Not everything needs to be high tech. There is nothing as great as a cabinet full of food storage containers and lids!)

  • Thanks to Pediatric Dentist David Rothman for chiming in with a bit of wisdom. His says that his kids favorite was the different colored stacking blocks that kept them happily playing for hours.

  • Dr. Schwanke's favorite item Sophie the Giraffe would be in this category. This is a classic favorite that has been loved by several generations.


  • Noe Valley Pediatric's Lily reminded me how important asimple doctors kit can be at getting kids more comfortable during their visits here.


Beyond equipment, there are now all sorts of apps

  • Robert, the daddy of baby Noah says that they found thebaby tracker app really useful


Other products


I don't advocate trying to live in a germ free world, but I imagine that most of us have disgustingly dirty cell phones that would benefit from a good cleaning, especially before we let our babies chew on them.

The book "Baby Bargains" another recommendation from Rita and Ricardo was a great resource to help them find general baby equipment (strollers, car seats, cribs, etc).  It's not just about bargains - it's about quality, and they test and know about all the latest products.

Bonus Wisdom tip from mama Megna

One of the things I realized when I was nursing was that if I was stressed my son almost always 'absorbed' the tension especially when I was nursing. This was one of the most direct osmosis affects I've seen of stress hormones. It was a reminder of always being cool calm and composed especially when around your child.

We traveled a lot with our son the first year and although traveling with the a baby it's no picnic, each time we did a trip he grew emotionally so much. We never regretted a single trip that we took whether it was Europe or to see great-grandparents. Traveling is an amazing thing for a child even that age. It made us as parents more flexible and not as regimented about having things a certain way, and socialized our son at a very early age.

This post lives forever on my blog. If you have some magic tips to share, let me know and I will update the post.

She says this big exercise ball was huge life and back saver those first couple of months

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