Friday, November 16, 2018

Food Safety Guidelines/Just in time for turkey leftovers

Food Safety guidelines/Just in time for Turkey leftovers

Thanksgiving is a holiday associated with lots of yummy leftovers so it's usually my signal to update my food safety post. If you ever watch the news you know that food contamination issues can happen all year round. This post will give you some safe guidelines for foods that you buy and cook. If you do a lot of eating out, restaurants are supposed to have their cleanliness rating publicly displayed. Check the bottom of the article for some great links on food storage guidelines; everything from egg safety and turkey leftovers to breastmilk storage.

It is certainly not a sterile world. As soon as they are able, your baby will start putting anything that they can reach into their mouths. You can't even begin to imagine the phone calls we get about the more disgusting items that some of our little patients have managed to get their hands and mouths on. Just this week we talked to parents of various kids who had possibly had a nibble or taste of the following things:

  • chap-stick
  • essential oils
  • particles from an exploded cold/hot pack
  • kitty litter

So yes, the world is full of germs, and while I don't generally get too concerned about a little dirt here or a big sloppy dog kiss there, foodborne bacteria can be nasty, and we need to minimize any exposure.There were over 300,000 reports of children under the age of five being impacted by tainted food last year alone.

Infants and young children are particularly vulnerable to foodborne illness because their immune systems are not developed enough to fight off infections. This is especially important for infants under 6 months of age. Extra care should be taken when handling and preparing their food and formula. Here are some basic food safety guidelines:

Wash hands for at least 20 seconds before food preparation. Soap is best. Hand sanitizer will do. Re-wash as needed after handling food that might carry germs. The most common offenders are poultry, meat, raw eggs.

Make sure kitchen towels and sponges are changed and cleaned frequently. Sponges can go through the dishwasher. Cloth can get easily contaminated and then spread germs. Watch out for potholders or other cloth items that come into contact with raw food.

Keep your refrigerator temperature at 40 degrees or colder. It is worth investing in an appliance thermometer so that you can keep track. All the science says that the 40 degree number is essential for keeping the bacteria from multiplying.

Your freezer should be below 0 degrees. To ensure the safety of your frozen food, you need to be sure that it has been actually kept constantly frozen. One clever trick to make sure of this is to keep a baggie filled with ice cubes in the freezer. If they remain cubes, you are in good shape; if they melt and refreeze as a block of ice that means that at some point your freezer was not cold enough. This can happen in a power outage or even if the door wasn't kept tightly closed. I am sad to say that if there was stored breastmilk in there that has thawed and refrozen, I would no longer consider it safe. Label things in your freezer and rotate so that you are using up older stuff first.

Check the dates of baby food jars and make sure the lid pops when you open them.

Don't put baby food back in the refrigerator if your child doesn't finish it and you used the "used" spoon to take the food directly from the jar. Your best bet - simply don't feed your baby directly from the jar. Instead, put a small serving of food on a clean dish. Add more as needed with a clean spoon. Remember that once saliva has come into contact with the food it is no longer sterile and some bacteria can grow quickly.

Powdered formula is NOT sterile. Don't mix up more than you need in advance. If the infant is less than 4 months, I would mix it with boiling water and let it cool.

Don't leave open containers of liquid or pureed baby food out at room temperature for more than two hours. Bacteria thrive in temperatures between 40-140 degrees

Don't store opened baby food in the refrigerator for more than three days. If you are not sure that the food is still safe, remember this saying: "If in doubt, throw it out." See links below for guidelines on how long food stays safe.

Make sure that foods are properly cooked. A food thermometer is the best tool for this.

  •  Beef...160
  •  Chicken ( white meat/ dark meat)...170/180
  •  Fish......160
  •  Eggs....not runny

For all of you "older kids" who will be baking this holiday season, watch out for the batter (I am a notorious offender.), Even one lick from raw food containing a contaminated egg can get you ill.

For all of you travelers: RESIST THE TEMPTATION. This is not an ideal time to have your baby try all sorts of new foods. This time of year we get calls from around the country from 'Pecan pie gone wrong' It is best to take your time with new foods in the comfort of your own home.( and emergency room)
"They had a taste of stuffing"
"What was in it?"
" I have no idea, oysters? chestnuts? eggs?"

You get the idea.....

Myth: Freezing food kills harmful bacteria that can cause food poisoning.

Fact: bacteria can survive freezing temperatures. When food is thawed, bacteria can still be present and can begin to multiply. Cooking food to the proper internal temperature is the best way to make sure any bacteria is killed.

Myth: vegetarians don't need to worry about food poisoning.

Fact: Fruits and vegetables are an important part of a healthy diet, but like other foods they may carry a risk of foodborne illness. Always rinse produce well under running tap water. Never eat the pre-washed 'ready to eat' greens if they are past their freshness date or if they appear slimy.

Myth: Plastic or glass cutting boards don't hold harmful bacteria on their surfaces like wooden cutting boards do
Fact: Any type of cutting board can hold harmful bacteria on its surface. Regardless of the type of cutting board you use, it should be washed and sanitized after each use. Solid plastic, tempered glass, sealed granite, and hardwood cutting boards are dishwasher safe. However, wood laminates don't hold up well in the dishwasher. Once cutting boards of any type become excessively worn or develop hard-to-clean grooves, they should be discarded.

Myth: Locally-grown, organic foods will never give you food poisoning.

Fact: Any food, whether organic or conventional, could become unsafe with illness-causing foodborne bacteria at any point during the chain from the farm to the table. Consumers in their homes can take action to keep their families safe. That is why it is important to reduce your risk of foodborne illness by practicing the four steps: Clean, Separate, Cook, and Chill.

Some excellent resources for food safety tips can be found at:  This site keeps track of any food recalls  This is as great site for seeing how long food will last. I used it just this week to figure out if an open can of chickpeas was still good. (After a week, the answer was no)   This site has loads of kid friendly activities

Enjoy your Thanksgiving!

Air Quality update November 2018

Air Quality Update

Wishing all of you a happy and healthy Thanksgiving.
I was all set with my Thanksgiving topic on how to deal with turkey leftovers and general food safety, but all the calls I have gotten in the office today prompted me to add a bit of focus on the air.

What would make us all jump for joy is a bit of rain. For those of you not in the Bay Area, go outside and take a deep breath of air for all of us. Today our air quality moved into the purple range. Very unhealthy for everyone. If you are traveling, I would think hard before returning home until things start to clear.

It is Horrid. It is eerie. It is scary. It is claustrophobic. As bad as it is for us with our scratchy throats, tight lungs and irritated eyes, my heart goes out to all those thousands of people who have lost loved ones, homes and are even closer to the fire. This feels even worse than last October, and those fires were weren't even as far away.

What can we do to deal with this smoke?

  • Stay indoors as much as possible!

  • If kids are stir crazy, consider a mall like Stonestown (especially if you can park underneath and avoid walking outdoors) Consider creating an indoor activity there like a scavenger hunt or bring a pad of paper and colored pencils; practice drawing

  • Sometimes we just need to turn on the tv or watch some videos on our ipads. Do what you need to do to get through this smokey period. As long as you control it and use tech time as a tool it's okay to make some exceptions and allow a little more than you might in normal circumstances. Your sanity counts for something.

  • After two years in a row, I fear that this seems like the new normal. I suggest ordering some extra N95 masks to keep on hand so that you are always prepared.

  • Avoid ANY strenuous activity.

  • If you are in your car, keep the air on recirculate.

  • Avoid adding to indoor pollution. Don't light candles or vacuum. No Smoking!!! DUH

  • Pets shouldn't be exposed to the smoke any more than we should. ( I know, try explaining that to them!)Toss the ball a little bit more indoors, but limit their outdoor time as much as possible.

  • Be aware that food delivery services are being impacted. Today, many of the couriers were not delivering due to safety concerns. Plan ahead with your meals.

Smoke is bad enough, but if we are ever in the situation that we need to be dealing with actual fire, I am sharing this essential information from a friend of mine who lives in Santa Barbara and has been through this a number of times.

Home Evacuation Checklist – How to Prepare for Evacuation:

Inside the House
  • Shut all windows and doors, leaving them unlocked.
  • unlatch the garage door
  • Remove flammable window shades, curtains and close metal shutters.
  • Remove lightweight curtains.
  • Move flammable furniture to the center of the room, away from windows and doors.
  • Shut off gas at the meter; turn off pilot lights.
  • Leave your lights on so firefighters can see your house under smoky conditions.
  • Shut off the air conditioning

  • Gather up flammable items from the exterior of the house and bring them inside (patio furniture, children’s toys, door mats, trash cans, etc.) or place them in your pool.
  • Turn off propane tanks.
  • Move propane BBQ appliances away from structures.
  • Connect garden hoses to outside water valves or spigots for use by firefighters. Fill water buckets and place them around the house.
  • Don’t leave sprinklers on or water running, they can affect critical water pressure.
  • Leave exterior lights on so your home is visible to firefighters in the smoke or darkness of night.
  • Put your Emergency Supply Kit in your vehicle.
  • Back your car into the driveway with vehicle loaded and all doors and windows closed. Carry your car keys with you.
  • Have a ladder available and place it at the corner of the house for firefighters to quickly access your roof.
  • Seal attic and ground vents with pre-cut plywood or commercial seals.
  • Patrol your property and monitor the fire situation. Don’t wait for an evacuation order if you feel threatened.
  • Check on neighbors and make sure they are preparing to leave.

Friday, November 9, 2018

The Pie Theory of life 2018/ Nurse Judy's Pie shifts

Somehow or other I currently have 2,400 subscribers who now get my weekly posts. The blog has had 270,000 visits which astonishes me. Thanks to all of you who read them and share them. Writing these has been a pleasure. I am always learning. Your feedback has been something that I cherish. In honor of this being my 100th post since starting the weekly emails on Constant Contact I am running one of my all time favorite posts. My kids and I live by the “pie theory.” My personal pie is going through some shifting pieces. Detail are at the bottom of the post.
This week's Topic

Finding Balance/ The pie theory of life
Here is an update of one of my top ten favorite posts.
Scroll to the end of the post for an update in the shift in my personal PIE

The "pie theory" got its inception many years ago. For a number of years (many years ago) I was the Parent Association president at my daughters' elementary school. It took an inordinate amount of my spare time, including meetings several times a week. On many levels it was rewarding being so involved but I assure you, I was delighted to pass the reins when my stint was over. Though I was really genuinely relieved to have my time back, I felt off balance by all the sudden free time in my schedule, and at first I couldn't figure out why I was so unsettled. I finally realized that although the new empty hours were welcome, they had created a bit of a vacuum. I filled it quickly (started taking up karate a few evenings a week), but it was right around that transition period that the "pie theory" helped me make sense of things.

Imagine that your identity is a circle (or whole pie). Who you are is divided into many pieces; some pieces are large, some small, some temporary. Some are constants that are with you life long, some are optional, some are good for your soul, while still others are energy sappers that give you little in return.

Are you:

  • Daughter?
  • Son?
  • Sibling?
  • Friend?
  • Spouse?
  • Ex spouse?
  • Grandparent?
  • Student?
  • Volunteer?
  • Pet owner?
  • In a job/occupation or seeking one?
  • Doing a hobby that takes time and energy?
  • Member of a book club or any club for that matter?
  • Churchgoer?
  • Exerciser?
  • House cleaner?
  • Carpool driver?
  • Event planner?
  • Adventure seeker?
  • and of course last but not least....Parent?

The list goes on and on. What activities make up your day, your week, your month, your year? What pieces make up your pie? Take a few moments to figure it out. Get a piece of paper and a working pen (if you can find one) and create your pie.

It's interesting to think how you can be identified in different ways by the various pieces of pie. Many folks recognize me as Nurse Judy. More than once I have actually looked at a rash, or given advice from a restaurant table (as my patient husband rolls his eyes.) There was a time years ago when I came to work one day and saw a construction worker on the roof of a neighboring building. He looked awfully familiar and I was struggling to place him; was he a parent from the practice? Someone from school? I could see that he recognized me as well; we kept looking at each other and a moment passed. I could see that he had figured it out first. He gave a big grin and called out "Ahoy there Java's mom!" Of course! I ran into him several times a week with his pack of dogs when I walked my dog Java. Not only did being a dog owner dictate my daily schedule and get me out walking rain or shine, it also included me as a member of a distinct social network in the neighborhood for many years. All the dog owners knew each other by sight and all the dogs by name. Being "Java's mom" was a wonderful piece of my "pie" for 12 years. If you are a pet owner, that piece has a very special place allotted to it. I am now proud to be grandma to my daughter's giant puppy Bowie.

Your pie is finite. You can only do and be so much, as there are only so many hours in the day. Some folks have too many things competing for time and attention, and figuring out which pieces can be compressed can be quite stressful. Sometimes we make poor choices.

For busy working parents this might be a foreign concept, but some folks don't actually have enough pieces to begin to fill the shell. A big empty pie can be just as unsettling as a full one. Have you ever noticed that when you are super busy you can manage to get through an entire to-do list very efficiently? On the other hand, on a quiet day you may have only one or two things on the list but somehow nothing gets done.

A healthy pie has plenty of interesting pieces that can grow and shrink according to your needs. The more forgiving and elastic the pieces, the easier time you will have finding a good balance.
Your pie will naturally change from year to year, but some changes are enormous. Some people are comfortable having a very crowded pie, while others are quite fine and happy doing nothing at all. Part of this is figuring out what your ideal is, and work towards that.

Any large sudden changes to your pie will make you feel unsettled, way less so if you have a glimmer of what is going on; hence this theory. Both of my daughters have taken this to heart. In fact Alana has permitted me to share her own blog post on the Pie Theory that she wrote several years ago:

(Blogging runs in the family I guess)

When there is a large shift in your pieces my girls and I refer to this as "pie disequilibrium." Common culprits might include:

Event planner:
Folks planning a wedding or large event can spend months dealing with all the fun details. When the event is over, that planner piece is gone, your pie has a gap.

Sports Fan:
My daughter Alana has a twinge of "Pie Disequilibrium" every October when baseball season is over.

My daughter Lauren had to learn how to deal with the extra time that appears after a show run is over.
Folks that spend much of their time and energy tending to someone else’s needs might find themselves suddenly with a large vacuum when that person is gone or no longer needs them.

As your children grow up it can be a tough adjustment (don't worry, they still love you.) Luckily this happens in stages. Kindergarten...a full day of Parents who have the "parent piece" taking up the entire pie may feel a twinge when their kids don't need them in quite the same capacity.

Huge life changes will create seismic shifts. Nothing will ever match the huge transitions that take place when you add the parent piece to your pie. My best advice to you as you shuffle all your pie pieces and see how things fit comfortably is to identify pieces that need to be protected so that they don't get too small.

Protect that piece. Get creative and make sure that you have time for the two of you; have some moments being a couple.

Being the best parent that you can be includes living by example. Let your kids have parents that are multifaceted and not consumed by any one thing (be that parenting or a job.)

Best of luck finding a balanced, interesting, and fulfilling pie!

Nurse Judy's shifting pie:

As many of you know, I have been working at Noe Valley Pediatrics for over 30 years. In July of this year I opted to remove the office manager slice of my pie. I am continuing with the parts of the job that I love, which are teaching parents, giving advice and writing.
I am now in the office Mondays and Thursdays. I am fortunate to be enlarging my mom piece, as both of my daughters and now my son-in-law, live several minutes away from me.

My travel piece gets to stretch a bit in December. My husband and I will be doing an exciting trip to Southeast Asia. I don’t do the mountain climbing with him; this is his turn to do some tamer traveling with the wife.

But the big news is that I am planning to expand the “piece of pie” that involves my writing. I have been encouraged by many, (gently nagged by a few) to go beyond the blog and write a book. I am at the very beginning of the process. I would love to hear from folks who are writers, or are in the business. I am currently gathering info and advice and would appreciate any wisdom or tips that you are willing to share.

Friday, November 2, 2018



It is all well and good to want your children to tell the truth, but until they have reached a certain age, don’t let yourself get too disappointed when you realize they have been less than honest. Many young kids can actually convince themselves that what they are telling you is the absolutely as real as can be. When they get a bit older they are simply calculating which outcome will get them in less trouble.

I had to learn this the hard way with my older daughter Lauren. Even back in her earliest years, she was an actress.

The earliest whopper that I found out about happened a day after the Northridge earthquake in LA. Lauren was in 1st grade.
When I went to school to pick her up, I was surprised when multiple people came up to give me consolation hugs.
“Judy, we are so sorry” “What a tragedy” “How old was the baby cousin that died in the earthquake?”

HUH? I was more than confused. I assured them that as far as I knew, everything was fine. We didn’t have family in LA.

“Hmm, but Lauren said…”

More confusion ensued. I picked Lauren up and asked her why on earth people were coming up to me and offering sympathy.
She looked genuinely puzzled. Actress, remember...she was going for her first academy award.

“Oh, I think I know” she said, “At recess we were playing some pretend games and someone must have overheard and thought it was real.” I accepted that without a second thought.

The next morning at school I bumped into her teacher.

“Oh Judy, that is so sad about the baby”

“Oh dear” I responded, “That is all a misunderstanding. People must have overheard kids playing and thought it was real.”

Mrs Calhoun paused, and then gently informed me that in fact, in ‘sharing’ yesterday when everyone was going around the circle telling their news, Lauren stole the thunder by announcing that her baby cousin had died in the Northridge earthquake. There was no misunderstanding or overhearing recess pretend games.

My daughter had given me a ‘look you in the eyes bald faced lie’ and I was mad.

We had a talk that evening about the importance of honesty (which likely went right over her head.) She continued to be caught in little lies, and promises meant little.

That week Goldie the fish was found floating. You might be disappointed to know that sweet Nurse Judy’s initial response was “Maybe if she thinks that breaking promises has consequences that isn’t such a bad thing

Fortunately, her daddy took it upon himself to make sure that she wouldn’t have to feel the guilt of having killed her fish with a lie. In fact there would be no mourning needed this time around. He took the dead fish to a pet store that kept late hours, found a fish that matched the general look and size, and Goldie II started her reign in the tank. Lauren was none the wiser.

The irony that this fish tale in included on a post about honesty is not lost on me. It is complicated. While my opinion might be tossed out in a court of law, I maintain that shielding someone from a difficult truth is sometimes the action that feels like the right thing to do. If Lauren had asked me directly about Goldie, I would have insisted on telling her the truth.

Scroll on down for a bonus tale of Lauren and her lying phase.

Children and adults might lie for a variety of reasons. These include trying to get out of trouble, attempting to impress someone or even to be polite. At the age of five, trying to avoid a punishment is often going to take precedence over the concept of honesty.

It is so important to let them know that you put more emphasis on their telling the truth than on the consequence for their dishonest behavior.

What can you do?

Model honesty.
“Tell them I’m not home” is a good example of an easy lie that we call can get trapped in. Be thoughtful enough to tweak it to “I’m not available.” If your kids catch you lying, there is no reason to expect them to act differently from the adults in their lives.

Talk about how being truthful often takes a lot of courage.
Read some of the great books out there that are all about telling the truth. Books are a good launching point for further discussion.

Help them avoid the lie by not asking questions that will get them into a defensive situation; instead state what you see:

Rather than “ Did you eat a cookie after I told you not to?”


A cookie is missing. I see crumbs on your face. I will be more disappointed in you not telling the truth, than I would be about the missing cookie

Help them avoid the lie by not asking questions that will get them into a defensive situation:

Rather than “did you break that vase?”


“I see that the vase is broken. Do you want to tell me what happened? Remember that telling the truth is more important to me than the broken vase.”

If you get through the years without a lying phase, wow! Most likely there will be a time when your children are not going to tell you the truth. Take a moment to figure out if there is an obvious cause for the lie and form your response based on that. Please don’t ever label your child a liar, even if they have some lapses.

Let’s be real. The true value of honest communication and trust between you and your child goes way beyond the missing cookies. It is essential to be able to be truthful with each other when your child becomes a teenager. They need to know that they can call you for a pick up, no questions asked, when they find themselves in a tricky situation. Hopefully they can feel free to talk to you about important issues and ask you difficult questions.This won’t happen without a trust that goes both ways. Consistent message about how you value honesty will hopefully help foster the trusting relationship that we are striving for, now and in the future.


Here is the bonus Lauren story that went down in family lore.
This was soon after my 'family tragedy' in the earthquake.
Lauren got a new teaching assistant who she adored. He had very long hair that he wore in a ponytail. His first name was Sotweed. His last name was also odd enough that when she first told me his entire name, I thought she was making it up.
I giggled and she admonished me “It isn’t nice to laugh at someone’s name”

You are right, I shouldn’t laugh

Shame on me though, when she would say his name over the next few weeks, I confess to an occasional giggle. Okay, so there we were in the car on our way to a school event where I was going to meet the famous Mr. S for the first time.

I told Mr S that you laugh every time I say his name.”

Let’s describe me as annoyed. ” Lauren, you are right that I shouldn’t have laughed at his name, but if it only happened in private, nobody’s feelings were hurt. Now I am embarrassed and perhaps Mr S feels badly about it. I am upset that you told him this”

Lauren mulled this over, you could see the wheels turning. She was clearly trying to figure out which path was going to get her in less trouble.

“I am just kidding, Of course I didn’t tell him”

I looked at her for a bit.

“I don’t know if you are telling me the truth. I am going to have to ask Mr. S if you said something to him or not. This is your opportunity to tell me what is true” (I was sorely tempted to threaten her new fish, but that was still a secret.)

Pause, more thinking...

“I did tell him that you laugh”

“Thank you for telling me the truth”


Hello Mr. S, I am afraid I owe you an apology.

Mr S immediately let me off the hook.
I have the kookiest name in the world, of course it makes people laugh.”

Mr. S, if you are reading this post, thank you for being such a great guy!

Friday, October 26, 2018

Acute Flaccid Myelitis

Acute Flaccid Myelitis

There are three categories of urgency levels when we get notices from the public health department:

  • Health Alert conveys the highest level of importance and warrants immediate action or attention.

  • Health Advisory provides important information for a specific incident or situation, this may not require immediate action

  • Health update provides updated information regarding an incident or situation. This is unlikely to require immediate action

This week we got a Health Advisory from the California Department of Public Health regarding the national increase in reports of suspected Acute Flaccid Myelitis cases. The Media has been all over this and it is scary indeed. It is hard not to get nervous. Of course I have had some calls about it.

It is NOT my intent to fan the flames and make folks panic, I just want to give you some basic knowledge and share what is currently known about it.
Acute Flaccid Myelitis (AFM) is a very rare neurological condition that is characterized by sudden onset of weakness in one or more limbs. An MRI will show distinct abnormalities of the spinal cord gray matter.
Nationally, from January 1 through October 16, 2018 the Center for Disease Control and Prevention (CDC) has reported 62 confirmed cases in patients from 22 US states. They are investigating other possible cases at this time, so the numbers will likely change.
More than 90% of the cases occur in patients who are under the age of 18 years old. Some lucky folks have recovered quickly and completely while others continue to experience paralysis and weakness.
There were similar episodes making the rounds a few years ago that were associated with Enterovirus D68 .

This time around patients have been tested for that strain of enterovirus. It has not been consistently detected in every patient with AFM, so there isn't a clear connection, but many experts still think that D68 is the most likely cause and that the virus has mutated to make it harder to detect. Other thoughts are that it could be connected with a mosquito borne illness. The investigations continue.

AFM is NOT thought to be contagious from person to person.
While I don’t want folks losing sleep over this, (our odds of winning the current giant lottery are on par with having to deal with this)
seek immediate medical attention if you see any of these symptoms:

  • Difficulty moving the eye or drooping eyelid
  • Facial droop or weakness
  • Difficulty swallowing or slurred speech
  • Sudden arm or leg weakness
If we are suspicious of AFM, further testing and likely an ER visit would be the next steps.

Friday, October 19, 2018

Halloween safety and activity guide 2018

Halloween can be such a fun holiday, but as you can imagine, as advice nurses we tend to hear about some of the misfortunes that can along as part of the festivities.

Carving a pumpkin can be a very fun tradition. Please make sure that your child's level of participation is consistent with their age and ability. Watch out for the sharp implements and make sure you assign your younger child to the safer tasks (young kids can draw on the pumpkin rather than carving.)

Clean up the mess. Pumpkin flesh is slippery and can cause falls and injuries when dropped on the floor. Layer newspaper or old cloths under your carving work space and clean up spills right away so no one slips or trips. Skip the candles, which may cause fires. A burning candle in a pumpkin may become a blazing fire if left unattended. Instead, use a glow stick (available in many colors) or flame-less candle to safely illuminate your jack-o'-lantern.

Choosing a costume
Children are more than twice as likely to be hit by a car on Halloween than on any other day of the year!

Decorate costumes and bags with reflective tape or stickers and, if possible, choose light colors. Have kids use glow sticks or flashlights to help them see and be seen by drivers. Is your dog going along with the trick or treaters? Have them wear a glow in the dark collar!

When selecting a costume make sure it is the right size to prevent trips and falls. Be sure to wear flame-resistant costumes. Remind your child that they need to pay very close attention to their surroundings and avoid walking near any candles or flames, especially if they have loose flowy costumes. If a sword, cane, or stick is a part of the costume, make sure it is not sharp or too long. A child may be easily hurt by these accessories if he or she stumbles or trips.

Make sure that no part of the costume is covering their ears solidly enough that their hearing might be impacted. Since masks can sometimes obstruct a child's vision, try non-toxic face paint and makeup as another option. Face paints have been in the news lately. Some of them have some toxic ingredients like lead. Be familiar with the ingredients before you apply anything to your child’s skin. Always test the makeup in a small area first. Always completely remove it before bedtime to prevent possible skin and eye irritation.

Make sure that your child doesn't have any latex sensitivity before you do too heavy of an exposure. Many masks are made of latex. We actually had a patient who had an allergic reaction to the hair tinsel. You may want to do a test run of the costume and make up a couple of days ahead of time to rule out any allergies.

Trick or treat rules
Children under the age of 12 should not be alone at night without adult supervision. If kids are mature enough to be out without supervision, remind them to stick to familiar areas that are well lit and trick-or-treat in groups. Never go into a strangers house without supervision.

Popular trick-or-treating hours are 5:30 p.m. to 9:30 p.m. so be especially alert for kids during that time if you are out driving.

A good meal prior to parties and trick-or-treating may discourage youngsters from filling up on Halloween treats.

Bring plenty of water along when you go trick or treating. Just trust me on this one.

Make sure that your children know that after trick or treating, the grown up needs to pick through trick or treat bag and toss anything that looks suspicious. There is a warning out in Colorado this year about "pot laced" treats. That could happen here just as easily. Anything that looks like it has been tampered with should get tossed. Some candies are real choking hazards. If you have a younger child in the house, make sure they don't have access to the stash.

If you have a child with nut allergies (I am sure this is NOT your favorite holiday) make sure that they turn over ALL the candy so that you can separate out anything that might cause trouble. My favorite allergist adds another piece of advice. Most of the time nuts may be just one of the ingredients, but as a general rule, kids who are allergic to nuts should also be able to identify the nuts that they are allergic to. If it is peanuts, make sure they know what an actual peanut looks like.

Expecting trick-or-treaters or party guests?
Consider purchasing non-food treats for those who visit your home, such as coloring books, stickers or tattoos. Provide healthier treats for trick-or-treaters such as low-calorie treats and drinks.(Okay, fine...maybe you don't want to be "that" house, but I had to put it on the list.) Be sure walking areas and stairs are well-lit and free of obstacles that could result in falls. Keep candle-lit jack o'lanterns and luminaries away from doorsteps, walkways, landings, and curtains. Place them on sturdy tables, keep them out of the reach of pets and small children, and never leave them unattended.

Now what do we do with all this candy???
Make a plan about how much candy they can eat at one time. It is okay to be a little more liberal than usual for a day or two, but come to an agreement about a reasonable candy intake over the next few weeks. Some dentists and orthodontists have buy back programs, where they will give your child a reward for turning in their candy. Check with your dentist to see if they participate.

Bibi, one of our mom's, doesn't bother with the dentist and has instituted her own buyback program. Her kids can exchange candy for new lego pieces.

You may need to be extra vigilant with teeth brushing this season.

Remember that candy freezes (and some of it is actually better that way; frozen snickers bars, yum!)

My daughter Lauren was about 6 when she caught on that mom and dad were pilfering through her trick or trick bag and stealing all the good stuff. After that she guarded her stash more carefully.

Here are some tips that some wise mamas have added to this post over the years:

"Once Cleo was out of the stroller and walking, we put glow stick bracelets and necklaces on her so we could see her more easily when out and about in crowded spaces in the dark (we do this at things like the Dia de Los Muertos parade, too.) Cliff's sells them in a big 100-stick bulk container. Not terribly eco, but gives a little extra "eyes on" help when navigating the crowds."

My little patient Franny, bent a glow stick in order to activate it and it broke. Some squirted in her mouth. While you do want to avoid unnecessary contact with the insides of a Glow sticks, they are non toxic

Here are some local Halloween activities for the 2018 season.

bayareakidfun Halloween events