Friday, August 17, 2018

Dealing with Motion Sickness/Something new on the horizon

It is not unusual for us to get calls from folks who have a child or family member that suffers from motion sickness. Females are more likely affected than males. People who suffer from migraines tend to be especially susceptible. While the majority of people who have the most issues with this are between 2-12, some younger babies seem to have trouble as well. We have some unfortunate moms who have babies that vomit every time they go out in the car.

If you know in advance that motion sickness is an issue, here are a few natural remedies that you may want to try. If you are someone who deals with this a lot, you will have plenty of car rides ahead to do your experiments and see what works for you.

Getting fresh air by having a window open is the first course of action. Do some distraction by playing a game that has your child looking out the window. Experts say to specifically look at the horizon. For those kids who are not super sensitive, you can play some 'I Spy' games. See if you can find interesting license plates or different colors or letters on signs. Don't sabotage your trip by bringing along trip activities that have your child focusing on things inside the car. Even the best passengers might be fine until they start reading or looking at a phone or map.

Most kids do best when their tummies are not too full or too empty. Little crackers to snack on might be useful.

There are wristbands that provide pressure to some acupressure points that seem to give relief. You can find these on Amazon. There are several brands. A popular one is called sea-bands. They come in multiple sizes and colors. Otherwise simply massage the wrist and lower arm area. The magic spot is located on the inner arm about 1.5 inches above the crease of the wrist, between the two tendons there.

Ginger seems to be very helpful. For older kids, there is a ginger gum specifically made for nausea (also available on Amazon). Find your favorite ginger cookie or candy. Trader Joe's has a wide assortment. Of course don't give anything to a young child that might be a choking hazard. Check out ginger lollipops (often marketed towards pregnant women.)

Motion Eaze is a topical aromatherapy that some folks swear by. You just dab a drop behind the ears and it provides relief within a few moments. Don't do this one for the first time before you embark on a long car ride. The smell is fairly pungent and other folks in the car might have a hard time with it. If you prefer not to apply a scent directly, there are several essential oils that have been found to help with nausea. Peppermint, spearmint, ginger and lemon are all on the list. Consider letting your child chose the favorite scent. You can apply a few drops to a cotton ball and put it in a baggy. The kids can take sniffs whenever they feel the need.

Hylands and Boiron both make a homeopathic motion sickness remedy. As with many homeopathic remedies they gets mixed reviews. Homeopathy does seem to be the ticket for some folks, and is unlikely to cause trouble as long as it is used as directed. It might be worth a try. My husband likes to cry "placebo"
I say, "Bring it on, whatever works!"

If you are going on a long car ride, plane ride or boat trip and you have struck out with the natural remedies there are some medication options. Benedryl is an antihistamine that often works quite well for motion sickness. It comes as a liquid. The bottle says for children over the age of 6, but in our office we do use it for younger kids. The dose usually agrees with the tylenol dose volume. Kids over 22 pounds would get 5 ml or one teaspoon. Always check with your own doctor's office to see what their policy is. Benedryl makes most kids sleepy, but don't count on that. It gets some kids hyper. You probably don't want to find that out on a cross country flight.

Dramamine is another choice. It is an over the counter medication specific for motion sickness. Children 2-6 years of age can take ½-1 tab; children 6-12 years of age can take 1-2 tabs. These chewable tablets can be repeated every 6 hours, no more than 3 doses in a 24 hour period. Start with the smaller dose first to see if it works. Giving the dose 30-60 minutes before travel is recommended. For kids over 6, Bonine is another reasonable choice. This medication can be given at the first sign of nausea and is less sedating.

For patients over the age of 12, if all else has failed some people use a scopolamine patch. This is a much stronger prescription medication that I would never use as a first line drug. Some of my motion sensitive older patients have found these valuable for cruises.

Luckily, kids do tend to grow out of it...except for an unfortunate few. If you or your child have chronic motion sickness issues, it can be eye related. Cover one eye for several moments to see if the symptoms ease. If this works, you may have something called vertical heterophoria. It is worth having a consult with an eye doctor. My favorite eye expert in this is Dr. Vincent Penza

Some people with chronic motion sickness have also gotten relief from chiropractic treatment.

There is a new product on the horizon that got my attention. The media is abuzz about special glasses that have been reported to be real game changers for folks who have tried them.

Unfortunately, I haven’t been able to find out how to get them in this country quite yet. If you are interested, it seems that pre ordering a pair is possible if you have connections in Europe who are able to send them to you.
In the meanwhile, if you or a family member suffers from this very annoying ailment, See if any of these other methods will help you out until those magical glasses become available

If you are on a car ride, assuming the kids are old enough to comply, have them try very hard to give you as much warning as they can. Ideally they should try to get in the habit of warning the driver at the first twinge. The initial signs are usually paleness, yawning and restlessness. They may feel a little sweaty. This is quickly followed by the nausea and vomiting. With enough warning you might have time to pull over and get them out of the car for a couple of moments until the motion sickness eases. Being stoic is not a good plan; it usually backfires.

In my car, I actually kept barf bags in the glove compartment. I used to collect unused ones from my airplane travels.They may come in handy. If you don't have an actual barf bag, have a container or plastic bag that you can whisk out at a moment's notice.

Your trunk should be prepared:

A change of clothes (don’t forget socks)
A clean towel
A plastic bag for putting the soiled clothes in
Some wet wipes
A lollipop to get the yucky taste away
Febreze for cleaning off the seats (you will bless me)

While kids are usually the ones most apt to barf in your car, motion sickness can afflict any of us at different times. I hope that some of these tips can help you out.

I remember my days as a carpool driver.
One of my little passengers had Emetophobia ( fear of vomiting) and would quite literally open the car door and leap out if anyone so much as made a gagging noise. It kept things interesting!

Friday, August 10, 2018

Back to school adjustment tips for you and your child

My regular readers have heard me repeat this analogy often.
Being a parent is like being the coach of a sports team. The real work is the preparation before the game when you learn and practice the plays. More work can be done after the game when you review how your team fared and work on any changes that need to be made.

During the actual game, you might be able to chime in to make little adjustments, but for the most part you simply get to watch. This is not the time to effect any real teaching or change. Recognizing the difference between “game time” and effective coaching opportunities is critical.

Having your child march off to a new daycare or preschool or school is game time. Doing some preparation ahead of time can be very valuable and can smooth the way.

Some kids go off with a smile and wave. You win. Others weep and you need pull them off your body as they clutch at you in desperation. You end up leaving them in their new situation feeling like you have somehow failed. Welcome to being a parent. You lost this round but there are many rounds ahead that will be more successful. Keep in mind that many of the kids are putting on a big show, and are feeling stressed and sad for the moment. Most of them calm down shortly after you are out of sight and end up having a fine day. You on the other hand, will feel like you have a fist clenched inside your gut.

Check in with the teachers for a reality check. They can tell you how your little one fared once you are out of the picture. Or do what Sandy did when he took Lauren to her first day of pre-school. He left her crying with her new teachers and then went to the side of the building, hid in the bushes, and watched through the window. Lauren was fine in about 5 minutes but those were among the toughest 5 minutes of his life.

The teachers should be an essential part of the team helping with this adjustment period.If you feel like your child might need a little extra help separating, talk to the staff about what options they can come up with. Sometimes having a hand to hold, or a loving lap to sit on can be very helpful

One friend or familiar face can make a huge difference. See if you can get a roster of the other children in the class before school starts. If you don’t know anyone, go ahead and cold call some families to see if they want to meet in a playground for an hour and let the kids play together for a bit.

Once school begins, ask your child to identify a few other children who seem nice. Reach out to those families and try to arrange some playdates outside of school hours

Communication is so important.

Create an arena where you and your child can have safe discussion about feelings and actions. This is a basic problem solving skill.

Make a list of some of the more common feelings that people might be feeling when they start a new school:

  • Happy
  • Sad
  • Nervous
  • Excited
  • Tired
  • Hungry
  • Lonely
  • Missing home
  • Confused
  • Bored
  • proud

I am feeling______________. You don’t need to limit it to one emotion.

Identify some things, good and bad, that might be triggering  the emotion:

  • I learned something new
  • I made a friend
  • I helped someone
  • Someone made a face at me
  • Someone wouldn’t hold my hand
  • Someone wouldn’t share
  • I didn’t like my lunch
  • I am scared of the toilet
  • I am having trouble with a skill that others seem to be able to do with ease

I am feeling ______________ because_______________

If the feeling expressed is a negative one - mad, sad, nervous, and you were able to identify a source, now is the time to make a list of possible things that might help.

Telling stories and teaching through play are really good methods for talking about the feelings and coming up with solutions.

Make up a pretend child who also happens to be going to a new school situation (what are the odds?) For this post we will call the pretend child Pat (the ultimate non gender identifying name). Pat can be the main character in many stories.
Sometimes the right moment presents itself and your child might be able to chime in and talk about what they think might be making Pat happy or sad. For some children this feels much easier than telling about themselves.

Practice saying goodbye. Do it several times.

Try some play sessions with a couple of dolls or stuffed animals; one is bravely heading off to school and proudly tells all about it after they are home. The other is having a much harder time. Talk about some things that may be tools that the brave bear is using or might help the scared bear.

Perhaps bringing something like a scarf that smells like home.
Maybe wear a necklace with a photo. Maybe find a little smooth round stone that you both rub some energy into and they can keep in in their pocket. Maybe write a little heart or doodle on their arm and cover it with liquid band-aid

"How was your day, dear?"

Avoid the “How was your day? Fine” trap. Get in the habit of doing a little checklist.

  • Tell me something you learned
  • Tell me something that surprised you
  • What was the silliest thing that happened?
  • What did you do that was kind?

Teach your kids the concept of a mitzvah. This is the Jewish term for doing a good deed or act of kindness. Getting in the habit of at least one “mitzvah” a day is something to strive for.
Beyond simple acts of kindness, consider giving them 3 small goals to achieve each day. They can tell you how they did.

If you are able to do a family dinner, that is the perfect time for conversations. Otherwise it is fine to do this at bedtime, but try to carve out a time where you can talk about the day.

This is a great opportunity to review tomorrow’s schedule and list any special things that are coming up that the family might be looking forward to.

Alana learned to debrief her day in excruciating detail, but it was a habit that endured for years. As my faithful readers know, she continues to share this with Sandy every day on her drive home from work.

Other considerations.... Dr. Elizabeth shared a story from one of her friends. They had made quite the big deal of the first day of kindergarten and the child went in without a hitch. The trouble occurred that evening when the little 5 year old realized that this school business wasn't an isolated event and she had to go back the following day.

It is essential that you make sure you are able to pick up your child on time, especially those first couple of weeks. If you are going to be late, have an alternate trusted adult who can be there. Make sure that the school has all of the current cell phone and emergency contact numbers.

Lots of studies show that eating a healthy breakfast makes a big difference. Have a breakfast plan and clothes picked out the evening before to avoid stressful confrontations.

Make sure your child is not overtired. Start bedtime early enough that they are getting the sleep they need.

You never know when your child will decide to make transition to school a “thing”. Some children who never had issues will decide that this is the year to challenge you. My daughter Lauren was reasonably well adjusted in school so I was caught by surprise when suddenly she was in third grade and a new problem reared its head. Alana was now in kindergarten at the same school. The kindergarten kids got picked up about 90 minutes earlier than the rest of the school and Lauren was simply not okay with that. The injustice of her younger sibling going to spend some private time with mom, while Lauren had to stay in class was more than she could stand. If she saw me anywhere on the campus during the early pick up time, she would get quite upset. I would like to say that this eased after a week or two, but if memory serves, I spend most her third grade year scurrying past the window of her classroom in a low crouch . If they were outside at recess it made things even more complicated. I believe I toyed with wearing camouflage in my efforts to make certain that she didn’t catch a glimpse of me during the early pick up.

Even if you are one of the lucky parents whose intrepid child marches into their new situation without a backwards glance, it is perfectly normal for you to be deeply impacted by these milestones that signal the passage of time and that your child is growing older.

Lauren reminded me of a cartoon that I used to have taped on the wall above my desk. It was a sketch of a doctor, nurse  mom and a baby. The baby was about to get a shot. The caption was. “you had better hold her close, she might cry."
The next frame was the nurse hugging the crying mom as the baby got the shot. Yes, this is likely to be just as tough on you as it is for your child!

Friday, August 3, 2018

Car Seat and Booster seat guide 2018

Car Seat and Booster seat Guide 2018

Kids grow! Make sure they are strapped in properly!

The Rules

Car seats are an essential part of keeping your child safe. Countless children’s lives are saved annually by being properly installed in a carseat during a crash. Governor Jerry Brown signed a law that went into effect on January 1st, 2017. This law requires children be rear facing to a minimum of 2 years old:

It is recommended that they remain rear facing until as close to age 4 as possible! More and more studies are showing that rear facing is the safest place and position in the car. In fact, it is 5 times safer than forward facing.

In the case of an accident, a child's head and spine are better protected if the car seat is rear facing. One study shows that children ages two and under are 75 percent less likely to die or be severely injured in a collision if they face the back. I know kids might appear to be squished but most children are actually quite comfortable sitting criss-cross, or with their legs up the seat. For those parents/caregivers who are concerned about leg room, Graco has released the Extend2Fit, a new seat which has a 4-position extension panel that provides 5" of additional leg room.

Children who are 40 pounds or 40 inches are exempt from the law and can face forward, but while they may be exempt from the law, they are not exempt from the laws of physics. Rear facing is safer. Please take a moment to click the link below. This video is a good illustration about why rear facing is so important:

Toddlers who have outgrown the rear facing weight or height limit for their car seat should use a forward facing car seat with a harness for as long as possible, up to the highest weight or height allowed by the car seat manufacturer.

The current California Law also requires a car seat or booster seat until your child is 8 years or 4 ft 9 inches. Height parameters make more sense than the previous weight ones. For a child to safely transition into a booster, we look beyond the child's age/height/weight. There's another set of criteria to help determine if your child is ready to transition to a booster. There is a '4 Step Test', in which all criteria should be met; don’t dismiss the importance of Step 4!

1. Child is an absolute minimum of 40 lbs
2. Minimum of 4 yrs old
3. There is a lap & shoulder belt in child's seating position
4. The Child can be trusted to sit properly for the entire trip, every trip - even while asleep. This means no slouching (back straight up against seat), no leaning to either side, no playing with the belt, etc... even unsupervised.

Developmentally, most children don't meet all of these steps until somewhere between 5-7 years old, and generally closer to 6 or 7 than 5. A lot of this has to do not only with physical maturity, but emotional maturity.

This is one of those times in your parenting life where your child NOT graduating is actually a good thing. The longer your child is harnessed, the safer and more protected they'll be.Your child needs to be tall enough so that the seat belt goes across the chest, not across the neck. The purpose of a booster is to properly position a child in the adult-intended seat belt. What you’re looking for is proper belt fit across the lap and shoulders - the belt should be low and tight on the hip bones (not on the belly), and should be hitting the shoulder bone, not the child’s neck.

Be aware that most newer car and car seat models use the LATCH system ( Lower Anchors and Tethers for Children). The Latch system attaches the car seat to the vehicle through anchor points that are installed in the car and connectors on the car seat. This is supposed to make the installation easier as well as eliminating potential errors that can result from installing a car seat with a seat belt. The LATCH system has a 65 pound weight limit. What many parents are surprised to find out is that this limit includes the weight of your child as well as the weight of the car seat (some can weigh up to 25 pounds!).

When children are old enough and large enough to use the vehicle seat belt alone, they should always use Lap and Shoulder Seat Belts for optimal protection. To determine if your child is ready to sit unassisted, they must pass the 5-Step test:

The 5-Step Test:

1. Does the child sit all the way back against the auto seat?
2. Do the child's knees bend comfortably at the edge of the auto seat?
3. Does the belt cross the shoulder between the neck and arm?
4. Is the lap belt as low as possible, touching the thighs?
5. Can the child stay seated like this for the whole trip?

If you’ve answered NO to any of the above, your child should remain safely boostered!

If your children complain about this rule, show them photos of race car drivers all bucked up in their restraint system. Be matter of fact about it and explain that there is no compromise for safety (there is also a mighty large fine if you are caught breaking this law.)

All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection. Airbags can actually be quite dangerous to a child so it is worth making sure that this isn't an issue with your car and the placement of your child's safety seat.

Picking the right car seat

If you are looking to buy a new car seat, check out these helpful links:

If you are someone who doesn’t own a car and is popping the car seat in and out of car services, finding one of the cars that is easier to install in becomes even more important

Making sure it is installed correctly

The AAA states that 75% of car seats are installed or used improperly. As your child grows, there are services offered here in the San Francisco Bay Area that will check out your car seat or booster seat and make sure it properly installed. Have the infant car seat checked before the baby is born and then again with each transition to a larger seat.

Below are some local resources for making sure that not only is your car seat properly installed but that it is the right fit for your child's size and age. They can make sure that all the straps are where they need to be and that you pass the "pinch test", making sure that the seat's harness is tight enough

To be super safe, consider having the car seat fit and installation checked every 6 months. Fortunately there are lots of places to help.

  • AAA 553-7208         2300 16th St suite 280. The contact person is Ingrid. Appointments need to be made ahead of time. You do not need to be a AAA member to take advantage of this free service

  • CHP (California Highway Patrol) 415-557-1094  This is a very popular and is by appointment only. Please make an appointment as far in advance as possible. The current wait when I called to update this post was pretty short, but it varies and sometimes can be longer than a month. The inspections are done at 455 8th Street in San Francisco

  • SFPD    415-575-6363 They try to have an officer at all of the local police stations who is trained to do the car seat safety inspections. Call the number above for more info.

  • The Colma police department 650-997-8321 Does a car seat inspection for free. As with the other options, this is by appointment only.

Willing to pay to have someone come to you?


The following links can you assist you in finding the right car seat:

  • Car Seats for the Littles - Car Seats for the Littles gives lots of great info about the specific brands of car seats on the market

  • The folks from sent me the following resource guides: We recognize how difficult it can be to find the right information on car seats, so we evaluated both infant and convertible styles to help inform parents. To find the best, we consulted with child safety experts, dove into federal ease-of-use ratings, surveyed hundreds of parents, and then took a closer look at the top options. You can see our guides here:

Other considerations

  • Car safety doesn't end with being safely buckled. I know it is hard to avoid distraction with a baby fussing in the back seat. Consider getting one of the specially made mirrors so that you can keep on eye on your rear facing baby. Make certain that they can't reach anything that is a choking hazard.

  • Don't let them hold the keys; they can lock you out!!

  • If your child is asleep in the car seat and you have arrived at your destination, leaving them snooze for a few minutes is fine, but keep them tightly buckled. Having a baby in a car seat without being tightly strapped in not safe. The loose straps can be a safety hazard.

  • WINTER CAR SEAT TIP: The straps need to be tight up against your baby; puffy coats or blankets need to be OVER the straps!

  • Never leave your child unattended in a vehicle. Children can die from prolonged exposure to excessive temperatures in a hot car.

  • Most accidents happen within a few miles of your house. Even a short trip down the block requires the full "buckle up". Hey parents, model good behavior and always make sure you fasten your own seat-belt!

  • Did you know that car seats expire? Most of them have a 6-9 year life span. This date can usually be found underneath or behind the seat. Buckles and straps can wear out. Prolonged exposure to sunshine can weaken the plastic. Also, the technology is always changing and this ensures that nothing gets too out of date. Save the instructions/registration in a safe place. Make sure you register your car seat. If there is ever a recall this will ensure that you are notified.

  • If you have an old car seat that you want to get rid of, Alioto's Garage has been offering a Recycled Car Seat Program. Anyone, not just regular customers, can drop a car seat off at any Alioto's location during regular business hours. They will recycle the usable parts and keep it out of our landfill:

Let me close by confessing that I am NOT a car seat expert. The seats that my children grew up with were much simpler (but not nearly as safe). When I see new parents struggling with all the straps and trying to figure things out, I am often as clueless as they are.

Here is the takeaway message. Putting your baby or older child in a car seat is an essential skill that you need to learn in order to travel with them safely. Find an expert to help you master this and make sure that you are using the car seat restraint properly. Safe travels

Friday, July 27, 2018

Drowning Prevention: Appoint a Water Guardian!

This is the time of year that many of my families are traveling. Anytime you are away from home, there are a range of safety issues that can arise. When you get to your vacation destination, do a basic assessment as soon as you arrive. Are there smoke and carbon monoxide detectors? Do you know where the fire extinguisher is? If you are visiting older relatives, are any of their medications safety out of reach? Are any unfamiliar pets comfortable with children?

Think like a toddler. What type of trouble can they get into? Can they open the doors on their own?

Water danger is one of the more essential considerations. If you are going anywhere that has a pool or is near water of any sort, you need to be aware that drowning can happen in just a few inches of water and it can happen quickly!!! According to the CDC drowning is now the most common cause of death in children under the age of four (excluding congenital issues)

We had a scare with one of our families a few summers ago. Several adults and children were enjoying a day at a friend's pool in the East Bay. They got out of the pool to have some lunch. Some of the oldest kids started to bicker. While the adults turned their attention to the squabble, a one year old got back into the pool unnoticed and submerged. Thank goodness another of the adults looked up, noticed, and was able to get her out and perform CPR. The little girl is perfectly fine, but this was terrifying for everyone. Dr. Karen Makely, one of the wonderful urgent care physicians over at St. Lukes, says that sometimes having a lot of adults around lends a false sense of security. Consider having each adult take turns being on a shift as the designated lifeguard.

It is so important to be aware that a person who is drowning usually does not thrash about and call attention to the fact that they are having trouble. They can slip silently under the water without being noticed until it is too late. Even if your child has proven themselves to be solid swimmers, you need to stay actively focused and engaged on watching them like a hawk while they are in the water.

Nurse Lainey sent me this link last week Levi's Legacy and I am going to do my part to spread the word. Many parents are on high alert when they are actively at a poolside but the danger doesn’t end when you are inside.

Levi's Legacy tells a heartbreaking story of a child who slipped out of the vacation home, made it out to the pool and drowned as the parents were busy doing some preparation for a family evening outing.

The important message here is that the lifeguard shift does NOT end when you go inside.

If you are staying anywhere with a pool, make certain that your child has absolutely no access to the pool area when there is no adult present. Hotels or apartments with fountains need to be treated with caution as well. If you do have pool access, there are a variety of pool alarms and safety monitors on the market. Some devices are little gadgets that your child wears around their wrist. Alarms and monitors may add a layer of safety but I would warn you not to have a false sense of security. Someone needs to be on duty. Take turns. Appoint a water guardian. On duty mean no distractions (that means your cell phone. Put it down, you can do it.)

I am linking some of my past posts that are swimming related.

Monday, July 23, 2018

A pet safety tip: Java and the Bologna

Java and the Bologna

Last week I got a call from a parent of a fairly young child who was bitten by a friend’s dog. The toddler was feeding the dog and a finger got in the way. Anytime there is food, a young person, and an animal, I am worried that inadvertent nibbles might happen. In this case, there was nothing malicious and the doggy was current on it’s shots. Anytime a bite breaks the skin, we want to keep an eye on it, but you might be surprised to know that human bites are more of a concern for causing infection than a dog bite.

This made me recall the tale of my old girl Java. The sweet golden wearing the nurses cap who decorates my blog was my family’s beloved dog. We had her for twelve wonderful years. Time zooms along; she would have been 19 years old this July. I still miss her deeply. The pet owners out there understand.

Towards the end of her life, she was a happy girl, but was moving pretty slowly. Instead of bounding across the grass to chase her favorite ball, we would toss the ball a paltry few feet and she would be satisfied with that. One day, she and I were playing the “old dog” version of fetch at the end of the grassy part of Midtown terrace playground.

All of a sudden her nose gave a twitch and my old girl absolutely flew across the park to the children’s play area where two women were giving a group of young children a snack. The kids were lined up on a bench about to eat what turned out to be bologna sandwiches. No one was more surprised than I was that Java could run so fast. I might add her that in her 12 years, although we were misguided dog owners who let her eat way too much “people food” (she loved pizza) bologna was uncharted territory for her.

Java had reached the picnic before I even figured out what was going on. By the time I had gotten to her, she had already stolen the first sandwich, wolfed it in one happy gulp and was about to get a second. There was total mayhem. The group had every reason to be seriously annoyed, but let me make it clear, these were not dog lovers under any circumstances.

I arrived just as one of the women grabbed her little girl’s hands holding the sandwich as Java was trying to snatch it. A finger got scratched and there was a drop of blood. More panic ensued. I got Java on her leash and profusely apologized. Java was as waggy as could be, She could smell another full bag full of sandwiches and was hoping for more. She was ‘bologna delirious’ and I just needed to get her out of there.

I assured the adult women that Java’s shots were up to date. I showed them her license, gave my phone number and suggested that I remove her from the scene, take her home (we lived across the street) and I would come back with band aids, Neosporin (and some lollipops). I told them I was a nurse. I would be right back.

I said to the kids, “The silly dog was not being a good girl. She wanted to steal your sandwich, which is a bad thing to do, but she certainly didn’t want to hurt anyone or scare you.I am sorry that that happened”

I dragged my reluctant dog home, grumbling at her the entire time, “I can’t believe you did that!!” I threw together some first aid stuff and rushed back to the park as quickly as I could.I was gone for no longer than five minutes.

Are you kidding me? As I got there, I could see red lights flashing from an ambulance and several fire trucks. They had called 911. The park happens to be across the street from a firehouse, so firetrucks hadn’t had to travel very far.
In fact, the firemen mostly all knew Java and me from years hanging out at the park. I arrived as one fireman was convincing the still distraught women that they probably didn’t need to go to the ER. He looked at me and rolled his eyes. The family ended up accepting my cuter band aids (although there was almost nothing to see on the little finger and no more bleeding.)

I thought that was the end of the story, but the Oscar Meyer gang also reported the incident to animal care and control. Poor Java was under house arrest for several weeks...Oh the indignity. We all took to calling her Kujo!

Even though a 911 call was wildly out of proportion, I really was horrified that this happened. Java was a gentle dog who loved all people, but especially loved kids. As is my way, I looked for the lessons. Should I have had her on a leash? Perhaps, but that wasn’t the lesson I came away with. Instead I started teaching the “Java Rule” at my safety classes
As you are teaching your kids about safe interaction with pets, keep these guidelines in mind.

  • Java's rule: Teach your child and practice this. If they are holding food, and a dog tries to get the food, they should drop it, rather that trying to keep it from the dog. This would be especially true if you are at a park and you don’t know the dog. Just open your hand and let it go. You can always replace the food.

  • If you are at home, make sure that your child can eat safely with no pets able to grab food away from them (droppings on the floor are a different issue.) If your dog is a food grabber, they need to be out of the room when your kid is eating. (Dogs should also be given the the same respect and should be entitled to the luxury of eating without a toddler in the room.)

  • Children shouldn’t be allowed to feed animals until they are old enough to be deliberate and hold the food out in a flat hand with a thumb safely tucked away.

Friday, July 13, 2018

The milk transition/calcium requirements

The milk transition/calcium requirements

Calls about the transition from breast milk or formula over to whole milk rank up there in the "frequently asked questions" category.
If you are breastfeeding and it works for you to continue to nurse beyond the first birthday, good for you! Don't be in a rush to stop. The length of time that you choose to nurse is a very individual and personal decision. For those moms who continue to breastfeed beyond the first year, that magical breast milk feels like a godsend if your child doesn't feel well. Not only is nursing a comfort, but breast milk is great for tummy bugs, eye issues and all sorts of stuff. One parent was poking a bit of fun at me and said "if you call Nurse Judy, she will just tell you to put breast milk on it."

On the other end of the spectrum, many moms (myself included) end up weaning sooner for any number of reasons. In our practice, the first birthday is probably the average age that the milk transition occurs. Keep in mind that if your baby is on formula and tolerating it well, there is no hurry to get off (except for the expense and the hassle). If you have a case of formula left over, by all means use it up.

While it is fine to carefully introduce milk-based products such as cheese or yogurt to your children once they are over 6 months, plain cow's milk is not an appropriate substitute for formula or breast milk in the first year, as it lacks some important nutrients. 

The first birthday is also usually when we recommend a blood test that checks the iron level. Formula has more iron than cow's milk, so if your child is a fussy eater it is important to make sure the iron levels are adequate before we switch over to plain milk. At our office, we usually send the patients to a local lab to have both the iron and lead levels done with one poke. If there are obvious concerns about diet or lead exposure, your doctor may end up doing the labs sooner.

Once you move along to cow's milk, I prefer that you use whole (full fat) milk. If possible, and you can afford it, go ahead and buy organic. I know there are folks out there that tout the benefits of raw milk, but I have a strong opinion that milk should be pasteurized. I have had parents asking me about vat pasteurization, and that does seem adequate.

Most kids who were on a milk-based formula have no trouble moving on to cow's milk. It is fine to do it gradually so that they get used to the taste (add a few ounces to the formula and see how they do). Intolerance will likely show up as tummy aches, poop changes or rashes. My older daughter got a terrible flare up of eczema when we first got her on milk (Eczema post). I put her back on her formula for a couple of months and when we retried the milk she was just fine with it.

But if you thought that the main choices about cow's milk were organic or fat content, think again. Along comes the choice between A1 and A2. Huh??? It turns out that there are indeed two kinds of cows out there (don't worry there won't be a test on the following paragraph).

A1 and A2 beta-casein are genetic variants of the beta-casein milk protein that differ by one amino acid. The A1 beta-casein type is the most common type found in cow's milk in Europe (excluding France), the USA, Australia and New Zealand. This is what most of us have grown up drinking. African and Asian cows are predominantly A2 cows. Milk from goats and humans contains only the A2 beta-casein.

There was a lot of buzz about this when I first wrote this post several years ago. The claim is that folks who have trouble with our common (A1) milk may in fact be able to tolerate A2 milk without any issues.
I rolled my eye when it first came around, but I confess that I have had some patients with milk intolerance who seem to do better on the A2 milk. In the past year, A2 milk has become more widely available at many grocery stores and doesn’t seem to be all that more expensive. For those of you with milk issues, it is worth checking out.

Milk is a great source of calcium, protein, vitamin D and the fat that your child needs for brain development. Not all proteins are the same. For those who can tolerate it, dairy milk is a complete source. It contains essential amino acids – the “building blocks” of protein – that our bodies need. The protein in most nut or plant-based milk substitutes is incomplete, meaning it's lacking in these essential amino acids. Since your body can’t produce essential amino acids on its own, it has to come from the choices you make in your daily diet - like dairy milk.

If you have a hard time getting your child(ren) to drink milk, it is important to make sure they are meeting those nutritional needs through other sources. If you choose to use a milk alternative such as goat, soy, rice, almond, coconut (seriously, there is a wide array of choices) the labels and see how they compare. In general:

Cow's milk and soy milk are both going to be the more complete sources of protein and calcium. Goat's milk is also good for protein and calcium, but doesn't have as much vitamin B-12. Almond milk and coconut milk have significantly less protein but are good sources of calcium.
It is important to be looking at the entire diet to make sure your kids don’t have any nutritional gaps

We want our toddlers to be getting at least 700 mg of calcium per day.
With a little planning, getting enough calcium should be reasonably easy if they are eating cheese and yogurt.
Table 1 and Table 2 at the bottom of the post will give you the calcium requirements through the ages and a list of calcium amounts in a variety of foods.

Interestingly, breast milk doesn't have quite as much calcium per ounce as cows milk, but the calcium it does have has twice the bio-availability. 


I personally don't feel the need to be completely off of the bottle at 12 months. I am perfectly fine with a snuggle bottle when first waking up or going to sleep for an extra couple of months. NEVER leave a bottle of anything other than water in bed. If a child falls asleep and keeps the bottle in their mouth it will cause tooth decay.

Try to transition most of the fluid intake to a cup. Once you start moving away from the bottle and transitioning to a cup, many kids significantly decrease their milk intake. Kids just don't like to drink as much milk from a cup. I couldn't tell you why. Some parents feel a little better assuring at least some milk intake by giving it in the bottle.

If you are trying to encourage your child to drink the milk from a cup, try adding a few drops of vanilla or a dash of cinnamon. Some kids might like it better warm. You can also try frothing it. I am not in favor of adding unnecessary sugar into your kids lives, so I would not suggest adding chocolate or strawberry flavor to the milk on a regular basis. Consider making smoothies with milk as the base. Kids like adding things into and turning on the blender. You can get a special cup that they have helped pick out. If you are using any alternative milks, watch out to make sure you aren't getting a sweetened version that is adding all sorts of extra sugar.

As is the way of things, There are those kids where getting enough milk in is always a challenge. One the other hand, there are those kids who drink too much milk are often anemic because they fill up on milk and don't eat enough solids. Those are the 'milkaholics'.
Once your little one is over a year, 12-24 ounces a day is a fine range.