Friday, January 22, 2021

No matter how much help you have, no matter how perfect your baby is, being a new parent is HARD!

No matter how much help you have, no matter how perfect your baby is, being a new parent is HARD! Little black bug, little black bug where have you been? I’ve been under the rug, said the little black bug… Lauren and I were sitting together as she nursed her newborn. My first grandchild. She was telling me that she had been singing the songs that my mom used to sing to her and that it made her cry. As she told me that, tears were welling up in her eyes. So, I also got weepy and we sat there letting the feelings in and crying together about the people that we were missing. Lauren is a lucky mom. She has a wonderful supportive husband who takes initiative and doesn’t wait to be asked. She has two sets of grandparents, and other close family who are in her COVID bubble and have been all hands on deck. Everyone is happy to hold the baby and give her and Adam a break whenever they need it. She has more support than most, especially during COVID. What’s remarkable is that, even with all these resources... IT IS STILL HARD! She has the “Nurse Judy Network”, where her baby has been treated like royalty and guess what? IT IS STILL HARD! She has plenty of milk and her baby got back to birth weight the first week. IT IS STILL HARD Nursing is challenging. It is not intuitive. Getting the baby to latch works well one moment, but is tricky the next. Not being able to sleep longer than a 3 hour stretch is exhausting. Hormones are a force to be reckoned with. All new parents need support. That is where Oath comes in https://www.oathcare.com/ I can’t sit by you in your nursery, but I can be right there when you have a question about spit up, poop, purple feet, hiccups ... you get the idea. The Oath community is a place where small, facilitated groups of parents can share their wisdom as well as the ups and downs of parenting. It is a place to cheer each other on as well as a safe place to be messy and vulnerable when things are feeling a bit overwhelming. Beyond the collective wisdom and experience of your fellow parents, we have a team of providers to assist you. Starting when you are pregnant, there is an OB, a nurse midwife, doula, pelvic floor specialist, traditional Chinese Medicine practitioner, and a mental health therapist available to you. Once the baby is born, our Oath parents can tap into a provider network that includes a pediatrician, lactation specialist, sleep expert, physical therapist and speech therapist. We are continually adding to our panel of experts. Oh, yes...then there is me, the advice nurse, helping you figure out when to worry and when things are perfectly normal. We furnish you on the way with stage appropriate educational content that is empathetic, data based, and draws from decades of experience caring for kids just like yours.. Your pediatrician is sure to be grateful that your source of information is a trusted one, as opposed to the minefield of disinformation that you may find when searching the internet for answers. If you are pregnant or know of someone who is expecting, I think you will find joining Oath incredibly valuable. This also makes a great baby shower gift! If you already have young children (our current groups are for 3 years and younger) please click the link to join the waitlist, so that we can match you with the perfect group. A value of $500, the Oath membership is only $19.50/month. Such a deal. Enter the promo code NURSEJUDY for a free month I would love to see you in one of the Oath circles.

Friday, January 15, 2021

Car seat guide 2021

Car Seat Guide 2021 Make sure you little ones are strapped in properly! It is important to check the fit as they grow! 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 car seat 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: https://csftl.org/updated-car-seat-law-california/ Even though the law is until they are 2, 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: Rear facing versus forward facing 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 feet 9 inches tall. 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 pounds 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 a 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: Does the child sit all the way back against the auto seat? Do the child's knees bend comfortably at the edge of the auto seat? Does the belt cross the shoulder between the neck and arm? Is the lap belt as low as possible, touching the thighs? 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 in a booster seat! 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: https://carseatblog.com/safest-recommended-car-seats/ https://www.babylist.com/hello-baby/best-convertible-car-seats 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 is 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. The reality is unless you are a certified child passenger safety technician, you’re not aware of some of the nuances of different kinds of seat belt systems, or the different features on different car seats. When you go to get help with your car seat make sure you go to a certified car seat technician. Then you will know you are getting the best information available. I have updated this information to reflect the changes during the pandemic. If you are reading this and we are fortunate enough to be in the clear, call the numbers below for current guidelines and info AAA https://calstate.aaa.com/automotive/car-seat-inspections Appointments need to be made ahead of time. You do not need to be a AAA member to take advantage of this free service. During COVID, they are offering virtual appointments only CHP (California Highway Patrol) 415-557-1094 This is very popular, and by appointment only. Please make an appointment as far in advance as possible. The inspections are done at 455 8th Street in San Francisco. They are NOT doing inspections during COVID 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. They are NOT currently offering inspections during covid Willing to pay to have someone come to you? http://www.buckledbaby.com/services/ Bryan is continuing to offer his services during the pandemic. ON-LINE RESOURCES The following links can you assist you in finding the right car seat: The National Highway Traffic Safety Administration website has a place to click to find updated local car seat inspection stations for those of you who are not in the Bay Area. NHTSA/Get Your Car Seat Inspected has a page where you can plug in your child's age and size and they will tell you what type of seat they should be in. 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 https://csftl.org/ The Car Seat Lady The Car Seat Lady video 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 an 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 as long as they are supervised, 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. I know most of us never register the products we buy but make sure you register your car seat! If there is ever a recall, this will ensure that you are notified, and this is one of those products where you must know if there is an issue! 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, January 8, 2021

I am a grandma

I am a grandma! I was all set to update my car seat guide this week. I planned to check in on the local resources to see what is available for people who want to get the car seats inspected during COVID. Making sure that the seats are installed properly is important. I didn’t get to all of the calls, but I have a very good excuse. Instead I will tell a story that involves a car seat. I am a grandma! Lauren was due on January 18th, but in the early hours of Monday morning her water broke. Coincidentally, she had an appointment already scheduled with her OB later that morning. They confirmed that her water had broken, she was sent home for the day with orders to return to the hospital that evening. Another lucky coincidence was that afternoon her doula was already scheduled to do a home visit. I went over and watched Jen help Lauren and Adam get prepped for labor. Sadly with Covid, the doula support would be virtual. Even though the due date was two weeks off, Lauren and Adam had been all ready to go. The nursery was ready, the go bag was packed, they had a cooler with meals and snacks all set. The only thing missing was causing some stress. The car seat had been ordered more than a month earlier but was on backorder. Without a car seat, a baby won’t be allowed to leave the hospital. We were figuring out a plan B of either buying or borrowing, but just in the nick of time, ding dong, UPS was at the door with the car seat. Fortunately, Jen the doula used to be certified to install car seats, and she was still at the house. Timing and serendipity, my grandson is part of my family for sure. Labor was the hardest thing Lauren had ever done (take that Kilimanjaro and Everest Base Camp!) Not being with her was one of the hardest things I have ever done. But, Now I am a grandma of a beautiful 6 pound 8 ounce grandson. Mother and baby are doing well. This boy will be welcomed into a village of family and friends with so much love. He couldn’t have picked better parents, that’s for sure. Next week I will make those calls and update the car seat information for you. As I call, I fully intend to have a baby snuggled in my arms.

Friday, January 1, 2021

Give your kids the gift of music

Both of my parents were amateur musicians and I grew up surrounded by music. My mom had played piano all of her life, but when she met my dad she learned the cello so that they could play together. They were members of the International Chamber Music Society, so visiting musicians from all over the world would connect and play together when they were in town. At the time, I completely took it for granted. String quartets in my living room were routine. The first time my poor husband Sandy crossed the threshold of my childhood home at the age of 18, my father placed a violin in his hands to see if he knew how to hold one properly. My mom promptly rescued him, “Robert, leave him alone!” It was expected that my sisters and I would learn to read music at the same time that we learned to read letters. I have such powerful and positive memories of playing violin and piano duets with my dad. Those are the ones closest to my heart. I of course also have memories of grumbling about being nagged to practice and being less than polite when dad would appear the moment I sat at the piano to turn on the metronome. It seems to me that most adults who took music lessons as a kid, even if they were in the group that complained about them, are grateful for that opportunity when they look back. At the same time, most adults who did not have music as part of their childhood, wish that they had. It is not hard to find the takeaway here. Give your kids the opportunity to learn an instrument. When they are all grown up, they won't regret it. I didn’t even consider that there were any other options. In my opinion, music should be a basic part of everyday life! My kids started piano lessons at an early age. I played piano duets with both of the girls, as I did with my mom, and she did with hers. Part of their nightly bedtime routine was daddy on the guitar making sure that both of his girls were well versed in all things Beatles and rock 'n roll. My mom always encouraged the family to learn to play an instrument that could be part of an ensemble. She thought that being part of the collective sound was the stuff that magic was made of. We were therefore delighted when our daughters' school started a music program. In 5th grade, each child was given a choice between several instruments. The choices varied a bit from year to year. When it was Lauren’s turn, she chose the flute. When Alana was in 5th grade, she was excited that one of the choices was the saxophone. This was Lisa Simpson's instrument and therefor Alana's first choice. At some point during the year there was a performance where they could show off what they had been learning. Although there would be many future opportunities to watch Lauren up on a stage, I don’t actually remember her 5th grade concert. Alana’s, however, lives on in my memory banks; indeed, in the memory banks of all who attended! First came the flutes...toot toot toot. We all politely applauded. Next came the guitars, strum strum strum...more applause. Now it was time for the group who had chosen the saxophone. To be fair, Alana had come a long way and to my ear, had a fairly nice tone. It was no longer torture listening to her practice, but adding in 10 extra novice players who all were playing in their own distinct key is something that is hard to quite capture. That first blast of sound that came charging out into the audience is something I will never forget. It was a palpable energy. If you were watching an animated cartoon, you would have been able to see it leave the stage. Words can’t really capture it. No two saxophones had the same sound coming from them. The audience took a collective deep breath and I believe we all had just one goal. Don’t laugh! These were our earnest children up there doing their best, but oh heavens, the shoulders were shaking. Most of us were managing to hold ourselves together, until one of the players made that feat even more difficult; a young boy named Max, with a round expressive face and a loud, infectious laugh. After that first blast, Max, who clearly had heard what the rest of had, simply put his instrument down and started to laugh. The laugh very quickly turned into a full howl. While the others kept playing, Max just sat there on stage and guffawed for the rest of the performance! How the other students managed to keep playing at this point was somewhat astonishing. We were all near tears of repressed laughter until that last cacophonous note was finally silent. More than 20 years later, all who were there still have vivid memories of that evening! So, yes, you might have to endure some recitals, but the benefits of having music in your life are enormous. I am not going to dive deeply into the studies, but they are bountiful. Music instruction appears to accelerate brain development in young children, particularly in the areas of the brain that are responsible for processing sound, language development, speech perception and reading skills. It isn’t just for kids. Older folks, including people with dementia are able to recall tunes long after they have forgotten so much else. (There is an amazing documentary about this, called Alive Inside.) Singing to your kids can instantly ‘change the climate’. You don’t need to be able to carry a tune. I have seen many a temper tantrum thwarted with a song. Break out of your comfort zone and expose yourself and the kids to as many genres of music as you can. When Alana was in high school, one of her Lowell teachers had the routine of playing a random piece of music as the students entered the classroom. These ranged from classical, classic rock, big band... Whoever could ‘name that tune’ would get a point. He was never able to stump Alana and as the semester went on, it became more and more of a personal challenge. He finally gave up when she was even able to identify a song from one of the more obscure Gilbert and Sullivan operettas. When she told me this story I felt absolutely victorious! Of course I recommend that you try to go a step beyond singing and listening to music. Give your kids some hands on experience actually playing an instrument. It doesn’t need to break the bank. There are now inexpensive keyboard options as well as many apps for learning some basics. Making sure that music is part of your life is an excellent New Years resolution.

Friday, December 25, 2020

The christmas cactus

The Christmas Cactus My grandmother had an enormous plant known as a Christmas cactus. They are known to bloom once a year. December is a common time for the flowers to come out, hence the name. Grandma gave a cutting to my mom. The cutting that my mom had thrived. It didn’t know that it was supposed to bloom just annually and would occasionally burst into bloom throughout the year. My older sister inherited Grandma's plant which also seems to have a mind of its own. Regardless of what was going on in the world or her personal life, mom would be joyful every time the plant bloomed. For her it was a signal of hope and positive energy. It was infectious and the entire family would somehow feel a lift. Prior to Covid, and when my parents were still alive, I made sure to go home to Pittsburgh every four months or so; these visits were even more frequent as both my parents got older. Scoff if you like, but more often than not, the plant would flower right before my visits and stay that way for several weeks. When mom died, my sister gave me a cutting of the plant. To say that I have not been very good at keeping plants alive is an understatement. Fortunately, Sandy has taken on the role of the plant tender. Historically he was no better at gardening than me, but after years of killing anything even remotely green, we now have an array of indoor plants that are flourishing under his care. The centerpiece is the offspring of the family plant. It has quadrupled in size since we have had it. I have given cuttings to my daughters. This week it burst into flower. It magically fills me with a sense of optimism. I feel my mom’s presence. Goodness, we all need hope and optimism more than ever after this year. Between the pandemic, the economy, the divisive politics, the climate woes, 2020 will be a year that most of us will be happy to see the last of. We all have pandemic fatigue. Please hang in there. The cactus is blooming. We are almost in a new year. Things will be better.

Friday, December 18, 2020

Santa and Covid

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 direct question and press for an answer, please don’t lie. 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 about Santa, we can put him 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. The Covid pandemic has added an extra layer to the conversation. This year some kids are worried that Santa will either have issues with social distancing or have trouble taking the time to wash his hands in between the houses that he visits. Talk about a potential 'Super Spreader'! 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 wrote this post a few years ago, 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, if you want to extend the magic for another year, you might deflect the questions fairly easily without telling a falsehood. 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, even virtually, who are 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 devastated 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: Even when Covid is no longer an issue, 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. If the kids are up for it, there are places that are making socially distanced Santa Visits possible this year. https://datebook.sfchronicle.com/entertainment/where-and-how-to-get-your-2020-photos-with-santa-in-the-bay-area

Friday, December 11, 2020

Dental checkups should NOT stop because of COVID

Dental Care 2020 Scroll down for the list of dental practices Covid has complicated so much of our normal lives. Doing a risk/ benefit analysis for daily activities can become so tedious. One of the questions many of my patients have asked me is about routine dental care during the pandemic. The current official recommendation now is that your child should have his or her first dental visit by age one, and this does not change due to COVID. In California, about one third of preschoolers have dental decay. It is much easier to prevent decay in toddlers' teeth than to fill a cavity in a young child. Tooth decay is the most common chronic childhood disease and it can be prevented. I reached out to Dr. Rothman who was my daughters’ beloved dentist (he made them laugh and they actually enjoyed seeing him!) Dr. Rothman has remained a trusted resource for me over the years even though my girls aged out of his practice. It turns out that he was the right person to ask! He actually chaired part of the Covid19 workforce on dental practices. He pointed out that dental practices were among the first to really deal with infection control. They have been using masks, gloves and face shields long before this pandemic. His office worked closely with the California Department of Public Health and Cal Osha when they developed practice guidelines and checklists. Dentist offices might actually be one of the safer places to bring your child. It IS considered an essential visit. Sadly, Dr. Rothman told me that he is seeing a real increase in cavities and gum disease that corresponds with people not going in for their routine dental visits. As parents, we may think, "baby teeth fall out, so we don't need to worry about them." This sounds logical, but unfortunately is not true. Luckily, dental science has found out many new facts about how to prevent dental decay. We now know that bacteria causes tooth decay. This "bad" bacteria can find its way into your babies mouths in many ways. Eating foods high in sugar is one of the most obvious offenders. In order to prevent decay in our adult teeth, baby teeth have to be kept healthy as well. What can you do to keep your child's teeth healthy right from the start? For the youngest babies with brand new teeth you can wipe them off with a soft piece of gauze or a wet washcloth. Not only are you cleaning off the teeth, (breast milk does have sugar) but you are getting the baby used to a routine. Training your child from the start that teeth get brushed is a good way to create good dental habits that will last a lifetime. There are other options besides the standard hand held toothbrush. For very young babies, there are little flavored towelettes specially formulated for wiping baby teeth. Spiffies was the first of these that I was familiar with. Now there are several brands available. You could also consider using a soft finger brush. These fit over your finger and if your baby will let you, this option allows you to get in there and do a nice thorough job. If you use a regular toothbrush, make sure it has soft bristles. Replace the brush when it looks like the bristles are getting worn. It is also a good idea to run all the family toothbrushes through the dishwasher every once in a while. One extra perk about routine dental care is that you might walk out of the dentist's office with a new toothbrush! Younger children will have an easier time handling a toothbrush with a thicker handle. Perhaps you can let your child be in charge for one brushing a day and the parent be in charge of the other; that way you know you are doing a more thorough job at least once a day. Some people use a two toothbrush approach. Toddler gets to hold one, but so do you. Both of you can be in there at the same time. Consider putting a little tune on while you brush. This can act as a timer. Brushing is ideally supposed to last 2 minutes. Do the best you can. A full two minutes might be a goal that is a little unrealistic for many of my patients. Brushing can be a little more fun and interactive nowadays with some fun apps. Sonicare-for-kids-sonic-electric-toothbrush brushdj brushupgame DisneyMagicBrushTimer TinyDentist Chomper chums my-bright-smile Don’t let it be too active, I once had a patient who got a fairly serious mouth injury from doing a little rough housing while brushing his teeth. Make sure your child isn’t running around with a toothbrush in the mouth. The American Dental Association recommends using a tiny amount (just a little dab) of fluoride toothpaste. It is important to note that too much can be harmful so keep the amount as small as a grain of rice. Once kids get to be over two and can spit it out after brushing, you can use a pea sized amount. Xylitol is another recommended ingredient for dental health. It is found in some toothpastes. This natural sweetener is found to help reduce bacteria and strengthen tooth enamel. It is important to use a toothpaste that is non abrasive: https://www.bestdentistguide.com/non-abrasive-toothpaste/ Most kids' brands are specially formulated to be gentle. Some adult ones are fine. Some toothpastes will have the abrasive rating noted on the package but it isn’t always easy to find. Ideally try to brush twice a day and floss once a day (for teeth that are touching.) Pay attention to habits that may or may not be good for your teeth. Children who are “grazers” tend to have more cavities than those who eat less frequently. Saliva neutralizes the acids in the mouth and actually ‘washes’ the teeth, but it needs about 2 hours in between meals to work. If someone is constantly eating, the saliva isn’t getting a chance to do its job. Foods that are high in carbohydrates and sugar are not healthy for our teeth or general health. A daily intake of 60 grams of carbs or higher more than doubles your chance of getting caries (and all that sugar can lead to type II diabetes in kids!) FINDING A DENTIST Find a dentist that treats very young children and bring your child to his or her first appointment when the first teeth erupt - no later than by age one. During the visit, the dentist will check your child for dental decay and talk to you about cleaning your baby's teeth. They might also talk to you about proper nutrition for keeping baby teeth healthy. If you have any concerns about the manner in which the teeth are erupting, having a dentist who is familiar with your child will be very useful. Another important thing to think about is that having a dentist can come in very handy if you happen to have any dental emergencies. Kids have accidents! It is not unusual for me to get calls about chipped or loose teeth after a fall. I usually suggest that they contact their dentist on those occasions, and the folks that already have one are way ahead of the game. If there is a dental emergency, early intervention can be the difference between saving the tooth or losing it. Some parents avoid taking children to the dentist to save money, yet studies show that the dental costs for children who have their first dental visit before the age of one are 40 percent lower in the first five years of life than for those who do not see a dentist before their first birthday. Consider this when deciding whether or not to add your child to your dental plan (if you are lucky enough to have one.) When I was working at Noe Valley Pediatrics, I compiled a list of popular practices based on patient feedback. Full disclosure, this list is from my 2018 post. There are lots of great practices that are not on my radar. We are fortunate to have lots of excellent choices in our city. If someone is conveniently located or is on your insurance plan that is certainly worth consideration. Many of them have updated their websites to reflect their COVID precautions. If the practice has not posted their protocols, it is very reasonable to call and ask. David Rothman 415-333-6811 is over on Ocean avenue near Stonestown. He was my kids' dentist and they loved him. He is an excellent dentist with a wonderful sense of humor. His office is able to do procedures under general anesthesiology in the office if needed. He remains my "go to" guy if I have any tooth related questions http://www.davidlrothmandds.com Bergen James, Doris Lin-Song and Jennifer Yu 415-668-3500 http://oneparkerpediatricdentistry.com/ Claudia Masouredis 415-753-2777  http://www.drmasouredis.com/ Dorothy Pang 415-681-8500 is on Taraval and 18th in the Sunset. Dr. Pang is affiliated with the UCSF dental school. If someone needs a dental procedure under anesthesiology she can do this at UCSF rather than in the office. http://www.opdsf.com/ Raymond Katz 415-751-7900 This practice is at 5233 Geary. https://www.sfdds4kids.com/ Han Pediatric Dentistry 415-681-3220 Dr. James Han’s office is at 1530 Noriega Street. Dr Han is also on staff at CPMC and attends any dental emergencies at the ER there. He can perform general anesthesia cases in the OR there as well. www.HanPediatricDentistry.com Dr. Charles Spitz and Dr. Tyler Davis 650-375-8300 Peninsula Pediatric Dentistry and Orthodontics. If you are looking for a practice down on the peninsula, this great practice is located in San Mateo. Dr. Davis works with Dr. Spitz, who used to have a practice in the Mission. They are located in the Mills Medical Arts building on the corner of South San Mateo Drive and 2nd Avenue in downtown San Mateo. http://www.spitzanddavis.com/ "We are a preventative practice first and foremost. We believe the best dental care is personalized to meet the individual needs and preferences of each child we see. We work hard to get to know our patients and their families. We're always willing to listen, to discuss options and to answer your questions." Anne Lee DDS 650-873-5212 Anneleedds.com Kid Smiles 415-681-5437 http://www.681kids.com/ There are some low cost options available as well. If you need assistance in finding a dentist, or low-cost children's health insurance in San Francisco, please call the Women and Children's Health Referral Line @ 1-800-300-9950. Low Cost Dentist options