There are so many different factors to consider when facing most of the common parenting issues. The Nurse Judy approach is a combination of many years of medical experience, a desire to treat things as naturally as possible, a large dollop of common sense. email nursejudysf@gmail.com to be added to my weekly email list
Friday, December 6, 2013
Vicks VapoRub on your feet?
Friday, October 18, 2013
Nurse Charity talks about biting
and children can get behind.
2. The play group/pre-school should make it their goal to prevent aggressive behavior of any kind by members, not just biting. So the plan should apply universally to undesirable, unsafe behavior.
3. Create a "safe place" to help isolate the biter. Remember they
maybe just as upset and bewildered as the child who is bitten, and
kids tend to strike back very quickly. Teachers and volunteers need
to move quickly to separate children, and KEEP CALM!
Depending on the age group, I would suggest a cozy
playpen type space, so even one adult can manage the situation. Pick
up the biter (or hitter or scratcher etc), say- "no don't bite, biting
hurts" and set the child into the safe place. Then the teacher/parent is free to put all of his or her attention to the child who was hurt.
7. If the skin is actually broken, a bite can become infected and might need to be evaluated.
Apologies- they are not developmentally appropriate for this age
group. Your child can apologize till they are blue in the face- it
might make the parent feel better- it will not sway or help the child
bitten.
This is something that happens when adults overlay their
feelings onto small children, and it opens up a huge can of worms. You ask your child to apologize before he is ready it comes out forced, the other parent gets even more upset.
Or they refuse all together. Yikes!! The child bitten refuses to accept the apology! Double yikes!! Other parents often take this as an opportunity to yell at your child, which is not helpful and can undo many of your family rules and consequences.
Wound tending- Many attachment parenting books talk about letting the biter help tend the wounds of the bitee- More trouble than it is worth. Sometimes the child who was hurt will not let the child help- leading to more tension. Or the care taking role your child wants to take is
prohibited- for example my child once wanted to provide a band-aid to
the child he hurt. The pre-school refused to let him.
A lot of reasoning, yelling, shaming, etc.- Keep the talking about biting age appropriate A lot more discussion other than- "Biting Hurts, no biting." in a clear firm, almost dead pan voice is all that is required. Even a baby genius does not have adult empathy or rationalization skills, and yelling at them does not actually make them anything but tense and afraid- which sets the stage for (yep, you guessed it), more biting. Also after having followed a lot of biting children in the past few years, including my own, some children are not biting out of aggression. Often times they are biting out of love (no really- biting feels good to the biter- and so they assume it feels good to the bitee as well), or a simple desire for more personal space.
Now for the hard part- if biting becomes a pattern
Someone needs to shadow the habitual biter at school/playgroup and keep a log, who does s/he bite? when does s/he bite? what happened that day, what is the weather, what is happening at home. Is there anyone who gets bitten more than others? Why is that? (friend who is always in close proximity, love bites to favorite people, too noisy of an environment, too many kids in one play area, not enough toys to child ratio, retaliation of aggression).
Ok then one needs to teach the other kids to help the habitual biter/hitter/scrathcer/pincher stop-
again this is a safety issue. Many parents and teachers will resist
this step making a single child the scapegoat. Do not let this happen! It
is a safety issue- everyone will be safer if the kids know what to do
if they notice their playmate is getting upset. It empowers potential
victims. It does not in anyway condone biting (or hitting or pushing
or scratching or any other aggressive behavior).
Usually kids are taught-
Take a step back
say "No bite" (no Hit, No scratch").
put out a stop hand
This also helps teachers who may have not been paying attention to come quickly.
Friday, August 2, 2013
Should you give tylenol before the shots? / vaccine reaction discussion
Wednesday, June 26, 2013
How much sugar is too much???
Nurse Jen is taking the summer off to spend quality time with her lovely daughters.
She is keeping her brain active by doing some writing for the blog on some interesting topics.
Here is Jen's first contribution.
Summer is officially here and many of us are planning out of town visits with friends and family. Ice cream at the pool, cookies and juice at a doting grandparent's house and a general lapse in regular healthy eating routines all spell out an increase in SUGAR INTAKE. While the occasional sweet is nothing to get worked up about (in fact, eliminating altogether will probably only make your child want sweets more) a lot of media attention has been paid to sugar lately. Although there are a lot of conflicting opinions about sugar out there, below you will find my summary of today's 'sugar buzz.'
If you're short on time, I start by listing the current recommended levels of how much sugar kids can consume. If you're inspired to read more, read on (additional reading suggestions are listed below.)
So what do we know NOW about how much kids can consume?
Preschoolers with a daily caloric intake of 1,200 to 1,400 calories shouldn't consume more than about 4 teaspoons (or 16 grams) of ADDED sugar a day. Children ages 4-8 with a daily caloric intake of 1,600 calories should consume no more than about 3 teaspoons of ADDED sugar a day (approximately 12 grams.) In order to accommodate all the nutritional requirements for this age group, there are just fewer calories available for discretionary allowances like sugar. (www.family education.com)
As your child grows into his pre-teen and teen years, and his caloric range increases to 1,800 to 2,000 a day, the maximum amount of added sugar included in his daily diet should be 5 to 8 teaspoons (approximately 20-32 grams). (www.family education.com)
Keep in mind when you're reading labels, four grams of sugar equals one teaspoon of granulated sugar.
What are Added Sugars?
Added sugars are sugars and syrups that are added to foods or beverages during processing or preparation. They do not include naturally occurring sugars such as those found in milk (lactose) and fruits (fructose). Added sugars (or added sweeteners) include natural sugars (such as white sugar, brown sugar and honey) as well as other caloric sweeteners that are chemically manufactured (such as high fructose corn syrup.) (American Heart Association, 2013).
How can I tell by looking at a Nutrition Facts panel if a product has added sugars?
Unfortunately, current nutrition labels don’t list the amount of added sugars (alone) in a product. The line for “sugars” you see on a nutrition label includes both added and naturally occurring sugars in the product. Naturally occurring sugars are found in milk (lactose) and fruit (fructose). Any product that contains milk (such as yogurt, milk, cream) or fruit (fresh, dried) contains some natural sugars. (AHA, 2013)
But you can read the ingredient list on a processed food’s label to tell if the product contains added sugars. Names for added sugars on labels include:
Brown sugar
Corn sweetener
Corn syrup
Sugar molecules ending in “ose” (dextrose, fructose, glucose, lactose, maltose, sucrose)
High-fructose corn syrup
Fruit juice concentrates
Honey
Invert sugar
Malt sugar
Molasses
Raw sugar
Sugar
Syrup
And what are we really consuming?
A study conducted by the AHA found children as young as 1-3 years already bypass the daily recommendations, and typically consume around 12 teaspoons of sugar a day. By the time a child is 4-8 years old, his sugar consumption skyrockets to an average of 21 teaspoons a day. The same study found 14-18 year old children intake the most sugar on a daily basis, averaging about 34.3 teaspoons. In general, a statement from the National Health and Nutrition Examination Survey conducted from 2001-2004 found the average American consumes the equivalent of 22.2 teaspoons of added sugar. That is about triple the recommended adult amount! (www.family education.com)
There is more added sugar in our food today so it is important to read labels- and look at your child's plate! Have you seen the myplate picture that replaced the nutrition pyramid we grew up with? Keep it in mind every time you make your child's plate. (www.myplate.gov)
An interesting fact
In 1822 Americans consumed the amount of added sugar in one 12-ounce can of soda every five days. Today we consume that amount every ten hours...which is equivalent to 12 cans of soda in five days. ("Are we too sweet?," 2012).
If you'd like to learn more....
Sugar Crusader Dr. Robert Lustig's recent book Fat Chance has received a lot of attention ( we have an office copy if you'd like to borrow it.) Lustig’s name probably sounds familiar - more than 3.6 million people have watched his 2009 viral YouTube mini-series Sugar: The Bitter Truth.
Dr. Lustig is Professor of Pediatrics in the Division of Endocrinology at UCSF and Director of the UCSF Weight Assessment for Teen and Child Health (WATCH) Program. He is nationally recognized in the field of pediatric neuroendocrinology and a leading expert on childhood obesity.
Lustig investigates not just the detrimental biological effects of consuming sweets. He is also interested in identifying how hidden sugars find their way into our diet and how our society's sugar consumption has contributed to declining health in the general population, not just among those who are classically obese. (Hoffman, 2013).
Why is sugar so bad for us?
The easy and widely accepted answer is that refined sugar and it's popular substitute high fructose corn syrup (H.F.C.S.) don’t come with any protein, vitamins, minerals, antioxidants or fiber, and so they either displace other more nutritious elements of our diet or are eaten in addition to what we need to sustain our weight, which is why we get fatter. Lustig (and some biochemists) argue, however, not about the consumption of empty calories. They state that sugar has unique characteristics, specifically in the way the human body metabolizes the fructose in it, that may make it harmful on its own, at least if consumed in sufficient quantities. (Taubes, 2011).
To simplify this theory, Gary Taubes of The New York Times writes "the fructose component of sugar and H.F.C.S. is metabolized primarily by the liver, while the glucose from sugar and starches is metabolized by every cell in the body. Consuming sugar (fructose and glucose) means more work for the liver than if you consumed the same number of calories of starch (glucose). And if you take that sugar in liquid form — soda (or fruit juices) — the fructose and glucose will hit the liver more quickly than if you consume them in an apple (or several apples, to get what researchers would call the equivalent dose of sugar). The speed with which the liver has to do its work will also affect how it metabolizes the fructose and glucose."
The last time an agency of the federal government looked into the question of sugar and health in any detail was in 2005, in a report by the Institute of Medicine, a branch of the National Academies. The authors of the report acknowledged that plenty of evidence suggested that sugar could increase the risk of heart disease and diabetes — even raising LDL cholesterol, known as the “bad cholesterol”—– but did not consider the research to be definitive. (Taubes, 2011).
Currently, the National Institutes of Health are supporting surprisingly few clinical trials related to sugar and high-fructose corn syrup in the U.S. All are small, and none will last more than a few months. Lustig and his colleagues at U.C.S.F. are doing one of these studies. It will look at what happens when obese teenagers consume no sugar other than what they might get in fruits and vegetables. Another study will do the same with pregnant women to see if their babies are born healthier and leaner. (Taubes, 2011).
So what to eat?
Lustig says (in his January interview with Oprah Magazine) "Real food! That's it. If it came out of the ground, or it's from an animal that ate what came out of the ground, you're good to go. But if a human processed it in between, either something was added, usually sugar, or something was removed, most likely fiber and micronutrients like vitamins and minerals. The key for most people is reducing insulin, and to do that, you have to put back fiber into your diet and cut back on refined carbohydrates and sugar. If you're buying food that has a nutrition label, it's been processed. And if any form of sugar is one of the first three ingredients, consider it a dessert. When I was a kid, we had dessert once a week. Now we have it once a meal, and it's almost always processed. That's the problem. " (Schomer, 2013).
Is sugar as bad as Lustig claims is?
The answer is......it could be. It very well may be true that sugar and high-fructose corn syrup, because of the unique way in which we metabolize fructose and at the levels we now consume it, cause fat to accumulate in our livers followed by insulin resistance and metabolic syndrome, and so trigger the process that leads to heart disease, diabetes and obesity. They could indeed be toxic, but they take years to do their damage. It doesn’t happen overnight. Until long-term studies are done, we won’t know for sure. (Taubes, 2011).
In the meantime, I suggest you try your best to stick with the AHA current guidelines and practice the delicate balance of limiting your child's sugar intake without making it into a major battle. Good luck!
Are we too sweet? Our kids' addiction to sugar. (2012). Retrieved June 26, 2013, from http://life.familyeducation.com/nutritional-information/obesity/64270.html
Hoffman, Jacquie (2013, January 30). Dr. Robert Lustig: UCSF’s Sugar Crusader. Synapse, the UCSF student newspaper. Retrieved from http://synapse.ucsf.edu/
Taubes, Gary (2011, April 13). Is Sugar Toxic? The New York Times. Retrieved from http://www.nytimes.com/
Schomer, Stephanie (2013, January). The Sweet Lowdown: Exposing the Unhealthy Truth About Sugar. O, The Oprah Magazine
Friday, June 14, 2013
Blocked tear ducts
Saturday, March 16, 2013
creative and inexpesive things to do with your child
- Collect and decorate rocks with colorful paints and glitter for a rock garden.
- Make a collage. Old magazines and old photos are great for this activity.
- Make an musical instrument... Use your imagination: a shoe box with rubber bands can be a guitar; Glasses filled with different levels of water make different tones; Tapping different surfaces with chopsticks makes different sounds.
- Go on a ‘use all your senses’ walk. What do they see, smell, hear, and feel?
- Create a scavenger hunt walk. Plan a list ahead of time of thing to find…like a dog, an airplane, or even a girl with purple hair.
- Go on an ABC walk. Find things that start with all the different letters…or find the actual letters on signs and license plates. This is a great game in a supermarket.
- Download Free coloring pages from the internet. With a little searching, you can get a picture of just about anything.
- Draw with chalk. Make a hopscotch board.
- Make your own play dough. You can find the recipe on line
- Make a fort using the couch cushions
- Write a story and illustrate it together.
- Decide on a recipe and bake or cook something. Kids will often try foods more eagerly if they helped with the cooking. Let them help sprinkle in different spices and be the taste-tester.
- Have a Tea party. Invite the dolls, and get out the good china that you never use.
- Trace your hands and feet and color them in.
- Have some down time while watching a video or a special TV program. There are some lovely educational TV programs and videos out there.
- Play a computer game. Don’t be afraid of controlled use. Children that don’t learn how to be comfortable on computers at a young age are at a distinct disadvantage in this high tech culture.
- Blow bubbles
- There is little out there that is as much fun as a big appliance box to get inside of . If you buy a new appliance or see a neighbor buying one, ask for the box.
- Wash the car!
- Read!
Nurse Judy' Blog
Welcome to my blog.
When I was the pediatric advice nurse at Noe Valley Pediatrics in San Francisco, I answered questions about a huge variety of topics. I also soon recognized that I got the same questions over and over again.
I started writing these posts in order to save myself from repeating the same answers constantly.
I combine 40 years of being a pediatric nurse with my experience of raising children (and now grandchildren) of my own. My approach combines the desire to treat things as naturally as possible, staying on top of the current data and a large dollop of common sense.
I understand that there are SO many opinions out there about just about every topic.
It can be confusing and overwhelming!
My suggestion is that you gather all of the various suggestions, sift through them and then figure out what instinctively feels right to you. If you try something and it doesn't work, learn the lesson, go back to the well and try one of the other choices.
I am just one more opinion to add to the list (but my batting average is pretty high)
If you are looking for advice about a particular topic, You can put the title in the search bar and see if I have covered that.
You can also skim through the list at the bottom. Once you know when the post was written, it is fairly easy to scroll down on the right and click on the month and year
I send out an email to folks on my list when I do a new post. If you would like to be added,just send me an email to nursejudysf@gmail.com or find me on substack.
Over time I have covered a wide and odd assortment of subjects, but I am happy to get comments or requests on topics that you would like me to address.
I hope you find these posts helpful.
~Nurse Judy
March 2013
Creative things to do with your child
How much sugar is too much ( Nurse Jen)
August 2013
Tylenol before vaccines?
October 2013
Nurse Charity on biting
December 2013
Vick vaporub on your feet?
February 2014
Impetigo
March 2014
Charity on warm weather nursing
April 2014
Roseola
May 2014
Your baby's weight/growth chart
spitting up
Nurse Jen blogs on how words matter
June 2014
Is it a Urinary Tract infection?
July 2014
Travel tips
Thrush (Nurse Charity)
August 2014
infant acne
Hep B/your first vaccination opportunity
September 2014
Pacifiers: Friend or foe
Tech time: how much is too much
Keeping play dates safe (Nurse Jen)
October 2014
Enterovirus D68
November 2014
Temper Tantrums
January 2015
Febrile seizures
February 2015
Charity blogs about nipple wounds
May 2015
Sleep tidbits part 1 infant
Sleep tidbits toddler/ shifting naps
Sleep tidbits leaving the crib behind
June 2015
Head aches
travel tips (updated)
July 2015
Cord care
November 2015
parapertussis
January 2016
February 2016
Vicks vaporub on the feet (update)
May 2016
Night Terrors (update)
Bed wetting
June 2016
Fathers Day post ( Mr Nurse Judy)
Talking to your kids about horrible headlines
July 2016
Travel tips (update)
Eye health/vision
September 2016
Achieving a healthy weight (update)
November 2016
Antibiotic considerations
taking your baby out into this germy world ( update)
story telling ( update)
Zika (update)
March 2017
Flat heads/PT options
May 2017
Mothers Day musings
June 2017
Father's Day
Water safety/ Dry Drowning
July 2017
Swimming ( update)
August 2017
Food Heroes and Villians
Problem solving skills (update)
First aid kit
September 2017
Organizing your stuff ( update)
October 2017
Smoke and air quality
November 2017
The Impact of a single sentence
December 2017
The best Present is your presence 2017
Will the real Santa please stand up 2017
January 2018
Building and protecting your immune system
Old letters and pictures
February 2018
The Misadventure of Nurse Judy/Managing stress 2018
We could all use a little bit more Mr Rogers
March 2018
The Back to work transition 2018
Dealing with Altitude 2018
Travel 2018
Attitude
Vision Health 2018
April 2018
Urgent care options 2018
Constipation 2018
TemperTantrums 2018
Warts and Molluscum
May 2018
Diaper changing tips
Lessons from my Mom
June 2018
Talking to your kids about homelessness
The Partners Job
My Fathers Influence
July 2018
July 4th safety tips (2018)
Speech milestones ( 2018)
Drowning/appoint a water guardian
August 2018
Motion sickness ( 2018)
Epipen/anaphylaxis ( 2018)
September 2018
Mental illness
Attention
Time outs
October 2018
Acute Flaccid Myelitis
November 2018
Pie Theory/Finding balance 2018
Air Quality
Impact of the recent smoke/radical acceptance 2018
December 2018
Keep a journal 2018
January 2019
Vaporizers/humidifiers 2019
Pertussis 2019
Four month sleep regression
February 2019
Head injury 2019
Hepatitis A 2019
Talking to your kids about sex 2019
Tech time/how much is too much 2019
March 2019
Urgent care options 2019
Cleaning up made simple 2019
Chicken Pox/Shingles exposure guide 2019
April 2019
There is no such thing as a silly question
Poisonous plants 2019
May 2019
The amazing Nanya/Mother in Law
Nurse Judy the mom
Bath time 2019
June 2019
Measles by the numbers
Fathers day Post
Travel safety
July 2019
Allergy alternative 2019
Lead exposure 2019
August 2019
When kids play favorites
Sleep tips/ insomnia
October 2019
Branching out from English only
November 2019
The Power of story telling 2019
Election time
December 2019
The Best Present is your presence 2019
Holiday safety 2019
The World can use more Mr Rogers 2019
January 2020
Habits update 2020
Flat head/ tummy time update 2020
Building and protecting your immune system
February 2020
Novel Corona Virus
Selling the family home/the end of an era
Covid-19 update
Adverse Childhood experiences
March 2020
social networking
Quarantine tips
Assessing Priorities
April 2020
Too much togetherness
It is okay not to be right all of the time
Poison Oak ( update)
Finding Humor in the time of Quarantine
Stop feeling guilty for finding moments of joy