When should your child start seeing a dentist?

 This post has been updated. Please check out the new post January 2017

Parents often ask us when they should start taking their kids to the dentist.

Believe it or not, the current recommendation is now that your child should have his or her first dental visit by age one.

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. Although tooth decay is the most common chronic childhood disease, it can be prevented.

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 wash cloth.

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 wonderful way to created good dental habits that will last a lifetime. 

Other options

Spiffies,: These are little flavored towelettes specially formulated for wiping baby teeth

Soft finger brush: These fit over your finger and if you baby will let you, allow you to get in there and do a nice thorough job

Toothbrush: Make sure it has soft bristles, replace when it looks like the bristles are getting worn.

The old recommendation was to use non fluoride toothpaste until kids were two. The new suggestion is to use a tiny amount( grain of rice size) of fluoride toothpaste. It is important to note that too much can be harmful so keep the amount tiny. Once kids get to be over two, you can use a pea sized amount.

http://www.healthychildren.org/English/healthy-living/oral-health/pages/FAQ-Fluoride-and-Children.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

http://www2.aap.org/ORALHEALTH/pact/ch5_sect1b.cfm

http://www.ncdhhs.gov/dph/oralhealth/library/includes/IMBresources/TopicalFluorideRpt%204-30-09%20edited%20with%20link%201-10.pdf

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.  

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.

Do consider this when deciding whether or not to add your child to your dental plan (if you are lucky enough to have one)

We are fortunate to have lots of excellent choices in our city.

Below is a partial list of dentists who we send patients to.

If someone is conveniently located or is on your insurance plan that is certainly worth consideration.

David Rothman 333-6811

Dr Rothman is over on Ocean avenue near Stonestown

He was my kid's 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.

Bergen James, Doris Lin-Song and Jennifer Yu   668-3500

They are located on Parker Street near Laurel Village

Claudia Masouredis 753-2777

Dr Masouredis is fairly close to our office, just up the hill on Portola.
Nurse Jen brings her kids here and they adore her.

Dorothy Pang 681-8500

Dr Pang is on Taraval and 18^th in the Sunset.

One of the things that sets her apart is that she 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.

Noe Valley smiles and Braces 678-5445

These folks are right here on 24^th street. They recently were a wonderful resource for some of our patients who had after hours dental emergencies

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Help your child keep their shining healthy smile! 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.

RECAP   Tips for Healthy Teeth

• Take your child to a dentist twice a year; starting by age one
• Brush your child's teeth everyday; as soon as they come in
• Make those snacks healthy ones: fruits, cheese, vegetables, nut butters, etc.
• Take care of your own teeth; adults can spread cavity-causing bacteria to children
• Never let your baby have a bottle or cup in bed that has anything other than water

Special Thanks to Margaret Fisher from the CHDP program for all of her information and support! 

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

HAND FOOT MOUTH (and butt) VIRUS

PLEASE SEE UPDATED POST MARCH 2016

We have started to get calls about hand foot mouth lately,so I thought I would do a little review.

Hand foot mouth is a very common illness that most kids get during childhood. It is easily spread through body secretions such as saliva and stool. Although the virus most commonly associated with it is called coxsackievirus there are other strains that sometimes circulate.

Most folks may only get it once, but I have seen some patients who don't seem to hold the immunity and have gotten it multiple times. As with most childhood illnesses, most of us got this out of the way when we were young. Adults who are unfortunate enough to come down with this tend to be quite miserable.

I actually like to call it Hand Foot Mouth and Butt, because in my experience kids often get blisters on their butts as well as on the hands and feet.

Some people have mild congestion, sore throat and fever as part of the package.

It is a very variable illness, meaning that one child will not look very sick and another can feel wretched. The lucky ones might simply have a mystery blister on the hand and that is the extent of it! Most of the time the worst symptoms resolve in a week or so.

Last fall when it was going around it seemed like it was a rougher strain Many of the kids had mouth involvement and some of the blisters on the hands seemed to last a bit longer.

There is no treatment for this virus. You simply support your child through it and of course call the doctor if something is causing you alarm.

Your goal is to keep your little one hydrated.

I have found that the kids with more mouth involvement are the most miserable. In extreme cases the mouth sores are so awful that they don't want to eat or drink and can have a risk of dehydration.

Keeping them comfortable is the best way to get them drinking. Even if they have no fever, it is appropriate to dose them up with Tylenol or Ibuprofen (Motrin/Advil).

Tylenol comes in a suppository form if they are resistant to taking medicine by mouth.   

Offer cool creamy and soft foods ( hooray if you have breast milk).

Avoid anything acidic or sharp, like orange juice or tortilla chips.

Smoothies are a great choice. 

I like an over the counter medication called Glyoxide that can be applied by Q-tip to affected areas ( if your child lets you anywhere near them!)

For older kids with mouth sores try this:

1/2 teaspoon of Benedryl mixed with

1/2 teaspoon of Maalox

Squirt this mixture around the mouth every 4-6 hours

Many kids get quite a bit of relief from this.

If you are worried about hydration it is worth having your child seen.

A dehydrated child will have very low energy, decreased urine output and not a lot of tears or drool. They seem dry and droopy. As with any case of dehydration, if the oral route is failing, they may need some IV fluids. This is usually done in the emergency room.

If your child is running around, has normal activity level, and reasonably wet diapers, then they are "managing" and I wouldn't be too concerned.

The exposure period for this illness is usually from three days to a week. In other words, if your child was exposed on a Monday...they may start to show symptoms as early as Thursday but if a week goes by without anything happening you are probably out of the woods.

On the other hand, If you child has the illness, they are contagious as long as they still have blisters or a fever and perhaps can shed the virus for a week or two afterwards.

If your child is happy and eating and has no fever but has a few blisters I would try to keep them away from a newborn or someone with a compromised immune system, but it seems excessive to expect you to keep your kids out of daycare if that is the only symptom.

Good hand washing is key to avoiding this.

Make sure the shared toys are cleaned frequently.

If your child gets this (I should say when..not if) don't freak out. Time will fix it.

Think about it as a rite of passage.

Give them something cool and creamy along with a big hug.

As always, if you look at them and you are WORRIED ( not just feeling sorry for them) call for an evaluation.

Tips for giving medication

PLEASE SEE THE UPDATED POST 2/2017
The compounding options have changed.
************************************************

Parents have to pick their battles. Sometimes things really aren’t so important and we don’t have to necessarily get “our way”. Generally though, the medication battle has to be one where we come out on top.

The assumption of course, is that you have decided for a valid reason that your child has a condition that needs to be treated. If this is the case, have firm but loving attitude.  

(Think Mary Poppins and her spoonful of sugar)

Make it clear that you mean business and whether or not they like it, they will be getting the medicine, one way or another.

For your young child, hold them at a 45 degree angle,  If they are flat they can choke a bit, and if they are sitting up too high they can spit.

If they are using their hands to knock the medication away, wrap them in a blanket (think straight jacket)

A syringe is much more effective than a spoon and is better for measuring.

Squirt a small amount in the side of a cheek.

Keep the chin elevated

Give a tiny bit at a time and wait for a swallow in between.

Some of our tough customers are most likely crying and screaming throughout the process. It gets easier.

If you are giving a teaspoonful, that would be 5 ml in a syringe. Giving .5 ml per squirt would mean 10 squirts. This may take several minutes, but the dose will go in.

The only kiddos that can beat this system if you are doing it slowly enough are the ones that learn how to vomit.

Okay, what are your options if you have a vomiter on your hands?

If your child needs antibiotics, sometimes we can give an injection.

If you are simply trying to get in a dose of fever reducers, Acetaminophen  (Tylenol) comes in suppository form that is quite easy to give.

For kids who are old enough to reason, lets give them some choices. What would they like to drink after the medicine? Should we have the pharmacy add a flavor?

Sometimes holding a lollipop and taking a lick after each squirt helps with a bitter taste.

Some of the generic antibiotics are truly vile. Azithromicin (Generic for Zithromax) is one of the worst. The name brand is significantly easier to get down, but most insurance companies won’t cover it without an enormous co-pay)

Do some  role play ahead of time.

Have one cooperative stuffed animal one stuffed animal (or doll) who kicks a fit.

For the cooperative doll say things like, “ I know this tastes a little yucky, but it is really important and it will help make you feel better. I am really proud of you for being so cooperative."

Let them be the parent who has to give the medicine to the uncooperative doll.

Choices and rewards are fine, but make it clear from the get go that the discussion will last 5 minutes and no more (set a timer) when the timer is up they will be given the medicine the same way a baby gets it, with no choices involved. When the kids realize you mean business they cave fairly quickly.

One reward method is to make it possible to earn 10 pennies per dose. Put the money on the table.

A penny is taken away for  every 30 seconds that passes without cooperation. Kids hate seeing something concrete being taken away.

If your child is old enough, this is a great math opportunity. A 10 day course of antibiotics can be worth 2 dollars (adjust the reward however you choose)

Never try to sneak medicine into a larger volume of food or drink. Your kids will know it is there. If they do end up taking only part of it, you will have no real idea how much of it they got.

I have actually had some pretty young kids who hate taking liquid medicine learn to swallow capsules or pills.

I start with tic tacs or other small pieces of candy. See if they can swallow one. If they fail, Oh well. They have a piece of candy in their mouth. If they can’t swallow it with water, try putting it on a spoon tucked  into some yogurt or jelly and see if it goes down.

Remember you are doing this with your child’s involvement. No sneaking things. Don’t lose their trust over something like this. You are on the same team, trying to help them feel better.

I just discovered that the pharmacy at 450 Sutter will compound  any medication. They can turn an antibiotic into a yummy tasting gummy. What a concept. They also deliver.
Their phone number is 392-4137. If this is an option you are interested in exploring, give them a call.
This is an especially good option for the Zithromax.

Most kids do end up taking some syrupy medications at some point or another. Please make sure you brush their teeth after each dose.

If they are taking antibiotics I strongly suggest that they also take probiotics to protect the body chemistry and prevent yeast. Ideally, don’t give a probiotic at the same time as the other medications, but stagger it throughout the day if possible.

Some children take a daily medication or vitamin pill and quite like them.

Telling your child that medicine and vitamins are not candy and can only be given by the grown up is a start, but it is also essential that they are kept in a child proof area. If your child does take an overdose of any medication call the Poison Control Center to find out how concerned you need to be.

Poison Control number for California is 1-800-222-1222

If you are ever giving a medication and are not sure about proper dosing, never hesitate to call your doctor’s office/ advice nurse for clarification.

Blocked tear ducts

We get calls all the time from parents with a young baby who has eye discharge.

Between 5-20% of babies are born with a blocked tear duct. The medical lingo for this is dacryostenosis. You may also hear it referred to a nasal lacrimal duct stenosis.

These babies have eyes that are crusty or watery. Some discharge is noted as well. It is usually worse when they first wake up from sleep.

My favorite approach is the most natural. Reach up to your own eye. Do you feel that little bulb on the inside corner near your nose? That is the tear duct. Gently massage it. It actually feels sort of good ( okay now stop rubbing your eye)

Now it is your baby's turn.

With a very clean finger, massage their tear duct. ( watch out for sharp nails)

If you are fortunate to have breast milk, add a few drops to the eye. You can tap it in with your finger, an eye dropper or squirt it in directly.

Now clean off the eye with a warm, wet cotton ball. I was always taught to wipe from the outside towards the nose. This direction avoids spreading the mucous throughout the rest of the eye, but there doesn't seem to be any consensus about this

If you don't have breast milk, Simply do the massage and clean with the wet cotton ball.

Think about having a clogged drain, if you can clear it without pouring in DRANO that is a better option. Massaging the duct often takes care of it. The breast milk is a bonus and more and more studies are finding remarkable healing properties in it.

Kids with blocked ducts are going to have the crusty eyes on and off.

If:

Baby seems happy and well

Eyes remain clear for several hours after treatment  

(remember, it is normal for them to be especially crusty when they first wake up)

There is no significant redness or swelling around the eye

Then:

I am fine with the "watch and see" approach.

Treat with the massage and breast milk for a day or so and then report back

If, however:

The baby seems very fussy

The eyes have green or yellow discharge that needs to be wiped off more than once an hour

There is significant redness in or around the eye

Then:

call for an appointment.( For older children, Goopy eyes can be conjunctivitis or a sign of an ear infection)

If we suspect an eye infection we will likely prescribe a course of antibiotic eye drops or ointment. 

Having a blocked tear duct is quite common. Most infants grow out of it within a few months. 90% will resolve on their own. Some kids don't clear until they are almost a year old. If it doesn't seem to be resolving or your baby is getting frequent eye infections, we will send you to see the ophthalmologist. They will schedule a simple procedure that unblocks the duct.

Bath time tips

There is not one bath routine that works for everyone.

Tub and sink sizes, babies temperament and willing partners will vary from family to family

* generally I suggest just sponging of any dirty areas until cord/ circumcision sites are healed (usually by 2 weeks you are good to go)

Once you are ready to submerge the baby,  safety is key

*NEVER LEAVE THE BABY FOR EVEN AN INSTANT

-Have all supplies at hand.

(towel, wash cloth, cup for rinsing)

-Wearing a terry cloth robe will help keep you dry as well as offering traction to a wet slippery baby

-If possible have the room temperature nice and cozy ( 75 degrees would be ideal)

-Check the water temperature to make sure it isn't too hot ( it might be worth buying a baby bath thermometer. There are several cute ones that float in the tub)

A good water temperature range would be between 36-38 Celsius or 97-100 Fahrenheit.

Some infants have a little trouble regulating their body temperature so water that is either too hot or too cold can make them uncomfortable.

( normal body temperature averages 37 or 98.6)

Too cold is no good, but too hot is probably worse.

Babies have very sensitive skin that can burn easily.

As a safety precaution I would have you turn down your hot water heater to 120 degrees.

Many hot water heaters come from the factory set to 140 degrees. Way too hot!!

-Make sure there are no electric cords or tools nearby ( like shavers or hair dryers) that can get pulled into the water

*Remember that babies can drown in even an inch or two of water

How Often?

Babies don't get too dirty and usually don't need to be fully bathed more than 2-3 times a week.

If they have dry skin it is important to not over bathe. ( slathering with a good lotion after the bath is also very important for these kids)

Faces and diaper areas should be washed at least daily

In the tub I would start with the face and head.......then do the body and end with the tush. ( going from the cleaner areas to the dirtier areas).

You can use a warm, wet cotton ball to clean the eyes. I suggest cleaning from the outside of the eyes in towards the tear duct/ nose.

Some kids can get irritations from sitting in the soapy water so if you have an older baby who enjoys the bath, let them play and then do the soaping and rinsing right before they get out. 

Using a cup to rinse the hair usually helps

Find a nice gentle baby soap. There are a lot of good brands. Watch for any rashes or irritation when trying anything new. Bubble baths can cause urinary discomfort in some sensitive little girls, so keep an eye out for that.

Adding a splash of apple cider vinegar to the tub seems to be useful at preventing some rashes. It is hard to give an exact amount since the tub volumes vary so much, but I usually suggest between 1/4 and 1/2 cup.

In my family we made baths a two parent operation. My husband would get in the tub first and I would hand in the baby. Many parents have told me that they loved this tip. The babies feel very secure being held and it is generally much easier to get them nice and clean from within the tub.

If you don't have two willing partners I would usually use a big sink until the babies are good at sitting. (watch out for the faucet. There are products out there that can cover them for safety).

For your toddler, consider a plastic rectangular laundry basket that fits inside your tub. Your baby will have something to lean against, and the toys can't float very far.

There is nothing quite like the scent of a clean, sweet smelling baby. Enjoy the moment!

Head lice/ Sklice co-pay coupon

This is the old head lice post.
Please see the updated post about Super Lice from
March 2016

Diagnosis:

Learning that your child has head lice can be incredibly aggravating. Trust me I know.

You might be suspicious because your child is scratching their head or you may have gotten a call from school that your child was exposed. It is rare to actually see the live lice crawling around ( although I was once measuring a child's height and there was actually a halo of lice crawling all over her head...ugh, I get itchy just thinking about it) 

Once a child gets head lice, the mature or adult head lice can lay up to 10 eggs or nits each day. These nits, or lice eggs, hatch in about 7 to 12 days. Baby lice or nymphs are about the size of a pinhead when they hatch, and quickly mature into adult lice in about a 9 to 12 days. 

Lice don't like light and they move very quickly, therefore the diagnosis is often made by finding the nits. These are small white, opaque or tan specks that adhere tightly to the hair shaft. If you flick something and it floats away, it may just be dandruff. The nits are usually close to the scalp. If they are further down the hair shaft, likely they have been around awhile undetected.

Check your child's head in a methodical manner paying special attention to the areas behind the ears, the nape of the neck and the crown. Make sure you are in a well lit area. Remember that if one person in the family is infested, you should check everyone. ( you may be able to feel a nit on your own hair, it will feel like a tiny little knot) 

If you have found some bug or nits, it is time to treat.

There are several good approaches.

Treatment Options:

Here is the least expensive and least toxic way to take care of things.

1. loosen the nits with either plain white vinegar or an "egg releaser" product such as Clear. Both Clear and vinegar work well but might neutralize the active ingredient in the Nix ( permethrin) and therefore should be used before the Nix and rinsed out thoroughly.
2. Wash hair with Prell Shampoo. Other shampoos with a silicon or lipid based conditioner might coat the lice and eggs and protect them from the Nix
3. Towel dry the hair so that it is still damp. Work the Nix through the hair and leave on for 30 minutes. ( ignore the package insert that says 10 minutes)
4. Rinse out the Nix and comb out the lice and nits. ( this is usually when you will see dead lice)
5. Getting a special Lice Comb will make this job much easier. Metal flea combs from the pet store work, but the best one is probably the Lice Meister comb. (You can find it on Amazon for about $18.) The plastic one that comes with the Nix is pretty worthless.

Nix does NOT seem to be 100% effective so I follow this up with 2 extra steps.

1.If your child is old enough and cooperative enough to sit still, using a flat iron ( hair straightener) will sizzle any nits that are left. I would suggest doing this daily for a week. Take very small sections of hair at a time.

2. Three days after the treatment with Nix, soak the entire head with olive oil, cover with shower cap and bandana and keep on for 3 or 4 hours. This will suffocate any of the hardy survivors.

Between the Nix, the Flat iron and the olive oil I have had a VERY high success rate of getting rid of lice the first time around.

There is also a new product on the market called SKLICE. This treatment is available only with a prescription. ( the Noe Valley Walgreen's tries to keep it in stock) Sklice is fairly non- toxic. It is approved down to 6 months of age. The cost will vary depending on your insurance plan. Sklice claims that you don't need to do any nit combing after the treatment ( although some schools have a no nit policy)

As of June 2013 you can go to www.SKLICE.COM  for a $25 copay coupon.
This website will give you all the directions that you need along with other useful lice info.

If money is no object there are companies that will do the treatment and nit removal for you. These are very effective, but don't kid yourself, they can be QUITE expensive

If you are local...Hair Fairies-415-292-5900.  

Clean up:

Wash sheets and pillow cases for the first two days after treatment. Wash towels, recently worn clothing and any hats or hoods that have been in contact with the lice.

( Sometimes a trip to a Laundromat that has the big dryers and lots of machines can help you take care of the clean up more efficiently.)

Items that can not be washed should be dry cleaned, put in a hot dryer for at least 30 minutes or placed in a zip lock bag in the freezer for 24 hours. Sealing items in an airtight bag for several weeks is also a common recommendation, but may not be reliable. Combs and brushes should be cleaned by soaking in hot water ( about 130*F) for 10 minutes. All rooms and furniture, including car seat should be vacuumed.

Prevention:

Lice do not jump or fly. Since they travel by crawling, it is important that your children learn not to share brushes, hats, hair bows or headphones.Crowded coat racks are a good way to catch them.

Teach them to hang their coats separately. If you child is in a class or day care with a lice outbreak, talk about eliminating any dress up boxes. If you child has long hair, pull it back into pony tail or braids to minimize the risk.

Although it is unproven, some people say that washing the hair on a routine basis with tea tree oil shampoo or vinegar rinses may act as a prevention.

Remember that lice do not care about family income, education, lifestyle or cleanliness. 10 million Americans are infested each year.

Take a deep breath, believe it or not there are worse things. I had one mom who was taking care of her kids head lice when she realized that he also had pin worms!

*****

Sorry if this post made you scratch your head..

I don't think there is necessarily a "lice season", but occasionally we have weeks with a steady stream of calls about this issue.

 Those calls have been coming in. There are outbreaks at several Bay Area schools.

Lice are indeed one of the Ten Plagues after all..

Happy Passover/ and Easter to those who celebrate/

Nurse Judy

Update 11/14  There has been a back order on Sklice and we have had a hard time finding it in the SF Bay Area.
I will update when it is widely available again.