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 25, 2015
The best Present is your presence
Friday, December 18, 2015
Dealing with loss/helping your child cope
- How do you, yourself deal with loss?
- What do you believe? Some folks have a deep faith that there is “More to it than this,” and others think that “this is it.”
- Are you comfortable sharing your belief system with your children?
- How do you find comfort?
- What can your friends and family do for you when you are grieving? Do you need hugs or space??
- ages 2-4 generally don’t grasp the concept of death as permanent
- ages 4-7 may feel responsible for the death because of their thoughts, actions, or lack of action
- age 7-11 just starting to see death as something irreversible
- over 11 has a better understanding about the loss
In my search for further local resources I reached out to my old friend Dr. Nancy Iverson.
A Lion in the House Movie that follows several children and teens and their families through illness and loss, grief and death. Though not all of the kids in the film die, they are certainly affected by their illnesses and loss of their "normal" childhood and teen years.
The Giving Tree Shel Silverstein.
Friday, November 27, 2015
The Power of story telling
My mom could go into a room full of chaos. “Once upon a time..” she would start in a steady calm voice.
It wouldn’t be long before everyone in
the room was hanging on her every word; whatever they had been in a
snit about a moment ago was forgotten.
She would then take her audience on a
magical journey with a story that she often made up as she went. If it
were a classic tale, you could count on her to take dramatic liberties. I
don’t believe she told any story quite the same way twice. In her
kindergarten classroom she would have her students shut their eyes as
she told her tales.
"Use your imagination", she would tell
them. "I am thinking of a big black dog, he has 2 floppy ears. He also
has 2 tails and 3 eyes!"
One distinct recollection of a
time when mom’s storytelling saved the day comes to mind. My younger
daughter Alana had several friends spending the night. In one of my
bigger lapses in good “mommy judgement” I had rented a movie that I
thought they would all enjoy. It turned out to be fairly dark and scary
(always pre-screen, don’t rely on faulty memory of what may or may not
be appropriate.) One of the girls started to cry and some of the other
girls started to get sad and upset. A few of them wanted to stop the
movie, but of course most of the others wanted to keep watching. The
situation seemed like it could go downhill quickly. Fortunately my mom
was visiting. She took control, turned off the movie and started to tell
stories. These weren’t toddlers; they must have been about ten. They
sat raptly listening to story after story. The evening was saved.
Books are wonderful too, but in truth, they also are not quite the same as a story. A story is yours to tweak as you please. Stories are powerful mediums for working through issues. Folks who have asked me for parenting advice over the years know that using stories is a favorite tool. For as long as I can remember I have been counseling parents to create a fictional child with a similar name. Talk about what that parallel child has been going through. This tends to be a very non threatening way to talk about all sorts of issues. Once upon a time there was a little girl who had an “owie” ear. The doctor had given her some medicine to make it better, but when she tried the medicine it tasted yucky.”....
Once upon a time there was a little boy who didn’t like to stay in bed……
Once upon a time there was a little girl who didn’t want to go to school...
Once upon a time there was a little boy who liked to put pieces of cheese in his nose….
These stories are great ways to
launch into a dialogue about all sorts of positive and/or negative ways
that the protagonist can deal with a variety of situations. This is an
excellent problem solving technique.
When I was working on this post, I
mentioned the storytelling theme to one of the wise mamas in my life.
She immediately referred to these as “Annie Stories”. It turns out that
back in 1988 this was quite the thing, and there was a book about how to
use this method:
I use storytelling at work on a
regular basis. Many of our savvy parents who know that they have a “shot
phobic” patient on their hands, will make sure that they schedule the
visit when Josie and I are both there. Josie is my amazing medical
assistant who has been my ‘right hand’ at the office for many years.
I can’t even count how many times I have
been called into an exam room where a crying, or cowering child is
terrified of a “dreaded shot”.... I start my story:
“Once upon a time there was a patient
who was so big. He played football for his high school. He was bigger
than me, he was probably bigger than the grown up in your house, he was
really big...and he was really scared of getting shots." At this point
90% of the kids are now still and listening to me talk. Yes, they might
be huddled on their parents lap, or on the floor under the chair. They
are probably not making eye contact, but I have their attention.
“He wasn’t afraid of getting
bumped around on the football field but he hated shots. He was so scared
of them that he would try to hide. He tried to hide inside the garbage
can, but he wouldn't fit..” Now 99% are listening and some are almost
laughing.
From here I am able to start a dialogue
with them about why we are giving the shot. “It is magic protection so
that if certain germs get inside of your body, you won’t get sick.” We
talk about the fact that we wish there was a less yucky way to get the
protection and that it is really normal for lots of people to be scared
of shots. We talk about the fact that being brave is trying hard to hold
still and it is still really okay to cry and yell if they need to. As soon as they are ready, Josie (the best shot giver in the country) has already gotten it done.
It all starts by engaging them with a story.
Not everything has to have a purpose. Sometimes stories are just for fun
If I happen to be taking a walk
outside and see something unusual such as a pair of shoes sitting by
themselves on a street corner, I can’t help to think to myself. Here is a
story. How did those shoes get there? Take turns telling the same
story. Families can have a wonderful time creating a collaborative tale.
Another wise Mama tells me that she used to have her kids give her three things that they wanted the story to include; perhaps a special name or a certain feeling.
Our kids these days are both
blessed and cursed with the enormous choices of digital wonders. I am
not opposed to limited use of regulated tech time, but it should not be
in place of plain old imagination.
Recent studies show that books and stories started young have a real impact on brain development:
This Black Friday, as people run around to shop for all kinds of new technological marvels, don’t forget to “power down” and be thankful for the magic moments that you capture as you snuggle with your kids and simply tell a story. "Once upon a time...... |
Friday, November 6, 2015
Parapertussis/Whooping cough's milder cousin
Friday, October 16, 2015
Hepatitis A: Are you protected?
Friday, July 31, 2015
Cord care
Cord care
Before birth, the umbilical cord is the connection between the baby and the mother through which the baby receives nourishment and oxygen. After birth it becomes useless. By the time the baby is several weeks old, this is something you will likely never think about again, but right after birth it deserves a bit of attention.
You may have heard of cord banking. Cord banking is a trend that comes in and out of fashion. The idea is to save your baby’s stem cells as an insurance policy in case there is a future medical need. In theory it is great. Unfortunately it is very expensive and it is hard to predict if the bank you choose will still be around in the future should you need it. At the time of this post, very few of my patients opt to do this, but it is worth checking to see if there are any updates.
The optimal timing for clamping the umbilical cord after birth has also been a subject of controversy and debate. There is a current trend to delay clamping for a few minutes after birth. It is best to discuss this with your OB ahead of time. The important thing is simple that the baby is tended to. If everything is stable, by all means, delay the clamping for a moment or two. If for some reason the baby needs attention, the clamping is done immediately, and you don’t get that extra time, please don’t focus on this as something to fret about. I imagine your baby's chances of becoming president one day won’t hinge too closely on how quickly they got their cord clamped!
Whenever it occurs, the umbilical cord is clamped and cut close to the baby's body. There are no nerves in the cord, so this is a painless procedure.
The cord clamp should be removed prior to leaving the hospital. It is a good idea to double check. I have occasionally seen newborns discharged with the clamp still on. Once the clamp is off, an umbilical stump remains attached to your baby's navel.
There is not much you need to do to care for it. Often, the less you fuss with it, the sooner it will fall off. It tends to fall off between 7-17 days (not everyone follows those rules.) At some point it will be hanging by a thread and you will see who the lucky person is on diaper duty when it finally comes off.
There are newborn diapers that have the little cutouts that are very useful. This helps you avoid having the cord rubbed and irritated. Hopefully you won’t need more than a few boxes of those. If you have a larger baby who is too big for size one, just roll down the diaper to avoid rubbing.
We want to keep the area dry so no actual submerging the baby in a tub until it falls off. Sponge baths can get the job done. Yes, babies get some pee and poop on there, don’t freak out. Just clean it as best as you can. If the cord gets a foul odor (trust me, you will know if it is smelly or not) call your pediatrician to get it checked out. A stinky cord can be a signal that the baby has an infection (called omphalitis.) The docs will do a good cleaning and get in there in a way that the parents often aren’t comfortable doing. If needed, the doctor may apply silver nitrate. This is a chemical that cauterizes the area. That will leave a grayish/black discoloration around the area that may take a few weeks to fade. It may take more than one application for the cord to be healed.
Once in a while a small piece of the cord stays in place. This is called a granuloma. If the baby is acting perfectly fine in every other respect, there is no need to rush in, but your doctor will want to take a look if things are not healing up. A persistent granuloma will usually need attention.
Once the cord is off, it is normal for the area to continue to ooze a bit for another week or so. It is quite common to have a bit of green or yellow stain on the diaper or shirt. Sometimes there is also what looks like blood. Unless there are actual drops of blood coming from the cord, I am not concerned about little staining. At this point you can clear around the area with a bit of alcohol and a dab of Neosporin.
Another thing that parents might call about are umbilical hernias. An umbilical hernia occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles. Umbilical hernias are common and typically harmless. They are most common in infants, but they can affect adults as well. In an infant, an umbilical hernia may be especially evident when the infant cries or strains causing the baby's belly button to protrude. This is a classic sign. Some of these are as big as golf balls. Usually this resolves on its own. As long as you can gently push the belly button back in, it is not a concern. If you have an inconsolable baby and the area seems to be stuck on the outside, that would need an immediate evaluation.
Before you know it, that cord will be off and most likely you won’t be giving much thought about your kid’s navel until they are teenagers and begging for permission to get it pierced. (It is also quite possible that when they turn that C in geometry into an A you will reluctantly give your blessing, as we did with our daughter Lauren!)