Friday, December 25, 2015

The best Present is your presence

I saw a bumper sticker a while ago that said:

Good parenting requires Twice as much time and half as much money.
So true!

This is the season for gift giving, but we all actually could do with a lot less stuff!! The best present I think that families can give to each other is the gift of self ( 
otherwise known as time and attention)

For kids who are old enough to understand, give a certificate that promises a special activity that you might do some time in the future.

It is great for families to do outings all together, but one on one time is so important if you can manage it. Mix and match so that you make sure that everyone gets special time with one other family member. This includes one on one time for you parents as well.

The list below has some old and new ideas.

Nurse Judy's Inexpensive and creative activities

Collect and decorate rocks with colorful paints and glitter for a rock garden.
This is a great one to use as a reward for good behavior. When they see the pretty rocks, they will remember that they earned them.

Make a collage. Old magazines and old photos are great for this activity.

Make a 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?

Make a personalized place mats. Take some family photos, glue onto cardboard and cover with clear contact paper. Kids will love to use these with meals.
Create a scavenger hunt walk. Plan a list ahead of time of thing to 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,

For a really special occasion, set up the tent and have a backyard camp out

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

Playing board games with the family is the stuff that great memories are made of

There is little out there that is as much fun as a giant box to get inside of . If you buy a new appliance or see a neighbor buying one, ask for the box.

let’s be optimistic: Make a rain gauge!

Play dress up. In my opinion, every house needs a good dress up box, (after Halloween is a great time to pick up costumes and things on sale)

If you can manage to make it work, try hard to have at least one meal of the day sitting down with the entire family. Have everyone say a little about their day.

Take advantage of where we live, there are always fairs, festivals and museums that are so close. SFKIDS.ORG   and Parenthoods are great resources for all of the happenings that are going on  

Make a scrapbook with keepsakes and photos of all the fun activities
Unless you are using the phone or tablet as part of the activity make sure you put them down and be fully engaged in what you are doing  
(emails can wait)

For Those lucky enough to live in or near the Bay Area, here is my list of quirky, only in SF things to do.
Fort Funston: Bring some dog treats and take a walk. You are pretty much guaranteed to see lots of fuzzy friends to pet.  If you are lucky you will see hang gliders. (Free)

Turrell Sky dome: For this you need an admission to the De Young museum. Many folks have no idea that this magical place exists. Go out to the garden by the cafe and follow the path and signs down to the sky dome. Once you are in there, make sure you sing and listen to the acoustics

The camera below the cliff house: Lots of folks don’t bother stepping in there, but it is worth it. The Camera Obscura gives a real time 360 view of the surrounding. It is only open when the weather is clear. It isn’t free, but it is reasonably inexpensive
The Wave Organ: This is an old exploratorium exhibit that remains out at the end of a jetty behind the St Francis Yacht club. When the tide is right (good luck, I have rarely been there are the right time) pipes will play music. It is an enchanting place regardless, especially if you are there when no one else is out there.  It is free

The Gingerbread house in the lobby of the Fairmont Hotel is worth a trip. It is only there until the New Year. This is free unless you opt to splurge on the very expensive tea.

I love the Stairway walks of SF book. If you child is old enough that they don't start asking to be carried half way through the walk, these are a great family activity.

Happy Holidays...go out and make some wonderful memories!

Friday, December 18, 2015

Dealing with loss/helping your child cope

Laughter/Crying/Happiness/Sadness. Life is such a balance.

Assuming you are lucky enough to have people, pets, or even objects that you care about, then dealing with loss is inevitable.

If you have a child, you need to be prepared to know how to approach the subject.
Parents, it may be helpful to ask yourselves the following questions:

  • 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??

There is not one simple approach for every person, child, or family. My mother-in-law liked to say that there is no right or wrong way to grieve. There are no rules. It is important to be supportive of the different paths that people take. There are also many cultural factors that may impact the situation.

If your family is hit with a loss, sudden or anticipated, unless we are talking about a goldfish, likely the death is hitting you just as hard, if not harder, than it is impacting your child ,though don’t minimize the loss of that goldfish as a valuable opportunity for ritual and conversation.( My husband managed to delay the "goldfish conversation" several times with a visit to the "24 fish store" where Goldie was replaced several time with no one the wiser)

The routine losses that the families in my practice deal with most often are the passing of a grandparent or beloved family pet. Those are the lucky ones. An anticipated loss is no less devastating, but this is the cycle of life that is sad but not shocking. Others are flattened by the loss of a partner, friend, sibling, child.

Parents don’t usually have the luxury of collapse. How do you help your child when you yourself are dealing with all the grief?

There are factors to keep in mind for each age that you are dealing with.
  • 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

Not to make light of the subject, but here is a classic family anecdote:

When Lauren was between 3 or 4, she went through a phase of obsessing over several musicals and movies that were centered around orphans. Annie and Disney's The Rescuers are ones that comes to mind, but I know there were others. One day she asked, “what is an orphan?”

We discussed that an orphan was someone who didn’t have any parents. We immediately went on to say that she was very lucky that she had both mommy and daddy, but if in the very unlikely event that anything ever happened to both of us, her aunt and uncle, Barbara and Richard, would be her guardians. She was quiet for a moment and then said, “ I had better have their phone number.”


Do's and Don't s

Do NOT say that an animal was “put to sleep” or use any phrase that can confuse your child. The words “passed away” are also fairly passive and confusing. They might wonder if that could happen to them at any time. Do NOT lie. Find a way to convey truth that you are comfortable with. Your child will know that you are very upset. Shielding them from honesty and communication is not doing them a favor. It is okay to be sad. It is okay to cry.

Find a ritual that you feel comfortable embracing. Take comfort in happy memories. Celebrate the life of the one you lost! Tell wonderful stories. Don’t be afraid to laugh.
Honor the memories with kind gestures.

Finding a good therapist to help you or your child give you coping tools is often a good idea. Check to make sure that the therapist has experience dealing with bereavement issues.

Books and stories can be an excellent launching off point for discussions. If you can’t come to terms with how you feel about death, you might be able to turn the spotlight  away from you with lines like:

“Some people believe…”
“Other people think……”

In my search for further local resources I reached out to my old friend Dr. Nancy Iverson.

Nancy has not only written several published articles about the grieving process, but has been involved in facilitating various support groups for many years. She pointed me towards Josie’s Place. (It was a bit of a treasure hunt.)

This is a small but wonderful center here in San Francisco that offers support groups and other services for families and children who have experienced loss.

Josie’s Place:
Groups meet in the Inner Sunset

If you scroll down to the bottom of the home page on their website in the "Articles on Grief/Grief Resources" tab, Pat Murphy, the director has cobbled together a list of other local resources that might be useful.

Janet Jaskula, RN, MS, A pediatric hospice nurse, also shared her list of resources:

This is a great book about what loss and grief can do if one does not deal with it.  Kids and adults.

"Fall of Freddie the Leaf" by Leo Buscaglia  

"Velveteen Rabbit" by Margery Williams

"There is a Rainbow Behind Every Dark Cloud"  written by a group of children with leukemia who attended The Center for Attitudinal Healing.

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. 

For parents, check out the the website of Barbara Karnes. Barbara Karnes is the author of  "Gone From My Sight."  She has some excellent combo coloring/story books about loss for kids.

Dr Nancy Iverson recommends the book:
"Never Too Young to Know" by Phyllis Rolfe Silverman

The very helpful children's librarian Liesel Harris-Boundy at the San Francisco Public Library West Portal Branch did some research for me and came up with some good choices for kids. Scroll down to the end of the post for her list.


I saw the following gem circulating around the internet and it resonated with me. I thought it worth sharing.

Someone put out a post asking for help dealing with grief. This answer was the response from a fellow in his late 70s:

I'm old. What that means is that I've survived (so far) and a lot of people I've known and loved did not.

I've lost friends, best friends, acquaintances, co-workers, grandparents, mom, relatives, teachers, mentors, students, neighbors, and a host of other folks. I have no children, and I can't imagine the pain it must be to lose a child. But here's my two cents...

I wish I could say you get used to people dying. But I never did. I don't want to. It tears a hole through me whenever somebody I love dies, no matter the circumstances. But I don't want it to "not matter". I don't want it to be something that just passes. My scars are a testament to the love and the relationship that I had for and with that person. And if the scar is deep, so was the love. So be it.

Scars are a testament to life. Scars are a testament that I can love deeply and live deeply and be cut, or even gouged, and that I can heal and continue to live and continue to love. And the scar tissue is stronger than the original flesh ever was. Scars are a testament to life. Scars are only ugly to people who can't see.

As for grief, you'll find it comes in waves. When the ship is first wrecked, you're drowning, with wreckage all around you. Everything floating around you reminds you of the beauty and the magnificence of the ship that was, and is no more. And all you can do is float. You find some piece of the wreckage and you hang on for a while. Maybe it's some physical thing. Maybe it's a happy memory or a photograph. Maybe it's a person who is also floating. For a while, all you can do is float. Stay alive.

In the beginning, the waves are 100 feet tall and crash over you without mercy. They come 10 seconds apart and don't even give you time to catch your breath. All you can do is hang on and float. After a while, maybe weeks, maybe months, you'll find the waves are still 100 feet tall, but they come further apart. When they come, they still crash all over you and wipe you out. But in between, you can breathe, you can function. You never know what's going to trigger the grief. It might be a song, a picture, a street intersection, the smell of a cup of coffee. It can be just about anything...and the wave comes crashing. But in between waves, there is life.

Somewhere down the line, and it's different for everybody, you find that the waves are only 80 feet tall. Or 50 feet tall. And while they still come, they come further apart. You can see them coming. An anniversary, a birthday, or Christmas, or landing at O'Hare. You can see it coming, for the most part, and prepare yourself. And when it washes over you, you know that somehow you will, again, come out the other side. Soaking wet, sputtering, still hanging on to some tiny piece of the wreckage, but you'll come out.

Take it from an old guy. The waves never stop coming, and somehow you don't really want them to. But you learn that you'll survive them. And other waves will come. And you'll survive them too.

If you're lucky, you'll have lots of scars from lots of loves. And lots of shipwrecks.


Liesel Harris-Boundy's recommended reading list:

Life Is Like the Wind by Shona Innes - 2014 Written by a clinical child psychologist, Barron's "A Big Hug" series offers a gentle and direct approach to the emotional issues that children face. This book introduces the concept of death to young readers by likening life to the ever-moving wind.

Missing Mommy by Rebecca Cobb - 2013

Ben's Flying Flowers by Inger M. Maier - 2012 Emily introduces her younger brother, Ben, to butterflies, which he calls "flying flowers," and when his illness makes him too weak to go see them she draws him pictures, but after his death she no longer wants to draw happy things. Includes note to parents.

Harry & Hopper by Margaret Wild  - 2011 Harry is devastated when he returns home from school to find that his beloved dog, Hopper, will no longer be there to greet him.

The Blue House Dog by Deborah Blumenthal - 2010 A boy whose beloved dog has died, and a dog whose owner also died, find each other and slowly begin to trust one another.

Always by My Side by Susan Kerner - 2013 A rhyming story written to help children understand that a dad's love is forever. Even if they grow up without his presence in their lives.

Rabbityness by Jo Empson - 2012 Rabbit enjoys doing rabbity things, but he also loves un-rabbity things! When Rabbit suddenly disappears, no one knows where he has gone. His friends are desolate. But, as it turns out, Rabbit has left behind some very special gifts for them, to help them discover their own unrabbity talents! Rabbityness celebrates individuality, encourages the creativity in everyone and positively introduces children to dealing with loss of any kind.

The Scar by Charlotte Moundlic. When his mother dies, a little boy is angry at his loss but does everything he can to hold onto the memory of her scent, her voice, and the special things she did for him, even as he tries to help his father and grandmother cope.

Remembering Crystal by Sebastian Loth - 2010 Zelda the goose learns about death and loss when her turtle friend Crystal disappears from the garden one day.

A Path of Stars By Anne Sibley O'Brien - 2012 A refugee from Cambodia, Dara's beloved grandmother is grief-stricken when she learns her brother has died, and it is up to Dara to try and heal her.

I Remember Miss Perry by Pat Brisson - 2006 When his teacher, Miss Perry, is killed in a car accident, Stevie and his elementary school classmates take turns sharing memories of her, especially her fondest wish for each day.

Friday, December 11, 2015

Essential equipment to make parents life easier

How old are my kids? They are so old that they slept on their tummies in cushy little cribs surrounded by tons of stuffed animals. They survived their early years without owning a cell phone or ipad.

The  baby swing that we owned was wound up with a crank. If you are a grandparent reading this, you are nodding as you remember the model that I am talking about. The babies loved it and would be lulled into a contented relaxed state for several minutes of clickety click, clickety clack. Then alas it would wind down and need to be cranked up again. This was a noisy process that more likely than not would wake the sleeping baby who had just nodded off.

Parents of young children have a much wider variety of “parenting hacks” to choose from. There are plenty of new things constantly coming onto the market that parents will refer to as “game changers”. These are the item that really make things feel more manageable. The following products are not personal endorsements; I am simply sharing wisdom from others that may be useful to my patients and readers.
Having a safe place where where your baby can comfortably hang out is essential.
Having them on a comfy 45 degree angle is a bonus.
Dr Anne likes the Boppy newborn lounger
Some of Dr Hurd’s favorites are

the Mamaroo
and the Snuggabunny
Khaley, one of the folks who works in our office loved the Fisher Price rocker for her crew:

You can rock it with your foot (never run out of batteries.) One of the nice things about this is that it is reasonably priced and can transition to be used as your kids grow.

For kids over 4 months, my husband Sandy says I can’t leave the doorway jumpers off the list. Our daughter Lauren absolutely loved hers and would bounce and twirl in that thing in rhythm to music.These of course only work if you have sturdy door jambs. With any carrier or swing, use your common sense and don’t keep the babies in there for ridiculous stretches of time.

Please never leave kids unattended.
Just this week I had a call involving a baby not fully strapped into a little bouncer who managed to flop himself forward and bonk his head (he’s fine.)

Don’t put carriers up on a high surface. Trust me, they manage to fall. You don’t want to be the person calling me about that. This is more dangerous if there is a toddler or large dog that can 'help' the baby get knocked over.
Wherever they are hanging out, Dr Anne also suggests checking out the
Summer Infant Snuzzler Infant Support for Car Seats and Strollers- this is terrific for small newborns or babies having a having a hard time transitioning to bassinet in first month.
If you are carrying your baby around with you check out the Nesting Days carrier. These are invented by  San Francisco’s postpartum doula Julie Arvan
Once the babies are over 4 months old, Noe Valley Pediatrics' Lily loved her infantino flip advanced convertible baby carrier  
For the Crib:
Dr Hurd suggests that all of her patients get invest in a simple crib wedge.
One of our patients Amy (mama of twins) told me about wonder bumpers
These are one of those “why didn’t I think of that” products
Many parents and Dr Anne all really like the Merlin Sleepsuit to help with the transition out of the swaddle around 3 months
Random Tips:
When asked for his favorite item, Dr. Schwanke put Sophie the Giraffe on the list.

This is a classic favorite of his that has been much loved by generations of  patients.
One more of Dr Anne favorite items are the
Amy also recommends Dr Brown's mixing pitcher
This is especially helpful for a family with twins who are mixing larger quantities of formula at a time.

My niece Lena says that the swaddle blankets with velcro were really useful. These give the option of snugging the arms tight while leaving the feet free to be strapped into a bouncer.

My lovely patients Rita and Ricardo spend a recent date night trying to brainstorm for me. They reminisced and thought about the most essential baby equipment (especially the first time around). Here's their list:
For the tall parents out there -- the Uppa Baby stroller line is great.They  have the Uppa Baby Vista and the Uppa Baby G-Lite strollers and both are great for Riccardo (who is 6'8').
The book "Baby Bargains" - - was a great resource to help them find general baby equipment (strollers, car seats, cribs, etc).  It's not just about bargains - it's about quality, and they test and know about all the latest products.
The Frenchie Mother towel - - this is a towel that velcros around mom or dad's neck and makes it easier for you to take the baby out of the bathtub (and keep you dry at the same time.)  So simple but such a good invention!
Mama Regan let me know about the Oogie bear, little scoop for removing little boogies

My super adorable neighbor and patient Sean loves his Zo li sippy cup. His mom Sara says she tried a bunch before they found this winner and that it helped them transition away from the bottle.
I couldn’t do a post like this without checking in with Jennifer of Hint Mama.
She send along the following tips
1.) Glow-in-the-dark pacifiers:
2.) Sleep sacks with loveys attached
3.) These lunch boxes:
Clive’s mom Kylie says favorite toy as infant and now great distracter in car seat is baby Einstein take along tunes.
(Bells and whistles are fine and entertaining. But there is nothing as great as a cabinet full of food storage containers and lids!)
Beyond equipment, there are now all sorts of apps
Robert, the new daddy of baby Noah says that they find the baby tracker app  really useful
Parenthoods is another great resource. It is available on i phones, but the general website is available to anyone
If your favorite life changer is missing from the list, let me know. All of my posts end up as resources on my blog. I will be happy to keep this one updated.

Thanks to Pediatric Dentist David Rothman for chiming in with a bit of wisdom. His says that his kids favorite was the different colored stacking blocks that kept them happily playing for hours.

Thanks to Nurse Lainey for telling me about the DockaTot

This product has been getting some rave reviews for helping out with the all important sleep issues.

Thanks to Tiila for sharing about the sleeper hero

Friday, December 4, 2015

Holiday safety check list/ Have you thought of everything?

This coming week, the winter holidays begin (although the radio station that wakes me up on work mornings has been playing Christmas Carols for a while already; what's that about!?)

Hanukkah (since it is based on a lunar calendar) doesn’t fall on the same date every year. Many folks laughingly refer to it as coming either “early or late” This year it is on the early side and begins on the evening of December  6th. That is my signal to update the holiday safety post.

For most people, holidays are a time for celebration. That means more cooking, home decorating, entertaining, and an increased risk of fire and accidents.

Call me a Debbie Downer if you must, but the mind of an advice nurse is a skewed one. For every aspect of holiday celebrations, I can tell you the story of a patient who called with a related accident. It is not my intent to scare folks with my tales. As I tell parents who attend my safety class, if you know ahead of time what accidents can happen, you have a way better chance of avoiding them.

Baking cookies is just one example. A patient's mom called to tell me that her 10 month old had sustained a burn on his hand. She was holding him in the crook of one arm as she removed the cookie sheets  from the oven. As she recounted, he turned into a cartoon character with a telescoping reach and he was able to stretch across her body and grab a hold of the piping hot tray. Simple solution: don't hold your child when you are working with hot stuff in the kitchen. Their arms are longer than you think. If even one accident has been prevented, this post was worth it.

Candles are another biggie. It was a winter evening several years ago in a cabin at Lake Tahoe. Dr Jessica and family lit some holiday candles and went to sleep. Somehow one of the candles ended up burning a hole through a plastic mat that was on the table. Luckily the smell of burning plastic woke them up before any real damage was done, but it was a frightening lesson. This was a vacation rental. In this instance there seemed to be no working smoke detector. She had no idea if and where there was a fire extinguisher. There are several obvious lessons here. Never to go to sleep leaving candles or a fireplace still burning. Get acquainted with the safety features of any place your family is staying.
Below are some safety checklists for dealing with the holiday season ahead. Some of these may seem like common sense but there might be a few tidbits in here that you haven't thought about.

For instance, button batteries. They are everywhere nowadays in all sorts of small electronics (and musical cards) and can be quite hazardous if swallowed. Take time in advance to do a mental inventory of items that you have around that may be powered by these. Put a piece of duct tape over the battery compartments to make sure they can't fall out.

Certain holiday plants like poinsettias can be mildly toxic (especially to someone with a latex allergy). You may not have them in your own house, but if you are visiting a friend or even a supermarket make sure little hands don't grab the pretty red leaves and put them in their mouths.

Be very careful transporting hot food to a holiday potluck. I have patients who have been burned from hot food spilling on them in a car.

Since Hanukkah comes first this year:

  •   Make sure that all candles are safely out of harms way
  •   the menorah should be on a glass tray or aluminum foil
  •   Make sure candles are not close to wrapping paper
  •   Don't go to sleep with candles still burning
  •   Don't leave the matches or lighters hanging around
  •   If you are frying latkes (fried potato pancakes that are a holiday tradition, yum) make sure that no one gets spattered by oil
  •  Never leave the hot oil unattended
  •  Remember that  adding water to a grease fire will make it worse! Baking soda is okay, but a fire extinguisher is best. Make sure you know how to use it.

Christmas tree checklist:

  • When purchasing a live tree, check for freshness. A fresh tree is less of a fire hazard
  • Cut 1-2 inches from the base of the trunk immediately before placing the tree in the stand and filling with water to ensure absorption
  • check the water level daily to avoid the tree drying out
  • When purchasing an artificial tree, look for the label "Fire Resistant"
  • Never use electric lights on a metallic tree. The tree can become charged with electricity from faulty lights and a person touching a branch could be electrocuted
  • Place your tree at least 3 feet away from all heat sources, including fireplaces, radiators and space heaters
  • Make sure the tree is steady enough that it can't be pulled over by a toddler
  • Trim your tree with non-combustible or flame resistant materials
  • Before using lights outdoors, check labels to make sure they have been certified for outdoor use
  • Make sure all bulbs work and that there are no frayed wires, broken sockets or loose connections
  • Plug all outdoor electric decorations into circuits with ground-fault circuit interrupters to avoid potential shocks.
  • Strings of lights and garlands are a staple of holiday decorating, but they can also pose a strangulation hazard.
  • Avoid trimming the tree with things that look like candy which may pose a temptation to the kids.
  • Keep sharp, glass or breakable ornaments out of reach of small children
  • Holly berries and other small decorations can be choking hazards
  • Don't overload extension cords; make sure that your extension cords are high quality
  • If you are going to use your fireplace, make sure that you have the chimney checked and cleaned if it has been awhile since you built your last fire.

Kwanzaa may be the safest of the holidays, (no hot oil or stressing the electrical outlets) but there are still candles involved, so make sure they are placed in a safe place and toddlers don't have access.

This is a great time to test your smoke alarms!!!
Stay safe and have a wonderful holiday season.