Will the real Santa please stand up! 2017

Topic of the Week: Talking to your child about Santa

Over the years several parents have asked me to weigh in on the ‘Santa discussion.’ What is the best way to keep the magic alive while not endangering the trust that is so important in any relationship? For this general discussion, we can put Santa into the fine company of the Tooth Fairy and the Easter Bunny, but it is safe to say that Santa is usually the member of this trio that has the most emotional connection. Let me preface this post by saying that I think it is essential to be honest with people in your lives. You don’t need to knock them over the head with the truth, but if they ask a question and press for an answer, please don’t lie. In my Jewish family, the girls never gave too much thought to the man in the red hat or the giant bunny, but we did get routine visits from the tooth fairy every time the girls lost a tooth. When I started writing this, I checked in with my grown girls to see if they remembered any feeling of betrayal when they realized that it was daddy sneaking the money under the pillow. Lauren tried hard to remember. She vaguely recalls that she figured it out reasonably early, but played along for several years. She wanted to make sure that the gravy train didn’t dry up. Alana says that she was too busy trying to figure out if monsters were real or not (thanks to having a big sister who teased her by making strange noises in the middle of the night) to worry too much about the Tooth Fairy. For the young kids who ask if the mythical creature is real, you might deflect the questions fairly easily without telling a falsehood if you want to extend the magic for another year. A simple,“What do you think?” works pretty well. Or, “It is fun to believe in magic sometimes and Santa is part of the holiday magic” Keep in mind that once your child gets to kindergarten believing that Santa is actually going to try to fit down your chimney, rather than the ‘spirit of the holiday magic,' they might be in for a shocking disappointment when they learn the truth. There are lots of kids at school eager to share the cold hard facts with your innocent child. It is much better if this discussion comes from you before your kids find out a harder way. I spoke to several people who recounted that they believed in Santa with all of their hearts and were completely heartbroken when they learned the truth.They felt deceived. One person told me that finding the truth was the moment they stopped believing in all magic. How sad! Letting them know the truth gently doesn’t have to be a negative experience. For older kids, I love a good story. Many stories start with an element of historical truth: “Once upon a time in a far off country there was a man named Nicholas. He loved to do good things for other people. What was special about him is that when he gave people presents or did nice things, he didn’t do it because he wanted something in return. He simply wanted to do good things. Lots of times he did it in secret and no one even knew who did something nice for them. Maybe this Nicholas was big and jolly and had a white beard.He became known as Santa Claus. Santa is a symbol of love and magic and hope and happiness. He teaches children how to believe in something that they can’t see or touch. I am on his holiday kindness team and now you can be too. Really little children might believe that there is one Santa who manages to be everywhere at once. Big kids like you get to know the secret. Team Santa is all the big kids and grown ups who want to help make other people happy. “ Perhaps take the opportunity to help your child be an active member of this awesome team; an initiation of sorts. Is there someone in your life that seems like they need a little kindness? What could you do for them. Is there a little gift that might make a difference? Plotting a secret kindness is the thing that wonderful lasting holiday memories are made of.  PS: The photo on Santa's Lap should be voluntary. If your child isn't eager to go sit on a strange guy's lap, please don't force them.

Reactive Airway/Wheezing/Inhaler tips

PLEASE SEE THE MOST UPDATED VERSION OF THIS POST  AUGUST 2021 We get calls all the time from parents worried that their child is wheezing. I am always going to pay attention to this complaint but not all breathing noises are the same. A whistling noise from congested nasal passages is not always something that we need to worry about. The wheezing that is going to get my antenna up is the noise from down in the lungs. Any squeak, crackle or wheeze can be a sign of inflammation. When a person is well, air can move easily in and out of the lungs through a network of airways. There are several things happening during a wheezing attack. The airway becomes irritated and inflamed; this produces mucus which can clog up the airway. The inflammation also causes the lining of the airways to swell and the muscles around these airways tighten; this is called a bronchospasm. Wheezing is actually quite common in infants; it is estimated that up to 25 to 30 percent of infants develop wheezing in their first year of life. Wheezing may be more common in babies because of their smaller airways. Also, children under two are susceptible to a common, but easily treatable condition called bronchiolitis. This is caused by a viral respiratory infection and is a frequent cause wheezing. If your child has multiple episodes of wheezing they may get diagnosed as having a reactive airway. Reactive airway is exactly what is sounds like. Something is “triggering” the lungs, and the airway gets inflamed. Triggers range from a new cold, a change in the weather, secondhand smoke, dust, pets and or other allergens. Having a season or two of wheezing does not mean they have a lifetime of asthma ahead of them. Some kids can grow out of this. If your child is wheezing it is important that they get prompt medical attention. If this is a first time event it is even more critical to get educated about medications and treatments so that you are prepared to recognize and deal with it in the future. In general, having a doctor take a good listen with a proper stethoscope is a good idea, but you will have important clues if you know what to look for. Pay close attention to the patient’s breathing. Is it faster than normal? Getting a sense of what normal looks like when they are well is a good idea. Age Category Age Range Normal Respiratory Rate Infant 0-12 months 30-60 per minute Toddler 1-3 years 24-40 per minute Preschool 4-5 years 22-34 per minute School Age 6-12 years 18-30 per minute Lift up the shirt and watch. Do the respirations appear labored? Look for the tummy going in and out, or any retractions. How are they feeding? If your baby needs to take more frequent breaks from eating that can be a warning signal that they are ill. For older kids, can they take a big deep breath without it triggering a coughing fit? If a patient is wheezing they are likely to get some special medicine prescribed. Albuterol (Ventolin/ Proair) and levalbuterol (Xopenex) are the common “fix it” medications. These help open up the airway by relaxing the tight muscles. Unfortunately it is not uncommon for patients to get a little amped up from the treatment. These medications should start to work within 6 minutes or so. Some parents report that the kids seem to cough even more after a treatment. Remember that this medication is loosening up an airway that was previously very tight. All of a sudden there is more room for the mucous to rattle around. A productive cough is normal. We would use either albuterol or Xopenex, not both at the same time. Some folks find that Xopenex is less likely to make them jittery. Insurance companies will often need to see documented failure with albuterol before the Xopenex is covered. These medications can be given through a nebulizer machine or through an inhaler. Most young kids do better with the machine, but as soon as they are old enough to cooperate with the puffer it is a quicker and much more convenient way to give the medication. If this is a short little illness, sometimes a few days of the albuterol-type medication will see you through. If you are requiring albuterol for longer than a week or find that you need to use it more than several times a month, it is a sign that the situation is not well controlled. An absolute key treatment for a reactive airway is the use of inhaled steroids and other anti-inflammatory drugs. In our office we use something called budesonide (Pulmicort) in the nebulizer, but switch over to an inhaler when the kids are old enough. Common brands are Flovent and Qvar. These can control and prevent future attacks. The steroids work by reducing the inflammation, swelling, and mucus production in the lungs. As a result a person is less likely to react to the triggers. All the studies agree, inflammation in the lungs is bad and can lead to scarring. The choice between allowing persistent inflammation or using proper dose of inhaled steroids is an easy one. Please don’t be reluctant to use the inhaled steroid if it is appropriate. The word steroid sounds scary, but when they are inhaled, they are not generally absorbed by the body, but are going straight to the lungs. If your child is given a prescription for inhaled steroids,It is not unusual for them to be on them for weeks or months, especially during the winter cold and flu season. Both of my kids had a few seasons of using the Pulmicort. As soon as I would try to wean off the daily dose, the dry hacky irritated cough would start right back up. Here are some tips regarding inhaler use: For younger kids, I start with some really basic teaching. Get a tissue and hold it up to their mouth. Have them practice blowing on it and then inhaling so that it sucks up to their mouth. This can help them to understand the difference between inhaling and exhaling. It is really important to shake the canister before each use. For the first use and any subsequent use if you haven’t used it for more than a week, the inhaler needs to be primed by spraying 2 to 3 puffs into the air. I know it seems wasteful, but it is necessary. If you child is having trouble, you want to make sure that you are actually giving the medication. Read the directions carefully for the specific information about each inhaler! Hold the medicine upright so that it doesn’t stick to the tongue. Breath coordination is difficult. Using a spacer will make the inhalation much more effective. For younger kids, the spacers come with a mask. Keep lips firmly around the mouthpiece. The spacers should not make noise. If there is a whistle, try to make the breath slower. Activate the medication and make sure to keep the spacer at the mouth for at least 5 breaths. Wait about 30 seconds in between puffs. If you are using albuterol and an inhaled steroid, give the albuterol first. It is a good practice to rinse the mouth out after the medication. This is especially true after the steroid. If your child has a history of wheezing, it is a good idea to keep track and make sure that you have un-expired medication on hand. If you are traveling have them with you! Most inhalers have counters now so you can see how many doses are left, but if yours does not there are some tricks for figuring out how much is left. Take the canister and place in glass of water. A full one will stay mostly upright. If it floats at a 45 angle, it is time to replace it. If it goes sideways, it is probably empty. Shaking it is not a reliable indicator because there is propellant inside, so it is hard to tell how much is in there. It is good practice to keep the inhalers in their box. When you come to a doctors appointment, please bring them with you so that you can show the doctors exactly what you have been taking. Please be aware that in February 2018 QVAR will be coming out with a new activation system that will not require a spacer or shaking of the cannister. It also won't require priming. The is approved down to the age of 4 years. Please make note if you have the old or new system. If you are using a nebulizer machine, make sure that you change the tubing at least every 6 months. If it is the disposable tubing, that should be used for no more than 15 treatments. I have found that a little tech time or videos are very useful in getting your child to sit still. This is one of those situations that bribery might come in handy. I shouldn’t have to add this, but please remember that the correct call for a child in true respiratory distress is to 911, not the doctor’s office.

The impact of a single sentence

Social media in general and Facebook in particular have their benefits and drawbacks There is no doubt that it is way easier to reconnect with long lost friends than it used to be.

Recently my husband got tagged in a 6th grade class photo from his good old PS 32 in New York City. This started a flurry of conversation between people who hadn’t been in touch for many many (many) years. There is really nothing quite like an old friend who knew you when. I believe he may actually stay reconnected with some of these folks.

With all the catching up that was going on, there was a comment from a girl in his class that caught my attention. She wanted to let Sandy know that after all this time, she still thought about his mother.

It turns out that way back when, after a school performance, my mother-in-law had made a bee-line straight over to this girl just to tell her what a wonderful job she had done. It wasn’t the simple “good for you”; mom had told her how moved she had been and that this young lady should be very proud of the performance. Fortyeight years later, this woman says that she still remembers how impacted she was by the interaction. Wow!

There are more people out there than we can count for whom a crumb of positive feedback is rare and important. Words, either kind ones or mean ones, are often put out there without much thought and the speaker moves on. This story illustrates how much a message can sometimes stick and make a profound impact.

Go out there on this Thanksgiving weekend and make a lasting positive impact with your conversations!

Fires/smoke and air quality alerts

The Bay Area Air Quality Management District (http://www.baaqmd.gov) has issued a Health Advisory and Spare the Air Alert this week. Very unhealthy air quality from the wildfires in the North Bay is causing unprecedented levels of air pollution throughout the Bay Area. Due to active wildfires and changing wind patterns, air quality could be impacted for many days to come. Outside of the active fire areas, air quality will be variable and unpredictable. Air quality may improve at times or get worse, very quickly. For those of you who are reading this and are not in the Bay Area, go outside and take a deep breath of fresh air. Now take another one and savor it. We tend to take so much for granted, Including breathable air, until we are faced with situations like this. Sunday evening in the middle of the night I woke up and thought I smelled smoke. I crept down to my kitchen to make sure that I hadn’t left on an appliance. There was nothing obvious. I poked my sleeping husband, “do you smell something?” He grunted “mmmph” which I took as a NO, so l went back to sleep. It turns out that many of the people I know had done some vestige of the middle-of-the- night sniffing around. Some had gone outside to make sure there was nothing burning in the immediate vicinity. When I turned on the news on Monday morning we had an answer. The news about the fire up in the north bay was devastating. So many homes, schools, and businesses are gone, including the home of one of my very best friends, where I was lucky enough to spend countless weekends in their little patch of heaven. It is heartbreaking. An acquaintance of mine who is a reporter reached out and I got my 30 seconds of fame later that morning http://m.sfgate.com/news/article/smoke-children-kids-health-air-quality-tips-12263921.php Understandably the phones and emails have been nonstop for parents worried about the impact of the smoke. It is not surprising that many people are experiencing some degree of irritation from the smoke. For those of you who are not local, we are talking about serious smoke. Here in SF we are almost 70 miles away from the actual flames but we are still impacted. There is ash on the cars. Have you ever been to a bonfire or campfire? You know how your clothes reek of smoke? That is how the air smells. The beautiful panoramic views that we get from our hilltops are clouded by a gray haze. Scratchy throat, stingy eyes, irritated sinuses, headaches are prevalent. The most basic suggestion is common sense. Pay attention to local air quality reports. The link will give you information about how the air is improving or worsening: https://www.airnow.gov/ Stay indoors and keep your indoor air as clean as possible. Keep windows and doors closed. Luckily it isn’t too hot this week, but if it gets warmer, run an air conditioner if you have one, ( most folks in SF don’t actually own one.) If you do have one, keep the fresh-air intake closed and the filter clean to prevent outdoor smoke from getting inside. Do not add to indoor pollution. Don’t use anything that burns, such as candles or incense. Don’t vacuum unless you have a really good filtered machine. Normal vacuums stir up particles that are already inside your home. Don’t smoke tobacco or other products; the air is already polluted enough!! Avoid any strenuous activity outside. It is fine to get to where you need to go. I just wouldn’t do any extra outdoor playing until things improve. I don’t think the bounce house birthday party in the park is a good idea this weekend. Use an air filter If you have a HEPA filter, use it. My patients reported that the local stores were completely out of the machines today. I would suggest that you take advantage of online shopping. It is probably not a bad investment even if the air is improved by the time you get it. I am by no means an expert on Hepa filters and there is a lot of information online. I feel like consumers reports is a pretty good guide, so I am including that: consumer reports air-purifiers buying guide Keep in mind that the ionic filters that create ozone are not recommended and will not remove the particles that we are concerned about. Do not rely on dust masks for protection. The only masks that will be at all protective are labeled N95 o N100. They don’t seal well on a young child, so your best bet is staying indoors. In San Francisco with our blessed fog that comes and clears things out on a regular basis, we are accustomed to better than average air quality. It is important to keep in mind that there are populations around the world where the norm is very unhealthy air all of the time. For most healthy folks, a week or so of terrible air won’t have a lasting impact. If you have a child with sensitive lungs absolutely keep an eye on them. Wheezing, shortness of breath, chest pain and/ or rapid heartbeat would be reason to get seen by the physician. If your child has a prescription for inhaled steroids, it might be a good idea to get those out and start using them at the first sign of any issues. Remember that if an inhaler hasn’t been used in over 2 weeks, it may need to be primed. At this time, there has been no medical directive issued to leave the area . It is hard to say how long the fires and bad air will be an issue, and more information may be forthcoming from the Air Quality District in the next few days. There seems to be no good answer at this point as to when to go and how far folks would need to travel to be safe as there are wildfires all over southern California as well. Do what you feel is best for you and your family. Your local municipalities should be able to provide you with information regarding air quality, safety precautions, evacuation and recommendations for local facilities that have filtered air. http://sfdem.org/airquality A friend of mine who lives in Santa Barbara and has been through this a number of times, posted a very good list that is worth sharing: Home Evacuation Checklist – How to Prepare for Evacuation: Inside the House Shut all windows and doors, leaving them unlocked. Remove flammable window shades, curtains and close metal shutters. Remove lightweight curtains. Move flammable furniture to the center of the room, away from windows and doors. Shut off gas at the meter; turn off pilot lights. Leave your lights on so firefighters can see your house under smoky conditions. Shut off the air conditioning Outside Gather up flammable items from the exterior of the house and bring them inside (patio furniture, children’s toys, door mats, trash cans, etc.) or place them in your pool. Turn off propane tanks. Move propane BBQ appliances away from structures. Connect garden hoses to outside water valves or spigots for use by firefighters. Fill water buckets and place them around the house. Don’t leave sprinklers on or water running, they can affect critical water pressure. Leave exterior lights on so your home is visible to firefighters in the smoke or darkness of night. Put your Emergency Supply Kit in your vehicle. Back your car into the driveway with vehicle loaded and all doors and windows closed. Carry your car keys with you. Have a ladder available and place it at the corner of the house for firefighters to quickly access your roof. Seal attic and ground vents with pre-cut plywood or commercial seals. Patrol your property and monitor the fire situation. Don’t wait for an evacuation order if you feel threatened. Check on neighbors and make sure they are preparing to leave. I also want to share some wisdom from Heather, a local mom who started a group called www.circleoflightsf.com As many of you know well, we have neighbors in need. 22 fires, many out of control, continue to rage in our backyard counties. In San Francisco, many miles away from the wildfires, we wake up daily to a visible, dense layer of smog and keep our stir-crazy kids and pets inside so they won’t breathe in what has become pretty horrible air quality. In the towns directly affected by this horrific and overnight destruction, hundreds of people have lost everything they have with thousands more forced to evacuate their homes, waiting in the wings to see what happens next. Some have lost or missing family members including precious animals. I cannot imagine what the air quality is closer to the destruction and active fire zone, nor how long it will take for kids to even be able to go back to school, much less what it will take to rebuild homes and businesses after the damage is done. Because many of you, like me, feel lost in how to help, I have asked my friends directly affected by this tragedy what we can do from afar. There are many resources available out there; here are a few I found to be noteworthy: 1.   Donate to a credible monetary fund in the area who is directly helping victims in Napa. This is a good and relatively easy one to do remotely; the fund will use the money however it is best needed on a day by day basis: http://www.napavalleycf.org/fire-donation-page/ http://www.napavalleycf.org/napa-fire-press-release/ 2.   Help feed and nourish Santa Rosa and the Sonoma County community by providing healthy and nutritious meals to those in need; SAGmonkey is run by a friend and long-time resident of Sonoma County who is generously giving his time and energies to help to rebuild our community. www.gofundme.com/sagmonkey Your donations will go directly to the purchase of food and supplies to prepare and distribute fully cooked meals over the course of the next three months. By utilizing the resources of the Redwood Empire Food Bank and other local food pantries we will prepare and distribute meals for those in need. We want to make a difference in the lives of our neighbors and friends by providing this service. We have a commercial mobile kitchen trailer that is fully licensed by the State of California and the County of Sonoma. 3.   Consider volunteering to staff a shelter, donating food and other needed items, and helping pets:  http://radioalice.cbslocal.com/2017/10/09/wine-country-wildfires-how-to-help/ Donation drop off points listed here for SF and East Bay residents to avoid tying up roads:  https://sf.curbed.com/2017/10/10/16453310/northern-california-wildfire-victims-volunteer-help 4.   If you know anyone who can host people or animals in need,the travel site HipCamp is connecting evacuees who cannot return to their homes with people who have available space to host them at ranches and rural properties, bed and breakfasts, and even RVs. Anyone who wants to be added to the list can contact HipCamp atJulie.Kukral@hipcamp.com. https://www.hipcamp.com/journal/land/northern-california-hosts-offering-fire-evacuees-a-free-place-to-stay 5.   ADOPT-A-FAMILY! We were lucky enough to be able to take in dear friends who had to evacuate their home this week. We’re trying to turn a tragedy into a “Fun sleepover” for kids, dogs and adults. Since our friends who live in an affected area know many people affected directly, they recommend this as something folks really need right now. This is a difficult task if you don’t know anyone there but worth the ask as you check in with friends, colleagues and local businesses etc. who may have been affected. Hoping the wind and weather helps us all see some relief soon… In love and light, Heather www.circleoflightsf.com

Organizing your crap....I mean treasures 2017

I spent last week in Pittsburgh, Pennsylvania at my childhood home going through stuff. I am certainly blessed that I am part of an awesome team and not dealing with this all by myself. My sisters, daughters and nieces were all there with me. Mom was a kindergarten teacher and as such she had kept piles of worksheets and odd stuff that could come in handy for a future craft project. She always claimed that she wasn't the pack rat in the family but I am not sure there is too much credibility to that statement. My dad absolutely didn’t believe in tossing things, so there is a workbench full of all sorts of unfinished projects. He came by it honestly. When folks were going through his mother's things, they came across a little baggy clearly labeled "String that is too short to use." The house was ( is...it very much still is) filled with generations of letters and photos, newspaper clippings and the occasional treasure. There are shelves of dusty old books dating back to as early as 1892. Of the pictures we found, some are labeled so that we know who they are. What a gift that is! I was so grateful for those faint markings on the back of a photograph to show me that I was looking at a picture of my Great Great grandmother...wow. This is the takeaway message for you. If you have old photos, make sure that they are labeled. Sit down with the older generation and have them identify whoever they can. Do it now. Don't wait. I toy with the idea of writing a book one day about this process. Perhaps the title would be “75 toothbrushes of Darlington Road”, because we found at least that many. After a fairly exhausting week, I had no energy to create a brand new post. It seemed timely to rerun an old post I had written about organizing stuff. Efforts taken now can prevent your kids from having to do what I am doing someday in the future. Here is the old post: Organizing your crap....I mean treasures The first thing that people tend to notice when they go into my garage is Brownie the large ugly (sorry Lauren) paper mache gorilla who has been taking up residence on a high shelf in there for almost 25 years. “Brownie” was created by Lauren’s first grade class. It was part of an enormous class project that ended up on display at a local mall many years ago. When the school year ended there was a drawing to see which lucky student won the right to keep Brownie for ever and ever. Lauren was the lucky winner. She was beyond delighted. We were horrified. For years, when we would do the occasional garage clean up, she was still not ready to part with him. Now he is simply a large barnacle. He has taken root and we barely notice him unless someone asks the usual "What on earth?..." He is part of the garage. The garage is full of many other objects that we likely don’t remember we have and don’t really need. Brownie is just the shining example. At least we can manage to fit our cars in (which probably makes ours better than many). To be fair, if my husband was left to his own devices, the garage would be immaculate. It is always a delicate balance figuring out what to keep and what to toss when you have a budding, prolific artist in your life. You want to value their creativity but there is only so much room on the fridge. Sadly more and more refrigerators are no longer even magnetic! On a side note, please make sure that your child is given the opportunity to create with real paper. Electronic programs can be amazing with what they can do, but they should not be a substitute for for crayons or water painting. Ceramic, or 3-D artwork is even more of a challenge for storage or display, especially when many folks in SF have limited room. One of the things I did when my girls were fairly young was to start organizing early, and it is something I am grateful for. Having a simple plan in advance can be very helpful. If you have room, get a display board for the special pieces, but just like a museum, art gets rotated. When it is time to make room for new art, what happens to the old stuff? The choices are recycle (a much kinder word than throwing out,) save, or give as a gift. If something is getting recycled, get it out of sight quickly. You don’t want your kid to find their art crumbled in the trash. For the things worth saving, each child should have one expandable file folder per year for things that are flat. My kids had one folder for each grade, as they got older the things that were saved morphed from art to school papers and projects that were keepers. For Lauren, my actress, that was where we kept programs and newspaper clippings. The files have limited space. Have your kids be part of the committee that decides what gets saved. At the end of the year we always had a lot of fun going down memory lane by looking through the folders. At that time we were able to do some further culling; not everything needed to be kept. Another option is to take photos of the art which can be kept in an album or stored digitally. These days art can easily be turned into calendars, mugs, birthday cards or anything really! Thinking about giving away some of the special pieces that you don’t need to keep? That is what extended family is for! Warning, there is always the danger that it will land back in your lap 20 years later. When my husband's parents passed away, there it was, a pile of art done by our kids that had been proudly displayed in their home for years. That art now belongs to us again, and it is keeping Brownie company in the garage.

What should you have in your first aid/emergency kit?

What should you have in your first aid/emergency kit?

A new mom recently asked me if she needed to purchase a first aid kit to have in the house in preparation for the new baby. There are indeed lots of commercially available kits out there, but it is pretty simple and less expensive to put together your own. Last week my post was all about being mentally prepared for a variety of situations. This seemed like a logical follow up. Having some items on hand is wise. Take time to make sure these things are organized and easily accessible so that you don’t waste time scurrying around if you need something quickly. Home: The following link is to my December post about having an appropriately stocked  medicine cabinet. What to have in your medicine chest That post gives you a hefty list for things you should keep available at home. Here are a few additions Every family with a young child should have a nasal aspirator: The hospital will send you home with a bulb aspirator, but many people find those awkward. I really advise that every new parent have a NoseFrida:  NoseFrida or NeilMed Naspira: NeilMed If the baby has a stuffy nose, or has secretions blocking their nasal passages, these snot suckers are a simple way to clear them. Have you ever had milk come out of your nose when you are laughing, sneezing or coughing? That can happen to your baby as well. An aspirator near by can make things less chaotic. Make sure you are prepared and own infant nail clippers or scissors. Some babies are born with very long nails and can end up really scratching themselves if you don’t clip or file them : Nurse Judy nail care I asked Dr Katherine Morioka of City Optometry what folks should have on hand in case of an eye injury. She suggests that a first aid kit should include artificial tears, an eye wash kit, gauze and first aid tape. Away from home: CAR: Every car that you drive should have its own emergency kit in the trunk. Some of the items I am going to add are NOT typically found on general lists. Have a change of clothes, extra diapers, clean socks, extra layers (for every family member.) In San Francisco, the fog can come in quickly; don’t end up looking like a shivering tourist and resort to having to buy another Alcatraz sweatshirt. A baggy with basic first aid supplies: Gauze pads/ a roll of coban self adhesive wrap/ Neopsorin/ antiseptic wipes (a clean pair of socks can serve double duty in case you don't have gauze.) A tweezer for removing a splinter or tick (shudder) Scissors Instant cold pack/ hot pack Tylenol or Motrin Zyrtec or Benadryl Anrica (for bumps and bruises) Flashlight/ Batteries Have some durable snacks, pouches or bars and some water. If you are on a road trip double down on this and make sure you have provisions in case you get stuck. An index card with important phone numbers including poison control. Okay, here are some things that are not on the general lists: Keep a pair of  heavy duty gloves on hand. Have some cash. Small bills are the best. If there is an emergency and there is no electricity for credit card or ATM transactions, having cash is invaluable. We learned this tip from an uncle who was impacted by Hurricane Andrew in Florida in 1992. There was no power for days. Family members needed to wire him money and he was not even an Nigerian prince offering us millions! Have a deck of cards or activity for your kids if you get stuck someplace. A fresh coloring book with crayons or something novel to keep them calm and entertained can help keeps everyone’s sanity. Barf bags (every time you fly, take the unused one from your seat) These are better kept in the glove compartment than the trunk. Have some empty gallon zip lock bags Portable potty: You can make your own. All you need is  an inflatable ring. Find a cheap inner tube or inflatable potty from Amazon. Tuck around a tall kitchen garbage bag, When they are finished going, the poop or pee is in the bag with very little clean up needed. When your child is just starting the toilet training journey, these can be really handy. Make sure you have baby wipes/ paper towels/ fabreeze or air freshener Disposable blue absorbent underpads (take the one from your office visit if your baby didn't pee on it!) You will find a lot of uses for these! Have some empty gallon zip lock bags Get in the habit of checking this stash thoroughly, several times a year. Perhaps do it with the clock change when you check your smoke detector batteries. Check expiration dates, diaper sizes, battery life, phone number accuracy,... etc. Diaper bag: As long as you are close to the car, you don’t need to carry too much with you. Keep a small baggie with some gauze/ antiseptic wipes/ small packet of neosporin. If you more than 30 minutes from the car, have tylenol/ibuprofen, and benedryl/zyrtec with you. If there are medications in your diaper bag, pay attention that young children don’t have easy access to them.

Problem solving skills 2017

Some of our patients are heading off to school within the next couple of weeks. It is a big adjustment for everyone. When you are no longer with your child 24/7 you want to make sure that they are prepared to deal with unexpected situations.

Today's topic is a about an important activity that you can do with your child that teaches them to be "problem solvers".  Adults need to learn to be problem solvers also. Some people are much better at this than others. For instance, if you got in a fender bender, what would you do? Many folks would just freeze and panic. What should you do?

• Assess for injury; call 911 if needed
• If you are on a highway, wait for assistance. Getting out of the car is often dangerous!
• Do you have an AAA membership? Know where the card is.
• Know where your insurance info is kept (make sure you have a copy accessible)
• Take a photo of any damage
• Take a photo of the other driver's insurance card and driver's license...etc.
• Always have a charger in your car for your cell phone so that a low battery is never an issue.

Having a plan in advance could help you stay calm.

But I do want to add one more benign tidbit here. What if you lost your cell phone or it ran out of batteries and you don't happen to have a charger? Do you know important phone numbers, or do you count on speed dial? Having a list of important numbers in an accessible place is a good idea for everyone.

I lived in New York back in the early eighties. It was a different city back then. At one point there were a rash of home break-ins and burglaries. A friend of mine who was an actress obsessed quite a bit about this. She went as far as rehearsing made up scenes for any given situation to avoid being frozen by fear. Go figure, one day someone did break into her apartment. She went right into her pre-rehearsed mode. Figuring that acting a bit cuckoo would get any 'bad guy' off balance, she immediately broke into the character that she had prepared. In a loud, shrill British accent she yelled, “Welcome!!! Would you like to stay for tea?" She did the Mad Hatter proud. She went on with a list of options. "Would you like herbal or black? I have delicious honey from local bees!" As expected, the intruder was completely caught off guard. He mumbled something, turned and ran. Brilliant. Not that I am recommending that particular course of action, but having a plan in advance is always a good thing.

Years ago, the concept that everyone would carry around an individual cell phone seemed as futuristic as the communicators on Star Trek. Now, of course it is hard to imagine how we got along without them. It was, however, the lack of the cell phone that prompted me to create a game that became a favorite in our family.

It must have been 1994 and I was on my way to pick up Alana from preschool. She was about 4 years old at the time. It was one of ‘those days’. I was uncharacteristically running late. Then I got stuck in terrible traffic. To compound things, I took some random turns to try to work around the congestion and ended up utterly lost. (Remember that this was also before Google maps or GPS.)  My stomach was in a knot and I wondered what my younger daughter would do when mommy was late picking her up. It turned out that she was calmly waiting for me in the office, but that was the day that the "what would you do if" game was created. It was all about building on the concept of planning in advance for an assortment of situations. It went something like this:

I would ask a question such as, "What should you do if mommy is late picking you up? What are some of the choices? Which is the best one?"

Getting a teacher or trusted grown up to wait with her or take her to the office was clearly the right answer and I praised her for figuring that out on her own. Alana loved this game. We created all sorts of situations:

" What if we were at a store and you couldn't find me?

Alana: " I would go to the check out and ask them to page you."

We never made it too simple...

Mommy :"What if they refused?"

Alana :"I would demand to talk to the manager"

Our scenarios covered any number of little emergencies including earthquakes, fires, and getting lost or separated. The better you are at problem solving, the easier it gets to improvise.

This game came in handy more than once. The shining example that comes to mind happened after years of playing this game. Alana and I were walking the dog on the beach one day. I had donated blood earlier that morning and didn't realize how foolish I was for doing anything strenuous. I got very light headed and ended up down on the sand trying hard not to completely pass out. Alana was ten at the time and she went right into problem solving mode. We did have cell phones at this point. She got the dog on the leash, patted some water on my forehead and calmly called daddy. I could vaguely hear her talking. "Mommy fainted...I think she is okay."

The game was such a success that my sister taught it to her kids. Hers had an interesting spin because they lived in Alaska at the time:

"What would you do if you saw a bear?"

"What would you do if a moose wanders into the yard?"

There were actually times when these things happened, and my nephews were able to act calmly and appropriately!

Topics can range from handling a bully to getting separated on Muni. Being prepared for unexpected situations can be invaluable.

If your child finds themselves without you and in need of assistance, finding a grown up wearing a uniform is often a valid option for some of the difficult situations. Finding a parent who has a child with them and asking them for help, might be another safe option.

This game is meant to empower. It is wonderful for some kids, but could be terrifying for others. You need to assess your child's temperament before playing. Either way, identify a problem or situation. Start with simple, less scary ones. Discuss all the possible solutions and then agree what the best plan should be for any given situation.

Stressful situations happen. Teaching your child to take a deep breath and use their problem solving skills is one of those things you can do now that can have lasting implications for them when they grow up. Even teaching a very young child to dial 911 in an emergency can be life saving!

You have to figure out if this will be empowering for your child as it was for Alana. My daughter Lauren never liked to play it. In fact, I remember one day when Lauren and I were taking a walk, I tripped on something, stumbled and fell. I was perfectly fine, but Lauren's reaction was to start screaming. As she says, "mommies aren't allowed to fall". Every kid is different. As your child grows, the situations that you might want to bring up will increase in scope.

Preparation is power.

It saddens me we have to be prepared for things other than losing track of our kids on Muni, but that is the world we live in.

Have a family plan in place in case of emergency.  If someone other than one of the regular people is going to pick up your child, have a family “safe word” so that they know they were sent by you.

Do you have your earthquake/emergency kit ready? Does it include adequate diapers, medications, pet food? Where will everyone meet up if home is not a safe option? Find out from your school what kind of emergency plans they have in place. Teach your kids to get in the habit of looking for emergency exits, especially for your older kids who are at a concert, theater or a club.

I think that the "what would you do" exercise is actually something that you might want to do with a nanny or caretaker. Training to keep calm in any type of emergency situation is essential.