Friday, December 29, 2017

They put WHAT in their mouth?


They put WHAT in their mouth?

Holiday seasons are especially challenging for childproofing. Christmas trees, presents, wrapping paper…..It is hard to stay vigilant 24/7. We usually get some pretty interesting calls this time of year.

Kids like to explore. Many times this involves sticking things where they don't belong.
Being fairly oral critters, most of the time the object they are handling gets placed in the mouth. When this happens there are two passages that it might go down.

If it goes into the esophagus it hopefully will make its way down into the stomach, through the intestines and then get pooped out.

If something was swallowed, here are things to consider:

Is it stuck?
How does the child look? Are they able to take a sip of water? Can they swallow just fine? Is their breathing relatively normal?

If something has gotten stuck in the esophagus they will look uncomfortable, There will be frequent coughing and throat clearing going on. You will know that something is amiss. This will necessitate a visit to the ER.

Is it poisonous?

If you have any doubt about that, call the poison control center


Is it potentially germ laden?
We get calls about kids eating things that are pretty disgusting. Young infants are the most vulnerable, but usually don’t have the dexterity to actually get something into their mouth without some help. Once they have mastered the hand/mouth coordination skill, they are old enough that a normal healthy gut has good bacteria that can be somewhat protective. If whatever it is that they ingested is going to cause trouble, symptoms will usually show up with tummy aches, vomiting and loose stools within a day or so. Persistent tummy upset will usually warrant a stool test to help us figure out what the culprit is.

Is it a battery?
Any battery can be trouble, but button batteries can be a tremendous hazard because they can be easily swallowed and they seem to be everywhere these days. Several years ago I got a call from a mom of 15 month old twins. There they were, sitting on the floor with mom's pedometer right in between them. It was open and the battery was gone. Because of the uncertainty involved, we did have to send them to get x-rays. Indeed there it was, that little battery, sitting in the stomach of one of the kids. In this case it passed safely, but if a battery gets stuck anywhere on the way it can cause a dangerous amount of damage. Please know where all the button batteries are in all of your little gadgets and make sure that your kids have no access to them. Keep a strict inventory and perhaps stick a piece of duct tape across any battery compartments.

Other objects that you need to be wary of are magnets. I am not talking about the little letters that you may have on your fridge. The ones that cause concern are the industrial strength magnets that you may find in some "grown up" toys like buckyballs or jewelry.
If more than one of those get swallowed it can wreak havoc on the intestines and be deadly. Keep them away from your kids!

Is it sharp?
If it is something that has a point or sharp edge, keep an extra close eye on your child. Make sure the tummy stays nice and soft. If your child seems to have a rigid painful belly, they will need to be seen right away. Keep an eye on the stools. Any dark, tarry poop or bright red blood would be a reason to get immediate help.
One of the sharpest things that we were keeping an eye out for some years ago was one of a Grandma's one carat diamond stud earrings. That passed through and was retrieved with no harm at all to the swallower (Grandma didn't want it back; it was reunited with the mate and is in a safe deposit box waiting until the little girl is 18.)

Most of the time, it is simply a matter of watching for the whatever it was to pass through. I have seen all sorts of stuff get swallowed and pooped out without incident. I think I have seen enough change to put a kid through college. Most coins smaller than a quarter go through fairly easily.

Let's encourage a quick passage! Increase the amounts of fluids that your child drinks. Perhaps add prunes. If your child is old enough that they are beyond simple pureed food, consider giving some corn kernels (You won't see that in any textbook). Have you figured it out yet? For those of you who need this spelled out, corn kernels are usually fairly recognizable after they have been pooped out. They can act as a marker. Corn can help you track the transit time.

If your child is old enough to know better and seems inclined to continue to put non food items in their mouth, this might be a condition known as Pica. Pica is the persistent eating of substances such as dirt or paint that have no nutritional value. This is worth pointing out to your doctor. There might be a nutritional deficit or something else going on.

If the object goes into the trachea it may block the airway and you have a choking situation on your hands or it could get aspirated into the lungs. Neither is good. Your child will clearly be having breathing difficulties if this has happened. They will likely have a color change is they are fully obstructed. If someone is obstructed, they can not speak or make sounds. Of course with any emergency you should call 911, but it is my hope that all parents and caregivers are trained to do a choking rescue.

To avoid this happening on your watch, it is SO important to keep little items away from the young kids. Anything that can fit into a toilet paper tube is too small for an infant or young child to be handling. Food pieces should be soft or cut into long strips rather than round pieces.
Encourage safe eating: sitting instead of running around, chewing and swallowing rather than shoving in wads of food. Parents, please model good behavior!

Dr Kaplan advises that a rule of thumb to keep in mind is that the size of your child's airway is about the same diameter of their pinky finger or ear canal. That is pretty small!
All parents should be able to do a choking rescue!







Friday, December 22, 2017

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.

Friday, December 15, 2017

Essential equipment 2017

Topic of the Week:
Essential Equipment


Essential equipment 2017
"stuff" that may 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 a cell phone or ipad to play with. The cell phone that I did have was as large as a briefcase and needed to be plugged into the car cigarette lighter for power. 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. This is the third year that I am doing this post. Every year I have added more items. Thanks to all of you who have chimed in.

Having a safe place where where your baby can comfortably hang out is essential.
.
For the Crib:
  • Dr. Hurd suggests that all of her patients invest in a simple crib wedge. Having them on a comfy 45 degree angle is especially important for babies with digestion issues or any congestion.
  • Dr. Anne has several parents who absolutely love the Snoo Bed.This is not cheap, but it was created by Dr. Karp who wrote the Happiest Baby on the Block series. It might be cheaper than several nights of night nurses!

  • One of our patients Amy (mama of twins) told me aboutwonder bumpersThese are one of those “why didn’t I think of that” products

Putting them down outside of a crib

  • Dr. Anne likes the Boppy newborn lounger


  • Some of Dr. Hurd’s favorites are:



  • Diane, a mom of twins passed along a tip. “When I started asking other twin parents which products I should buy two of, at least 5 people told me I should get two fisher price rock and plays (with auto rock). They were all correct. The rock and plays are amazing. When my girls are a little bit congested (which has happened a lot in the first 6 weeks of life), the incline helps them sleep better. And on those challenging nights where they are both fussy, I can put them each in a rocker and turn them on and they can rock gently for hours. Make sure to buy the one with the auto rock option, because the regular one you have to rock manually”

  • If you don’t mind a manual version, You can rock this Fisher Price rocker 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.

  • Thanks to Nurse Lainey for telling me about the DockaTot This product has some big fans


Blankets and Swaddles

  • Many parents and Dr. Anne all really like the Merlin Sleepsuitto help with the transition out of the swaddle around 3 months

  • 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.




  • 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.

For some of our toddlers and preschool kids working on their sleeping skills, thanks to Tila for sharing the sleeper heroAfter she told me about it, I have passed this tip along and many parents have called it a difference maker

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.



  • Once the babies are over 4 months old, Noe Valley Pediatrics' Lily relied on her infantino flip advanced convertible baby carrier

  • For the babies who are starting to take their first steps, Nurse Lainey loves to recommend Little balance box

Food related

This is especially helpful for a family with twins who are mixing larger quantities of formula at a time



You can wipe it clean and it cuts down on messes

  • My super adorable neighbor and patient Sean loved 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. (Welcome to baby Kate, Sean’s new sister!)


Other Random tips

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').

Other parents let me know about

  • The Frenchie Mother towell - 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!

Thanks Caroline for letting me know about another towel suggestion: I have a pretty random suggestion for essential equipment, but it made my life so much easier that now it’s my go-to gift for new parents. I absolutely loved my apron towel. Especially when Jack was a squirmy, wet baby. It made me feel so much more comfortable bathing him by myself.
You clip the towel around your neck before the bath, and after the bath you just pick up the baby to your chest and flip the hood up.


  • Mama Regan let me know about the Oogie bear, little scoop for removing little boogies

  • Noe Valley Pediatrics Eileen reminded me that this list isn't complete without the nose frida or other nasal aspirator. Having one of those is a must have for every parent


I couldn’t do a post like this without checking in with Jennifer of Hint Mama. She sent along the following tips





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. Not everything needs to be high tech. There is nothing as great as a cabinet full of food storage containers and lids!)

  • 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.

  • Dr. Schwanke's favorite item Sophie the Giraffe would be in this category. This is a classic favorite that has been loved by several generations.


  • Noe Valley Pediatric's Lily reminded me how important asimple doctors kit can be at getting kids more comfortable during their visits here.


Beyond equipment, there are now all sorts of apps

  • Robert, the daddy of baby Noah says that they found thebaby tracker app really useful


Other products


I don't advocate trying to live in a germ free world, but I imagine that most of us have disgustingly dirty cell phones that would benefit from a good cleaning, especially before we let our babies chew on them.

The book "Baby Bargains" another recommendation from Rita and Ricardo 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.

Bonus Wisdom tip from mama Megna

One of the things I realized when I was nursing was that if I was stressed my son almost always 'absorbed' the tension especially when I was nursing. This was one of the most direct osmosis affects I've seen of stress hormones. It was a reminder of always being cool calm and composed especially when around your child.

We traveled a lot with our son the first year and although traveling with the a baby it's no picnic, each time we did a trip he grew emotionally so much. We never regretted a single trip that we took whether it was Europe or to see great-grandparents. Traveling is an amazing thing for a child even that age. It made us as parents more flexible and not as regimented about having things a certain way, and socialized our son at a very early age.

This post lives forever on my blog. If you have some magic tips to share, let me know and I will update the post.

She says this big exercise ball was huge life and back saver those first couple of months

I

Friday, December 8, 2017

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. For older kids, escape rooms are a ton of fun. A membership to one of the local museums or the Exploratorium is another good gift to give to the family.

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 of Nurse Judy's inexpensive and creative activities has some old and new ideas.

  • 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 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 find...like a dog, an airplane, or even a girl with purple hair.

  • Go on an ABC walk. Find things that start with all the different letters...or find the actual letters on signs and license plates. This is a great game in a supermarket.

  • Download free coloring pages from the internet. With a little searching, you can get a picture of just about anything.

  • Draw with chalk. Make a hopscotch board.

  • Make your own play dough. You can find the recipe on line.

  • Make a fort using the couch cushions,

  • 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.

  • Okay, now put that screen away and get some fresh air! Families can play some sports outside. Find a patch of grass, a basketball hoop or one of the city tennis courts and get active.

  • 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)

  • Read!

  • 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 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)

  • Take a ferry ride. The route from the Ferry building to Jack London square is super easy, and there are snacks and a bathroom available!

  • 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 area. 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

  • Musee Mecanique If they love it there...consider earning points for future play there

  • Labyrinth down at Land’s End is worth checking out.

  • Walking tours are free and plentiful. These are a fun way to get outside and learn a little history of the city.

  • 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!

If you have something that you think would be a good addition to this list, let me know!