Friday, September 29, 2017

Head Lice 2017/updated treatment and referral options


Head Lice 2017/updated treatment and referral options

I hope you don’t need to be reading this post except for a bit of  Schadenfreude

Lice is a chronic problem that our patients deal with throughout the year. My original post about lice back in 2013 actually went viral. I learned to accept that my moments of fame are generally poop or vermin related. Lice have become more resistant and the treatment and services available have changed over the years, so it time to update the post.


Diagnosis:
Learning that your child has head lice can be incredibly aggravating. Trust me I know. You might be suspicious because your child is scratching their head or you may have gotten a call from school that your child was exposed. It is rare to actually see the live lice crawling around, although I was once measuring a child's height and as they stood tall against the wall there was actually a halo of lice scurrying all over her head...ugh. Not everyone gets itchy, Your child might be crawling with them and never give a clue.

Once a person gets head lice, the mature or adult head lice can lay up to 10 eggs or nits each day. These nits hatch in about 7 to 12 days. Baby lice or nymphs are about the size of a pinhead when they hatch, and quickly mature into adult lice in about 9 to 12 days. Lice don't like light and they move very quickly, therefore the diagnosis is often made by finding the nits. One site claims that the average speed of a louse is 3.75 inches per minute. This is equivalent to 18.75 feet in one hour, and approximately 450 feet per day. This is over the length of one football field! The nits are small white, opaque or tan specks that adhere tightly to the hair shaft. If you flick something on a hair and it floats away, it may just be dandruff. The nits are usually close to the scalp. If they are further up the hair shaft, likely they have been around awhile undetected and got farther away from the head as the hair grows.

Check your child's head in a methodical manner, paying special attention to the areas behind the ears, the nape of the neck and the crown. Make sure you are in a well lit area. Remember that if one person in the family is infested, you should check everyone. I have had moms speculate that people with a Y chromosome don’t do too well at this task. If you don't have someone reliable to check your head, you may actually be able to feel a nit on your own hair; Run your fingers through your hair from scalp to the ends. A nit will feel like a tiny little knot. If you feel something, yank it out and take a look. A nit doesn't encircle the entire hair, but looks like a tiny sesame seed stuck on one side.

When my children were in elementary school we all got it. That was when I became an expert and spent weeks doing head checks on their entire school. My eyes aren’t as good as they used to be, but I can still consider myself a better than average ‘nitpicker’. Is that a good thing? I am not sure.

I thought I was done dealing with lice on a personal level, but when my daughter Alana was a SENIOR at Lowell, she and many of the peer helpers ended up with head lice. The culprit was an old couch in their break room that was infested. The reason that I share this is so that you know I have been there. I understand why some parents start insisting that they want to pour strong pesticides on their little darlings’ heads. Stop. Take a breath. There are other options.

If you have found some bug or nits, it is time to treat. You have several methods to consider.

Nurse Judy Original Method
My old post had a several step protocol for using the over the counter medication. It still may be the most cost effective way to treat and I have parents successfully get rid of lice if they do all of the steps. Poison, Suffocate, Sizzle.

If you see a lot of nits, you should start by loosening them up with either plain white vinegar or an “egg releaser” product such as Clearlice. Both of these work well but might neutralize the active ingredient in the Nix and should be used first and rinsed out thoroughly.

Next step is to wash the hair with a strong stripping shampoo such as Prell. This is a classic old shampoo that should be at a local, larger drugstore. You can certainly get it online. Experts say that this helps the Nix be much more effective because it strips the hair of any oil and makes it hard for the lice to hide. The next step is a 30 minute application of Nix. Ignore the package that tells you to leave it on for 10 minutes. This application is still way less toxic than the more concentrated version that is used to treat scabies and is left on the entire body for 24 hours.

One of the moms in my practice shares the tip that combing out the hair while it still has the conditioner in it stops the bugs from being able to move as you are combing it out. She found it much easier than working on the dry hair. (Thanks Alice.)
Alice's family also loved using this

 to view the comb out, especially if they just have the eggs.Seeing the eggs helped convince her kids that the combing out was indeed necessary.

There are resistant bugs out there, so Nix alone will not be enough. The media gave these guys the moniker Super Lice a few years ago. The stuff of nightmares. There is a new UltraNix on the market that claims to be more effective

You have killed the weaker ones with the Nix, but to get the stronger bugs, you need to follow up a day or two later with cetaphil or oil. Olive oil or coconut oil are probably the best oil choices, but it really doesn’t matter. What we are doing is suffocating any survivors. Slather the hair with the goop of your choice, put on a shower cap and leave it on for several hours. Some studies say that it takes 6 hours to do the job. Do NOT put your child to sleep wearing a plastic shower cap on their head. This should be done during waking hours. The Prell shampoo will come in handy once again to help you rinse out so that the hair doesn’t feel too oily.

The final step for kids who are old enough is to sizzle any survivors with a hair straightening flat iron. When you comb out, It is important to use a good metal flea comb. Having a good one makes a big difference. Do a daily thorough combing to make sure you aren't finding new nits.


Prescription route

If you have good insurance, there is a prescription medication called Sklice

Sklice is a lice treatment that has been on the market for several years. The key factor is that the super lice are NOT resistant to Sklice yet. Sklice is fairly non-toxic. It is the only FDA approved drug that contains Ivermectin. Ivermectin has been used as an oral medication to treat river blindness in millions of patients. To treat lice, it is applied topically and left on for ten minutes. It is approved down to 6 months of age. The cost will vary depending on your insurance plan. As of March 2016 you can go to www.sklice.com for a $10 copay coupon. This website will give you all the directions that you need along with other useful lice info. With the copay assistance, your out of pocket price may not be more than $40.
Sklice directions claim that you don't need to do any nit combing after the treatment. One tube/one ten minute treatment. Even folks with lots of hair just need to use the one tube. I have asked the Noe Valley Walgreen's to keep it in stock.

Services

If you opt to hand off the responsibility and hassle and money is no object, there are companies that will do the treatment and the nit removal for you.
Hair Fairies has been taking care of head lice for nearly two decades. There are eight locations nationwide. We are lucky enough to have several in the Bay Area. Our closest location is probably the salon on Fillmore street here in the city:415-292-5900.

Folks who have used them have nothing but good things to report. The fee is based on the time it takes to pick all the nits. The cost can add up, but many parents are so happy to have someone else do this for them, that they feel it is a worthwhile expense.
Maria Botham, the president and CEO says:

"We’ve dedicated ourselves to understanding head lice and getting rid of them. We use that expert knowledge to develop safe, mild, clinically proven head lice removal products and techniques — and, ultimately, to bring confidence and peace of mind to families like yours. Each situation, each child and family is special, so we treat you that way. Our skilled technicians are professional and personable, our salons reassuring and fun. And, simply put, our products work! We use them in our salons every day. That’s why families, healthcare professionals, schools and camps around the country trust Hair Fairies to get rid of head lice. It’s a responsibility we take seriously. So many parents tell us they’ve spent hundreds of dollars and countless hours trying over-the-counter products that claim to get rid of head lice but don’t. All while their child is miserable. Hair Fairies is the better choice — economically and emotionally. If your family encounters head lice, take a deep breath. Stay calm. Hair Fairies is by your side."
Tell them that Nurse Judy sent you for a free head check. If head lice or nits are found, the NURSE JUDY promo will get you 20% off your first treatment. For the record, I receive nothing in return for my recommendation of this or any other product that appears in my blog.


Lice Clinics of America – South San Francisco is a science-based lice removal company. This is a new service that was not included in the last post. They are the exclusive provider of the revolutionary AirAllĂ©TM device, an FDA-cleared medical device that kills head lice and lice eggs using just heated air; this allows us to offer a single (~1 hour) treatment to get rid of 99.2% head lice and lice eggs. Their clinic is committed to treating every patient in a caring, clean and professional manner. Their core values lie in client centered, quality service. The results are guaranteed!
They are located at 1001 Sneath Lane, Suite 107, San Bruno, CA 94030. The clinic is open seven days per week by appointment only! 650-746-8788The total cost is $185 per treatment. Some PPO insurances will cover part of the cost. If everyone in the family is treated they will give a 30 day guarantee. Tell them Nurse Judy sent you and get a 10% discount.
If you don’t want to leave home, There are a few companies that do home visits.

Go on line or call 415-574-8198. Sharon, the owner, founded the company in 2008. They use all natural and organic products. They service many of the local schools and preschools in the Bay Area. There is a $10 travel fee and a $35 cost for head checks. If lice are found, that $35 is applied to the treatment. Each treatment is $100/ person. They recommend two treatments. There is a 30 day guarantee.
Both Hair Fairies and Bug-A-Lugz will furnish you with a form to bring to your doctor for a signature. Some insurance may reimburse for these services.

Nitcontrol.com I learned of this company from one of my patients who had a good experience with him. He comes out to your house and charges by the hour, 125/hr plus a small travel fee. He works all over the Bay Area. He managed to go through all three family members in just over an hour, much cheaper than Sklice for all.

Lice Patrol
8/2019 one of my patients informed me that they recently used Lice patrol and were very pleased with the service.
 Here is their feed back.
Martina Mitchell of Lice Patrol had literally nothing but five-star reviews on Yelp. She was able to make a house call the next day for, get this: All of us including my mom (who chose an unfortunate time to visit from out of town and sleep on our couch), our nanny, our nanny share buddy, and his two parents. She was thorough, methodical, calming, and is coming back in five days to check again! It was $420 for three and half hours and eight people, and two combs to boot

LiceDoctors
800-261-9389 or 1800-224-2537
www.licedoctors.com
Their website is a wealth of good information.


Clean up:
Sadly, getting rid of the bugs is probably the easiest step. It is essential to make sure you eliminate any lurking lice in your house (and car) that are waiting to crawl right back into your treated hair.
Wash sheets and pillow cases for the first two days after treatment. Wash towels, recently worn clothing and any hats or hoods that have been in contact with the lice. (Sometimes a trip to a Laundromat that has the big dryers and lots of machines can help you take care of the clean up more efficiently.) Items that can not be washed should be dry cleaned, put in a hot dryer for at least 30 minutes or placed in a ziplock bag in the freezer for 24 hours. Sealing items in an airtight bag for several weeks is also a common recommendation, but may not be reliable. Combs and brushes should be cleaned by soaking in hot water (about 130*F) for 10 minutes. All rooms and furniture, including car seat should be vacuumed. I have never been a fan of the pesticide sprays, but I am intrigued by the non toxic versions that are now on the market.
Hair Fairies has an all natural lice repellent spray that folks swear by for spritzing around all the areas that could have infested. This can help with all of your non-washables such as hats, carpets, couches and car seats. Maria the owner says that some folks even take the spray with them on airplanes (great idea!)
Prevention:
Lice do not jump or fly. Since they travel by crawling, it is important that your children learn not to share brushes, hats, hair bows or headphones. Crowded coat racks are a good way to catch them.
(As are old nasty couches in a Peer Helper break room.) Teach them to hang their coats separately. If your child is in a class or daycare with a lice outbreak, talk about eliminating any dress up or costume boxes.

Are you at an event with a photo booth that has all of those creative hats to try on for the picture? Tag, you’re it.

If your child has long hair, pull it back into ponytail or braids to minimize the risk. Although it is unproven, some people say that washing the hair on a routine basis with tea tree oil shampoo or vinegar rinses may act as a prevention.

Both Hair Fairies and Bug-A-Lugz have special shampoos that they sell as part of the practice that can be used preventatively.
Remember that lice do not care about family income, education, lifestyle or cleanliness. 10 million Americans are infested each year.

Pets do not transmit or carry human lice.
As icky as lice are, it is important to keep one’s sense of humor. There are worse things out there, really. Years ago I had come across an article equating the “stages” of dealing with lice to the Elizabeth Kubler Ross stages of grieving. Thanks to the wonders of the internet I was able to dig it out of cyberspace:


And here is another post that a mom shared. This woman does a weekly parenting blog.

If this post made you itchy just reading it, trust me, I have been scratching my head all week.

Friday, September 22, 2017

A rash of rashes/when do you need to worry? 2017


A rash of rashes/when do you need to worry?

If you sneak a peek at the Noe nurses' email these past couple of weeks, most of the subject lines include the words, rash, spots, blotches or bites.

You can't imagine the scope of the emails we get. Some come along with photos of random body parts, not all of them easily identifiable. Rashes can be spotty, blotchy, hivey, oozy. They can be caused by allergies, bug bites, scabies, bed bugs, poison oak, contact dermatitis, virus, bacteria or fungus. They can be on only one body part or cover most of the patient. They can be part of a chronic condition that comes and goes, or something acute.

Once in awhile I can look at a photo of a rash and have a good guess what I am looking at, but more often things aren't completely clear cut. The most important thing really comes down to one very important and basic question: "Do we need to be worried about this rash or not?"

To simplify things, I divide rashes into one of two categories - Am I curious or concerned?

Rashes that I am curious about

If your child  is acting fine but has a random rash, ask yourself the following questions:

-Are there any new medications? (especially antibiotics. Even if it is the end of a course, this is important information.)

-Was there a recent illness/fever? If you had a mystery fever and then a rash comes out once the fever is gone, I am NOT as concerned about it. There are quite a few viral syndromes that wave goodbye with a rash

-Are there any new foods?

-Have they been enjoying lots of citrus or berries lately?

-Are there any new soaps, detergents, bubble baths?

-Have you used a new sunscreen or lotion of any sort?

-Do you have pets? (Think fleas)

-Has there been an exposure to a new animal? (think allergies)

-Has your child been in a hot tub?

-Is the weather very warm? (my San Francisco babies don’t like the heat)

-Has your child been laying in the grass or sand?

-Has there been any recent travel?

-Any recent hiking? (think poison oak)

-Has your child done recent a art project with a new substance?

-Have you checked the mattress and area around the bed to see if there are any spiders or insects hanging around? (shudder)

If your detective work has given a promising clue, make the common sense adjustments and see if you see any improvement.

Regardless of what is causing a rash, there are  several basic staples that are worth keeping on hand. The first three on the list  are used for basic skin care and can be somewhat preventive.

  • Cetaphil cleanser (no water needed, apply and wipe off)
  • Aquaphor
  • You all know that I love adding a splash of apple cider vinegar to the tub for all sorts of rashes
  • Over the counter hydrocortisone cream/ointment for itchy areas
  • Over the counter Neosporin or prescription Mupiricin for any open areas
  • Over the counter anti-fungal cream/ointment for any possible yeast rashes.
  • oatmeal bath (don't clog your drain with real oatmeal, there are special products used for this)
  • Zyrtec or Benedryl
  • Bleach! Believe it or not, many dermatologists will suggest a diluted bleach bath for helping clear up eczema or bacterial infections.

Of course feel free to call the advice nurse to help you troubleshoot. If you are a patient at  Noe Valley pediatrics we would likely try to schedule a convenient appointment slot for you to come in and have us take a look if a rash is persistent and your best attempts at clearing it with a variety of OTC creams isn't helping.  If the docs are baffled, the next step may be the dermatologist.


Rashes that I am worried about

Any purple rash needs to be evaluated. These rashes don't lighten up when you press on them. If you have a child who has a purple rash and also has a fever and looks ill, they need to get to an emergency room immediately to rule out meningitis. A stiff neck, vomiting and headache would make me even more concerned. These kids look SICK.

Any rash that comes along with a fever at the same time is probably worth being seen. Strep throat can do this. We have still not ever seen an actual case of measles in the office, but that also would present with a rash and fever at the same time. The patient will look sick.

Other viral syndromes that may have the rash and fever at the same time are Slap Cheek and Hand Foot Mouth. We don't have anything other than suggestions for symptomatic relief for those. You simply will need to ride them out.

If the rash is oozy and crusty it might be bacterial. Impetigo is fairly common.

If your child has had it in the past and you already have Mupiricin, you can try to treat a small area. If it isn't clearly taking care of things, an appointment is warranted. Sometimes oral antibiotics are indicated.

If a rash seems to have fluid filled centers, it could be chicken pox!

If the rash seems very painful or itchy certainly try Zyrtec or Benedryl, but if your child is uncomfortable let's get them seen to see if we can help. Some itchy rashes like poison oak may need oral steroids.

Hives are scary because most people associate them with a severe allergic reaction. What most people don't realize is that most of the time hives are not always a big deal. They are a signal that the body is reacting to something, but often it can be viral. I have had patients with mystery hives that have cycled on and off for several weeks before finally fading. If your child has hives along with any facial swelling or difficulty breathing, they need immediate attention. If they have a history of severe allergy to something, you should have an epi-pen or AuviQ on hand and follow that up with an emergency room visit for some close monitoring.

Any painful rash that is only on one side of the body and doesn't cross the midline could be shingles. It is rare for children to get this, but it can happen.

So to recap, if you are WORRIED, make sure that you are seen appropriately sooner than later. If you are simply curious, it is time to play detective.

Friday, September 15, 2017

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.

Friday, September 8, 2017

Fevers 2017


Last week in the SF Bay Area the heat was unprecedented. .For the first time in my 31 years of living here, I went to a night game at AT&T park wearing shorts and a sleeveless shirt (orange of course) I didn’t even bother to bring a sweatshirt. Seasoned Bay Area people know that normal equipment for the ball park for a summer night includes sweatshirts and a blanket.
One the Friday before the 3 days weekend, the phones exploded with calls about very high fevers. I am not sure if some were heat related or there was a new virus making the rounds.

Fevers tend to get parents very worried, but those who attended my illness class know that they are only one of the factors that you need to consider when evaluating a sick child. I am always more interested in your child's overall mood and behavior than I am in any specific number on a thermometer. Kids get fevers. An adult with a high fever is usually more miserable and needs to be evaluated sooner to figure out what is going on.

There are many methods out there for measuring a body temperature. I personally don't feel the need to invest in any expensive thermometers. I am generally quite satisfied with a digital underarm reading. The important thing is that however you take it, your thermometer seems accurate. Test it on yourself or other family members and take your child's temp when they are healthy to make sure you trust it. I don't have a favorite brand.
If you have one of the new ear or temporal scanning units feel free to keep using that. Sometimes their "high" readings seem a little higher than I believe to be accurate; don't ever let a number freak you out.
Temperatures can be measured in either Fahrenheit or Celsius
Here is a quick conversion chart that might come in handy.
98.6 F=37 C
99.5F=37.5C
100.0F=37.8C
100.4F=38C
101F=38.4C
102F=38.9C
103F=39.5C
104F=40C
105F=40.6
For this post, I will be referring to the temperatures on the Fahrenheit scale.
*****
For any child older than 3 months
As long as your child is active and happy, I generally don't feel the need to "treat" a fever unless it is over 101.5 or so.
One of the most common questions that our advice nurse team gets is, "When do I need to worry about a fever?" As I mentioned, I am much more concerned about the lethargic, whimpering child who has a normal body temperature than I am the singing child with 104. But, here is the
Nurse Judy's rule about fevers:
If the fever is over 102 (it doesn't matter how you measure, just be consistent):
*Treat with proper dose of Acetaminophen or Ibuprofen
*Do a tepid bath or place cool compresses on the forehead, insides of elbows and neck
*Get them drinking. Little sips at a time are fine. A Popsicle or ice-chips are good for older kids.
*re-check the temp in 45-60 minutes
If it is STILL over 102 and hasn't budged at all, that is a fever that I am concerned about.
It is time to get your child seen.
When children are in the process of spiking a fever, it is not uncommon for them to tremble and look shaky. When fevers are breaking it is common to have lots of sweating.
Children with fevers may have a higher respiration and pulse rate.
One of the more frightening aspects of a fever can be a febrile seizure.

 About 4% of children will have these. Febrile seizures can be terrifying to watch, but they usually stop within 5 minutes. They cause no permanent harm. Trust me, if you have never heard of this, watching your child have a seizure has been reported as the scariest experience EVER.
Knowing that that they do happen once in awhile and are generally harmless should help keep you from freaking out. If your child is having a seizure they may have large jerky motions and their eyes may roll back. Your job is to stay calm. Make sure their airway is open. It is perfectly reasonable to call 911.

Once your child has had even one febrile seizure we tend to be more aggressive with fever control and will treat even a low grade fever. It is important to talk with your doctor about this so that you have a plan in place that you are comfortable with. Most kids grow out of the seizures by the time they are 5 years old.
If the fever is accompanied by a very fussy child, I want them seen so that we can figure out what is going on.
Even if your child is acting just fine, if a fever lasts for more than 3 days, I consider it time to have a look so that we can make sure there isn't an infection source (like ear infection, urinary tract infection, strep throat or pneumonia.) Any fever that comes along with a purplish rash could be an emergency (this is not the singing child. They would look alarmingly ill.)
During flu season, we sometimes do see a fever that lasts for five days or longer. If there is a classic virus going around that I am seeing a lot of, I will occasionally relax my "3 day rule". If the kids seems like they are 'managing' (drinking, peeing, easy breathing, consolable, fever responds to medications) I am okay watching them for another couple of days.
This particular illness that we are seeing does have 4-5 days of fairly high fevers. A small group of these have ended up with respiratory infections that did need to be treated, so my 3 day rule is staying in effect.
Many viral syndromes "wave goodbye" with a rash. Roseola is a classic example.
If your infant is under 3 months of age we want to be notified of any fevers!
However, there are a few common causes:
*over bundling....
Seriously, sometimes the babies come in with 10 blankets wrapped around them. Please don't do that. The best rule of thumb is giving them one layer more than you are wearing. If your baby was indeed over bundled, get some of those layers off and re-check the temp in about 10 minutes to see if they have cooled down.
*dehydration..
..Sometimes if moms milk isn't in yet, babies can be simply dehydrated and need to get some fluids. This is the time that you need to squirt some milk or formula directly into your baby's mouth. You can use a syringe or a dropper. More often than not the elevated temperature will normalize fairly quickly from some fluids.
If there is no obvious cause for an elevated temperature, and it doesn't resolve within 20 minutes your baby needs to be evaluated. Giving a fever reducing medication to a newborn should only be done under strict guidance from your pediatrician.
Some fever facts:
*Fevers turn on the body immune system. They are one of our body's protective mechanisms
*Many fevers can actually help the body fight infection.
*Fevers that are associated with most viral syndromes and infections don't cause brain damage. Our normal brain's thermostat will not allow a fever to go over 105 or 106.
*Only body temperatures higher than 108°F (42.2°C) can cause brain damage. Fevers only go this high with high environmental temperatures (e.g., confined to a closed car.)
Click here for my blog post about dosages for Tylenol and Advil
Dosage chart

Friday, September 1, 2017

Dealing with Bullies 2017


There has never been a more important time to teach our children about tolerance and kindness. Bullies can start their habits when they are really young. I am updating this post from several years ago.

Kids can be so mean sometimes. I am not sure if it is harder to watch your child be bullied or to be the bully. In my case, for a period of time when our daughter Lauren was four, she was getting routinely picked on by another little girl at preschool. To compound things, this girl was in my carpool. I would drive the kids to school three days a week. Carpool parents - be aware of this astonishing fact. You are invisible. You are privy to all sorts of interactions and conversations that might leave you either horrified or amused as you drive the car full of kids hither and thither. In this case I had to watch Emily torture Lauren every single day, impervious to the fact that I was in the car. (As you can imagine it was pretty infuriating.)

This is what I would hear, with mild daily variations:

Emily: "Your shirt is ugly"
Lauren (clearly upset): "what? why?"

Emily: "I have a special thing I brought for show and tell and I am going to let everyone else in the car have a peek except you"
Lauren: "But I want to see it too!"

Emily: "You can't come to my birthday party"
Lauren (even more upset): "Why?" 

After a few weeks of this I realized that I needed to stage an intervention.

I drew two faces. One was smiley face with pretty eyelashes. The other was a grumpy frowny face. I then said to Lauren " Which one would you like to be?" I was dealing with a four year old girl, this wasn't rocket science. As predicted she pointed to the smiling image. I touched the grumpy drawing and said " Emily seems to want to turn your smiley face into a grumpy face. I wonder if you could keep the smile face on even when someone is being mean. Let's try!"

We got out the trusted barbie dolls and did some role playing. We spent a dramatic session as Barbie cheerfully let all sorts of slights and insults roll of her very shapely back. We created an assortment of interesting scenarios. Barbie never lost her cool.

I wasn't quite ready to paint Emily as a complete bully. I liked her parents and she wasn't mean 100% of the time. I tried to give her an out. As we put the Barbie's away I said, "I wonder why Emily says mean things sometimes. Maybe she is feeling grumpy herself because she is a little tired."

The very next day in the car we I was interested to see if all of our practice would make a difference. It didn't take long to find out.

Emily: "your shirt is ugly"
Lauren (with a big fake smile plastered on her face that I could see through the rear view mirror): "Luckily, you don't need to wear it. I think your shirt is pretty."

Emily: "you can't see my sharing"
Lauren: "I am sure it is very interesting"

Emily. "You can't come to my party"
Lauren: "I hope you have a fun time"

From the driver's seat I watched Emily become more and more confused and upset that her power seemed to be slipping. I refrained from giving an audible whoop and driving into the bushes.

And then...

Lauren (in a sickeningly sweet voice): "Are you a bit tired Emily?"
Emily (grumpy): "NO, I'm NOT tired"
Lauren (knowingly): "I think you must be a little tired"

No one watching could have accused her of doing anything wrong but she had discovered a way to gently torture Emily a bit, and she was running with it.

A few weeks later I was at a school event and I bumped into Emily's dad who drove the carpool the other two days. He said to me, "something is going on in the car that I don't understand". "Oh? What would that be?" asked innocent mom. "Lauren keeps asking Emily if she is tired and Emily starts getting very upset". Hmmmmm.

As you can see, finding one on one time and playing through things can be quite effective. If you can, it is also helpful is to identify the "nice kids" in the class. Ask your child who they might like to play with, reach out to that family and try to arrange some play dates outside of school time. If your child can have some solid allies in the social group, it makes it much easier to stand up to, or deal with someone else who is unkind. Keep in mind that it is a rare friend that is completely reliable. They all have days where they "might be tired". 

Was Emily actually a bully? Perhaps she was looking for attention or actually just needed a nap. Often young children are really simply trying to figure things out. Nevertheless, if your child is routinely on the either end of hurt feelings, it is worth some attention.

Looking for other ways to empower your child? Check outKidpowerThis is a fabulous organization that came out of Santa Cruz. They now have groups and classes all over the place. They have an entire section devoted to dealing with bullying with all sorts of really excellent resources: Kidpower - Bullying

If all of your efforts at home don't seem to be taking care of the issue, talk to your school to see if they have any anti bully programs in place. There is a inspiring program No Bully , that got its start in San Francisco. Talk to your school about looking into it. Keep in mind that most of the time you won't actually witness the bullying. Pay attention to your child's mood and behavior. If you notice any dramatic changes make sure you find opportunities for your child to communicate about what may be going on. Sitting with them in a quiet room before bedtime is a great time to do a daily debriefing about the day. In our family that was a ritual.

Let's turn the tables. If you hear that your child is the bully, or you get to see them in action, make sure that you carve out some one on one time to work on some skills. Some kids seem to be bullies because they simply want attention and don't know a better way of making and keeping friends.Talk to them about kindness. Talk about choices. Find one particular situation that you know about and work on that. "You pushed your sister and made her cry. What was going on? Were you mad, sad, frustrated? What were some other choices that you could have made? What should be the consequence if it happens again? What should be a nice treat/ reward if you make a better choice the next time you are in that situation?"

If you find that you are having issues on either side of this spectrum that are beyond your scope, the next step may be having a meeting with your child's teacher.

Your child may not be directly involved in any bullying but it is the rare child who doesn't see occasional evidence of meanness happening around them. This group of observers are often the kids who can make a real difference. Not only do we want our children to be kind, we also want them to figure out the best way to be brave without putting themselves in danger. Sometimes it takes a certain amount of bravery to play with a child who is a target to the bullies. At the very least talk about reporting any bullying to a grown up or teacher.

These days with all the social media, a good bit of bullying can happen over cyberspace. Make sure that kids know that you reserve the right to monitor their online accounts. Until they are ready to pay for their own cell phone plans, it is what it is.

Kidpower outlines some concrete actions for dealing with this.


Little actions can make an enormous difference to someone.