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.

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. Volunteer as a family 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!

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.