July 4th safety tips 2018/ You probably have NOT thought about of all of these

July 4th 2018 The phone calls that we get following the July 4th holiday are fairly predictable so here are some tips that can help you all have a safe & healthy holiday weekend. Since some of the holiday festivities may involve large crowds, I have some recommendations for dealing with situations where you might find yourself in a throng of people. Dress your child in bright clothes that stand out from the pack. Take a photo of them before you set out, so if heaven forbid you get separated, you have a current picture to pass around that shows exactly what they are wearing. Another sensible and creative idea is to write your phone number on your child's wrist and cover it with liquid band-aid to make sure it doesn't wash off. Make a solid plan with your older children. What should they do if they lose sight of you? Where should you meet up? This is a good time for the : What would you do if....activity Will it be loud? Loud music and fireworks can be damaging to your child's sensitive ears. Consider getting some ear protection if you are going to be someplace that can put hearing at risk: How loud is too loud? Please be very careful of fireworks. If you are skipping the organized shows and planning on setting them off yourself, make sure your kids don't have any access to the fireworks or matches ahead of time. Do an inventory and know exactly what you have on hand. Keep the kids at a safe distance during the actual fireworks. Have a bucket of water or a hose nearby. Try to keep your pets indoors with windows closed in case the noise bothers them. I have not ever had a pet/child injury from fireworks, but Nurse Lainey points out that if your pet gets stressed from the fireworks, they need close observation if they are around your babies. I have NEVER had a morning-after-July 4th without a call or two about fireworks injuries. Don't let this be you making that call. I will be kind, and I will help you out, but I may make you squirm! If you are in San Francisco chances are you probably don't have to worry about the heat. When my kids were growing up, our July 4thfireworks watching usually included warm blankets, hot chocolate and lots of thick fog. I remember one year when Lauren was 3 or 4 and we were driving to a vantage point, she saw a traffic light through the fog. "Is that a firework? It's beautiful!" Ah, our San Francisco babies. For those of you escaping the city make sure you stay well hydrated and protected from sun. Get in the habit of doing a skin sun exposure check at least every 30 minutes (more frequently for fairer kids) to see if it is time to reapply the sunscreen. Be very wary about applying any of the aerosol sunscreens around a heat source (like a grill.) These are flammable and there are horror stories out there about terrible burns that have occurred. Sunscreen post Let's move our discussion over to grills. I was watching the news and a story came on about the hazards of metal bristles coming loose from utensils that are used to clean your grill. These metal strands may get lodged into pieces of food. People have been reporting mouth injuries and worse. Happily, that is one call that I have never gotten, but it seemed like a caution worth sharing. Check your utensil brushes to make sure there is nothing loose. While you are at it, check the grill surfaces to make sure there are no pieces of any foreign objects that can get stuck in the food. Make sure your child can't get anywhere near any type of grill. The danger begins from the moment you light it and are waiting for it to be ready, until long after the cooking is done and you are certain it is completely cool. If you are cooking meat, make sure that it is thoroughly and safely cooked. Food borne illnesses don't just love under-cooked meat; other foods can transfer the bacteria also. Pay attention to any picnic foods that will be out of refrigeration for several hours: Food Safety post If your picnic/meal is outside and you will be spending time in grassy, wooded places, make sure you do a head to toe check for ticks once back inside: Tick Post Ticks are rampant right now. Finding them early before they have been attached for a couple of hours will vastly decrease any concern about disease transmission. No, it is not okay to keep your child in bubble wrap; that isn't my intent. Go forth and have a festive, fun and safe holiday. Happy 4th of July! Nurse Heidi just read this post and said, "This is why we always stay in!!! Go have fun; Really???"

My Father's Influence

I am actually writing parts of this post from the airplane on my way home from Pittsburgh. My siblings and I are in the process of clearing out the family house. This is an emotional, enormous and  daunting process that will take upward of a year, at least. (If anyone wants to buy a magical house in Squirrel Hill mid 2019, reach out to me.) This 100 year old house is palpably imprinted with the energies of everyone who ever lived there. It is the house of requirements, right out of a Harry Potter novel. The kids would find the exact thing they needed for a school project, the right dose of allergy medication, an eclectic book on a subject that they were interested in. This visit, my pants were too loose (hooray!),  I opened up a closet, and there was the perfect belt. My dad would have turned 91 on June 21st. His birthday was always the week of Father's Day; some years they fell on the same day. We lost him 10 & 1/2 years ago. Time plays tricks and it feels impossible that it was so long ago. I have shared a good bit about my mother and it is time give a shout out to my father. I had planned to write a post about my dad this week, and since we had the week together the family recalled some classic stories like the time dad tried to calculate the width of a canyon based on how long it took for a sound to echo. In the same vein no one in the family can help but to think of dad during a thunderstorm.  We all find ourselves calculating how far the lightning strike is by counting the seconds between the boom and the flash. The lock for my high school locker was Kr Cr Ar -- If anyone needs help figuring  out the code that would be 36 Krypton  24 Chromium 18 Argon. My dad had us remember combinations based on the periodic table. Yep, he was a nerdy scientist. This had its pros and its cons. The first time my poor husband Sandy visited my house (at the vulnerable age of 18) my dad handed Sandy a Scientific American magazine and asked about alternative approaches for addressing the problem posed in the article. Deer in the headlights would probably be an accurate description of Sandy in that moment. My mom rescued him “Robert, leave him alone.” Dad had so many varied interests. He loved music and played his violin until his last days. Certain pieces of music bring him right to me. He loved animals. When he was older, he used to sit on the porch and all the neighborhood dogs and cats would stop by to hang with him. He was curious about everything and brilliant until Alzheimer’s dimmed his mind. If anyone had a question, before the days of google, the obvious choice was to “ask Grandpa.” He loved to do things. When I was growing up he was a very involved dad. We were always on the go to fairs, concerts, bowling or sporting events (Go Steelers, Pirates and Penguins); I don’t remember him saying no. He was recycling and composting long before it was fashionable. My dad didn’t tell jokes, but he was the universal recipient and appreciated any humor that was directed his way with a broad grin and a big laugh. One of the traits that  I got from him in spades and am most grateful for was his problem solving ability. If you come to me just to ketch and vent, I have learned to tell folks that they need to warn me in advance and I will try to simply listen. Without that caveat, I go right into problem solving mode. Identify the issue  (sometimes this is the most challenging aspect) Who owns the problem What are some solutions. Learning that not everyone wants to have someone “fix” them,  is something that I continue to work on. This would have been a foreign concept to my father. If he saw something that could use some correction or fine tuning, he would dive right in. A man limping? Let's evaluate the physics of his gait. An off key singer (his favorite)? He invented a method to teach anyone to sing. In some cases this might be total strangers. His kids and grandchildren coined the verb “to Grandpa someone” which translated as constructive criticism, or instruction that was more than likely unasked for. He was pretty sure that anyone could learn anything, and he was ready and eager to teach. My dad had a remarkably even temperament. It is possible that he never once raised his voice to me. I would like to think that this was mutual, but every time he tried to teach me the error of my bowling technique, I would lose control of my temper ( I should have listened, I am a terrible bowler.) It was no fun being mad at him. He would simply get sad and say something along the lines of “I am going into the backyard to eat worms.” He was a family man who loved his wife, children and grandchildren with all his heart and we knew it. He started with girls only, three daughters, followed by five granddaughters. The switch flipped. The next two grandchildren were boys, followed by two great grandsons, who he never got to meet but would have been so proud of. We are quite the force of nature when we all get together. My daughter Lauren is getting married in August, and oh my goodness would my dad have been over the moon at the man she chose. Adam would have been the one to say “tell me more about how you can measure a canyon by the echo." They would have loved each other. Anyone who knows me will tell you that I truly believe that dad will be at that wedding, watching from somewhere and beaming.

The Partner's job

Father's Day seems to be the appropriate time for this post that I have been working on.

While it is true that there is a certain intimacy between the birth mother and the baby that feels a little exclusive, don’t forget that you are an essential member of the team.

When I first found out I was pregnant, Sandy started reading all the resource books. He found a recipe for a protein shake that I was supposed to drink nightly. I remember it as pretty vile. I took one sip and then handed it to him, “Here, the baby will have a healthy father.” He did convince me to drink it nightly, but he also made a double portion and swigged his own portion down in support.

As the one who gave birth, I can only imagine what it feels like to be the partner. On one hand, the magical experience of growing a baby, feeling it move, feeling that bond is something that is unique to the person who carries the child. On the other side of the coin, that same little (or not so little) fetus, is bouncing on the bladder, causing heartburn and last but certainly not least...needs to come out!

Good partners go along to the birthing classes and learn to pant and blow along with the birth mom, but being an ideal support goes well beyond being a good labor coach.

Physical support

It is essential that you help your partner physically replenish.

For those first couple of days, make sure the birth mom needs to do nothing other than nurse the baby and rest. Someone else besides mom (are you lucky enough to have a grandparent around?) can do the changing and the burping.

Your job is to keep mom well hydrated. Every time the baby nurses, make sure that mom has something to drink. Plenty of fluid is lost during the birthing process and every time a woman nurses, she is losing even more. Good hydration is also really important for establishing a good milk supply.

If you are lucky enough to have a support system, consider having a friend organize some meals for your family for the first week or so.

Having a supportive community is so helpful but you may need to be the gatekeeper. Everyone has different social needs and mom probably needs rest more than she needs company. As you moderate your visitors, you also need to make sure they are healthy. If someone has a cold, they are not doing you a favor if they come over. If you are feeling shy, tell them that nurse Judy gave you your marching orders. Nurse Charity puts it very clearly:

Anyone in your home should be able to:

1. buy/prepare food and clean up the kitchen.

2. Watch you breastfeed

3. and scrub your toilet.

Anyone you would not feel comfortable asking to do those things, or who would be incapable of those things is not good postpartum company and should leave their casserole at the door with a friendly wave! This includes family. So if your mom is a busy body with no boundaries, she should wait a bit to come and "help" with the baby.

Emotional support

Prepare for hormones. At one of my baby boot camp sessions last year, one of the postpartum moms simply couldn’t stop weeping. Her baby was lovely and she was having a reasonably easy time, she just cried….all the time. Before long, every pregnant mom in the class was also crying, just because. Sometimes crying happens. Everyone got their own box of tissues and the class went on to talk about sleep, poop, spitting up and all those things that I cover. Crying is very normal, up to a point. Postpartum depression (PPD) is very real. It has nothing to do with prior mental health issues, or level of education. It can happen to anyone.

I think it is essential to talk ahead of time about PPD. If your partner sees any warning signs, agree that you will trust them enough to reach out for help.

More wisdom from Nurse Charity about postpartum depression

The post-partum time is a marathon of newly acquired skills. No one feels certain. Everyone is struggling to get it all done. So this is a time to think about needs vs wants. (I want the kitchen table to be clear of baby clutter, I need a shower). Prioritize needs over wants.The primary caregiver cannot do everything, by the same token - neither can you. Priorities are feed everyone, sleep round the clock (this means you too!), get a shower in, and then pick ONE thing you need to feel human. That one thing is different for everyone, but it should be doable in 20-40 minutes: examples are- read the paper, take a walk, call a friend, an extra grooming task, a project you love.

Don't compare your babymoon to anyone else's. Each family has their own strengths and skills and their own set of challenges. Be like an astronaut and work the problems you have with the skills and resources you have.

Post-partum depression for partners is a REAL thing. (1 out of 4 non pregnant partners experience depression during the pregnancy or within the year after birth). 

Click for a list of possible Postpartum Depression Symptoms:

the-symptoms-of-postpartum-depression-anxiety-in-plain-mama-english!

Here are some resources just in case

Parentline

This is a free counseling service available through the University of San Francisco.

1-844-415-BABY (2229).

It is NOT a crisis line.

415-441-KIDS (5437)

This is a 24/7 crisis and counseling line for parents who are under any kind of stress. This includes Postpartum Depression. They have resources available for emergency respite care, parent groups etc

(415) 781-0500

Crisis Line for SF bay Area. This is commonly referred to as the suicide prevention line but it is useful for any emotional crisis. You do NOT have to be suicidal to call.

Breastfeeding support

Talking to a breastfeeding mother about her milk supply is akin to walking across a minefield.

Breastfeeding is a learning process.Rest and fluids for mom are a good start, but you are an essential part of the team that will be assessing success. The first several days are really tough. Most mom’s think that for some reason this process is supposed to be the most natural thing in the world, they put the baby up to their breast, the milk will flow and the baby will feed. Think again. It takes a good bit of learning for 90% for the mom/babies.

Aside from plumping pillows, offering a drink (not whiskey although you will be tempted) and helping with positioning, it is hard to watch the frustration of a new mom and a crying baby who are both trying to figure it all out. Having a lactation consultant set up in advance is useful. There is a lot of learning that can be done before the baby arrives that can mitigate some of the common issues.

For families that choose to breastfeed, we want to do everything we can to support the success of nursing, but it is essential to recognize when it is not working. Breastfeeding moms have so much emotional “stuff” that creeps into the equation that sometimes it is hard to hear and accept the first and most important rule of breastfeeding: It is simple. “FEED THE BABY.” If there isn’t enough breast milk or the baby can’t seem to transfer the milk, then we need to offer some form of supplementation or feeding method.

When the milk is in, you can see drops of milk coming from the nipples. You should actually also be able to hear the baby swallowing during feeding. A nice glug glug glug is a great sign. After a feeding it is typical for them to appear sleepy and almost drunk. There will be wet diapers and nice poops. The baby will be gaining weight. A satisfied baby will be calm and have periods of being alert.

If an infant is NOT gaining weight, and this is where it gets tricky, please help support your partner to accept that being a good parent is not about the breast milk. Sometimes a little bit of supplement gets things moving in the right direction. This is often a bridge to successful breastfeeding and should not be looked at as a sign of failure. More times than not, it is a baby learning problem.

You are both in agreement that you want a happy, healthy baby. Babies who are not getting enough to eat are neither of those. A mom who is spending her entire day pumping and nursing is also not getting enough rest. Exhaustion will impact her ability to produce milk, enjoy the baby and stay emotionally balanced.

Partners and daddies. You can't actually birth a baby or have breast milk flow out of your breasts, but aside from that, your role as co-parent can be anything you make it to be.

Your relationship with your partner will change (hopefully strengthen). Each parent will have a distinct relationship with each of your children. Parents often take turns being the favored parent. Don’t take it personally when you don’t get picked….go read a book. Enjoy your moment of freedom. Nurse Lainey reminds you that it likely won’t last long.

There are some great resources out there for you fathers-to-be. Armin Brott, known as Mr Dad has some books just for you. Armin also does classes monthly through newborn connections for expectant dads: https://mrdad.com/

New Dad Class

I asked him for his favorite piece of wisdom and this is was essentially his best advice.

Jump right in and start doing things. Change that diaper, soothe the fussy baby. You will become more comfortable the more you do. Mistakes will happen, and you will learn lessons. Don’t be afraid of that.

Finally, feel free to check out these Father's Day posts from Sandy, aka Mr. Nurse Judy, describing his philosophy of parenting, leading to the outstanding relationship he has with our daughters, through all stages of their respective lives:

https://nursejudynvp.blogspot.com/2016/06/a-fathers-day-post-from-mr-nurse-judy.html

https://nursejudynvp.blogspot.com/2017/06/and-now-word-from-mr-nurse-judy-fathers.html

Talking to your child about homelessness

Last month as I was sitting at my desk, (probably talking to someone about their child’s poop if we’re being honest) a frantic passerby rushed into the office. She told us that someone had fallen and was bleeding profusely, and thought that since we were a medical office, perhaps we could help. My medical assistant, the amazing Josie, had the sense to grab some gloves and gauze, and we rushed out to see what was going on.There were several other people already at the scene assisting an elderly woman who was on the ground. As luck would have it, one of the helpers, who happened to be a mom with a child in this practice, was a doctor. She was holding pressure to the wound with a nice, large towel that another passerby happened to have with him. He was on his way to the gym. (Any Hitchhiker’s Guide to the Galaxy fans out there? Always carry a towel!) Somebody else had already called 911. This supportive group of onlookers were holding her purse, talking to her, and keeping her calm until the ambulance arrived (a disappointing 11 minutes wait). While I never got follow up, (and I hope the accident victim was okay), I was struck at the time by how quickly a group of people acted like caring human beings and stopped to help. They put their busy lives on hold for the moment and waited until it was clear that they were no longer needed. Sadly, this response is not something to take for granted. I have been thinking about doing a post on this for quite awhile, but the issue is so big and tricky. The streets of San Francisco often are filled with people who need help and we all walk past them, myself included. It doesn’t always feel safe to intervene. Mental illness and drug use are real issues. So sometimes it is scary, or overwhelming, or we have nothing to give, or we want to choose carefully how we do give and choose not to offer random handouts. Regardless of the reason, walking past someone who is on the ground simply feels wrong! Having a child with us often compounds this issue. What do we say when we see people who are so much less fortunate than we are? THE CONVERSATION I think it is safe to say that anyone living with a child in an urban area is likely to get the question at some point. “Why is that person lying on the street? Why don’t they have a home? Why? Why? Why???” Consider putting some thought into your answer now so that you can be prepared with a response that you feel comfortable with. Beware, words are powerful and kids can make connections that are not intended. If a child hears you point to poverty, job loss, or illness as the simple cause, they could worry that if someone they love gets sick, or complains that they are having trouble paying a bill, they might end up on the street too. Kids under five need to be reassured that they are safe, that they have a warm bed and plenty of food. Keep the discussion age appropriate. You can wait until they ask, rather than initiating the conversation. A simple “they don’t have a place to live” might be enough. They will learn quite a bit simply by seeing your actions and reactions. Five to eight year-olds are transitioning to seeing themselves as part of a community rather than having the world revolve around ‘me’. They are becoming interested in solving the problems they see. Beyond reassuring them that they are safe, invite them to ask questions and think about options. Just like every single person is unique, every situation is different and everybody has their own story. Your answers might include talking points such as Poverty: Maybe bad luck; no money, no job in combination with no family or friends to help, not enough housing. Societal marginalization also plays a part (sadly, society isn’t set up the same way for all people from all walks of life). Mental illness: Maybe the person is not well. Bodies can get sick and so can minds. Often there is medicine that can help make things better, but some people get so confused that they don’t know how to get help. Drug use: Medicine can be very good when it is used for the right reasons. Some people use drugs they shouldn’t use and ended up not being able to make good choices. If the opportunity presents, listen to their stories. In any case, it is important not to make sweeping generalizations. The goal of this discussion is to cultivate feelings of empathy and action, not shaming. We want to help, but Safety First The Neighborhood Emergency Response Team ( NERT)holds classes, free to the public, to train us for how to deal with an emergency such as a large earthquake. They spend several weeks teaching people how to help, but NERTs first rule is the most important one: Don’t go in to rescue someone if it feels unsafe. This same rule needs to be taken to heart here. If you are walking and have any concerns that an interaction with a stranger on the street could pose a danger, then walk right by. If there is someone who looks like they need help call 311 and report it: https://sf311.org/homeless-concern-homeless-person ACTION Most of you have probably heard this tale, but if not, now it is time for the starfish story (now known as the sea star) A young girl was walking along a beach upon which thousands of starfish had been washed up during a terrible storm. When she came to each starfish, she would pick it up, and throw it back into the ocean. People watched her with amusement. She had been doing this for some time when a man approached her and said, “Little girl, why are you doing this? Look at this beach! You can’t save all these starfish. You can’t begin to make a difference!” The girl seemed crushed, suddenly deflated. But after a few moments, she bent down, picked up another starfish, and hurled it as far as she could into the ocean. Then she looked up at the man and replied, “Well, I made a difference to that one!” How can we prepare our children for these inevitable encounters with people who are homeless? We want our kids to have compassion, to be safe, to feel empowered. We can’t help everyone, but even simple kindness can make a difference for one person. Most people appreciate even the gesture of a smile, but here are some more tangible things that you can do with just a bit of planning. First of all - don’t assume anything, ask a person if they would like the help. Have some extra socks to hand out Give small containers of hand sanitizer Get some starbucks cards or gift cards that can be redeemed for food Donate part of an allowance to a homeless shelter Restaurant portions are so big, perhaps split your meal and box it up before you start eating and give it to someone on your walk back to the car. Somebody with poor teeth might not be able to eat that bagel; don’t be offended if your gesture is rejected. Birthdays and holidays are a great time to talk about how fortunate we are. Some kids ask their friends to donate to a non-profit instead of getting presents, or do a “toy-purge” – giving outgrown toys and games to charity before receiving new presents. We can’t cure homelessness, but we can brighten the day of one person at a time with some simple kindness and teach our kids how to have compassion. We can also learn a lot from our children. Thanks to my daughter Alana (now a social worker…who could have predicted? ) my family has a warm relationship with an older gentleman who spends his days on the sidewalks of West Portal. About ten years ago Alana was still in high school and had left the local movie theater on a dark drizzly night waiting for her dad to pick her up. Mr R decided to wait with her because she shouldn't be out ‘alone’ and they began a friendship that lasts until this day. He calls her bright eyes and tosses his cane in the air and runs into her arms for a big hug every time she visits home. Check out this heart warming story that has been on the news recently. With all the rough stuff in the media, this was a breath of fresh air: A little boy in Birmingham Alabama puts on a superhero cape and makes sandwiches for the homeless folks: https://www.cnn.com/2018/05/21/us/iyw-boy-helps-homeless-trnd/index.html

Thanks to Kara for telling me about a book, See you.

It has become a family favorite, check it out.