My mom could go into a room full of chaos. “Once upon a time..” she would start in a steady calm voice.It wouldn’t be long before everyone in the room was hanging on her every word; whatever they had been worrying about a moment ago was forgotten. She would then take her audience on a magical journey with a story that she often made up as she went. If it were a classic tale, you could count on her to take dramatic liberties. I don’t believe she told any story quite the same way twice. In her kindergarten classroom she would have her students shut their eyes as she told her tales. "Use your imagination", she would tell them. "I am thinking of a big black dog, he has 2 floppy ears. He also has 2 tails and 3 eyes!"One distinct recollection of a time when mom’s storytelling saved the day comes to mind. My younger daughter Alana had several friends spending the night. In one of my bigger lapses in good “mommy judgement” I had rented a movie that I thought they would all enjoy. It turned out to be fairly dark and scary (always pre-screen, don’t rely on faulty memory of what may or may not be appropriate.) One of the girls started to cry and some of the other girls started to get sad and upset. A few of them wanted to stop the movie, but of course most of the others wanted to keep watching. The situation seemed like it could go downhill quickly. Fortunately my mom was visiting. She took control, turned off the movie and started to tell stories. These weren’t toddlers; they must have been about ten. They sat raptly listening to story after story. The evening was saved.Books are wonderful too, but in truth, they are perhaps not quite the same as a story. A story is yours to tweak as you please. Stories are powerful mediums for working through issues. Folks who have asked me for parenting advice over the years know that using stories is a favorite tool. For as long as I can remember I have been counseling parents to create a fictional child with a similar name. Talk about what that parallel child has been going through. This tends to be a very non threatening way to talk about all sorts of issues.Once upon a time there was a little girl who had an “owie” ear. The doctor had given her some medicine to make it better, but when she tried the medicine it tasted yucky.”....Once upon a time there was a little boy who didn’t like to stay in bed……Once upon a time there was a little girl who didn’t want to go to school...Once upon a time there was a little boy who liked to put pieces of cheese in his nose….These stories are great ways to launch into a dialogue about all sorts of positive and/or negative ways that the protagonist can deal with a variety of situations. This is an excellent problem solving technique.When I was working on this post, I mentioned the storytelling theme to one of the wise mamas in my life. She immediately referred to these as “Annie Stories”. It turns out that back in 1988 this was quite the thing, and there was a book about how to use this method:I use storytelling at work on a regular basis. I can’t even count how many times I used to be called into an exam room where a crying, or cowering child was terrified of a “dreaded shot”.... I would start my story:“Once upon a time there was a patient who was so big. He played football for his high school. He was bigger than me, he was probably bigger than the grown up in your house, he was really big...and he was really scared of getting shots." At this point 90% of the kids had stopped thrashing about and were now listening to me talk. Yes, they might have been huddled on their parents' lap, or on the floor under the chair. They were probably not making eye contact, but I had their attention.“He wasn’t afraid of getting bumped around on the football field but he hated shots. He was so scared of them that he would try to hide. He tried to hide inside the garbage can, but he wouldn't fit..” Now 99% were actively listening and some were almost laughing.From here I was able to start a dialogue with them about why we were giving the shot. “It is magic protection so that if certain germs get inside of your body, you won’t get sick.” We talked about the fact that we wish there was a less yucky way to get the protection and that it is really normal for lots of people to be scared of shots. We talked about the fact that being brave is trying hard to hold still and it is still really okay to cry and yell if they need to. Before you knew it, they were ready and my wonderful assistant Josie had already gotten it done.It all starts by engaging them with a story.Not everything has to have a purpose. Sometimes stories are just for fun.If I happen to be taking a walk outside and see something unusual such as a pair of shoes, sitting by themselves on a street corner, I can’t help to think to myself. Here is a story. How did those shoes get there? Take turns telling the same story. Families can have a wonderful time creating a collaborative tale. Another wise mama tells me that she used to have her kids give her three things that they wanted the story to include; perhaps a special name or a certain feeling.Our kids these days are both blessed and cursed with the enormous choices of digital wonders. I am not opposed to limited use of regulated tech time, but it should not be in place of plain old imagination.Recent studies show that books and stories started young have a real impact on brain development:This Black Friday, as people run around to shop for all kinds of new technological marvels, don’t forget to “power down” and be thankful for the magic moments that you capture as you snuggle with your kids and simply tell a story. "Once upon a time......
- Head lice/ Sklice co-pay coupon
- Should you give tylenol before the shots? / vaccine reaction discussion
- Skin fold irritations
- HAND FOOT MOUTH (and butt) VIRUS
- Tips for giving medication
- Strep Throat
- The Poop series: Chapter #1 Baby poop
- Nurse Judy' Blog
- Anaphylaxis/Do you need an epipen?
- Pinworms (ugh)
Friday, November 29, 2019
Posted by Nurse Judy at 11:32 AM
Friday, November 22, 2019
Here is my updated food safety guide, just in time for the turkey leftovers
I was recently back in Pittsburgh PA continuing the adventure of clearing out the family home. My long term readers know that this has not been a quick process (understatement!)
Horrifyingly, this trip I found some fairly disgusting food in the fridge that could have qualified as a science project in a high-school fair. Yuck. In some cases like this, it is clear that something has spoiled and no one in their right mind would even open the container, let alone put it in their mouth. Unfortunately, most of the time dangerous food isn’t quite so obvious.
It seems that stories in the news about nationwide recalls of contaminated foods are becoming more and more frequent. Many times safe handling and proper cooking can eliminate most of the risk. This post will give you some good knowledge and resources
Food Safety guidelines
Thanksgiving is a holiday associated with lots of yummy leftovers so it's usually a good time to update my food safety post. If you watch the news you know that food contamination issues can happen all year round. This post will give you some safe guidelines for foods that you buy and cook. If you do a lot of eating out, restaurants are supposed to have their cleanliness rating publicly displayed. Check the bottom of the article for some great links on food storage guidelines; everything from egg safety and turkey leftovers to breastmilk storage.
It is certainly not a sterile world. As soon as they are able, your baby will start putting anything that they can reach into their mouths. You can't even begin to imagine the phone calls I have gotten about icky things that some of my little patients have managed to get their hands and mouths on. Chap-stick, particles from an exploded hot pack, kitty litter, the little packet in shoe boxes that says do not eat. You name it, they lick it.
So yes, the world is full of germs, and while I don't generally get too concerned about a little dirt here or a big sloppy dog kiss there, foodborne bacteria can be nasty, and we need to minimize any exposure.There were over 300,000 reports of children under the age of five being impacted by tainted food last year alone.
Infants and young children are particularly vulnerable to foodborne illness because their immune systems are not developed enough to fight off infections. This is especially important for infants under 6 months of age. Extra care should be taken when handling and preparing their food and formula. Here are some basic food safety guidelines:
Wash hands for at least 20 seconds before food preparation. Soap is best. Hand sanitizer will do. Re-wash as needed after handling food that might carry germs. The most common offenders are poultry, meat, raw eggs.
Make sure kitchen towels and sponges are changed and cleaned frequently. Sponges can go through the dishwasher. Cloth can get easily contaminated and then spread germs. Watch out for potholders or other cloth items that come into contact with raw food.
Keep your refrigerator temperature at 40 degrees or colder. It is worth investing in an appliance thermometer so that you can keep track. All the science says that the 40 degree number is essential for keeping the bacteria from multiplying.
Your freezer should be below 0 degrees. To ensure the safety of your frozen food, you need to be sure that it has been actually kept constantly frozen. One clever trick to make sure of this is to keep a baggie filled with ice cubes in the freezer. If they remain cubes, you are in good shape; if they melt and refreeze as a block of ice that means that at some point your freezer was not cold enough. This can happen in a power outage or even if the door wasn't kept tightly closed. I am sad to say that if there was stored breast milk in there that has thawed and refrozen, I would no longer consider it safe. Label things in your freezer and rotate so that you are using up older stuff first.
Check the dates of baby food jars and make sure the lid pops when you open them.
Don't put baby food back in the refrigerator if your child doesn't finish it and you used the "used" spoon to take the food directly from the jar. Your best bet - simply don't feed your baby directly from the jar. Instead, put a small serving of food on a clean dish. Add more as needed with a clean spoon. Remember that once saliva has come into contact with the food it is no longer sterile and some bacteria can grow quickly.
Powdered formula is NOT sterile. Don't mix up more than you need in advance. If the infant is less than 4 months, I would mix it with boiling water and let it cool.
Don't leave open containers of liquid or pureed baby food out at room temperature for more than two hours. Bacteria thrive in temperatures between 40-140 degrees
Don't store opened baby food in the refrigerator for more than three days. If you are not sure that the food is still safe, remember this saying: "If in doubt, throw it out." See links below for guidelines on how long food stays safe.
Make sure that foods are properly cooked. A food thermometer is the best tool for this.
Chicken ( white meat/ dark meat)...170/180
For all of you "older kids" who will be baking this holiday season, watch out for the batter (I am a notorious offender.), Even one lick from raw food containing a contaminated egg can get you ill.
Myth: Freezing food kills harmful bacteria that can cause food poisoning.
Fact: bacteria can survive freezing temperatures. When food is thawed, bacteria can still be present and can begin to multiply. Cooking food to the proper internal temperature is the best way to make sure any bacteria is killed.
Myth: vegetarians don't need to worry about food poisoning.
Fact: Fruits and vegetables are an important part of a healthy diet, but like other foods they may carry a risk of foodborne illness. Always rinse produce well under running tap water. Never eat the pre-washed 'ready to eat' greens if they are past their freshness date or if they appear slimy.
Myth: Plastic or glass cutting boards don't hold harmful bacteria on their surfaces like wooden cutting boards do
Fact: Any type of cutting board can hold harmful bacteria on its surface. Regardless of the type of cutting board you use, it should be washed and sanitized after each use. Solid plastic, tempered glass, sealed granite, and hardwood cutting boards are dishwasher safe. However, wood laminates don't hold up well in the dishwasher. Once cutting boards of any type become excessively worn or develop hard-to-clean grooves, they should be discarded.
Myth: Locally-grown, organic foods will never give you food poisoning.
Fact: Any food, whether organic or conventional, could become unsafe with illness-causing foodborne bacteria at any point during the chain from the farm to the table. Consumers in their homes can take action to keep their families safe. That is why it is important to reduce your risk of foodborne illness by practicing the four steps: Clean, Separate, Cook, and Chill.
Some excellent resources for food safety tips can be found at:
www.foodsafety.gov This site keeps track of any food recalls
www.Stilltasty.com This is as great site for seeing how long food will last. I used it just this week to figure out if an open can of chickpeas was still good. (After a week, the answer was no)
www.fightbac.org This site has loads of kid friendly activities
Enjoy your Thanksgiving!
Posted by Nurse Judy at 9:44 AM
Friday, November 8, 2019
This week's topic
Car Seat Safety Guide 2019
Kids grow! Make sure they are strapped in properly!
Car seats are an essential part of keeping your child safe. Countless children’s lives are saved annually by being properly installed in a car seat during a crash. Governor Jerry Brown signed a law that went into effect on January 1st, 2017. This law requires children be rear facing to a minimum of 2 years old:
It is recommended that they remain rear facing until as close to age 4 as possible! More and more studies are showing that rear facing is the safest place and position in the car. In fact, it is 5 times safer than forward facing.
In the case of an accident, a child's head and spine are better protected if the car seat is rear facing. One study shows that children ages two and under are 75 percent less likely to die or be severely injured in a collision if they face the back. I know kids might appear to be squished but most children are actually quite comfortable sitting criss-cross, or with their legs up the seat. For those parents/caregivers who are concerned about leg room, Graco has released the Extend2Fit, a new seat which has a 4-position extension panel that provides 5" of additional leg room.
Children who are 40 pounds or 40 inches are exempt from the law and can face forward, but while they may be exempt from the law, they are not exempt from the laws of physics. Rear facing is safer. Please take a moment to click the link below. This video is a good illustration about why rear facing is so important:
Toddlers who have outgrown the rear facing weight or height limit for their car seat should use a forward facing car seat with a harness for as long as possible, up to the highest weight or height allowed by the car seat manufacturer.
The current California law also requires a car seat or booster seat until your child is 8 years or 4 ft 9 inches. Height parameters make more sense than the previous weight ones. For a child to safely transition into a booster, we look beyond the child's age/height/weight. There's another set of criteria to help determine if your child is ready to transition to a booster. There is a '4 Step Test', in which all criteria should be met; don’t dismiss the importance of Step 4!
1. Child is an absolute minimum of 40 lbs
2. Minimum of 4 yrs old
3. There is a lap & shoulder belt in child's seating position
4. The Child can be trusted to sit properly for the entire trip, every trip - even while asleep. This means no slouching (back straight up against seat), no leaning to either side, no playing with the belt, etc...even unsupervised.
Developmentally, most children don't meet all of these steps until somewhere between 5-7 years old, and generally closer to 6 or 7 than 5. A lot of this has to do not only with physical maturity, but emotional maturity.
This is one of those times in your parenting life where your child NOT graduating is actually a good thing. The longer your child is harnessed, the safer and more protected they'll be. Your child needs to be tall enough so that the seat belt goes across the chest, not across the neck. The purpose of a booster is to properly position a child in the adult-intended seat belt. What you’re looking for is proper belt fit across the lap and shoulders - the belt should be low and tight on the hip bones (not on the belly), and should be hitting the shoulder bone, not the child’s neck.
Be aware that most newer car and car seat models use the LATCH system ( Lower Anchors and Tethers for Children). The Latch system attaches the car seat to the vehicle through anchor points that are installed in the car and connectors on the car seat. This is supposed to make the installation easier as well as eliminating potential errors that can result from installing a car seat with a seat belt. The LATCH system has a 65 pound weight limit. What many parents are surprised to find out is that this limit includes the weight of your child as well as the weight of the car seat (some can weigh up to 25 pounds!).
When children are old enough and large enough to use the vehicle seat belt alone, they should always use Lap and Shoulder seat belts for optimal protection. To determine if your child is ready to sit unassisted, they must pass the 5-Step test:
The 5-Step Test:
If you’ve answered NO to any of the above, your child should remain safely boostered!
If your children complain about this rule, show them photos of race car drivers all bucked up in their restraint system. Be matter of fact about it and explain that there is no compromise for safety (there is also a mighty large fine if you are caught breaking this law.)
All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection. Airbags can actually be quite dangerous to a child so it is worth making sure that this isn't an issue with your car and the placement of your child's safety seat.
Picking the right car seat
If you are looking to buy a new car seat, check out these helpful links. The folks from Reviews.com sent me the following resource guides:
We recognize how difficult it can be to find the right information on car seats, so we evaluated both infant and convertible styles to help inform parents. To find the best, we consulted with child safety experts, dove into federal ease-of-use ratings, surveyed hundreds of parents, and then took a closer look at the top options. You can see our guides here:
If you are someone who doesn’t own a car and is popping the car seat in and out of car services, finding one of the cars that is easier to install in becomes even more important.
Making sure it is installed correctly!
The AAA states that 75% of car seats are installed or used improperly. As your child grows, there are services offered here in the San Francisco Bay Area that will check out your car seat or booster seat and make sure it properly installed. Have the infant car seat checked before the baby is born and then again with each transition to a larger seat.
Below are some local resources for making sure that not only is your car seat properly installed but that it is the right fit for your child's size and age. They can make sure that all the straps are where they need to be and that you pass the "pinch test", making sure that the seat's harness is tight enough
To be super safe, consider having the car seat fit and installation checked every 6 months. The reality is unless you are a certified child passenger safety technician, you’re not aware of some of the nuances of different kinds of seat belt systems, different features on different car seats.
When you go to get help with your car seat make sure you go to a certified car seat technician. Then you will know you are getting the best information available.
CHP (California Highway Patrol) 415-557-1094 This is a very popular, and by appointment only. Please make an appointment as far in advance as possible. The current wait when I called to update this post was pretty short, but it varies and sometimes can be longer than a month. The inspections are done at 455 8th Street in San Francisco.
SFPD 415-575-6363 They try to have an officer at all of the local police stations who is trained to do the car seat safety inspections. Call the number above for more info.
The Colma police department 650-997-8321 does a car seat inspection for free. As with the other options, this is by appointment only.
Willing to pay to have someone come to you?
The following links can you assist you in finding the right car seat:
The National Highway Traffic Safety Administration website has a place to click to find updated local car seat inspection stations for those of you who are not in the Bay Area.
NHTSA/Get Your Car Seat Inspected has a page where you can plug in your child's age and size and they will tell you what type of seat they should be in.
Car Seats for the Littles - Car Seats for the Littles gives lots of great info about the specific brands of car seats on the market
Car safety doesn't end with being safely buckled. I know it is hard to avoid distraction with a baby fussing in the back seat. Consider getting one of the specially made mirrors so that you can keep an eye on your rear facing baby. Make certain that they can't reach anything that is a choking hazard.
Don't let them hold the keys; they can lock you out!!
If your child is asleep in the car seat and you have arrived at your destination, leaving them snooze for a few minutes is fine as long as they are supervised, but keep them tightly buckled. Having a baby in a car seat without being tightly strapped in not safe. The loose straps can be a safety hazard.
WINTER CAR SEAT TIP: The straps need to be tight up against your baby; puffy coats or blankets need to be OVER the straps!
Never leave your child unattended in a vehicle. Children can die from prolonged exposure to excessive temperatures in a hot car.
Most accidents happen within a few miles of your house. Even a short trip down the block requires the full "buckle up". Hey parents, model good behavior and always make sure you fasten your own seat-belt!
Did you know that car seats expire? Most of them have a 6-9 year life span. This date can usually be found underneath or behind the seat. Buckles and straps can wear out. Prolonged exposure to sunshine can weaken the plastic. Also, the technology is always changing and this ensures that nothing gets too out of date. Save the instructions/registration in a safe place. I know most of us never register the products we buy but make sure you register your car seat! If there is ever a recall, this will ensure that you are notified, and this is one of those products where you must know if there is an issue!
Let me close by confessing that I am NOT a car seat expert. The seats that my children grew up with were much simpler (but not nearly as safe!) When I see new parents struggling with all the straps and trying to figure things out, I am often as clueless as they are.
Here is the takeaway message. Putting your baby or older child in a car seat is an essential skill that you need to learn in order to travel with them safely. Find an expert to help you master this and make sure that you are using the car seat restraint properly. Safe travels
Posted by Nurse Judy at 8:44 AM
Friday, November 1, 2019
This post is geared for families with kids who are no longer infants.
It is that time of year. Our mailboxes are filled with flyers telling us to vote yes on this and no on that. The phone is ringing and if it isn't the IRS, it is possibly the recorded voice of a celebrity telling you why to support a candidate.Television and radio spots are election related. Many give a collective sigh of relief when election day comes and goes. But take a moment and remember what it’s all about.
It was drilled into me at an early age that voting matters. I have early memories of going with my parents to their polling place. Knowing something about the issues and people running for office is our responsibility. Of course growing up in Pennsylvania was quite a bit different than the robust California ballots that we are faced with here. Having to figure out how to vote on all of the propositions can be overwhelming.
Let your kids see the process. Invite friends over to talk about the issues. It is a great way for them to to see that many of the ballot measures are multifaceted and often not black or white. How do you weigh all of the arguments? How do you sift through all of the information to find the points that sway you the most? How do you deal with friends and family who are of different opinions. How would they vote if they were eligible? Why? There are so many talking points and lessons to be learned.
If you vote by absentee ballot, have your kids help you fill them in and put them in the mail. If you go to the polls, take your kids with you. And wear your "I Voted" sticker proudly.
Posted by Nurse Judy at 10:03 AM