- 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, December 25, 2020
The Christmas Cactus My grandmother had an enormous plant known as a Christmas cactus. They are known to bloom once a year. December is a common time for the flowers to come out, hence the name. Grandma gave a cutting to my mom. The cutting that my mom had thrived. It didn’t know that it was supposed to bloom just annually and would occasionally burst into bloom throughout the year. My older sister inherited Grandma's plant which also seems to have a mind of its own. Regardless of what was going on in the world or her personal life, mom would be joyful every time the plant bloomed. For her it was a signal of hope and positive energy. It was infectious and the entire family would somehow feel a lift. Prior to Covid, and when my parents were still alive, I made sure to go home to Pittsburgh every four months or so; these visits were even more frequent as both my parents got older. Scoff if you like, but more often than not, the plant would flower right before my visits and stay that way for several weeks. When mom died, my sister gave me a cutting of the plant. To say that I have not been very good at keeping plants alive is an understatement. Fortunately, Sandy has taken on the role of the plant tender. Historically he was no better at gardening than me, but after years of killing anything even remotely green, we now have an array of indoor plants that are flourishing under his care. The centerpiece is the offspring of the family plant. It has quadrupled in size since we have had it. I have given cuttings to my daughters. This week it burst into flower. It magically fills me with a sense of optimism. I feel my mom’s presence. Goodness, we all need hope and optimism more than ever after this year. Between the pandemic, the economy, the divisive politics, the climate woes, 2020 will be a year that most of us will be happy to see the last of. We all have pandemic fatigue. Please hang in there. The cactus is blooming. We are almost in a new year. Things will be better.
Friday, December 18, 2020
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 direct question and press for an answer, please don’t lie. 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 about Santa, we can put him 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. The Covid pandemic has added an extra layer to the conversation. This year some kids are worried that Santa will either have issues with social distancing or have trouble taking the time to wash his hands in between the houses that he visits. Talk about a potential 'Super Spreader'! 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 wrote this post a few years ago, 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, if you want to extend the magic for another year, you might deflect the questions fairly easily without telling a falsehood. 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, even virtually, who are 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 devastated 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: Even when Covid is no longer an issue, 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. If the kids are up for it, there are places that are making socially distanced Santa Visits possible this year. https://datebook.sfchronicle.com/entertainment/where-and-how-to-get-your-2020-photos-with-santa-in-the-bay-area
Friday, December 11, 2020
Dental Care 2020 Scroll down for the list of dental practices Covid has complicated so much of our normal lives. Doing a risk/ benefit analysis for daily activities can become so tedious. One of the questions many of my patients have asked me is about routine dental care during the pandemic. The current official recommendation now is that your child should have his or her first dental visit by age one, and this does not change due to COVID. In California, about one third of preschoolers have dental decay. It is much easier to prevent decay in toddlers' teeth than to fill a cavity in a young child. Tooth decay is the most common chronic childhood disease and it can be prevented. I reached out to Dr. Rothman who was my daughters’ beloved dentist (he made them laugh and they actually enjoyed seeing him!) Dr. Rothman has remained a trusted resource for me over the years even though my girls aged out of his practice. It turns out that he was the right person to ask! He actually chaired part of the Covid19 workforce on dental practices. He pointed out that dental practices were among the first to really deal with infection control. They have been using masks, gloves and face shields long before this pandemic. His office worked closely with the California Department of Public Health and Cal Osha when they developed practice guidelines and checklists. Dentist offices might actually be one of the safer places to bring your child. It IS considered an essential visit. Sadly, Dr. Rothman told me that he is seeing a real increase in cavities and gum disease that corresponds with people not going in for their routine dental visits. As parents, we may think, "baby teeth fall out, so we don't need to worry about them." This sounds logical, but unfortunately is not true. Luckily, dental science has found out many new facts about how to prevent dental decay. We now know that bacteria causes tooth decay. This "bad" bacteria can find its way into your babies mouths in many ways. Eating foods high in sugar is one of the most obvious offenders. In order to prevent decay in our adult teeth, baby teeth have to be kept healthy as well. What can you do to keep your child's teeth healthy right from the start? For the youngest babies with brand new teeth you can wipe them off with a soft piece of gauze or a wet washcloth. Not only are you cleaning off the teeth, (breast milk does have sugar) but you are getting the baby used to a routine. Training your child from the start that teeth get brushed is a good way to create good dental habits that will last a lifetime. There are other options besides the standard hand held toothbrush. For very young babies, there are little flavored towelettes specially formulated for wiping baby teeth. Spiffies was the first of these that I was familiar with. Now there are several brands available. You could also consider using a soft finger brush. These fit over your finger and if your baby will let you, this option allows you to get in there and do a nice thorough job. If you use a regular toothbrush, make sure it has soft bristles. Replace the brush when it looks like the bristles are getting worn. It is also a good idea to run all the family toothbrushes through the dishwasher every once in a while. One extra perk about routine dental care is that you might walk out of the dentist's office with a new toothbrush! Younger children will have an easier time handling a toothbrush with a thicker handle. Perhaps you can let your child be in charge for one brushing a day and the parent be in charge of the other; that way you know you are doing a more thorough job at least once a day. Some people use a two toothbrush approach. Toddler gets to hold one, but so do you. Both of you can be in there at the same time. Consider putting a little tune on while you brush. This can act as a timer. Brushing is ideally supposed to last 2 minutes. Do the best you can. A full two minutes might be a goal that is a little unrealistic for many of my patients. Brushing can be a little more fun and interactive nowadays with some fun apps. Sonicare-for-kids-sonic-electric-toothbrush brushdj brushupgame DisneyMagicBrushTimer TinyDentist Chomper chums my-bright-smile Don’t let it be too active, I once had a patient who got a fairly serious mouth injury from doing a little rough housing while brushing his teeth. Make sure your child isn’t running around with a toothbrush in the mouth. The American Dental Association recommends using a tiny amount (just a little dab) of fluoride toothpaste. It is important to note that too much can be harmful so keep the amount as small as a grain of rice. Once kids get to be over two and can spit it out after brushing, you can use a pea sized amount. Xylitol is another recommended ingredient for dental health. It is found in some toothpastes. This natural sweetener is found to help reduce bacteria and strengthen tooth enamel. It is important to use a toothpaste that is non abrasive: https://www.bestdentistguide.com/non-abrasive-toothpaste/ Most kids' brands are specially formulated to be gentle. Some adult ones are fine. Some toothpastes will have the abrasive rating noted on the package but it isn’t always easy to find. Ideally try to brush twice a day and floss once a day (for teeth that are touching.) Pay attention to habits that may or may not be good for your teeth. Children who are “grazers” tend to have more cavities than those who eat less frequently. Saliva neutralizes the acids in the mouth and actually ‘washes’ the teeth, but it needs about 2 hours in between meals to work. If someone is constantly eating, the saliva isn’t getting a chance to do its job. Foods that are high in carbohydrates and sugar are not healthy for our teeth or general health. A daily intake of 60 grams of carbs or higher more than doubles your chance of getting caries (and all that sugar can lead to type II diabetes in kids!) FINDING A DENTIST Find a dentist that treats very young children and bring your child to his or her first appointment when the first teeth erupt - no later than by age one. During the visit, the dentist will check your child for dental decay and talk to you about cleaning your baby's teeth. They might also talk to you about proper nutrition for keeping baby teeth healthy. If you have any concerns about the manner in which the teeth are erupting, having a dentist who is familiar with your child will be very useful. Another important thing to think about is that having a dentist can come in very handy if you happen to have any dental emergencies. Kids have accidents! It is not unusual for me to get calls about chipped or loose teeth after a fall. I usually suggest that they contact their dentist on those occasions, and the folks that already have one are way ahead of the game. If there is a dental emergency, early intervention can be the difference between saving the tooth or losing it. Some parents avoid taking children to the dentist to save money, yet studies show that the dental costs for children who have their first dental visit before the age of one are 40 percent lower in the first five years of life than for those who do not see a dentist before their first birthday. Consider this when deciding whether or not to add your child to your dental plan (if you are lucky enough to have one.) When I was working at Noe Valley Pediatrics, I compiled a list of popular practices based on patient feedback. Full disclosure, this list is from my 2018 post. There are lots of great practices that are not on my radar. We are fortunate to have lots of excellent choices in our city. If someone is conveniently located or is on your insurance plan that is certainly worth consideration. Many of them have updated their websites to reflect their COVID precautions. If the practice has not posted their protocols, it is very reasonable to call and ask. David Rothman 415-333-6811 is over on Ocean avenue near Stonestown. He was my kids' dentist and they loved him. He is an excellent dentist with a wonderful sense of humor. His office is able to do procedures under general anesthesiology in the office if needed. He remains my "go to" guy if I have any tooth related questions http://www.davidlrothmandds.com Bergen James, Doris Lin-Song and Jennifer Yu 415-668-3500 http://oneparkerpediatricdentistry.com/ Claudia Masouredis 415-753-2777 http://www.drmasouredis.com/ Dorothy Pang 415-681-8500 is on Taraval and 18th in the Sunset. Dr. Pang is affiliated with the UCSF dental school. If someone needs a dental procedure under anesthesiology she can do this at UCSF rather than in the office. http://www.opdsf.com/ Raymond Katz 415-751-7900 This practice is at 5233 Geary. https://www.sfdds4kids.com/ Han Pediatric Dentistry 415-681-3220 Dr. James Han’s office is at 1530 Noriega Street. Dr Han is also on staff at CPMC and attends any dental emergencies at the ER there. He can perform general anesthesia cases in the OR there as well. www.HanPediatricDentistry.com Dr. Charles Spitz and Dr. Tyler Davis 650-375-8300 Peninsula Pediatric Dentistry and Orthodontics. If you are looking for a practice down on the peninsula, this great practice is located in San Mateo. Dr. Davis works with Dr. Spitz, who used to have a practice in the Mission. They are located in the Mills Medical Arts building on the corner of South San Mateo Drive and 2nd Avenue in downtown San Mateo. http://www.spitzanddavis.com/ "We are a preventative practice first and foremost. We believe the best dental care is personalized to meet the individual needs and preferences of each child we see. We work hard to get to know our patients and their families. We're always willing to listen, to discuss options and to answer your questions." Anne Lee DDS 650-873-5212 Anneleedds.com Kid Smiles 415-681-5437 http://www.681kids.com/ There are some low cost options available as well. If you need assistance in finding a dentist, or low-cost children's health insurance in San Francisco, please call the Women and Children's Health Referral Line @ 1-800-300-9950. Low Cost Dentist options
Posted by Nurse Judy at 3:38 PM
Friday, December 4, 2020
This week's topic Talking Barbie takes a Bath This post is not going to educate or problem solve, but it might make you giggle, which is actually what we all need these days. Sandy’s uncle Bernie was a very senior executive at Mattel, and a friend of Ruth Handler, the inventor of Barbie. What this boiled down to was that every December, an enormous box would be shipped to our house filled with the latest toys, and dolls. My girls ended up with an absurd amount of Barbies. And we even had boxes labeled with extra Barbie parts - arms, legs, heads... My kids could entertain themselves endlessly with these. My sister-in-law Barbara was just recounting a memory of watching her nieces play with the dolls. At one point Lauren declared “This is boring. Let’s play Barbie in Russian”. They proceeded to continue the activity that looked to be completely unchanged, but now the various Barbies spoke to each other with Russian accents. Somehow this added just the element of excitement that was lacking, and the play happily continued. One year, a very special Barbie made an appearance. This one talked. When you pushed the button on her back she would come out with a multipart statement such as “ Want to go to the Beach? With Ken? Tomorrow?” When you mixed and matched, it turned out to be a pretty wide range of Barbie appropriate statements (no Russian accent). This was a long time ago. My 4 and 7 year old daughters shared a bedroom and the third bedroom in the house was an office/toy room. One evening the girls were in the tub. They had brought some dolls in there with them. They were past the age of needing eagle eye supervision, but I was in my room keeping an ear out when I heard the new Barbie chatting. I went into the bathroom and said, “this Barbie should probably not be in the tub. I don’t think she should get wet.” No problem; they handed her over and I put her away. A short time later I heard her talking. “ Want to get some pizza/ with Skipper? On Monday?” “Hey girls...I told you Barbie can’t be in the tub” “She isn’t in here!” This is when I heard Sandy pipe up from the office…”uh, she is in here.” So, there she was, right where I had left her, just occasionally coming out with something to say. We figured at some point it would just stop. Bedtime routine continued and the girls were tucked in. Sandy and I were down in the kitchen when some time later the girls appeared; they were laughing and holding the Barbie. “We can’t fall asleep. She is keeping us up.” Sure enough, Barbie was now ranting and it was LOUD. “Pizza, shopping, beach, Ken, Ken….” Sandy, who was always the bedtime enforcer, took the doll and said, “okay...back up to bed, we will take care of her”. He wrapped her up in a towel and you could still hear her yacking away. So we did the next obvious thing, we opened the oven door (it wasn’t on of course) and put the towel wrapped rambling Barbie in it. You could still hear her. It was a little Twilight zone-ish. We looked at each other at the same time and said “batteries, Duh!” Laughing at ourselves that our ‘obvious’ solution had been to wrap her up and try to muffle her, we retrieved Barbie from the oven and with the help of a small screwdriver, removed the battery. We left her on the kitchen counter. The next morning, I was down in the kitchen making lunches for the kids to take to school (Alana in general refused sandwiches so I always had to be a little more creative.) I was still a little sleepy, so when the Barbie, sitting on the counter suddenly said “Do you want to go shopping?” I confess that I let out a scream and dropped whatever I had been holding. Unbeknownst to me, Sandy had replaced the battery before he left for work Since she was no longer yelling, we let her talk herself out until the battery finally died, at which point she was relegated to the status of just another Barbie. Wishing you all a season filled with plenty of things that make you smile!
Posted by Nurse Judy at 8:46 AM
Friday, November 27, 2020
The day after Thanksgiving is typically when people start thinking about the upcoming Holiday season. Flip through some radio stations and you are sure to find seasonal songs playing already. According to a news story that I was watching this week, people are actually starting to decorate for the holidays even earlier than usual because, well…..we need to be cheered up after this horrible year. Early tree sales are soaring. Over the years I have continued to update my holiday safety post. Whenever I think I have seen it all, strange accidents and events come to my attention and get added to the list. This year aside from warnings about candles, trees and lights the biggest safety issue is a sad one.....Stay away from people who are not in your quarantine bubble. I know that there are probably a number of you who are relieved that you have an excuse to avoid the large family gathering, but for others it is heartbreaking to be away from larger, traditional gatherings. The COVID numbers are frightening. Just a few weeks ago, things looked like they were improving. Alana and I gleefully got our first pedicures in more than 8 months. Now? Looking at the uptick in cases, I wouldn’t have taken the chance. Back in June I did a post that addressed the risk/benefit for easing out of the restrictions. Your health and the health of your family are simply more important than a holiday gathering. I fear that many people ignored all the warnings and gathered for Thanksgiving this week. I hope I am wrong, but if I am not, we can expect even a bigger increase in cases as well as a strain on the hospital systems in the coming weeks. If that is the case, I would be really nervous about going anywhere! Go ahead and decorate your house (safely) Make your wonderful meals and create a magical atmosphere in your home, but please please make smart choices when it comes to leaving the safety of your bubble. Holiday Safety Checklist Have you thought of everything? The lights are twinkling and the radios are playing the holiday tunes. People are putting up the holiday decorations. It is time for the holiday safety post. Take a moment to give this a careful read. There may be some things that hadn't occurred to you. For most people, the holidays are a time for celebration. That means more cooking, home decorating, entertaining, and an increased risk of fire and accidents. For every aspect of holiday celebrations, I can tell you the story of a patient who called with a related accident. It is not my intent to scare folks with my tales. As I tell parents who attend my safety class, if you know ahead of time what accidents can happen, you have a way better chance of avoiding them. I have seen some wild and improbable things over the years. Baking cookies is just one example. A patient's mom called to tell me that her 10 month old had sustained a burn on his hand. She was holding him in the crook of one arm as she removed the cookie sheets from the oven. As she recounted, he turned into a cartoon character with a telescoping reach and he was able to stretch across her body and grab a hold of the piping hot tray. Simple solution: don't hold your child when you are working with hot stuff in the kitchen. Their arms are longer than you think. If even one accident has been prevented, this post was worth it. Candles are another hazard. It was a winter evening many years ago in a cabin at Lake Tahoe. Dr. Jessica and family lit some holiday candles and went to sleep. Somehow one of the candles ended up burning a hole through a plastic mat that was on the table. Luckily the smell of burning plastic woke them up before any real damage was done, but it was a frightening lesson. This was a vacation rental. In this instance, there seemed to be no working smoke detector. She had no idea if and where there was a fire extinguisher. There are several obvious lessons here. Never go to sleep with candles or a fireplace still burning. Get acquainted with the safety features of any place your family is staying. Below are some safety considerations for dealing with the holiday season ahead. Some of these may seem like common sense but there might be a few tidbits in here that I am betting you haven't thought about. Beware of button batteries. They are everywhere nowadays in all sorts of small electronics (and musical cards) and can be quite hazardous if swallowed. Take time in advance to do a mental inventory of items that you have around that may be powered by these. Put a piece of duct tape over the battery compartments to make sure they can't fall out. Certain holiday plants like poinsettias can be mildly toxic (especially to someone with a latex allergy). You may not have them in your own house, but if you are visiting a friend or even a supermarket make sure little hands don't grab the pretty red leaves and put them in their mouths. Be very careful transporting hot food to a holiday potluck. I have patients who have been burned from hot food spilling on them in a car. WARNING TO PET OWNERS! One of my patients had a tragedy several years ago. An eight year old healthy dog got into a wrapped package that was filled with chocolate. The amount ingested proved to be too toxic for this little dog to handle and they didn't make it. Please don't let this happen to you. Make sure that any mystery packages are nowhere near where a pet can get to them. Christmas tree checklist: When purchasing a live tree, check for freshness. A fresh tree is less of a fire hazard Cut 1-2 inches from the base of the trunk immediately before placing the tree in the stand and filling with water to ensure absorption. Don’t add chemicals that might be toxic to kids or pets. A dash of plain 7 up can help keep the tree healthy. check the water level daily to avoid the tree drying out When purchasing an artificial tree, look for the label "Fire Resistant" Never use electric lights on a metallic tree. The tree can become charged with electricity from faulty lights and a person touching a branch could be electrocuted. Place your tree at least 3 feet away from all heat sources, including fireplaces, radiators and space heaters Make sure the tree is steady enough that it can't be pulled over by a toddler. You may need to attach it to something solid. Trust me, trees get knocked or pulled over. Older kids running around can cause this issue, it isn’t just toddlers. Trim your tree with non-combustible or flame resistant materials. Before using lights outdoors, check labels to make sure they have been certified for outdoor use. Make sure all the bulbs work and that there are no frayed wires, broken sockets or loose connections. Plug all outdoor electric decorations into circuits with ground-fault circuit interrupters to avoid potential shocks. Strings of lights and garlands are a staple of holiday decorating, but they can also pose a strangulation hazard. Avoid trimming the tree with things that look like candy which may pose a temptation to the kids. Keep sharp, glass or breakable ornaments out of reach of small children. Holly berries and other small decorations can be choking hazards. Don't overload extension cords; make sure that your extension cords are high quality. If you are going to use your fireplace, make sure that you have the chimney checked and cleaned if it has been awhile since you built your last fire. (make sure that it isn’t a spare the air day) http://www.sparetheair.org/stay-informed/todays-air-quality This is not a safety issue, but it is worth mentioning. Is your child exhibiting any new allergy symptoms? Take a minute to consider whether or not they started during the holiday season. Trees, scented candles and other seasonal extras can trigger some allergies. Hanukkah doesn’t fall on the same date every year since it is based on a lunar calendar. Many folks laughingly refer to it as coming either “early or late”. It also has more spelling variations than any other holiday. This season the first candle will be lit on the evening of Thursday December 10th. Make sure that all candles are safely out of harm's way. The menorah should be on a glass tray or aluminum foil. Make sure candles are not close to wrapping paper. Don't go to sleep with candles still burning. Don't leave the matches or lighters hanging around. If you are frying latkes (fried potato pancakes that are a holiday tradition, yum) make sure that no one gets splattered by oil and of course, never leave the hot oil unattended Remember that adding water to a grease fire will make it worse! Baking soda is okay, but a fire extinguisher is best. Make sure you know where it is and how to use it. Kwanzaa may be the safest of the holidays, (no hot oil or stressing the electrical outlets) but there are still candles involved, so make sure they are placed in a safe place and toddlers don't have access. If I missed any holidays, let me know! I will add them to this post in the future. This is also a great time to test your smoke alarms and carbon monoxide detectors!!! Stay safe and have a wonderful holiday season.
Friday, November 20, 2020
I have always loved Thanksgiving. For more than 25 years, several close families have joined with ours to create wonderful holiday traditions. Our typical celebration includes deep fried turkey, boozy cranberry sauce, my grandmothers award winning apple chocolate chip cake (recipes below), games after dinner and Sandy wearing his special "uglier than you can imagine" Thanksgiving pants. Mostly it was about friends and family gathering with our numbers growing every year as we would figure out how to creatively fit more people around the table. One fond memory from many years ago comes to mind. My daughters were probably 6 and 3 years old. We were taking turns sharing our thoughts about what we were thankful for. This was long before an activity like this would simply bring on heavy eye rolling from Lauren, but at the age of six, she embraced this activity with a gusto. She was thankful for rainbows and sparkles, family and love...she went on for several minutes with a fairly classic list of things that made a 6 year old girl feel happy. The other kids at the table followed her lead and the lists of things to be grateful for were getting longer and longer. Then it was 3 year old Alana’s turn. “Lani, what are you thankful for?” There was a moment's pause and the one word answer. “Soda” This year of course we will be putting our more than 25 year tradition on pause. My usual 30 people will be limited to 6 (this will ensure that there is plenty boozy cranberry sauce to go around.) I understand how hard it is to be away from friends and family during the holiday season. I also know how lucky I am to be in a quarantine bubble with my local immediate family. That beats soda any day. For everyone who is impatient and tempted to go to a larger gathering, please be smart. Hang in there for a bit longer. There is a light ahead. I know it is still dim, but it is there. In honor of Thanksgiving, I am reposting my food safety guidelines. There are some terrific links in here that you might want to bookmark for later. 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 more than 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. Beef...160 Chicken ( white meat/ dark meat)...170/180 Fish......160 Eggs....not runny 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 Breastmilk storage guide http://www.eggsafety.org Enjoy your Thanksgiving! Grandma Fuffy’s apple chocolate chip cake Beat together 3 eggs 1 3/4 cups sugar 1 cup oil (can make some of it apple sauce) sift together 2 ¼ cups flour (can substitute cup for cup Gluten free flour) ½ teaspoon salt 1 teaspoon baking soda ¼ teaspoon baking powder Mix together wet and dry ingredients Add ½ cup of chopped nuts ( optional) ½ cup chocolate chips ( sometimes more seem to find their way into the bowl) 4 cups peeled and diced apples ( about 4 apples) this is the only pain in the butt part of this recipe, otherwise it is so easy cook in ungreased 9X13 pan in 350 oven if you use only oil it is about an hour, if you use some applesauce it is done more quickly, use a toothpick to check the center ******************************************************************* Cranberry Puree (8 servings) 1 pound of fresh cranberries 2 cups of sugar 3/8 cup of Marsala wine ½ cup of Grand Marnier 1/8 cup of Angostura Bitters Cook cranberries and sugar in heavy medium saucepan over medium heat until cranberries are very soft, stirring frequently, about 20 minutes. Puree mixture in blender with half of Marsala wine. (The original recipe says that you should strain this mixture into a medium bowl, pressing to extract as much fruit as possible, although I don’t bother with this step as I think the texture with the seed and fruit bits is more interesting.) Whisk in remaining Marsala wine, Grand Marnier, & bitters. Cover and refrigerate overnight. (Can be prepared up to 5 days ahead.) Serve well chilled. (The amounts of alcohol can be decreased but not by more than ½ of what is called for; the less liquids added, the more jelly-like the puree.) Don't eat this cranberry sauce and drive!!
Posted by Nurse Judy at 9:49 AM
Friday, November 13, 2020
RSV season November is considered the start of RSV season. It will be interesting to watch this year to see if the social distancing and masking makes this season easier. RSV State Trends If your child was premature, or has cardiac or pulmonary issues, talk to your doctor's office ASAP to find out if your child fits into the guidelines to get a medication called Synagis As of now, we can’t do anything to prevent the flu or Covid for these youngest and most vulnerable patients, but we CAN do something about RSV. Since many of us are doing our best to limit exposure to others, I am keeping my fingers crossed. According to the data from this week, we are still in good shape. In any event it is worth educating yourself about this virus, so I have updated my post from several years ago. If you have a baby who was premature or has any cardiac or lung issues, make sure you pay special attention to this post and click the guidelines link above. What is severe RSV disease? Respiratory syncytial (sin-SI-shul) virus, or RSV, is a common, seasonal, and easily spread virus. In fact, nearly all children will get their first RSV infection by age 2. Like most viruses, it ranges in its severity from case to case. Covid tends to be easier on children than adults. Not so with RSV. Severe RSV disease is the number one reason babies under 12 months old have to be admitted to hospitals in the US. You know the wretched colds that knock you flat and stand out in your memory? These are the colds that come with runny noses, sniffling and sneezing, harsh cough and fever. That illness might well be RSV. I actually can almost diagnose it over the phone when I hear the patients coughing. The cough sounds like it hurts. Generally the first signs are runny nose and decreased appetite. The cough follows a few days later. There is a rapid test (a swab to the nose) that many offices can do to see if it is RSV or not, but unless your child is looking really sick, it might not be worth an actual office visit to get an official diagnosis since It doesn't necessarily change the approach. This is a virus and antibiotics would not be appropriate. Time usually fixes this and all that your medical team can offer is often the same symptomatic treatment and supportive care that we would do for any bad cold and cough. Treat the fever as needed To clear the nose, squirt some saline or breast milk in each nostril and then suck it back out with either a Nose Frida/ aspirator or the Neil Med Naspira. I think those are much easier to use than the standard bulb aspirators. Another available product that some parents like is the Oogie bear. This is a safe little scoop that can safely get into the nostril and remove the more stubborn boogers. If your child is having trouble eating because of all the congestion, try doing some clearing about ten minutes before a feeding. It is also helpful to keep their heads elevated. They may need to spend the night in a safe infant seat or you can try to raise the mattress a bit. For older kids, add an extra pillow. Let them sit in a steamy bathroom, and use a humidifier at night. Increase fluids during the day. RSV can cause ear infections and pneumonia. In fact some studies show that somewhere between 25-40% of young infants with the RSV virus will have bronchiolitis or pneumonia. Severe RSV disease symptoms include: Coughing or wheezing that does not stop Fast or troubled breathing A bluish color around the mouth or fingernails Spread-out nostrils and/or a caved-in chest when trying to breathe Gasping for breath If your child is having trouble breathing, or significant trouble feeding, they may need to be hospitalized for a night or two for fluids, oxygen and observation. When I was working in a busy pediatrics office, we routinely had to hospitalize several kids for this every year (not just young babies.) Since most of our children don’t fit the guidelines to get Synagis, please take precautions to prevent the spread of this nasty virus, especially for the youngest most vulnerable babies. Wash your hands before touching your child. Make sure others wash up, too. Clean toys, crib rails, and any other surfaces your baby might touch. Try to keep your baby away from crowds. Avoid anyone with a cold or fever. Don't let anyone smoke near your baby. Tobacco smoke exposure can increase the risk of severe RSV disease. Sadly it takes multiple exposures before you develop immunity. Most folks get RSV about 8 times until they finally seem to be not as vulnerable! It spikes again in older folks when the immunity tends to wane and it can sweep through retirement communities, so be cautious for the older adults in your life as well. If your child is unfortunate enough to get a nasty case of RSV during the season it may take a long time for the lungs to calm down. In my experience it is not uncommon for these kids to have a tough winter. Every new cold seems to re-trigger the wheeze. This does NOT necessarily mean they have asthma. With any cold or illness, RSV is no exception, your best bet is to pay attention to the first sign of illness. Here is my blog post with my list of things you can do to boost and protect your immune system. According to our local pediatric acupuncturist, Dr. Den, at The Acupuncture Den, the actual symptoms are more important than any official western medicine diagnosis. Whether or not it is RSV, a common cold or even teething, if seen in the office early on, a treatment can help the body to heal itself more easily and will also help with symptom relief (non-needle treatment options are available!) If you didn’t manage to stop it in its tracks quickly enough, traditional Chinese medicine can still be very helpful as the infection runs its course. Dr. Den keeps high quality pediatric herbal tinctures stocked in her office, and encourages the families in her practice to keep a bottle or two on hand, as they are most effective when used at the first signs of trouble. While some of the tinctures are highly specific, others can be used more generally (when you know your child is getting sick but you’re not sure yet what’s going on). In terms of the common cold, the flu, and RSV, the two tinctures Dr. Den recommends to keep in your medicine cabinet are CQ Jr (perfect for the first signs of illness) and Lung Qi Jr. (if it starts to move into the chest). For more information about pediatric acupuncture (or grown-up acupuncture!) and/or herbal medicine, please reach out to Dr. Den. She’d love to hear from you! Special thanks to Julanne and Den for their input!!
Posted by Nurse Judy at 9:33 AM
Friday, November 6, 2020
Teaching your child to be a good winner or loser It is our job as parents and educators to teach our kids the all important lesson of how to lose and how to win without being an ungracious %%$%. I started writing this post several months ago, but put it on the back burner. The topic was on my mind from watching the news a little too often. The ability to remain civil and be a good sport seems to be a waning skill. Some adults don’t seem to have the capacity to say, “Congratulations, you won, good job.” When I see an adult acting badly, It gets me thinking, what was their childhood like? Was love and approval conditioned on success? Is success measured solely by winning or losing? Now, after watching this historic election for the past several days, I decided to dust off this piece and finish it. My post about RSV can wait until next week. There will be times in life where we don’t succeed or come out on top. Tools for dealing with those situations gracefully are gifts that you can give to your kids from a fairly young age. This should be an essential lesson for people of all ages Sports and games of all sorts should be a normal part of growing up. Children who are blessed with siblings haven't had to take a break from social interactions. For all the others the quarantine has made that very challenging. After the quarantine, at some point, life will go back to normal. We will return to our normal social interactions. Kids will be put in situations where they are playing and competing. Find time to have real conversations about winning and losing. When your child is having a temper tantrum because they just lost a card game with their sibling is probably NOT the ideal time. When you find that magic moment, here are some talking points. Was playing the game fun? Was the actual activity less fun because you didn’t win? Is there luck involved? Is there skill involved? If you practice, do you think you could improve? Is there knowledge involved? Could you study and learn? Tell stories about people who win and lose and how they act nicely or like spoiled brats. Get out the stuffed animals or dolls and play it through. Exaggerate how sweet and gracious the good winners and losers act. Go over the top acting out the obnoxious poor losers or boasting winners. Who would they rather spend time with? Consider doing the following: We are going to try something. It involves playing a game. For the game, only one person can win. But in the big experiment you will all be awarded points One point for winning the game but three points for: Compassion. Being happy for the person who won Being kind and gracious to the people who didn’t win. By all means, it is perfectly fine to try hard and be proud of yourself for winning. On the other hand, losing shouldn’t be shameful or something we can't handle. We need to teach our kids about what is really important and to recognize when things are less consequential, so that they don’t get consumed with the importance of getting the gold medal. Admittedly some contests are much more important than others, but regardless, character matters! My daughter Lauren ( Inclusive Arts ) teaches improv and theatre classes, and told me about several of the ways she teaches her students to cope if an activity doesn’t go their way. If it is a game in which a group is working as a team to accomplish a shared goal, and one or more group members seems to be struggling with the challenge, at any point in the activity, any member of the group can call out ‘AGAIN!’ which everyone then echoes all together with a big celebratory gesture (changing the narrative from “we have to try again” to “we get to try again”). She also uses what is called “the failure bow”; if there is a competition or an activity in which the possibility of being eliminated or losing exists, they get the opportunity to do an epic bow while everyone else applauds. The goal (and usually the result) is to maintain the feeling of celebration regardless of the outcome. Model good behavior. Show your kids the proper way to lose and win. Don’t whine and throw the game board across the room if you lose, or accuse your opponents of cheating. Don’t taunt people when you win. Pay attention to when your kids take the high road and let them know that you noticed! Since Lauren weighed in on this post, she couldn’t help but point out that when her father Sandy would win a game, he would ‘Assume the Position’ which translated to doing a royal sprawl of celebration with a loud and satisfying sounding “Aaaaaaaaaah.” It is okay to be a little bit of a brat...just keep it fun! If children are reassured that trying hard, having fun, and being kind and gracious are the things that make parents proud, and encourages other people want to engage with them, than a very important lesson will be learned.
Posted by Nurse Judy at 9:46 AM
Friday, October 30, 2020
Halloween 2020 style Sometimes circumstances demand flexibility. For folks who love to do a festive Halloween, this year you may need to be a bit more creative. https://sf.gov/celebrate-safer-halloween-during-pandemic I am going to tell a quick story. It is actually about July 4th, not Halloween, but bear with me. For those of you who live in San Francisco, you know that our 4th of July is a bit different. People all over the country are out in their shorts, sandals and tank tops watching fireworks. Invariably here in SF, we are huddled under blankets, drinking hot chocolate, sitting on a peak somewhere and looking carefully to see if we can see a glimmer of the fireworks through the fog. In the 35 years that I have lived here, I can recall only a handful when the weather was clear. In any event, when Lauren was 3 or so, I bundled her and some neighbors into my car and decided to drive to see if there was any place in the city clear enough to see the light show. The fog was so thick that it was getting hard to drive. Through the fog, there was a traffic light that just turned red. Three year old Lauren got excited “Is that a firework? It’s beautiful!” It was becoming apparent that it was NOT going to be clear enough to see anything, so we pulled to the side and watched several traffic light changes through the fog. The kids oohed and aahed every time they went from red to green. And then we returned home. If my kid can get excited about a traffic light, with the right attitude your kids can still have special memories of Halloween 2020. There is nothing about the quarantine to stop us from having fun with costumes. Think about having a zoom costume party with friends and family. At the very least have your own photo shoot. Maybe take all the photos and turn them into a book, or some mugs that you can bring out next year when Halloween rolls around again. The SF Chronicle is still doing their costume and decoration contest this year. Submit photos of your decorations and/ or costumes, by midnight tonight and maybe you will be published! Not having to deal with enormous bags of candy is not such a bad thing. Of course, your kids (and you too; who are we kidding?) can still have some candy. Make them work for it and perhaps do a treasure hunt around your house or yard. I heard of one family who is planning to trick or treat in their own house. The kids will knock on all of the doors inside the house and get to say “trick or treat”. The internet is full of amazingly creative ideas for spooky foods that you can concoct together. they don’t all need to be loaded with sugar! Here is one list, but there are tons of them out there. Covid is no reason that we also can't enjoy the fun activity of carving a pumpkin, but keep these safety tips in mind Be careful of sharp implements! Make sure that any carving is age appropriate. Younger kids can decorate them with paint instead of carving them. Pumpkin innards are slippery! Make sure you do a thorough clean up so that no one slips on slime and gets hurt. Since many of you are going to make the safe choice to stay in, perhaps cuddle together and watch a Halloween movie. The goal is not to have something so scary that your kids will end up with nightmares. Here is a good list of options. I am not in the habit of wishing time away, but 2020 might be an exception to that. I hope that someday years in the future, when you look back at photos of years that have passed, you look at pictures of your pandemic Halloween and you remember only sweet and special memories. Stay safe and make good choices!
Posted by Nurse Judy at 10:47 AM
Friday, October 23, 2020
Adjusting to the time shift I am quite certain that it will happen. Forty eight hours or so before the official directive to set our clocks back, I will glance at a clock somewhere in my house and do a double take, “What? It is only 9 o'clock? It feels so much later!” Sandy will laugh and we will know that he ‘got me yet again’. There are so many clocks to adjust in our houses these days between the clocks in the cars, microwaves, coffee makers, etc. Some adjust automatically, but for the others, in our family it is Sandy’s job to make the changes, and for all of the years that we have been together, it has been his habit to start the process several days ahead of time. Even though I should know better, invariably there will be the moment I look at a clock and get confused and caught off guard. Indeed, twice a year the powers that be have decided that we need to adjust our times either one hour backwards or forwards. Some people love it and others hate it, but unless the law changes, or you live in Hawaii or Arizona, it is something most of us need to deal with. In general, for most adults, other than a tiny bit of lag, a one hour time shift is a no big deal. However it is quite the thing when you have a baby who is already waking up at 6 am. If you don’t make a bit of effort in advance, the ‘Fall Back’ means the babies are now awake at 5am (shudder!) With a little bit of planning, the following tips should make it a bit easier for you. Before we tackle the time shift, let's review some sleep basics. There are many different approaches to helping your kids sleep well, but here are the cornerstones. Getting enough sleep is essential, not only for the health of your child, but for the sake of your own sanity. If your child has the ability to do some self soothing, everything will be easier on you. It is never too early to start paying attention to this. Even if they are only able to doze off without having a nipple in their mouth or by having you actively rocking them once a day, consider that a win. Create a routine and strong sleep association, such as a special song, massage or snuggle. Make the environment conducive to good sleep. People tend to sleep better in cool dark rooms. Babies are no exception. A perfect temp is somewhere around the 68 degree range. See what you can do to keep the room dark. Consider the use of a Hepa filter or white noise machine. Hopefully once your little one weighs more than 14 pounds, they are giving you a good stretch at night and are on somewhat of a regular schedule. This is not something I count on for babies who are younger than 4 or 5 months. For you newer parents, take a deep breath, you need to be patient for just a bit longer. Babies still need to be feeding at night for the first several months. This phase will pass. Even though the young ones don’t usually have a real schedule in place yet, and it is normal for them to be feeding during the night, self soothing, sleep associations and a good environment are still very important, trust me! If you start good habits early, you will tilt the odds in your favor for getting a good nights sleep sooner than later. Once your baby is routinely sleeping through the night, the sleep goal should be that they stay in bed roughly 11 hours after bedtime. If bedtime is 7:30pm, the ideal wake up time would be 6:30 am (I see some of you rolling your eyes at the concept of 6:30 am being considered ideal. Someday you will be able to sleep in again, just not right now.) The simplest way to adjust to the new time zone is to do it gradually. I would suggest starting a week or so earlier and every night, move the bedtime 10 minutes earlier. This fall, the official time to change the clocks is 2am, Sunday, November 1st, but most people (except Sandy) change the clocks on Saturday night. For toddlers and preschool kids, many parents end up purchasing a toddler clock or someway that the kids can see so they know when they are allowed out of bed in the morning. If they get up earlier, for the big kids, calmly walk them back to their room, but with the infants, you can do the check in and pat them. Pam from Sweet Dreams suggests not switching your clocks until you actually wake up on Sunday morning. I tend to agree with her, but I would add that being conscious of the “extra hour” can be a fun thing to do with your kids. For the grown ups, make sure you each get an hour of being off duty. Spend it doing something just for yourself, maybe a bubble bath, or some meditation or go for a run. It is your hour. Your partner gets one as well. For the kids, ask them how they would like to spend their hour. I want to make one more point about the early waking. When my sisters and I were young, my mom was the first one up. She loved the dawn. Sometimes it was because it was the only time she could claim quiet time before the rest of us woke up, but there was something about it that called to her. The reason that this lifestyle worked for her was because whenever she could, she also went to sleep early. Many of us get a second wind in the evenings and enjoy some adult time once the kids are in bed, but if you are routinely exhausted in the morning, it might be worth the effort to put your kids schedule on the back burner for the moment and take a look at your own. Sleep needs vary. How much do you tend to get? How much do you think you need? If you are running at a steady deficit, this is going to start taking a toll on every aspect of your life. Much of the time it is simply about making better choices. Yes, I am saying that perhaps you should stop binge watching whatever series you are following, or put down candy crush and get into bed! If you have trouble falling asleep, make sure your iron and vitamin D levels are within normal limits. When your kids have grown and you are retired, you can sleep in as late as you wish. The years with young kids in the house are fleeting. Most kids are early birds. See if you can train yourself to embrace this, or at least not look at it as torture. If life offered the option of going back in time, I wouldn’t rule out a 6 am encounter with my babies Enjoy your extra hour! I hope your kids behave. You are on your own with your pets......
Posted by Nurse Judy at 1:48 PM
Friday, October 16, 2020
Happy Birthday to Frida the Lamp As many of you know, Sandy and I spent 2 months last year wandering around Europe by train and by foot. Knowing what we now know, I am so grateful that we traveled while we could. We packed extremely sparingly. We each had one small rolling suitcase and shared one smalI backpack that we took turns wearing (meaning I had it 5% of the time and Sandy had it the other 95%) I found that packing cubes were essential (Sandy found them useless). My suitcase was like an intricate puzzle. Things just fit exactly. There wasn’t a spare micro inch for anything else. We didn’t do much shopping, because we simply couldn’t fit anything extra. I joked that every time I used a Q-Tip there was a tiny bit more room in my suitcase. Because we were doing so much walking, we were grateful that we were able to manage traveling so lightly. Typically we would simply have to manage our stuff from the train station to whatever lodging we had chosen. Finding lodging that was walking distance to the train station location was always a consideration when selecting our hotel, or AirBnB. It was amazing how much walking we did. We ended up taking a total of 3 cabs/ubers the entire 2 months! A bit over the midway point in our trip we were in the lovely city of Florence. Our daughter Lauren and her husband Adam had been in Italy several months earlier. She had a favor to ask. While they were there she had fallen in love with a lamp that she saw in a cute little store. It wasn’t cheap. She wavered for several days and couldn’t stop thinking about it. Adam strongly encouraged her to just buy it, and finally Lauren agreed. On their last day, they returned to the store and to their great dismay found that it was closed. How many of you have had the item that “got away”, you were in a store eyeing something, but decided for whatever reason not to buy it and the moment was lost? For Sandy and me, it was a clock. If you live in the Bay Area, you might have seen it. Many years ago, a quirky store in Sausalito had several amazing clocks in their window. These were large clocks with gold wire mechanical figures climbing and moving about throughout. We were both enthralled. It wasn’t so much that they were expensive, but they were also big, and we weren’t even sure where we could put it. One day we were over in Sausalito and saw that the store was going out of business. The one clock left was on sale; should we finally get it? We gave ourselves a night to think about it. When we went back the next day it was gone. The store was shuttered. Of course now that we had lost our chance, we really wanted it even more. We did an internet search putting in all the keywords that might help us, but we never saw anything quite like it. We were out of luck. We still look for it! Whenever we pass an antique shop we pop in to see if ‘Our Clock” is there. So, when Lauren told us about the lamp, we understood. She insisted that she would want to reimburse us, but could we go by and purchase one of the lamps for her? She remembered exactly where the store was. We went to the store and immediately understood why she was charmed. It turns out that there were dozens of these wonderful lamps. They were figures holding umbrella lamp shades. Each one was wearing something different and was holding a different colored umbrella. They all had names. They were all unique. We connected with Lauren over WhatsApp, explained to the puzzled shop owners what we were doing, and wandered through the store showing her all of the options. It is easy to take for granted how easy it is to communicate these days. When I traveled as a teenager my poor mom had to wait weeks for the airmail letters to get through. Lauren ended up choosing the lamp named Frida. We started the process of buying it but when we got to the shipping option we were shocked to find that the shipping cost was almost as high as the cost of the lamp. We did some searching around to see what all the options were. The lamps were NOT available for purchase in the US and there was no way to ship it without paying exorbitant costs. We updated Lauren and she sighed and told us to never mind. Sandy and I thought about it overnight and both of us came to the same conclusion. We would get it and just carry it with us. The store did a magnificent job creating a little handle on the large box and we were on our way. Did I mention “large box’? The lamp was taller than my suitcase. So, as mommies and daddies will do for their kids, we schlepped this large lamp with us for the rest of our travels. If this lamp had her own passport, it would be an impressive one, When we were lucky, Frida got her own seat on the train. During our last night in Amsterdam, for some reason we were upgraded to a 4 bedroom suite (the benefit of traveling off season); Frida the lamp got her own room! On our flight home, she was too large to take on as a carryon, but we were amused that she was literally the first thing to appear on the baggage carousel. Friday now lives happily shedding some light on Lauren’s piano. It is hard to fathom that it was almost exactly a year ago that we got her. It feels like just moments have past, while at the same time it could be a century ago. Many of my posts and stories have a lesson to be gleaned. Hmmmm, not sure what the lesson from this one is. Maybe.. When you see something super special, if you can afford it, don’t let it get away. There are usually more regrets from passing it by, then buying it. OR A bit of short term schlepping is absolutely worth the long term pleasure. OR When we are all are able to travel once again, packing cubes are great! (except for Sandy, but I think more people agree with me!)
Posted by Nurse Judy at 9:26 AM
Friday, October 9, 2020
Teething symptoms and remedies: Dos and Don'ts Normal infants have 20 primary (baby) teeth which have started to develop in the womb. The teeth start to erupt through the gums around 6 months of age. The baby teeth are then shed at various times throughout childhood. At the end of this post, you will find a chart with the normal range of ages when most teeth start to come and go. Occasionally, I have a patient that doesn’t seem to like to follow rules, ignores the charts and does things their own way. I know of one baby who was born with teeth! Another started out with the upper canines and looked like a little vampire. As you can imagine, those parents were so happy when the rest of the teeth popped through. There is some heredity involved. If one of the parents was very early or late it is possible for the baby to follow suit. If you are lucky enough to have the option, check with grandma to see if she remembers anything special about your teething pattern! It is rare for teeth to actually make an appearance before 4 months. Once in a while parents will notice a smooth round white bud on a baby’s gum. This is a little benign cyst called an Epstein Pearl. It is not a tooth and it usually goes away without causing any bother. Many parents think of teething as something they are only dealing with for their young infants. Think again. If your 6 year old is going through an extremely grumpy phase, or has a mysterious bout of mild, clear congestion that has been hanging on for a few weeks, take a feel in the back of the mouth and see if those first permanent molars are starting to pop through. Once your child reached the age of 21, all 32 of the permanent teeth have usually erupted and they can no longer blame their grumpiness on teething. Just like the timing varies, the symptoms may also vary greatly from child to child and even from tooth to tooth. By far, the most common first teeth are the ones in the bottom middle (and they are so cute once they come through). Take your clean finger and run it along your baby’s gum. If the tooth is imminent you may feel that the area of the affected gum feels soft and boggy. Let's talk about the symptoms. Many healthcare providers and dentists dispute that there is any real relationship between teething and any of the symptoms below, but I have been an advice nurse for a long, long (long) time. I speak to parents of teething babies all of the time, and I maintain that I see a connection. Fussiness: Teething is uncomfortable. Most parents report that the babies seem fussier than usual right before a tooth pops through. Do what you can to relieve symptoms, but if your baby is inconsolable (screaming with NO break) for more than 30 minutes and there is nothing you can do to calm them down, please call to have them checked. That would be an extreme reaction and we want to see if there is something else going on. Drooling: Drooling starts weeks and weeks before you actually see a tooth pop through. Many kids will get a drool rash on their chins and cheeks. There are several products that I find quite useful for this. Clean off the area with Cetaphil cleanser (no water needed, apply with a cotton ball and wipe off). Follow it up with aquaphor or cerave ointment (which you can use multiple times throughout the day). Gnawing/biting: Biting on things will feel great to the baby; not so good to your nipples if you are nursing. If your baby starts biting you during feedings I recommend a loud “ouch!!” and immediately remove them from the breast. Most babies can be trained to stop this. Remember that you want to make the association mildly unpleasant so that they will stop the habit quickly. Biting = loud yell and loss of breast! If you are too gentle some babies will think it is quite amusing and will continue to bite at will. Poor Sleeping: If your little one is miserable, this is not the time for sleep training. I would go in quietly and try one of the teething remedies listed below. If you are going through a rough patch remember that parents should take shifts. Give yourselves each a few hours where you are off duty. There is no reason for both of you to be up all night. If you have the option, it is often best for the NON-breastfeeding parent to go in, unless it is time for a feeding. This is a slippery slope; I would try not to feed for comfort throughout the night. Bleeding/bruised gums: It is not unusual to have a little bit of bleeding on the gums. Once in a while you may also see a purple/bluish bruise on the gums right before a tooth breaks through. This will usually resolve without any intervention although something cold will feel soothing. Mildly elevated body temperature: Most dentists will remind you that teething does not cause an actual fever, but I commonly see it associated with an elevated temperature. If a fever goes higher than 100.5 I am not likely to blame it on teething. Any fever that is lasting more than three days is worth a call to the doctor's office to check in. Loose stools: You will likely get differing opinions on whether or not teething can be the cause of loose stools and again; I will state here that I see it all the time. Some folks speculate that swallowing all that saliva and drool might be the reason. Regardless, I do think there is a link. If you have a baby with loose stools, you want to go with the bland, starchy diet and make sure they are on probiotics. Breast milk is safe, but other milk-based products may aggravate the situation. Rashes: If your child has sensitive skin and/or eczema sometimes, you might notice that the general rashiness flares up during active teething. Congestion: Many young teething kids seem to have a clear runny nose and congestion. This can last for weeks and weeks. Sometimes it causes a post nasal drip that in turn causes a little hacking cough. Ear tugging: When kids are working on some of the upper teeth they tend to poke and play with their ears. Uh oh, many of these symptoms are the same thing we look out for if we suspect an ear infection. Even though teething may well be the cause, if I have a patient who is very fussy, feverish, and is having trouble sleeping, I am likely going to want to have someone take a peek in those ears. It is worth having an arsenal of tools at the ready for dealing with the months of teething that you have ahead of you. Chinese herbs: These are a great place to start. A very safe pediatric herbal tincture called Tender Teeth can be obtained at The Acupuncture Den, a family practice located in Noe Valley. Please contact Dr. Den to arrange a pick-up or mail delivery if you’re not in San Francisco. Beyond just the herbs, our local acupuncturist can offer relief with acupuncture and/or non-needle techniques. Many parents report babies taking a long and deep nap after a treatment! Cool teething rings: make sure they are made out of a safe material. Do not tie any teething rings around your baby's neck. Strangulation is a real risk! Frozen washcloth: Wet half of a washcloth and put it in the fridge or freezer. The baby will be able to hold the dry half and chomp happily on the frozen side. For an interesting twist, consider soaking the washcloth in chamomile tea before chilling it. Distraction: There is nothing as nice as a body massage and a warm bath by a calm singing parent. Homeopathic drops: The ones I am most familiar with are Camilia by the Boiron company. Click the Boiron link for a coupon. Orajel’s new formula is also safe. https://www.orajel.com/en/products/child-oral-care/orajel-non-medicated-cooling-gels-for-teething. The older formula which actually numbed the gums was recalled years ago due to safety issues. Make sure you read the labels carefully to make sure that it is Benzocaine free Feeding bags (baby safe feeder, or sassy teething feeder): If your baby has had some solid foods introduced, these feeding bags are great for teething relief. Add a cold hunk of fruit or veggie (pick a food that they have been introduced to already so that you don’t need to worry about any odd reactions) and let them gnaw away happily. With the mesh bag you don’t need to worry about them breaking off a piece that could be a choking hazard. You can find these bags online pretty easily. You can also fill one of the bags with a frozen ‘Milksicle'.Take 3 or 4 ounces of breastmilk, or formula, and combine it with some fruit, like banana, pear or mango. Puree until very smooth and stick it into an ice cube container. Pop out a frozen cube and add to the mesh feeding bag. Spa in your mouth - cool cucumbers of course! This is for kids who have proven themselves to be able to handle actual pieces of food, but for your toddlers who are cutting teeth, these might be a hit. Peel the cucumber, slice into circles, get rid of the seeds. Put the cucumber circles in a bowl in the fridge to keep cool. Teething Tube I actually just learned about these little gizmos from Pam of Sweetdreams infant care. She tells me that her grandson loves this, and it was very helpful getting him through the teething process Chew beads: I have had multiple parents tell me that these beads seemed to help but there is valid concern about these being a potential choking hazard. If Grandma feels strongly about using these, I have no objection as long as you have checked carefully for safety (nothing that can get loose) and are actively watching the baby while they chew on them. These should never be in a crib. I worry about strangulation with any necklace. Brandy/alcohol: Ask great grandma what she used to do for teething and she may tell you that she used to put whiskey or brandy on the baby’s gums. Obviously giving our babies alcohol is not something that most doctors would suggest today, but I actually wouldn’t worry if you caught grandma rubbing some directly on the gums. It probably does help. Some folks also say that rubbing pure vanilla extract on the gums is an effective home remedy. That may be from the alcohol content (I am referring to a tiny amount applied topically, no swigging booze!) Acetaminophen (Tylenol) and Advil (Ibuprofen) are useful but I prefer not to overuse them. Make sure you are using the proper dose. Start with the other approaches first. If possible, I would prefer to keep these as remedies for night time use only. Tylenol and Advil are quite safe but if they are used for a long period of time they can be stressful to the liver and kidneys. If you find that you have gone more than 5 nights where you are depending on these meds to keep your child comfortable, give your doctor's office a call to see if you need to make sure that nothing else is going on. DO NOT USE Any product that contains Benzocaine or Belladonna!! Once your child has teeth, it is especially important to keep bottles out of the crib. Milk has sugar and can cause tooth decay if a baby sleeps with a bottle in their mouth. It is never too early to start brushing the teeth. Let's get your baby in good dental habits. It is important to use a soft toothbrush and non abrasive toothpaste. The current recommendation is to use fluoride toothpaste; just a teeny bit the size of a grain of rice. Once they have a mouthful of teeth it makes sense to start shopping for a pediatric dentist that you can establish a relationship with. This will come in handy if you have any tooth questions or mouth injuries. Your next task is to figure out what the going rate for the tooth fairy is! I can’t help you there. Wishing you easy teething!
Posted by Nurse Judy at 9:55 AM
Friday, October 2, 2020
This week's topic Your Family Tree/ How far back can you trace? When Lauren was in 4th grade, her class was given an assignment. Pick a grandparent or great grandparent who immigrated to this country. Where did they come from? What was their story? Lauren ended up picking one of her great grandmothers, Mollie Kivowitz, but the project got me thinking. I was curious to trace all of the branches to highlight each of the ancestors who made the courageous journey to a new life in America. Sandy and the girls bought me a family tree program for Chanukah that year and I went to work. As part of my search I sent letters to relatives and talked to older aunts and uncles trying to get as much information as I could. I was very fortunate to find relatives from different branches who had already done a lot of family tree legwork and were willing to share. In the process I made wonderful connections with long lost relatives. Some branches are easier to find information on than others. For one thing, a name like Smith is going to be a lot tougher than one like Kivowitz. There are other factors. My paternal grandfather, Asher Isaacs, came from a family that had the distinction of being the only family in America at that time that could claim having 8 members (including my grandfather) who were members of the Phi Beta Kappa honor society. That branch was almost too easy, since there are actually multiple books written about them. Other branches take quite a bit more digging and the information is going to be based on a combination of stories that were passed down along with census searches. It is easier than it used to be. A lot of this stuff is online. Here is an assignment to all of you. If you are blessed enough to have people to ask, capture this information while you can. See what you can find out! On my mom’s side I have a second cousin who is a popular comedian/late night talk show host. Mom would tell stories about sitting on the porch with her first cousin and doing the routine catching up on kids. “Lauren got the starring role in her high school play” "Seth is hosting the Whitehouse Correspondents' Dinner" Um. My father's side is peppered with people that were known to have the 'second sight' and includes his first cousin Dr. Brian Weiss, MD, an author who has written extensively about past life regression therapy ( brianweiss.com/ ) (No, I don’t have a familiar relationship with either of my famous relatives.) Simply writing the names down in a family tree program doesn’t necessarily bring their stories to life. During my search, I was able to capture a lot, but so much has been lost to time. I am grateful for whatever stories have been captured and sad at all of those that are beyond my reach. After my mom died, when we were at the family house sorting through old letters, I came across a pile of correspondence between my mom’s parents. These were love letters, filled with personality and pet names; sweet and funny treasures, but they left me thinking. I wonder how Flora and Asher met? How is it that I didn’t know that story? The loss of my mom pierced through me with the realization that there was no one left to ask. Some little piece of my brain nudged me to do an internet search. Amazing, there it was! Back in 1987, the Pittsburgh chapter of the National Council of Jewish Women did an oral history project. My grandmother was interviewed! She was 86 at the time. There are 4 sections of the interview, each 30 minutes, that are online. In the first section she gives me the answer I was seeking. She tells the story of how she met my grandfather! I felt like the universe had given me a gift. I just listened to these again this week as I was getting my daily steps. The first sounds of her voice still get me choked up, but then I get swept up in her stories. Make this effort for your children and their legacy. How far can you go back? Some families can’t trace back too far, others can go back many generations. Celebrate the remarkable mix of cultures and DNA that have combined to create you and any offspring that you might have. Don’t be afraid of the moonshiners or the proverbial black sheep that are on your tree. They all led to this moment in time. Time passes and opportunities are fleeting. Talk to your older relatives! They will likely love telling you their tales!
Posted by Nurse Judy at 10:55 AM
Friday, September 25, 2020
I wrote my first post about loss back in 2015. I updated it in 2017 when I was dealing with the loss of my mom Ruth Ann. The same week that my mom died, I was still working at Noe Valley Pediatrics. We lost a young patient one day and a young mother the next. Both were sudden and unexpected. Those were tragedies. An 86 year old woman, who was able to peacefully pass away in her own bed with her family around her is not. As I noted in the intro to my post: My mom was pretty amazing. She was a force of good. She routinely wrote thank you letters to strangers who were kind and good at their jobs. She actively reached out to lonely friends, family, and acquaintances to let them know that someone was thinking of them. She was the second mom to all of my childhood friends. She was the kindergarten teacher who remained beloved by all of her students. She was incredibly charitable. I was incredibly blessed with both of my parents. A wise friend once shared a theory with me that the world is like a scale that is a precarious balance between good and evil. The smallest act of kindness might be the essential spark that is making the difference in tipping the scale in the right direction. It is going to take a lot of kindness and good deeds to make up for her loss. This week we lost another Ruth. My Oath team was on a zoom meeting together when the news came through. We sat in stunned silence as the emotions slammed through us. Children all over the world watched their parents weep and mourn. Talk to them. Teach them. May her memory be a blessing and may all people recognize and embrace her legacy that all people should be treated with equal rights and respect. This week's topic Dealing with loss/helping your child cope Laughter/Crying/Happiness/Sadness. Life is such a balance. Assuming you are lucky enough to have people, pets, or even objects that you care about, then dealing with loss is inevitable. If you have a child, you need to be prepared to know how to approach the subject. Parents, it may be helpful to ask yourselves the following questions: How do you, yourself deal with loss? What do you believe? Some folks have a deep faith that there is “More to it than this,” and others think that “this is it.” Are you comfortable sharing your belief system with your children? How do you find comfort? What can your friends and family do for you when you are grieving? Do you need hugs or space?? There is not one simple approach for every person, child, or family. My mother-in-law liked to say that there is no right or wrong way to grieve. There are no rules. It is important to be supportive of the different paths that people take. There are also many cultural factors that may impact the situation. The routine losses that the families deal with most often are the passing of a grandparent or beloved family pet. Those are the lucky ones. An anticipated loss is no less devastating, but this is the cycle of life that is sad but not shocking. Others are flattened by the loss of a partner, friend, sibling, child. If your family is hit with a loss, sudden or anticipated, unless we are talking about a goldfish, likely the death is hitting you just as hard, if not harder, than it is impacting your child, though don’t minimize the loss of that goldfish as a valuable opportunity for ritual and conversation. (My husband managed to delay the "goldfish conversation" several times with a visit to the "open till midnight fish store" where Goldie was replaced several times with no one the wiser!) Parents don’t usually have the luxury of collapse. How do you help your child when you yourself are dealing with all the grief? There are factors to keep in mind for each age that you are dealing with. ages 2-4 generally don’t grasp the concept of death as permanent ages 4-7 may feel responsible for the death because of their thoughts, actions, or lack of action age 7-11 just starting to see death as something irreversible over 11 has a better understanding about the loss Not to make light of the subject, but here is a classic family anecdote: When Lauren was between 3 or 4, she went through a phase of obsessing over several musicals and movies that were centered around orphans. Annie and Disney's The Rescuers are ones that come to mind, but I know there were others. One day she asked, “what is an orphan?” We discussed that an orphan was someone who didn’t have any parents. We immediately went on to say that she was very lucky that she had both mommy and daddy, but if in the very unlikely event that anything ever happened to both of us, her aunt and uncle, Barbara and Richard, would be her guardians. She was quiet for a moment and then said, “ I better get their phone number.” Hmmmm. Do's and Don't s Do NOT say that an animal was “put to sleep” or use any phrase that can confuse your child. The words “passed away” are also fairly passive and confusing. They might wonder if that could happen to them at any time. Do NOT lie. Find a way to convey truth that you are comfortable with. Your child will know that you are very upset. Shielding them from honesty and communication is not doing them a favor. It is okay to be sad. It is okay to cry. Find a ritual that you feel comfortable embracing. Take comfort in happy memories. Celebrate the life of the one you lost! Tell wonderful stories. Don’t be afraid to laugh. Honor the memories with kind gestures. Finding a good therapist to help you or your child give you coping tools is often a good idea. Check to make sure that the therapist has experience dealing with bereavement issues. Books and stories can be an excellent launching off point for discussions. If you can’t come to terms with how you feel about death, you might be able to turn the spotlight away from you with lines like: “Some people believe…” “Other people think……” In my search for further local resources I reached out to my old friend Dr. Nancy Iverson. Nancy has not only written several published articles about the grieving process, but has been involved in facilitating various support groups for many years. She pointed me towards Josie’s Place. (It was a bit of a treasure hunt.) This is a small but wonderful center here in San Francisco that offers support groups and other services for families and children who have experienced loss. Josie’s Place: Info@josiesplace.org 415-513-6343 Groups meet in the Inner Sunset For children over the age of 7 www.josiesplace.org If you scroll down to the bottom of the home page on their website in the "Articles on Grief/Grief Resources" tab, Pat Murphy, the director has cobbled together a list of other local resources that might be useful. Janet Jaskula, RN, MS, A pediatric hospice nurse, also shared her list of resources: The Heart and the Bottle This is a great book about what loss and grief can do if one does not deal with it. Kids and adults. "Fall of Freddie the Leaf" by Leo Buscaglia "Velveteen Rabbit" by Margery Williams "There is a Rainbow Behind Every Dark Cloud" written by a group of children with leukemia who attended The Center for Attitudinal Healing. A Lion in the House Movie that follows several children and teens and their families through illness and loss, grief and death. Though not all of the kids in the film die, they are certainly affected by their illnesses and loss of their "normal" childhood and teen years. The Giving Tree Shel Silverstein. Or check out this newer version that I quite prefer! https://www.topherpayne.com/giving-tree For parents, check out the the website of Barbara Karnes. Barbara Karnes is the author of "Gone From My Sight." She has some excellent combo coloring/story books about loss for kids. Dr. Nancy Iverson recommends the book: "Never Too Young to Know" by Phyllis Rolfe Silverman The very helpful children's librarian Liesel Harris-Boundy at the San Francisco Public Library West Portal Branch did some research for me and came up with some good choices for kids. Scroll down to the end of the post for her list. ****************************************************************** I saw the following gem circulating around the internet and it resonated with me. I thought it worth sharing. Someone put out a post asking for help dealing with grief. This answer was the response from a fellow in his late 70s: I'm old. What that means is that I've survived (so far) and a lot of people I've known and loved did not. I've lost friends, best friends, acquaintances, co-workers, grandparents, mom, relatives, teachers, mentors, students, neighbors, and a host of other folks. I have no children, and I can't imagine the pain it must be to lose a child. But here's my two cents... I wish I could say you get used to people dying. But I never did. I don't want to. It tears a hole through me whenever somebody I love dies, no matter the circumstances. But I don't want it to "not matter". I don't want it to be something that just passes. My scars are a testament to the love and the relationship that I had for and with that person. And if the scar is deep, so was the love. So be it. Scars are a testament to life. Scars are a testament that I can love deeply and live deeply and be cut, or even gouged, and that I can heal and continue to live and continue to love. And the scar tissue is stronger than the original flesh ever was. Scars are a testament to life. Scars are only ugly to people who can't see. As for grief, you'll find it comes in waves. When the ship is first wrecked, you're drowning, with wreckage all around you. Everything floating around you reminds you of the beauty and the magnificence of the ship that was, and is no more. And all you can do is float. You find some piece of the wreckage and you hang on for a while. Maybe it's some physical thing. Maybe it's a happy memory or a photograph. Maybe it's a person who is also floating. For a while, all you can do is float. Stay alive. In the beginning, the waves are 100 feet tall and crash over you without mercy. They come 10 seconds apart and don't even give you time to catch your breath. All you can do is hang on and float. After a while, maybe weeks, maybe months, you'll find the waves are still 100 feet tall, but they come further apart. When they come, they still crash all over you and wipe you out. But in between, you can breathe, you can function. You never know what's going to trigger the grief. It might be a song, a picture, a street intersection, the smell of a cup of coffee. It can be just about anything...and the wave comes crashing. But in between waves, there is life. Somewhere down the line, and it's different for everybody, you find that the waves are only 80 feet tall. Or 50 feet tall. And while they still come, they come further apart. You can see them coming. An anniversary, a birthday, or Christmas, or landing at O'Hare. You can see it coming, for the most part, and prepare yourself. And when it washes over you, you know that somehow you will, again, come out the other side. Soaking wet, sputtering, still hanging on to some tiny piece of the wreckage, but you'll come out. Take it from an old guy. The waves never stop coming, and somehow you don't really want them to. But you learn that you'll survive them. And other waves will come. And you'll survive them too. If you're lucky, you'll have lots of scars from lots of loves. And lots of shipwrecks. ******************************************************************** Liesel Harris-Boundy's recommended reading list: Life Is Like the Wind by Shona Innes - 2014 Written by a clinical child psychologist, Barron's "A Big Hug" series offers a gentle and direct approach to the emotional issues that children face. This book introduces the concept of death to young readers by likening life to the ever-moving wind. My Life Changed A Journal for Coping With Loss & Grief by Amy Dennison - 2003 Parenting Through Crisis Helping Kids in Times of Loss, Grief, and Change by Barbara Coloroso - 2001 Missing Mommy by Rebecca Cobb - 2013 Ben's Flying Flowers by Inger M. Maier - 2012 Emily introduces her younger brother, Ben, to butterflies, which he calls "flying flowers," and when his illness makes him too weak to go see them she draws him pictures, but after his death she no longer wants to draw happy things. Includes note to parents. Harry & Hopper by Margaret Wild - 2011 Harry is devastated when he returns home from school to find that his beloved dog, Hopper, will no longer be there to greet him. The Blue House Dog by Deborah Blumenthal - 2010 A boy whose beloved dog has died, and a dog whose owner also died, find each other and slowly begin to trust one another. Always by My Side by Susan Kerner - 2013 A rhyming story written to help children understand that a dad's love is forever. Even if they grow up without his presence in their lives. Rabbityness by Jo Empson - 2012 Rabbit enjoys doing rabbity things, but he also loves un-rabbity things! When Rabbit suddenly disappears, no one knows where he has gone. His friends are desolate. But, as it turns out, Rabbit has left behind some very special gifts for them, to help them discover their own unrabbity talents! Rabbityness celebrates individuality, encourages the creativity in everyone and positively introduces children to dealing with loss of any kind. The Scar by Charlotte Moundlic. When his mother dies, a little boy is angry at his loss but does everything he can to hold onto the memory of her scent, her voice, and the special things she did for him, even as he tries to help his father and grandmother cope. Remembering Crystal by Sebastian Loth - 2010 Zelda the goose learns about death and loss when her turtle friend Crystal disappears from the garden one day. A Path of Stars By Anne Sibley O'Brien - 2012 A refugee from Cambodia, Dara's beloved grandmother is grief-stricken when she learns her brother has died, and it is up to Dara to try and heal her. I Remember Miss Perry by Pat Brisson - 2006 When his teacher, Miss Perry, is killed in a car accident, Stevie and his elementary school classmates take turns sharing memories of her, especially her fondest wish for each day.
Posted by Nurse Judy at 9:22 AM
Friday, September 18, 2020
This evening ushers in the holiday Rosh Hashana, which is the Jewish New Year. I think everyone is ready for a fresh start! There is so much going on around us! I am taking a break from things like poor air quality and viruses and simply telling a story this week. This week's topic A strange but true story about a pair of socks Serendipity? Coincidence? All I can tell you is that odd things happen more than you would think to me and my family. My husband for years tried to find explanations that made sense, but he finally gave up. Here is one such tale. The mysterious socks Social media is a mixed bag. I try to avoid the political spats and focus more on the sweet updates from family and friends (admittedly I don’t always succeed.) One of the more enjoyable aspects of Facebook is the memories that surface. Just this week a memory popped up from 2013 about a pair of socks. I had forgotten all about it. It was such a strange story that I have no way of explaining it. I can only promise you that Sandy the skeptic bore witness to it. When we moved out to San Francisco back in 1985, I made it clear that moving to the west coast was contingent on me going back to visit my family in Pittsburgh several times a year. Sandy was very supportive of this. The big brick house where I grew up in the actual Mister Rogers Neighborhood of Squirrel Hill became a second home to my kids as they regularly came back with me to visit family. As the kids got older, they still made it their business to get back there, but they no longer were able to come with me on every visit. On that August visit seven years ago, I had gone solo. The house had several stories and somehow, much to my mom’s dismay, was a magnet for “stuff”. My childhood home and it’s various collections are featured in many of my posts over the years. Aside from the generations of letters, photos and treasures, new and odd things had a way of appearing. My mom had taken the term barnacle and used it to describe things that somehow took root in a place where they had no business being. That empty container of hand sanitizer in your house that has been sitting on it’s side, on the coffee table for several weeks, and somehow looks like it belongs there...that’s a barnacle. During this particular visit, my mom had asked a favor. Somehow the set of steps going from the second floor up to the attic had amassed a collection of stuff. Would we be kind enough to go through it and clear the area? She had someone coming to do some work on the third floor and has been asking for people to get the steps clear. My visits were often her catalyst to getting things done. My sister, my niece (who lived up on the third floor) and I started our sorting. Here was a copy of the Pittsburgh Post Gazette with Lauren and I on the cover, the day after the Loma Prieta earthquake. Here were piles of clothes to go to the thrift store; here were some books. Piles were made. Keep it, toss it, donate it. We were making good progress. At the bottom of a bunch of clothes was one sock. It had a distinct embroidered pattern and I recognized it as mine. “Hey that sock is one of mine.” This was August, sandal weather in Pittsburgh. My best guess is that this sock got separated from its mate (as socks do) during a laundry during my last visit, which in this case was December. That is a good definition of a barnacle. The sock had somehow taken root on the steps and folks just stepped around it. But for now, I stuck it in my suitcase. I spent a week in Pittsburgh and then stopped for a few days in Denver to visit one of my best friends. The day before I was heading home I spoke to Sandy for what was a fairly routine call. “I miss you very much and can’t wait to have you home. There are fresh sheets on the bed, and I cleaned the house from top to bottom...it would be nice if the house could stay neat for at least a day once you are home.” (As an side, there is of course a reason why he had to ask me that; I am not the neat one in our relationship!) “Yes dear.” I got home to a truly spick and span house. I brought my suitcase up to our bedroom, and plopped it on the bed. Before I even opened it, I turned around and saw that on my dresser was a single sock. Yes. It was the mate of the lone sock in my suitcase. I picked it up in a bit of shock and yelled “Why is this sock here?” Sandy looked puzzled. “I have no idea, I didn’t put it there, I straightened up everywhere, maybe Alana put it there." As soon as Alana came home that afternoon I waved the sock in her face. ”Where did this sock come from?” “Gee Mom, it is nice to see you too!, I have no idea where that sock came from. It has been hot out and I haven’t worn socks for awhile." I opened up the suitcase and pulled out the matching sock to show them. This sock had been sitting on a step in Pittsburgh for months and months and somehow its mate was waiting for it. If you are waiting for me to follow up with an explanation, I have none. I will say that if I knew I had one wish, it likely would not have been to find a missing sock. There is a follow up. The socks were clearly special. On my next trip to Vegas I brought them along. Yes I got a straight flush at the poker table and the slot machines smiled at me a bit more than they usually do. When we came home and did the laundry, only one of the socks came out. Somehow I think it will turn up again. Is this my strangest story? Probably not. What is yours?