Friday, January 31, 2020

Building and Protecting your immune system

My background is in western medicine but my patients over the years have been on the receiving end of advice from me that includes some more natural or holistic suggestions.
This post in particular strays a bit from the basic western medicine path and includes a combination of conventional wisdom, along with some anecdotal remedies shared with me by healers from a variety of modalities. Some of the things that I suggest can be found, as my husband laughingly describes it, down the “placebo aisle” of the local drugstore, but as we are in the full throes of a variety of illnesses, many families are ready to try anything.
My kids grew up with my husband's grandma’s recipe fondly referred to as Muggala Guggala, (see below for recipe*) I imagine many families have their own health rituals. As long as you are not ignoring a condition that warrants medication such as asthma inhalers or antibiotics, there is little harm in exploring some natural options. Who knows, you might find something that helps.
Good Hand Washing is the cornerstone to staying well.
If you were out and about in a crowd of sniffling,coughing people make sure you scrub up and change your clothes as soon as you get home. Try not to touch your hands to your eyes. I just did my post on habits. If you are someone who is constantly touching your face, this might be a good habit to try to conquer. Recently, in the news, was a story about how Purell and hand sanitizers are NOT as good as soap and water. Those are convenient to have as a back up when you are out and about, but as soon as you are near a sink, scrub up.
Getting enough sleep is essential. If kids seem tired, you might need to start the bedtime routine a bit earlier. For older kids and adults make sure you limit the screen time for at least an hour before going to bed. Most experts suggest longer than that, but I accept that it often isn’t that realistic. Sleep tips

Make sure you and your kids are getting enough Vitamin D. Many folks have vitamin D levels that are significantly below where they should be and would benefit from a daily supplement .
Make sure you are getting enough IronMagnesium, iron and vitamin D are all connected to sleep as well as to a healthy immune system. (Magnesium also helps with pooping.)
I don’t love to binge on most vitamins, but a multivitamin that has A and C is especially important during the cold and cough season. Check out Ester C. This is an exclusive form of vitamin C that is designed to give round the clock immune support. Sandra Roddy Adams, my chiropractor, gives this a big thumbs up.
Zinc is an important cold fighter and some studies show that it can decrease the duration of a cold by 50%. Zicam lozenges are what I like. I actually think that the generic orange flavor tastes the best. These work better if you catch it early! With any zinc product, it might be best to take with something in your stomach to avoid nausea. Kids need to be old enough to safely take a lozenge or chews
I asked my cousin Sam, who is a retired family practice physician if he had any favorite supplements. Echinacea,
ginger, garlic, myrrh, cayenne, vitamin C, vitamin B6 and bioflavonoids all made his list. For the grown ups out there, he recommended a Source Naturals Wellness Formula that has a lot of the good stuff in one capsule.
More and more experts are suggesting that having a healthy gut is essential to the immune system. My friend Sari is a craniosacral therapist in Arizona. When I reached out to pick her brain about this post she concurred with me that many current studies are finding that having a healthy gut is essential to the immune system.
Probiotics are good for any age
For newborns The product evivo is a good one to look into.
Oil of oregano is thought to be a great immune booster. I would recommend this for grown ups or kids over 6 who are very cooperative. It has a very strong taste and causes some oregano burps but can work pretty well
Omega 3s are mostly found from eating fish, but most people probably don’t get as much as they should. This supplement makes it to most of the lists as a worthy supplement.
Local honey has antioxidants and is thought to be helpful for the immune system. Dr. Anne was the one who added this to the list. She actually adds honey to her coffee! I tried it and it isn’t bad. Remember that infants under one year should NOT eat honey
Chinese Medicine
As I mentioned in a post several weeks ago, I was poised to fall into the abyss and was coming down with a cold and cough. I ended up getting an acupuncture treatment and started taking some herbs. The cold ended up quite mild and didn’t go down into my lungs.
There are some Chinese formulas that are very safe and effective. Choosing which one to use isn’t easy without the advice of an expert. The right herbs depend on exactly what type of cough is going on. Chinese herbs are not a one size fits all answer. Our local acupuncturist Den Bremond in Noe Valley is also an RN. She is a lovely resource for not only helping build that immune system, but also helping you get back to health if you are already ill.
My amazing friend Anita is another acupuncturist on my team of healers. I wish she was local, but she is based in Colorado.
She encourages warming foods for her patients. These keep the internal temperature up. Viruses prefer the cold environment. She suggests that drinks be room temperature or warm/hot. Don’t add ice to drinks. Use warming spices and herbs such as garlic, cinnamon and cloves. Soup is always good!

Here is a bonus acupressure point good for boosting the immune system: acupressure point stomach 36
While staying warm and eating and drinking warm foods is good when you are sick, there are studies that suggest that for healthy folks who are trying to stay that way, doing a cool water rinse at the end of your shower can be an immunity booster.

Herbs and Homeopathy

Sambuccol is at the top of my list when it comes to my personal self care. This is an elderberry base, fairly widely available that has some scientific studies backing up it’s immune boosting properties. (Even Sandy doesn’t scoff at this one.) I actually start taking these the moment that I feel the scratchy throat feeling that makes me worried that I am starting to come down with something.The earlier you start, the better it works. The bottle says for children over 2. The UK version gives the dosage for over 1.
 These are homeopathic sprinkles that I refer to as fairy dust.
I don’t understand homeopathy, but many folks swear by these. I take a tube every time I fly. Sandy tried to figure out what’s in them and the only ingredient he recognized was duck liver.
This herb is on many folks list of remedies. The studies have been mixed as to whether or not it works. Make sure you are a label reader when getting this supplement
My friend Oran is a wonderful healer who lives in Israel. Both of my daughters had moments during their travels there when they showed up on her doorstep with various illnesses and she nursed them back to health. She has the ‘No White’ rule when people are sick. No white sugar, no white flour and no dairy. All of those can contribute to inflammation.
It is very important to avoid secondhand smoke. If you are someplace where the air is dry, or in SF you have turned the heat on, consider using a humidifier at night. Make sure you keep it clean and turn it off during the day. Running it 24/7 can create a mold situation.

Another breeding ground for germs in your house is the pet food bowl. Your pet’s food bowl could actually be making you and your family sick if you don’t wash it frequently. A study by NSF International showed that pet food bowls ranked as the fourth dirtiest place in the house. Regardless of if you feed your pet dry or wet food, the bowl may have a residue that can harbor bacteria like E. coli and Salmonella. I am guilty of this one but Sandy has it covered. When our grand-dog Bowie is over, he scrubs out the bowl every time he leaves!
It is fairly common for parents to call the doctor, incredibly frustrated when their kids seem to be sick all the time. It makes sense when you think about it. If they are depleted from illness number one, when illness number two comes around they are more vulnerable. Everyone is being exposed to so much this season. Unfortunately most viral syndromes simply take time. Antibiotics are NOT useful for a virus.
If you are stuck in a cycle of catching one thing after another and the above suggestions haven’t helped, explore your options and see if you can keep your child out of daycare for a week or so. Sometimes that break makes a big difference.
Don’t forget to swap out the toothbrush or put it in the dishwasher.
Muggala Guggala - 1 cup milk, 1 Tbsp of butter, 2 Tbsp honey - heated in a saucepan.

Friday, January 17, 2020

Flat Heads/The Importance of Tummy Time

Once upon a time, people had their babies. They lived in multi-generational homes with lots of support. Life was simpler.

Now we are surrounded by gadgets and high tech contraptions. Many of us have less family around. There seem to be more rules. Some of the new rules are science based, including the very important ones about safe sleeping.

In 1992, the American Academy of Pediatrics initiated the "back to sleep" program in order to try to combat Sudden Infant Death Syndrome. Since this program began, the rate of SIDS has decreased by over 40%. An unintended consequence though was the number of babies who have flat heads from spending so much time on their backs. Nice round heads are becoming a real rarity.

This flat head condition is called plagiocephaly. Statistics claim that It occurs about once every 300 births, but I think more babies than that have at least mild cases.  Interestingly, little boys are twice as likely to have issues with this, and right side flattening is more common than left. Many babies with plagiocephaly were predisposed to it because of their position in utero.
Newborns' skulls have a lot of plasticity, so they are pretty susceptible to external pressure. Up until about six months of life, the skull is naturally thin and flexible. It can easily change shape. It turns out that if you drop a cell phone on your baby’s head it will actually leave a little dent!  Yes that is a real call that I got from a frantic mom. (Don’t worry his little head is fine.)

Positional plagiocephaly does NOT affect brain growth or development, and by ages 4-6 months, most heads have developed a normal shape. But early intervention and recognition can speed up the rounding process and hopefully keep things from getting worse.

Babies  don’t have a lot of motor control during their early months, so they can’t always easily re position themselves. Babies who do tummy time will have an advantage.
Tummy time should be started early and often. It doesn’t need to be hazing. Even one minute at a time can count.
The first tummy time can be within their first couple of days. Start by having your baby simply lay on you. Don’t worry about the cord (you most likely aren’t that firm of a surface.) Tummy time is an excellent way for them to develop muscles and work on their head control. It is also great for their digestion! 
Even though Infants lack head control, they should be able to turn their heads to either side at rest. Some babies, particularly those with shortened neck muscles may develop a more serious kind of flattening. You may hear this condition referred to as torticollis. If you find that they don’t easily move their head from side to side easily I would suggest a visit to a Physical Therapist or Chiropractor. It is never too early for an evaluation. 
There are little steps that you can do right from the beginning that minimize your baby having one favorite side. You would be surprised how many parents don’t recognize the fact that their babies heads are a bit tilted.
Try to  give each side equal attention:

  • Make sure you swap feeding positions.
  • Offer objects from either side.
  • Alternate directions on the changing table.
  • Consider changing the position of the crib or the orientation of the baby in the crib to reduce the baby’s tendency to look in the same direction.
  • When awake and supervised, prop the baby onto one side with a foam wedge or a towel rolled lengthwise along the baby’s back.
  • Change positions when feeding, carrying, and holding the baby.
  • Provide supervised upright play as soon as the baby has upright head control.
  • During quiet alert times, also encourage mid-line control. Place their hands together and have them look straight at you.

Jennifer Maeder, a local lactation consultant and Tummy Time Method provider adds:

Parenting today includes the use of a lot of ‘containers’ - equipment such as swings, bouncy seats, car seats, and other infant containers to help hold babies in our modern world. Another influence is ‘containment,’ or the over reliance on excessive swaddling with products like the SNOO and restrictive swaddling blankets. Too much of this can have a negative effect on hip development and inhibit movements vital for optimal breastfeeding and maybe even neurodevelopment. I’m all for making parenting more manageable, but consistent, daily tummy time is essential to counter these practices that decrease natural floor time that is key to supporting motor and sensory development. 
If your baby struggles to enjoy tummy time, has plagiocephaly, torticollis or other asymmetries, or you just want to optimize postural development and a healthy nervous system function (including digestion) - daily, consistent tummy time (3-5 sessions per day, 4-5 waves per session) can help. Remember, we frequently expect babies to learn to self regulate quickly. Babies need practice to succeed. The interaction between parent and baby in tummy time provides the chance for connection, interaction and play. Check out this video for a step by step how to on “tummy time waves” from neonatal occupational therapist and founder of the Tummy Time Method!, Michelle Emanuel:

For anyone interested in finding out more, or having a little coaching, Jen holds her Tummy Time Method classes at check them out!

As Jen mentioned, pay attention to  places where their little head is up against a hard surface. The crib is the main culprit, but anywhere you put them down for a bit counts. Anytime that the baby doesn’t have their heads in contact with a firm surface is a bonus!
Sandra Roddy-Adams, a San Francisco based chiropractor who does cranio-sacral works on a lot of babies, weighed in on the importance of tummy time.

Supervised tummy time is important because babies begin developing their cervical lordosis (neck curve) around 3-6 months. This curve is formed as the baby begins to lift his/her head. This helps train the surrounding postural muscles and enhances visual awareness. A noticeable flattening of the base of the skull (occiput) or a spine out of line, can also interfere with tummy time and development.

If the birth was challenging or if you begin to notice some things like the base of the skull not changing/rounding, difficulties nursing on one side, or a continued head tilt on one side in the car seat or stroller, bringing them sooner than 3 months to see if a gentle adjustment is needed to align their spine can help create symmetry and ease in their bodies and brains. I actually recommend that babies get their nervous system/spine checked as newborns. (I am also a huge advocate of wearing your babies in slings.)
It is not recommended that babies have a pillow for night sleeping, but I am fine with one of the memory foam infant pillows for changing tables. There are quite a few options for this available on Amazon. Janet Green Babb, a SF PT, 
says that one product that her clients have found helpful is a pillow called Mimos Baby Pillow.
She suggests to parents that they should feel their baby's neck, shoulders, arms with gentle massage. This can give  information about symmetry. She agrees that if there are any concerns, it is important to begin therapy early to develop a home program of stretches and exercises. 
She has a list of gentle exercises that she shows parents how to do at home.
If all of your tummy time and intervention have not been as successful as we like, the next referral will be to the craniofacial or neurosurgery team for an evaluation. Either of those specialists  might end up sending you along to the pediatric orthotist team. The orthotists do some scanning (no radiation) and become part of the team that is monitoring your child’s head shape. In some cases, the kids may end up with helmets. Insurance companies vary greatly with their coverage of helmet therapy. The orthotist team at UCSF is top notch.

Although helmet therapy is usually not started prior to 5 months of age, there is little downside to having a referral sooner. For those of you interested in further details about the cranial helmet remolding process, see the information in my old post; the link is at the bottom. Although we sure do see a lot of kids with flat heads, very few of them end up needing a helmet.
Annie, one of my mom’s whose son ended up requiring a helmet, shared her story and wisdom. Her little guy is a second child with a mellow temperament so she wonders if that led to a bit more time hanging out in his infant seat.
Her doctor repeated the need for tummy time at each visit, but Annie thinks that with a bit of hindsight, if she had seen a helmet in her future she would have been more aggressive with it. At 2 months she did end up at the chiropractor who loosened up the neck muscles. These treatments made a big difference in his favoring one side over the other, but this little guys head was seriously flat and keeping him off of it did not seem to be helping as much as we needed it to. Annie adds a healthy dose of perspective: “There are worse things, We are fortunate to live in a place where this can be fixed.”
For more information about Helmets or local resources check out my old post on this topic:

Friday, January 10, 2020

Thumb sucking/nail biting/ dealing with habits

Most of us have habits. Some are good. Some are irritating. Some can be harmful. During my years as an advice nurse, I have had countless conversations with parents who were at their wits end due to their kids nail biting and/or thumb sucking. When it comes to children's habits, those are possibly the first that come to mind.

For the record, the American Academy of Pediatrics doesn’t feel the need to intervene with thumb sucking until a child is over five. Your dentist might not agree, but thumb sucking isn't usually a concern until a child's permanent teeth come in. At this point, thumb sucking might begin to affect the roof of the mouth (palate) or how the teeth line up. The risk of dental problems is related to how often, how long and how intensely your child sucks on his or her thumb.I usually try to get a start on it when they are about four.

The first day of kindergarten or when other transitions are taking place are not a good time to tackle a comforting behavior.

Other kids come up with some pretty creative nasty habits that make the parents of the thumb sucker consider themselves lucky. One of the more unusual was the 4 year old who wouldn’t stop licking shopping carts (yuck!) If your older child is consistently putting non food items in their mouth, that behavior can be related to low iron or even an elevated lead level and is worth checking out.
Is it your new year's resolution to tackle your child’s habit? Here is a truth - nagging doesn’t work. In fact, giving a lot of negative attention to a habit might even make it worse.

The most effective way to address a habit is to work on it as a team, which means that your child has to be involved and motivated to make a change. Change will only happen when your child is willing to take an active role with the problem solving. Maneuvering so that you can even have this discussion with your child without them shutting you down is easier said than done. You need to find the magic opportunity.

I like to share the “supermarket analogy” for this. Many of the parents who have picked my brain about parenting issues have heard this one before, but it is worth refreshing.

Imagine your child is the checkout clerk at a supermarket. You are the shopper. There you are, putting the items on the conveyor belt and the checker is systematically scanning them. But then, you aren’t sure quite what the issue is, but something you placed on the conveyor triggered something. The clerk made the abrupt choice to close the line mid transaction. It doesn’t matter that you are not finished, you haven’t paid, or that you have ice cream melting in the cart. There will be no more shopping at this moment. This lane is closed.

In spite of this, many of us still stand there, putting more and more items on the belt. We are wasting our time of course. There will be no transaction completed right now.
The parents of teenagers are probably nodding.

Whenever you want to have a conversation that has an agenda or a teaching moment, you need to find the right moment. Make sure the “line is open”. You might need to use the express lane (or pick one short topic.) If this is a pattern, try to figure out if you recognize what triggers the line to abruptly shut down and approach that subject delicately.

It is tricky, but it can be done. When is your child most likely open for a ‘transaction’? Maybe broach the subject when you are in the car, taking a walk, or sitting on the side of the bed during bed time. One-on-one time is usually best if you can manage to carve some out of your schedule. Allow your child to be involved in the choice of whether or not they want to invite other family members or wise friends to the brainstorming.

Before you even start the 'habit discussion' consider reading a general book about habits. Berenstain Bears and the Bad Habit, is a good one.

In this classic, Mama Bear explains what a habit is by comparing it to her pushing the wheelbarrow back and forth between the shed and the garden. Over time the wheels have made a deep rut. It is easy enough to wheel the barrow on that well worn track but it would take some effort to push it in any other way. As Mama and Sister walk along to the garden, they talk about the habit in question. Sister Bear nibbles her nails. They brainstorm together about a solution. Reading a book or telling a story about habits is a great launching point for the discussion.
Identify the habit that you want to address. Point out other folks you know with different habits so your child doesn’t feel singled out. Do you have habits that you are willing to address and deal with at the same time?

What are some of the consequences of the habit? Downsides of nail biting or thumb sucking could include broken and irritated skin, germs, crooked teeth, teasing from other children...

Keep in mind that talking about germs can be a slippery slope for some sensitive kids. We don’t want to end up with Lady Macbeth on our hands by terrifying them about living in this germ filled environment. Find a middle ground. There are indeed germs in our world. We can’t get rid of all germs, but good hand washing and keeping our hands our of our mouths is important for everyone. Freaking them out by teaching them about pin-worms should be reserved for older kids.

What is the benefit of breaking the habit? Pretty nails, no broken skin, no teasing, less risk of germs. Sore fingers can hurt!

What is a good reward to work towards if they succeed? A special outing is my favorite. It also might work to earn points towards a bigger ticket coveted toy or game. What are some ideas that you might come up with to help break the habit?

In the Berenstain Bear book, they start the day giving Sister Bear 10 pennies that she will need to give back through the day every time she is caught nibbling. Sometimes the act of having to give something back is indeed more effective than the promise of earning it.

There are some products you can apply to make the fingers taste nasty, but I only like to use those when the child has agreed that they are motivated to stop the hand to mouth habit and want to give that a try. A jingly bracelet might serve as a reminder. Having lots of healthy crunchy snacks available to chomp on can help too. When you first start out, small goals might be easier to attain. Maybe a sticker can be earned every hour that they succeed in remembering to keep their hands out of their mouth (or whatever the habit is that you are working on.) Talk about mindfulness.
One simple mindfulness exercise is to take a deep breath. Think about where your hands and feet are. Tighten them and then relax them. Take another deep breath. This is good for any habit, but especially for those that involve the hand in the mouth.
Make an agreement about how your child would like you to be their cheerleader. Do they want you to verbally remind them when you see them failing? Do they actually have the power to ask you to stop with the nagging? (This might be you own habit!) They might be relieved to have the power to take your frequent reminders off the table.

How about a finger snap,a quick whistle or a tap on your nose if you see them doing the habit? What is their preference?

Don’t forget about positive reinforcement for times when you notice they are NOT doing the habit. Experts support that positive reinforcement is one of the best ways to reinforce behaviors. Obviously you don’t need to overdo this by making comments every minute, but giving attention for progress can go along way.

Not all habits are bad ones of course. Think of some good ones that you might all want to work on this year! Practicing gratitude and thinking about things in our lives that we should be grateful for is a great one. It is by no means automatic.