Friday, May 29, 2020

How and when to talk to your kids about sex. It might be sooner than you think!

I have been doing this blog for many years. I try to stay fresh with new thoughts and ideas, but I also continually update old posts. Things change, new information emerges, sometimes something will come along making headlines that feels like it is worth addressing.

The ‘Talking to your kids about sex post” is one that I have posted several times over the years. I am updating it because there is a new resource that I want you all to know about. I have tacked information and the link to a brilliant playbook option on to the bottom of the post.

Comes the moment in every family when it is time to have the talk about sex, but how and when? It varies with every child.

There is a story about a young boy visiting his grandparents’ house one summer. He came rushing in from outside where he had been playing with some new friends from the neighborhood. “Grandma, what’s it called when two people are in bed, but one is on top of the other one?”

Grandma was taken aback for a moment but sat him down and gave him a matter of fact talk about the birds and the bees, so to speak. The little boy listened carefully with his eyes open wide and then ran back out to join his friends. It wasn’t long before he ran back into the house saying, “Grandma, it’s called BUNK BEDS and Mrs. Wilson wants to talk to you!"

The all important moral of this story is to make sure that when your child presents you with a question, you understand what they are actually asking before you launch into any complex explanations. You could start with a statement such as “ I am so glad that you asked me. I am always happy to help you find answers to things. Tell me more about what you are wondering about."

My sister Amy has her own tale. She and her husband are National Park rangers and they moved to Utah when her oldest son was in 4th grade. Even when reading the Harry Potter series, my nephew Asher covered his ears when they were reading any scenes that involved kissing, but now that they were living in a new place, he had a question.

“Mom, where do babies come from”? Amy paused and then followed up appropriately. “Is there something specific that you are wondering about?”

“I heard that babies happen when a mommy and daddy love each other very much and their souls connect.”

My sister's family was now living in the heart of Mormon country where most families were quite a bit larger than he was used to seeing. He knew that his mom and dad seemed to love each other a lot, but they just had 2 kids, Asher and his brother Ben. The math wasn’t adding up. Why didn’t their ‘souls connect’ as often as most of the neighbors. Amy went on to let him know that there was a little more to it than that, but it involved some more mechanics including some of that “Kissing stuff”. Nope, this wasn't his moment.There was no need to talk about it that day.

Get yourself as comfortable as you can with the discussion. What do you call body parts? Does your family use a nickname (perfectly fine) or is your child able to rattle off the anatomical names for all of their “parts"? Of course having discussions about bodies usually comes long before discussions about sex.

Many parents are a little shocked and uncomfortable when infant boys have erections or they notice young boys and girls masturbating. This is incredibly common (the human race is fortunate that masturbation doesn’t actually cause blindness.) While it is usually quite normal, if you notice that your child is constantly touching themselves to excess, I want to make sure there is no irritation or external cause. Maybe their underwear is too tight. Have they been running around in a wet bathing suit? That could be yeast. Itching could even be something like pinworms! If there is no obvious underlying issue, consider having a discussion about that fact that, yes it feels good, but our bodies are delicate and it is important not to touch so much that things can get sore. Some families have a talk about family rules and theirs might be that gentle touching is a private activity. Beware, a true story - one of my families who made a point of having accurate vocabulary was caught off guard one night when their 4 year old son made an announcement at a fairly formal dinner party with mom’s boss. “ I am going to go into my room now so that I can touch my penis in private.”

This is also an important time to have a discussion about body ownership. No one should be able to touch any part of your child’s body without permission. Exceptions are parents and doctors (with parents present) and that should never be a secret! Empowering your child about their body early is important.

And then they get a little bit older….

I remember driving a van loaded with carpool kids to school many many years ago. I caught a piece of the conversation that was going on in the back seat and my ears perked up a bit as I tuned in.

“Yours have done it at least twice." “Yours have done it at least once” "Ours have done it at least twice...Oooh/Yuck”

As soon as you feel that your child is curious and is possibly going to be picking up odd or skewed information from their friends or classmates, it is important that you make an opportunity to have a chat. It is essential that your child sees you as the trusted source of correct information and is comfortable asking you questions. Unfortunately in this high tech world, it is becoming increasingly easy for kids to be exposed to all sorts of things with very adult content at a very young age.

You may want the help of a book. Amazon and libraries have an enormous amount of books that you can use as a resource. There are many good ones out there. I would suggest that you skim through several until you find one that feels like it is the right comfort level for you. You may want to do this research a little ahead of time. (At the end of this post is a new and worthwhile resource to check out.)

Liesel Harris-Boundy from the West Portal Branch of the San Francisco Public Library was kind enough to come up with a list of good books on the subject that she is familiar with. Liesel shared that an ObGyn friend recounted that her 7-year old son asked her, "Mom, what's a vagina?" and though this woman talks about vaginas all day, she was unprepared to tell her son and excused herself from answering! That reserved part of her upbringing came through in spite of all her medical training! This is to remind you that we all have different comfort levels dealing with this, but gather your wits about you, it needs to be done.

The following books should all be available through the library. Once the libraries reopen, go in and leaf through a few until you pick one that you like.

You want to make sure that the books are geared to the correct age. Some are guides for the parents and some are meant as a resource for the child.
There are many different kinds of families, it isn’t always mommy plus daddy equals baby. I was happy to find out about the book below.

What Makes a Baby is a children’s picture book about where babies come from that is written and illustrated to include all kinds of kids, adults, and families. Geared to readers from preschool to about 8 years old, it teaches curious kids about conception, gestation, and birth in a way that works regardless of whether or not the child in question was adopted, conceived using reproductive technologies at home or in a clinic, through surrogacy, or the old fashioned way; and regardless of how many people were involved, their orientation, gender and other identity, or family composition. Just as important, the story doesn’t gender identify people or body parts, so most parents and families will find that it leaves room for them to educate their child without having to erase their own experience.

Once you do pick the book that you feel comfortable using as a resource, go ahead and buy a copy so that there isn’t a time limit.

If your child is embarking on puberty and you are looking for something more interactive than a book, check out the Heart to Heart seminars hosted by Stanford. They hold these in multiple locations. The San Francisco class is held at CPMC on California street:

During this Covid quarantine, they are offering classes online!

A list of other classes they offer are here:

One mom in our practice who went to the session thought it was very worthwhile, but she wished she had taken it earlier. She thought ten or eleven would have been perfect.

So what’s new?

Caricia, a local mom with two daughters was reading an article that included some disturbing statistics. Global estimates published by WHO indicate that about 1 in 3 (35%) of women worldwide have experienced either physical and/or sexual intimate-partner violence or non-partner violence in their lifetime. The sad fact is that these are the same statistics that existed 30 years ago. Knowing what we know, why haven’t we been able to improve this?

She gathered together a group of other parents to take a deeper look. It turned out that the public school where her children attend does the standard 5th grade sex ed that we all probably remember. They actually still use a VHS tape from 1984. Woe unto them when the VCR breaks. This is perfectly adequate to teach kids about periods and erections, but this is no longer the same world. Kids these days need to learn more about consent and boundaries. They should be aware of gender identity. They need to be given tools that will help them be able to have healthy relationships. They need to be able to navigate the online world safely. Social media is a minefield.

This group of parents embraced this project with a gusto. They traveled the world in search of information. The disparities between different countries was notable. The Netherlands is the country with the best health outcomes so they headed there to learn more. One of the successes that the Netherlands has achieved is the lowest incident of teen pregnancies and sexually transmitted diseases. If the data is to be believed, the kids wait. The first sexual intercourse was reported to be the age of 19 and, this is important, it was with someone they cared about. Contrast that with this country where the average age is 16 and the experience is more likely to be casual. Once they returned from their travels, they studied the curricula from leaders in the field here as well.

The thinking is that we need to start our education earlier. Perhaps as young as 5 years old. At the very least, young children should be comfortable with their bodies. They should be given the rules that a surprise is okay, but a secret is not.

This is a crazy scary world; we do NOT want porn or sexting to be our kids first introduction to sex. Parents need to be the ones to get there first with accurate information. How do we tackle this?

You can thank this group of parents for creating a method that will help guide you through this. These educational activities focus on empathy and safety as well as biology. These are broken down into 3 age appropriate segments.


These are rough age ranges because they recognize individual differences in families and children. These are also directed to parental comfort. The books are spiral bound. If there is something a parent wants to avoid, a page can be removed.

Hopefully there isn’t anything that you are too uncomfortable to talk about. The goal is normalizing this topic and keeping the conversations safe and open. The website is

This goes well beyond simply reading a book to get necessary information. What they have is playbooks that include games and activities that can open dialogue opportunities. There is also a robust list of books and resources on the site ( some overlap with the list I have above).

Bottom line, honesty and communication are essential. As awkward as this conversation may feel to some of you, you really don’t want your kids to be getting their sex education from the neighborhood kids (or even worse, the internet!) For your teens, you can act as a safe boundary from the nastier places on the internet. Make clear rules that as long as you are paying for the phone plan, you have access to the browsing history whenever you want (but don't abuse that right!) There might be the kid out there who feels saved by this. “Sorry, I can’t sent you a photo of my ‘whoozee whatsis’, my parents check my phone.”

Don't force too much information on a younger child who isn't interested. Letting them know that you are always open and willing to talk about "grown up" stuff with them is a great start. These playbooks might be just this thing.
Click below to find more about and/or support this project

Friday, May 22, 2020

Rashes/ When to worry 2020

Rashes/when to worry

Rashes are a fact of life. Over the course of my career as an advice nurse, you can't imagine the scope of the emails I have gotten from people asking for me to help them figure out what is going on. Some came along with photos of random body parts, not all of them easily identifiable. Rashes can be spotty, blotchy, hivey, oozy. They can be caused by allergies, bug bites, scabies, bed bugs, poison oak, contact dermatitis, virus, bacteria or fungus. They can be on only one body part or cover most of the patient. They can be part of a chronic condition that comes and goes, or something acute.

Once in a while I can look at a photo of a rash and have a good guess of what I am looking at, but more often things aren't completely clear cut. The most important thing really comes down to one very important and basic question: "Do we need to be worried about this rash or not?"

This has never been more important. Data is continuing to emerge about a multi system inflammatory disorder in children that is apparently connected to COVID-19. It is very rare, but important to be aware of. 

Rashes that I am curious about

If your child is acting fine but has a random rash, ask yourself the following questions:

-Are there any new medications (especially antibiotics; even if it is the end of a course, this is important information) ?

-Was there a recent illness/fever? If you had a mystery fever and then a rash comes out once the fever is gone, I am NOT as concerned about it. There are quite a few viral syndromes that wave goodbye with a rash

  • Have they had a MMR or chicken pox vaccination within the past 2 weeks?

  • Are there any new foods?

  • Have they been enjoying lots of citrus or berries lately?

  • Are there any new soaps, detergents, bubble baths?

  • Have you used a new sunscreen or lotion of any sort?

  • Do you have pets? (Think fleas!)

  • Has there been an exposure to a new animal? (think allergies)

  • Has your child been in a hot tub?

  • Is the weather very warm? (my San Francisco babies don’t like the heat)

  • Has your child been laying in the grass or sand?

  • Has there been any recent travel?

  • Has your child done a recent art project with a new substance?

  • Have you checked the mattress and area around the bed to see if there are any spiders or insects hanging around? (shudder)

If your detective work has given a promising clue, make the common sense adjustments and see if you see any improvement.

Regardless of what is causing a rash, there are several basic staples that are worth keeping on hand. The first several on the list are used for basic skin care and can be somewhat preventive.

  • Cetaphil cleanser (no water needed, apply and wipe off)

  • Aquaphor or Cerave ointment

  • A good moisturizer

  • You all know that I love adding a splash of apple cider vinegar to the tub for all sorts of rashes

  • Over the counter hydrocortisone cream/ointment for itchy areas

  • Over the counter Neosporin or prescription Mupiricin for any open areas

  • Over the counter anti fungal cream/ointment for any possible yeast rashes.

  • oatmeal bath (don't clog your drain with real oatmeal, there are special products used for this)

  • Zyrtec or Benadryl

  • Bleach! Believe it or not, many dermatologists will suggest a diluted bleach bath for helping clear up eczema or bacterial infections.

Of course feel free to call your advice nurse or doctors office to help you troubleshoot. If a rash is persistent and your best attempts at clearing it with a variety of OTC creams isn't helping, You may be sent to the dermatologist.

Rashes that I am worried about

Any purple rash needs to be evaluated. These rashes don't lighten up when you press on them. If you have a child who has a purple rash and also has a fever and looks ill, they need to get to an emergency room immediately to rule out meningitis. A stiff neck, vomiting and headache would make me even more concerned. These kids look SICK!

Any rash that comes along with a fever at the same time is probably worth being seen. Strep throat can do this. Fortunately measles is not common at the moment, but that also would present with a rash and fever at the same time. The patient will look sick.

Other viral syndromes that may have the rash and fever at the same time are Slap Cheek and Hand Foot Mouth. We don't have anything other than suggestions for symptomatic relief for those. You simply will need to ride them out.

If the rash is oozy and crusty it might be bacterial. Impetigo is fairly common.

If your child has a history of impetigo and you already have Mupirocin, you can try to treat a small area. If it isn't clearly taking care of things, an appointment is warranted. Sometimes oral antibiotics are indicated.

If a rash seems to have clear fluid filled centers, it could be chicken pox!

If the rash seems very painful or itchy certainly try Zyrtec or Benadryl, but if your child is uncomfortable let's get them seen to see if we can help. Some itchy rashes like poison oak may need oral steroids.

Hives are scary because most people associate them with a severe allergic reaction. What most people don't realize is that most of the time hives are not always a big deal. They are a signal that the body is reacting to something, but often it can be viral. I have had patients with mystery hives that have cycled on and off for several weeks before finally fading. If your child has hives along with any facial swelling or difficulty breathing, they need immediate attention. If they have a history of severe allergy to something, you should have an epi-pen or AuviQ on hand and follow that up with an emergency room visit for some close monitoring.

Any painful rash that is only on one side of the body and doesn't cross the midline could be shingles. It is rare for children to get this, but it can happen.

Here is an important update to this post.

Data is continuing to emerge about a multi system inflammatory disorder in children that is apparently connected to COVID-19. It has some similarity to a rare illness called Kawasaki Disease that causes blood vessels to become swollen or inflamed throughout the body. This new Pediatric Multisystem Inflammatory Syndrome (PMIS) has many similarities, but where Kawasaki is much more common in patients under 5 years of age, this new illness doesn’t care so much about the age.

The kids look sick! As Dr. Ted from Oath Pediatrics says, most parents can easily recognize that these kids need to get right to the hospital, not wait to get a call back from the doctors office. This is a very serious condition. Most kids will recover, but medical treatment and hospitalization are essential. Red flags include:

  • swelling and redness in the hands and feet
  • redness or cracking in the lips or tongue
  • swollen lymph nodes in the neck
  • high fever
  • red eyes
  • belly pain
  • trouble breathing
  • confusion

A child who has a rash, but is happily playing and doesn’t have other symptoms mostly likely does NOT have PMIS. Scroll up to the rashes we are curious about.

So to recap, if you are WORRIED, make sure that you are seen sooner rather than later. If you are simply curious, it is time to play detective!

Friday, May 15, 2020

Vitamin D levels/ more important than ever

This week's topic
VItamin D levels/ More important than ever

Food superstars come and go. One minute something is going to cure all of your ills and the next minute it might be considered poison (lets just hope that chocolate and wine stay on the beneficial foods list !) One of the good guys is vitamin D. At the same time that scientists were recognizing the importance of this vitamin, they were also discovering that many folks are vitamin D deficient without being aware of it. 

Suddenly with the pandemic wrecking the world as we know it, Vitamin D is making headlines again. No one is suggesting that it can prevent covid-19, or cure it. What they are finding though is a correlation between a patient’s vitamin D level and how they fare once they get sick. People with vitamin D deficiencies seem to be having a rougher time. One wonders if this isn’t part of the issue for folks living in nursing homes. They likely aren’t getting outside for a dose of sunshine and I wonder if anyone thinks about their D level.

Years ago, vitamin D deficiency was most associated with Rickets (a disease that causes very soft bones.) More recent studies found that vitamin D levels are also very important well beyond good bone health. Deficiencies are linked to multiple illnesses including diabetes, cancer, heart disease and even mood disorders. Some studies are watching the link between low levels of D and obesity. There are ongoing studies underway to see if there is a link between low Vitamin D levels and increased allergies. Other studies are linking D deficiency to insomnia and ADHD. There have been studies linking Vitamin D and cognitive health in older folks. This list goes on and on.

Just recently a large-scale meta-analysis using more than 10,000 participants concluded that vitamin D supplementation may help to prevent acute respiratory tract infections. Even without the pandemic it is important to make sure our babies are getting enough.

There are 2 forms of vitamin D: D2 and D3. Most experts are in favor of focusing on D3, which is the more natural form. Quality infant formulas have vitamin D in them. Babies who get 32 ounces of formula per day have their needs covered. If your baby is breastfed, that is a different story. 

The American Academy of Pediatrics recommends that all breastfed babies start getting 400 IU of a vitamin D supplement within the first few days of life. (IU stands for international units, which is a common way that vitamin D is measured.) Unfortunately, the segment of the population who often test the lowest for vitamin D are pregnant and breastfeeding women. If you are a nursing mom and you are deficient, your baby is simply not getting the amount that they need from your milk. It would be nice to believe that breast milk is a "complete source" for all of your baby's needs. With vitamin D this is not necessarily the case; it comes down to the mom. If mom has a good level, her milk might be adequate but there are no good reasons to take a chance.

There are some studies that claim that if a nursing mom takes 4,000 IU/daily, this can adequately fortify the milk and ensure that the baby is getting the suggested amount of 400 IU. Giving vitamin D drops directly to the baby can take the guesswork out of this and remains the AAP recommendation. 

There are many different brands available for your baby. If you are giving your baby a multivitamin supplement like Poly-Vi-Sol, that already has the D in it. If you are giving the D alone, one of the most common brands is the Enfamil D-Vi-SOL. One dropper is 1 ml; this gives the daily dose of 400 IU.

Babies seem to tolerate this well. There are some other forms out there that give 400 IU in each drop! That is quite a difference. It is essential that you be a careful label reader! Vitamin D is one of the fat soluble vitamins, you cannot get "too much" from natural sources such as the sun or diet, but as with any supplement, you don’t want to overdo it. 

Dr Den from the in Noe Valley says that Vitamin D is the supplement that she encourages in many of her patients. She likes the Nordic Natural brand that doses the 400 IU in one drop. Nordic Naturals also has a 1000 IU gummy which most kids find super yummy. Den isn't usually a fan of gummies especially when the drops are so easy, but most kids really like these. You can order these from her website. You need to click on the pharmacy tab, sign in and go from there.

Children over the age of one, and all adults, should make sure they are at the very least getting 600 IU daily. I have no concerns about bumping that up to the 1,000 unit gummy if that is the easiest way to get your kid to cooperate. Milk and orange juice that have D added, some fatty fish, and cod liver oil are on the short list of good dietary sources for vitamin D, but a person would have to drink ten tall glasses of vitamin D fortified milk each day just to get minimum levels of vitamin D into their diet.

Other foods like some mushrooms and eggs will get you a bit, but not enough to begin to make a dent in the daily requirement.
Historically much of our vitamin D is/was from sun exposure. Folks who live in sunny climates generally have higher levels. Darker pigmented skin has a harder time absorbing it. Being out in the sun unprotected for 30 minutes, 2 or 3 times a week, would probably give most people the amount they need. But wait!! Do we really want to expose ourselves and our children to the risks associated with sunburn? To compound things, the rays of natural sunlight that produce vitamin D in your skin cannot penetrate glass. This means you can’t get vitamin D from indirect sunlight in your car or at home.
In fact, our recent healthier sunscreen practices are quite possibly the cause of our lower vitamin D levels. Weak sunscreens (such as SPF 8) can block Vitamin D by up to 95%. It is hard to find a balance. Some exposure is healthy, but overdoing it is problematic, Sunburn and an elevated risk of skin cancer don’t seem like a sensible answer.

In any event, it isn’t a bad idea to know what your level is. The next time you are getting routine blood work, consider asking your doc to add an order for the vitamin D level. The recommended test usually ordered is a 25-hydroxy vitamin D level. There is some debate about what the proper level should actually be, but everyone seems to agree that:

  • < 12ng/ml is severely deficient.
  • 12-20 ng/ml is still not adequate
  • 20-50ng/ml is a reasonable range of normal
(measurement is nanograms/milliliter)

Many naturopaths and healers prefer the level to be over 50. 
40% of folks tested in this country are low!! Please make sure that you and your baby are not one of those. Daddies, you need it too!!! 

I have had many calls over the years from frantic parents who are learning about this for the first time and haven’t been giving any supplements to their kids. Take a deep breath. It is more common than you might think that the vitamin D discussion didn't make the list and your baby is several months old before you learn about the recommendation for the supplement. Please don't stress. This is not just a recommendation for newborns; it is a lifelong health issue. We can’t manage the past. Now you know and can make a vitamin D plan for your family.

None of the studies on the magic of Vitamin D are definitive. Some of the studies have flaws. Of course Vitamin D is no magic bullet, but if taken in safe doses it can likely have a positive impact on your health. My family takes it daily!

Friday, May 8, 2020

The impact of a single sentence

The impact of a single sentence
My Mother-in-Law’s birthday was this week.

This week I am rerunning a short one that is always relevant.

Social media in general and Facebook in particular have their benefits and drawbacks There is no doubt that it is way easier to reconnect with long lost friends than it used to be.
A few years ago my husband got tagged in a 6th grade class photo from his good old PS 32 in New York City. This started a flurry of conversation between people who hadn’t been in touch for many many (many) years. There is really nothing quite like an old friend who knew you when. I believe he may actually stay reconnected with some of these folks.
With all the catching up that was going on, there was a comment from a girl in his class that caught my attention. She wanted to let Sandy know that after all this time, she still thought about his mother.
It turns out that way back when, after a school performance, my mother-in-law had made a bee-line straight over to this girl just to tell her what a wonderful job she had done. It wasn’t the simple “good for you”; Elaine had told her how moved she had been and that this young lady should be very proud of the performance. Forty eight years later, this woman says that she still remembers how impacted she was by the interaction. Wow!
There are more people out there than we can count for whom a crumb of positive feedback is rare and important. Words, either kind ones or mean ones, are often put out there without much thought and the speaker moves on. This story illustrates how much a message can sometimes stick and make a profound impact.


I was taking a walk with Alana and I told her that I was re-running this old post. She thought it was worth mentioning that it isn’t only words that make a difference. As we walk along with our masks on, it is more important than ever to make socially distant but kind and pleasant acknowledgements to the people we pass. You never know when kind words or positive attention are exactly what someone might need to keep moving forward. Folks are so stressed right now. A nod of your head and a smile with your eyes can count. Even better is a “Hi, enjoy this lovely weather" or "Oh what a sweet doggy.” This simple interaction might be the only one that some people are getting these days. Only do this when it seems appropriate. There is no need to engage with someone who makes you feel uncomfortable.

Friday, May 1, 2020

The science of Hair Loss

Quarantine day 200001, or at least that's the way it feels. My hair is getting long. Easy enough to pop it into a ponytail; it will be long enough to donate when all of this is over. Sandy’s hair was driving him crazy and a ponytail was not an option. We actually looked online to see if we could procure a Flowbee. Remember those? It was a hair-cutting tool attached to a vacuum cleaner, a strange but brilliant concept from decades ago. Evidently we weren’t the only one with that idea and they are all sold out. With little option, Sandy trusted me with the scissors and for the first time in 44 year relationship, I gave him a haircut. It came out surprisingly well, but I will stick to writing and giving advice. The scissors will be turned over to more able hands as soon as we move into that phase of looser restrictions. In the meanwhile, health and safety are more important than lovely haircuts. Since hair was on my mind and I have also recently gotten some questions about it from my Juno chat groups, I thought I would address this topic in a post.

This week's topic
The science of hair loss
When I was the advice nurse at Noe, I would get the occasional call from a parent who was worried that their kid's hair seemed to be falling out at an alarming rate. They seemed otherwise well. The parents were always surprised when I asked them to think back and see if there had been any stress or illness several months ago. Here is a little hair science to explain why.

People typically lose about 100 hairs a day. This usually doesn't cause noticeable thinning of scalp hair because new hair is growing in at the same time. Hair has a growth stage and a resting stage. The growth stage usually lasts about three years. The resting phase ranges from one to six months, but three months is the most typical. During the resting phase, the hair remains in the follicle until the new hair starts to grow in.

Roughly 5 to 15 percent of the hair on the scalp is in the resting phase at any one time.It starts to shed when the new growth stage starts. If you want to get technical and impress folks at your next Zoom happy hour, growing hairs are called anagen hair and resting hairs are referred to as telogen hair. If there is some hormonal changes or stress to the system, as many as 70% of the growing hairs become resting hairs which are poised to fall out.

Those resting hairs don’t shed until the new hair coming in pushes them out. This happens a full 2 to 4 months after the triggering event. It is usually not something that has long term consequences and most of the time the hair grows back fully.

I mentioned stress or illness. Hormones are another common cause. Mommies who recently gave birth, I am talking to you. Even in the throes of exhaustion with all of your shirts covered with spit up, it is hard not to notice all of those hairs on your pillow when you wake up. This is very very normal. Your hair will grow back.

Pregnancy isn’t the only culprit. Hormonal changes from getting on or off various birth control methods can also trigger this reactive hair loss.

Other common causes could be thyroid issues, certain medications, jet lag, nutritional deficiencies, eating disorders, excessive sun exposure. This list goes on and on.

So, if you or your child are experiencing excessive hair shedding, see if you can figure out a cause, relax and give yourself some time for it to grow back. If it remains a mystery and doesn’t show signs of slowing down, it is time to check in with the dermatologist.

Let's talk about your baby’s hair. Babies are born with their complete set of hair follicles. They just have wide variations in when the hair will actually grow in. Remember that babies are exposed to huge hormone fluctuations, so even those who are born with a full head of thick hair are likely to lose it within a few months. Interestingly, often the hair that grows back can be an entirely different color and texture. This is all normal.

If there is only one area that seems to be thinning, that is often positional. Little ones who get plunked down on their backs (following the guidelines) often have a patch that has less hair.

Aside from infants, if you or your older child has a distinct patch of hair loss, rather than general shedding, make sure it isn’t from something as obvious as tight ponytails or barrettes. If that isn’t the cause, it is worth checking with your doctor or dermatologist to make sure there isn’t an underlying issue. If the patch is scaly and circular, that could be ringworm.Dr Lawrence Cheung, my 'go to' dermatologist says that there is lots of clinical research going on that will hopefully help with future treatment for more serious hair loss conditions.

If your child is pulling their hair out this might be because they are itchy! Check the scalp to make sure you don’t see any irritation. While you are there, check for nits. ( I know you hate me now and many of you are scratching your heads) If the head looks clean, hair pulling can be a simple habit ( blog post) . It could also be a condition called Trichotillomania (pronounced trik-o-till-o-MAY-nee-uh), or something that is stress related. It is worth talking to your doctor if this persists.

Interesting Hair trivia

  • Your hair can grow up to 0.5mm per day – that’s 6 inches per year! 

  • When wet, a healthy strand of hair can stretch an additional 30% of its original length.

  • Goosebumps from cold or fear are the result of hair follicles contracting, causing the hair and surrounding skin to bunch up.

  • Balding only begins to become visible once you’ve lost over 50 percent of the hairs from your scalp.

  • Anything that’s been in your bloodstream, including drugs, alcohol and minerals can be detected in your hair, which is why hair is most commonly used as forensic evidence. The only thing that cannot be identified by your hair is your gender – both men’s and women’s hair is identical in structure.

  • Stress diagnostics can measure cortisol levels in hair. There are fascinating future implications for this that I will discuss in a future post.