- Head lice/ Sklice co-pay coupon
- Should you give tylenol before the shots? / vaccine reaction discussion
- Skin fold irritations
- HAND FOOT MOUTH (and butt) VIRUS
- Tips for giving medication
- Strep Throat
- The Poop series: Chapter #1 Baby poop
- Nurse Judy' Blog
- Anaphylaxis/Do you need an epipen?
- Pinworms (ugh)
Friday, November 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.
Posted by Nurse Judy at 9:52 AM
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