- Head lice/ Sklice co-pay coupon
- Should you give tylenol before the shots? / vaccine reaction discussion
- Skin fold irritations
- HAND FOOT MOUTH (and butt) VIRUS
- Tips for giving medication
- Strep Throat
- The Poop series: Chapter #1 Baby poop
- Nurse Judy' Blog
- Anaphylaxis/Do you need an epipen?
- Pinworms (ugh)
Friday, December 25, 2020
The Christmas Cactus My grandmother had an enormous plant known as a Christmas cactus. They are known to bloom once a year. December is a common time for the flowers to come out, hence the name. Grandma gave a cutting to my mom. The cutting that my mom had thrived. It didn’t know that it was supposed to bloom just annually and would occasionally burst into bloom throughout the year. My older sister inherited Grandma's plant which also seems to have a mind of its own. Regardless of what was going on in the world or her personal life, mom would be joyful every time the plant bloomed. For her it was a signal of hope and positive energy. It was infectious and the entire family would somehow feel a lift. Prior to Covid, and when my parents were still alive, I made sure to go home to Pittsburgh every four months or so; these visits were even more frequent as both my parents got older. Scoff if you like, but more often than not, the plant would flower right before my visits and stay that way for several weeks. When mom died, my sister gave me a cutting of the plant. To say that I have not been very good at keeping plants alive is an understatement. Fortunately, Sandy has taken on the role of the plant tender. Historically he was no better at gardening than me, but after years of killing anything even remotely green, we now have an array of indoor plants that are flourishing under his care. The centerpiece is the offspring of the family plant. It has quadrupled in size since we have had it. I have given cuttings to my daughters. This week it burst into flower. It magically fills me with a sense of optimism. I feel my mom’s presence. Goodness, we all need hope and optimism more than ever after this year. Between the pandemic, the economy, the divisive politics, the climate woes, 2020 will be a year that most of us will be happy to see the last of. We all have pandemic fatigue. Please hang in there. The cactus is blooming. We are almost in a new year. Things will be better.
Friday, December 18, 2020
Let me preface this post by saying that I think it is essential to be honest with people in your lives. You don’t need to knock them over the head with the truth, but if they ask a direct question and press for an answer, please don’t lie. Over the years several parents have asked me to weigh in on the ‘Santa discussion.’ What is the best way to keep the magic alive while not endangering the trust that is so important in any relationship? For this general discussion about Santa, we can put him into the fine company of the Tooth Fairy and the Easter Bunny, but it is safe to say that Santa is usually the member of this trio that has the most emotional connection. The Covid pandemic has added an extra layer to the conversation. This year some kids are worried that Santa will either have issues with social distancing or have trouble taking the time to wash his hands in between the houses that he visits. Talk about a potential 'Super Spreader'! In my Jewish family, the girls never gave too much thought to the man in the red hat or the giant bunny, but we did get routine visits from the tooth fairy every time the girls lost a tooth. When I wrote this post a few years ago, I checked in with my grown girls to see if they remembered any feeling of betrayal when they realized that it was daddy sneaking the money under the pillow. Lauren tried hard to remember. She vaguely recalls that she figured it out reasonably early, but played along for several years. She wanted to make sure that the gravy train didn’t dry up. Alana says that she was too busy trying to figure out if monsters were real or not (thanks to having a big sister who teased her by making strange noises in the middle of the night) to worry too much about the Tooth Fairy. For the young kids who ask if the mythical creature is real, if you want to extend the magic for another year, you might deflect the questions fairly easily without telling a falsehood. A simple, “What do you think?” works pretty well. Or, “It is fun to believe in magic sometimes and Santa is part of the holiday magic” Keep in mind that once your child gets to kindergarten believing that Santa is actually going to try to fit down your chimney, rather than the ‘spirit of the holiday magic,' they might be in for a shocking disappointment when they learn the truth. There are lots of kids at school, even virtually, who are eager to share the cold hard facts with your innocent child. It is much better if this discussion comes from you before your kids find out a harder way. I spoke to several people who recounted that they believed in Santa with all of their hearts and were completely devastated when they learned the truth. They felt deceived. One person told me that finding the truth was the moment they stopped believing in all magic. How sad! Letting them know the truth gently doesn’t have to be a negative experience. For older kids, I love a good story. Many stories start with an element of historical truth: “Once upon a time in a far off country there was a man named Nicholas. He loved to do good things for other people. What was special about him is that when he gave people presents or did nice things, he didn’t do it because he wanted something in return. He simply wanted to do good things. Lots of times he did it in secret and no one even knew who did something nice for them. Maybe this Nicholas was big and jolly and had a white beard. He became known as Santa Claus. Santa is a symbol of love and magic and hope and happiness. He teaches children how to believe in something that they can’t see or touch. I am on his holiday kindness team and now you can be too. Really little children might believe that there is one Santa who manages to be everywhere at once. Big kids like you get to know the secret. Team Santa is all the big kids and grown ups who want to help make other people happy. “ Perhaps take the opportunity to help your child be an active member of this awesome team; an initiation of sorts. Is there someone in your life that seems like they need a little kindness? What could you do for them? Is there a little gift that might make a difference? Plotting a secret kindness is the thing that wonderful lasting holiday memories are made of. PS: Even when Covid is no longer an issue, the photo on Santa's Lap should be voluntary. If your child isn't eager to go sit on a strange guy's lap, please don't force them. If the kids are up for it, there are places that are making socially distanced Santa Visits possible this year. https://datebook.sfchronicle.com/entertainment/where-and-how-to-get-your-2020-photos-with-santa-in-the-bay-area
Friday, December 11, 2020
Dental Care 2020 Scroll down for the list of dental practices Covid has complicated so much of our normal lives. Doing a risk/ benefit analysis for daily activities can become so tedious. One of the questions many of my patients have asked me is about routine dental care during the pandemic. The current official recommendation now is that your child should have his or her first dental visit by age one, and this does not change due to COVID. In California, about one third of preschoolers have dental decay. It is much easier to prevent decay in toddlers' teeth than to fill a cavity in a young child. Tooth decay is the most common chronic childhood disease and it can be prevented. I reached out to Dr. Rothman who was my daughters’ beloved dentist (he made them laugh and they actually enjoyed seeing him!) Dr. Rothman has remained a trusted resource for me over the years even though my girls aged out of his practice. It turns out that he was the right person to ask! He actually chaired part of the Covid19 workforce on dental practices. He pointed out that dental practices were among the first to really deal with infection control. They have been using masks, gloves and face shields long before this pandemic. His office worked closely with the California Department of Public Health and Cal Osha when they developed practice guidelines and checklists. Dentist offices might actually be one of the safer places to bring your child. It IS considered an essential visit. Sadly, Dr. Rothman told me that he is seeing a real increase in cavities and gum disease that corresponds with people not going in for their routine dental visits. As parents, we may think, "baby teeth fall out, so we don't need to worry about them." This sounds logical, but unfortunately is not true. Luckily, dental science has found out many new facts about how to prevent dental decay. We now know that bacteria causes tooth decay. This "bad" bacteria can find its way into your babies mouths in many ways. Eating foods high in sugar is one of the most obvious offenders. In order to prevent decay in our adult teeth, baby teeth have to be kept healthy as well. What can you do to keep your child's teeth healthy right from the start? For the youngest babies with brand new teeth you can wipe them off with a soft piece of gauze or a wet washcloth. Not only are you cleaning off the teeth, (breast milk does have sugar) but you are getting the baby used to a routine. Training your child from the start that teeth get brushed is a good way to create good dental habits that will last a lifetime. There are other options besides the standard hand held toothbrush. For very young babies, there are little flavored towelettes specially formulated for wiping baby teeth. Spiffies was the first of these that I was familiar with. Now there are several brands available. You could also consider using a soft finger brush. These fit over your finger and if your baby will let you, this option allows you to get in there and do a nice thorough job. If you use a regular toothbrush, make sure it has soft bristles. Replace the brush when it looks like the bristles are getting worn. It is also a good idea to run all the family toothbrushes through the dishwasher every once in a while. One extra perk about routine dental care is that you might walk out of the dentist's office with a new toothbrush! Younger children will have an easier time handling a toothbrush with a thicker handle. Perhaps you can let your child be in charge for one brushing a day and the parent be in charge of the other; that way you know you are doing a more thorough job at least once a day. Some people use a two toothbrush approach. Toddler gets to hold one, but so do you. Both of you can be in there at the same time. Consider putting a little tune on while you brush. This can act as a timer. Brushing is ideally supposed to last 2 minutes. Do the best you can. A full two minutes might be a goal that is a little unrealistic for many of my patients. Brushing can be a little more fun and interactive nowadays with some fun apps. Sonicare-for-kids-sonic-electric-toothbrush brushdj brushupgame DisneyMagicBrushTimer TinyDentist Chomper chums my-bright-smile Don’t let it be too active, I once had a patient who got a fairly serious mouth injury from doing a little rough housing while brushing his teeth. Make sure your child isn’t running around with a toothbrush in the mouth. The American Dental Association recommends using a tiny amount (just a little dab) of fluoride toothpaste. It is important to note that too much can be harmful so keep the amount as small as a grain of rice. Once kids get to be over two and can spit it out after brushing, you can use a pea sized amount. Xylitol is another recommended ingredient for dental health. It is found in some toothpastes. This natural sweetener is found to help reduce bacteria and strengthen tooth enamel. It is important to use a toothpaste that is non abrasive: https://www.bestdentistguide.com/non-abrasive-toothpaste/ Most kids' brands are specially formulated to be gentle. Some adult ones are fine. Some toothpastes will have the abrasive rating noted on the package but it isn’t always easy to find. Ideally try to brush twice a day and floss once a day (for teeth that are touching.) Pay attention to habits that may or may not be good for your teeth. Children who are “grazers” tend to have more cavities than those who eat less frequently. Saliva neutralizes the acids in the mouth and actually ‘washes’ the teeth, but it needs about 2 hours in between meals to work. If someone is constantly eating, the saliva isn’t getting a chance to do its job. Foods that are high in carbohydrates and sugar are not healthy for our teeth or general health. A daily intake of 60 grams of carbs or higher more than doubles your chance of getting caries (and all that sugar can lead to type II diabetes in kids!) FINDING A DENTIST Find a dentist that treats very young children and bring your child to his or her first appointment when the first teeth erupt - no later than by age one. During the visit, the dentist will check your child for dental decay and talk to you about cleaning your baby's teeth. They might also talk to you about proper nutrition for keeping baby teeth healthy. If you have any concerns about the manner in which the teeth are erupting, having a dentist who is familiar with your child will be very useful. Another important thing to think about is that having a dentist can come in very handy if you happen to have any dental emergencies. Kids have accidents! It is not unusual for me to get calls about chipped or loose teeth after a fall. I usually suggest that they contact their dentist on those occasions, and the folks that already have one are way ahead of the game. If there is a dental emergency, early intervention can be the difference between saving the tooth or losing it. Some parents avoid taking children to the dentist to save money, yet studies show that the dental costs for children who have their first dental visit before the age of one are 40 percent lower in the first five years of life than for those who do not see a dentist before their first birthday. Consider this when deciding whether or not to add your child to your dental plan (if you are lucky enough to have one.) When I was working at Noe Valley Pediatrics, I compiled a list of popular practices based on patient feedback. Full disclosure, this list is from my 2018 post. There are lots of great practices that are not on my radar. We are fortunate to have lots of excellent choices in our city. If someone is conveniently located or is on your insurance plan that is certainly worth consideration. Many of them have updated their websites to reflect their COVID precautions. If the practice has not posted their protocols, it is very reasonable to call and ask. David Rothman 415-333-6811 is over on Ocean avenue near Stonestown. He was my kids' dentist and they loved him. He is an excellent dentist with a wonderful sense of humor. His office is able to do procedures under general anesthesiology in the office if needed. He remains my "go to" guy if I have any tooth related questions http://www.davidlrothmandds.com Bergen James, Doris Lin-Song and Jennifer Yu 415-668-3500 http://oneparkerpediatricdentistry.com/ Claudia Masouredis 415-753-2777 http://www.drmasouredis.com/ Dorothy Pang 415-681-8500 is on Taraval and 18th in the Sunset. Dr. Pang is affiliated with the UCSF dental school. If someone needs a dental procedure under anesthesiology she can do this at UCSF rather than in the office. http://www.opdsf.com/ Raymond Katz 415-751-7900 This practice is at 5233 Geary. https://www.sfdds4kids.com/ Han Pediatric Dentistry 415-681-3220 Dr. James Han’s office is at 1530 Noriega Street. Dr Han is also on staff at CPMC and attends any dental emergencies at the ER there. He can perform general anesthesia cases in the OR there as well. www.HanPediatricDentistry.com Dr. Charles Spitz and Dr. Tyler Davis 650-375-8300 Peninsula Pediatric Dentistry and Orthodontics. If you are looking for a practice down on the peninsula, this great practice is located in San Mateo. Dr. Davis works with Dr. Spitz, who used to have a practice in the Mission. They are located in the Mills Medical Arts building on the corner of South San Mateo Drive and 2nd Avenue in downtown San Mateo. http://www.spitzanddavis.com/ "We are a preventative practice first and foremost. We believe the best dental care is personalized to meet the individual needs and preferences of each child we see. We work hard to get to know our patients and their families. We're always willing to listen, to discuss options and to answer your questions." Anne Lee DDS 650-873-5212 Anneleedds.com Kid Smiles 415-681-5437 http://www.681kids.com/ There are some low cost options available as well. If you need assistance in finding a dentist, or low-cost children's health insurance in San Francisco, please call the Women and Children's Health Referral Line @ 1-800-300-9950. Low Cost Dentist options
Posted by Nurse Judy at 3:38 PM
Friday, December 4, 2020
This week's topic Talking Barbie takes a Bath This post is not going to educate or problem solve, but it might make you giggle, which is actually what we all need these days. Sandy’s uncle Bernie was a very senior executive at Mattel, and a friend of Ruth Handler, the inventor of Barbie. What this boiled down to was that every December, an enormous box would be shipped to our house filled with the latest toys, and dolls. My girls ended up with an absurd amount of Barbies. And we even had boxes labeled with extra Barbie parts - arms, legs, heads... My kids could entertain themselves endlessly with these. My sister-in-law Barbara was just recounting a memory of watching her nieces play with the dolls. At one point Lauren declared “This is boring. Let’s play Barbie in Russian”. They proceeded to continue the activity that looked to be completely unchanged, but now the various Barbies spoke to each other with Russian accents. Somehow this added just the element of excitement that was lacking, and the play happily continued. One year, a very special Barbie made an appearance. This one talked. When you pushed the button on her back she would come out with a multipart statement such as “ Want to go to the Beach? With Ken? Tomorrow?” When you mixed and matched, it turned out to be a pretty wide range of Barbie appropriate statements (no Russian accent). This was a long time ago. My 4 and 7 year old daughters shared a bedroom and the third bedroom in the house was an office/toy room. One evening the girls were in the tub. They had brought some dolls in there with them. They were past the age of needing eagle eye supervision, but I was in my room keeping an ear out when I heard the new Barbie chatting. I went into the bathroom and said, “this Barbie should probably not be in the tub. I don’t think she should get wet.” No problem; they handed her over and I put her away. A short time later I heard her talking. “ Want to get some pizza/ with Skipper? On Monday?” “Hey girls...I told you Barbie can’t be in the tub” “She isn’t in here!” This is when I heard Sandy pipe up from the office…”uh, she is in here.” So, there she was, right where I had left her, just occasionally coming out with something to say. We figured at some point it would just stop. Bedtime routine continued and the girls were tucked in. Sandy and I were down in the kitchen when some time later the girls appeared; they were laughing and holding the Barbie. “We can’t fall asleep. She is keeping us up.” Sure enough, Barbie was now ranting and it was LOUD. “Pizza, shopping, beach, Ken, Ken….” Sandy, who was always the bedtime enforcer, took the doll and said, “okay...back up to bed, we will take care of her”. He wrapped her up in a towel and you could still hear her yacking away. So we did the next obvious thing, we opened the oven door (it wasn’t on of course) and put the towel wrapped rambling Barbie in it. You could still hear her. It was a little Twilight zone-ish. We looked at each other at the same time and said “batteries, Duh!” Laughing at ourselves that our ‘obvious’ solution had been to wrap her up and try to muffle her, we retrieved Barbie from the oven and with the help of a small screwdriver, removed the battery. We left her on the kitchen counter. The next morning, I was down in the kitchen making lunches for the kids to take to school (Alana in general refused sandwiches so I always had to be a little more creative.) I was still a little sleepy, so when the Barbie, sitting on the counter suddenly said “Do you want to go shopping?” I confess that I let out a scream and dropped whatever I had been holding. Unbeknownst to me, Sandy had replaced the battery before he left for work Since she was no longer yelling, we let her talk herself out until the battery finally died, at which point she was relegated to the status of just another Barbie. Wishing you all a season filled with plenty of things that make you smile!
Posted by Nurse Judy at 8:46 AM