Making the time shift a little less painful

 

I am quite certain that it will happen. Forty eight hours or so before the official directive to set our clocks back, I will glance at a clock somewhere in my house and do a double take, “What? It is only 9 o'clock? It feels so much later!” Sandy will laugh and we will know that he ‘got me yet again’. There are so many clocks to adjust in our houses these days between the clocks in the cars, microwaves, coffee makers, etc. Some adjust automatically, but for the others, in our family it is Sandy’s job to make the changes, and for all of the years that we have been together, it has been his habit to start the process several days ahead of time. Even though I should know better, invariably there will be the moment I look at a clock and get confused and caught off guard. Indeed, twice a year the powers that be have decided that we need to adjust our times either one hour backwards or forwards. Some people love it and others hate it, but unless the law changes, or you live in Hawaii or Arizona, it is something most of us need to deal with. This fall, the official time to change the clocks is 2am, Sunday, November 7th. In general, for most adults, other than a tiny bit of lag, a one hour time shift is a no big deal. However it is not quite as benign when you have a baby who is already waking up at 6 am. If you don’t make a bit of effort in advance, the ‘Fall Back’ means the babies are now awake at 5am (shudder!) With a little bit of planning, the following tips might make it a bit easier for you. Before we tackle the time shift, let's review some sleep basics. There are many different approaches to helping your kids sleep well, but here are the cornerstones of my sleep advice. Getting enough sleep is essential, not only for the health of your child, but for the sake of your own sanity.  If your child has the ability to do some self soothing, everything will be easier on you. It is never too early to start paying attention to this. Even if they are only able to doze off without having a nipple in their mouth or by having you actively rocking them once a day, consider that a win. Create a routine and strong sleep association, such as a special song, massage or snuggle.  Make the environment conducive to good sleep. People tend to sleep better in cool dark rooms. Babies are no exception. A perfect temp is somewhere around the 68 degree range.  See what you can do to keep the room dark. Consider the use of a Hepa filter or white noise machine. Hopefully once your little one weighs more than 14 pounds, they are already giving you a good stretch at night. This is not something I count on for babies who are younger than 4 or 5 months. For you newer parents, take a deep breath, you need to be patient for just a bit longer. Babies still need to be feeding at night for the first several months. This phase will pass. Even though the young ones don’t usually have a real schedule in place yet, and it is normal for them to be feeding during the night, self soothing, sleep associations and a good environment are still very important, trust me! If you start good habits early, you will tilt the odds in your favor for getting a good night's sleep sooner than later. Once your baby is routinely sleeping through the night, the sleep goal should be that they stay in bed roughly 11 hours after bedtime. If bedtime is 7:30pm, the ideal wake up time would be 6:30 am (I see some of you rolling your eyes at the concept of 6:30 am being considered ideal. Someday you will be able to sleep in again, just not right now.) Okay..so now how do we deal with the time change? The simplest way to adjust to the new time zone is to do it gradually. I would suggest starting a week or so earlier and move the bedtime 10 minutes later every night.  Alternatively you can simply start 4 nights in advance and do a 15 minute per night adjustment. For toddlers and preschool kids, many parents end up purchasing a toddler clock or some way that the kids can see so they know when they are allowed out of bed in the morning. Oath’s sleep consultant Anne Del Valle adds If you have children over the age of two, you can put a digital clock in the room and put a piece of tape over the minute numerals, so that they can see if it is 6 o’clock or 7 o’clock, but they cannot see the minutes, which often confuses toddlers. I would just set the clock forward half an hour so that at 6:30, it reads 7:00 and I would let them get up a little earlier than normal, knowing that by the end of the week, they would be back on track and sleep until their normal wakeup time. If they get up earlier than the sanctioned time, for the big kids, calmly walk them back to their room. For the infants, give them a chance to see if they can settle. Check the time, five minutes can feel like an hour. Parent’s can take shifts so you know who’s turn it is to go in. It is better for a nursing mom to keep her distance until she is ready and willing to do a feeding. Some people decide to wait and not actually adjust the clocks until you actually wake up on Sunday morning. Being conscious of the “extra hour” can be a fun thing to do with your kids. For the grown ups, make sure you each get an hour of being off duty. Spend it doing something just for yourself, maybe a bubble bath, or some meditation or go for a run. It is your hour. Your partner gets one as well. For the kids, ask them how they would like to spend their hour. I want to make one more point about early waking. When my sisters and I were young, my mom was the first one up. She loved the dawn. Sometimes it was because it was the only time she could claim quiet time before the rest of us woke up, but there was something about it that called to her. The reason that this lifestyle worked for her was because whenever she could, she also went to sleep early. Many of us get a second wind in the evenings and enjoy some adult time once the kids are in bed, but if you are routinely exhausted in the morning, it might be worth the effort to put your kids schedule on the back burner for the moment and take a look at your own. Sleep needs vary. How much do you tend to get? How much do you think you need? If you are running at a steady deficit, this is going to start taking a toll on every aspect of your life. Much of the time it is simply about making better choices. Yes, I am saying that perhaps you should stop binge watching whatever series you are following, or put down candy crush and get into bed! If you have trouble falling asleep, make sure your iron and vitamin D levels are within normal limits. When your kids have grown and you are retired, you can sleep in as late as you wish. The years with young kids in the house are fleeting. Most kids are early birds. See if you can train yourself to embrace this, or at least not look at it as torture. If life offered the option of going back in time, I wouldn’t rule out a 6 am encounter with my babies. Enjoy your extra hour! I hope your kids behave. You are on your own with your pets...... And now for you science nerds.. Prepare to be wowed by Dr Ted's bonus information below. Circadian Rhythms: Why is shifting sleep so tough in the first place?! To understand why daylight savings can be so disruptive, it can be helpful to understand the physiology of our internal clocks. At the very center of our brains, the hypothalamus, there is a physical nucleus of our sleep/wake cycle. That nucleus takes in signals about the daytime, like lights, sounds, and adrenaline, to keep us awake during the day, and signals about the nighttime, such as quiet and darkness, to produce the body’s natural sleep hormones, like melatonin. However, imagine how confusing it would be if the hypothalamus didn’t have an internal clock to assist with these shifts? We would fall asleep in darkness, and bolt upright through every loud noise at night. To assist with these shifts, the sleep nucleus of the hypothalamus physically builds up proteins and cells during the day, then breaks them down at night (this is an oversimplification, but just imagine that it physically changes shape through a predictable 24-hour cycle). Now, imagine you shifted all the signals for light and sound in a single day, against the physical internal clock of the hypothalamus. No wonder the body gets confused! This is why good sleep hygiene matters: having the same bed time and same wake time every day makes it easier for your hypothalamus to keep its rhythm. When you sleep at the same time every night, your body will start to produce melatonin in anticipation of bed time, allowing you to fall asleep much more easily. Keeping rooms dark, quiet, and relatively cool will help to support your body’s ability to maintain deep restful sleep.

Earthquake and natural disaster preparedness

 

Earthquake and natural disaster preparedness

It is almost the anniversary of the Loma Prieta earthquake. Many of you reading this might be too young to recall it. I can remember it like it was yesterday The earthquake struck at 5:04pm on Tuesday October 17th 1989. The shaking lasted 20 seconds. I will start my story by mentioning that I had airline tickets for a flight at 7am on October 18th to go to visit my parents in Pittsburgh. On this particular visit, I was traveling with my 26 month old daughter Lauren. Sandy was not coming with us. The morning of October 17th, I got a call from USAir. There was an equipment change. Would we be willing to switch our reservation the next day from the 7 am flight to one that left at 11 am? In return we would get 2 round trip tickets. We could still keep the bulkhead seats at the front of the plane. To this day, I have never since heard of an airline reaching out the day before travel for something like this. In any event, this was a no-brainer, I was happy to make the swap. After the call from the airline, as per our daily routine, I dropped Lauren off and headed to work in Noe Valley. Sandy worked downtown and at the end of his day would take the underground Muni back to our house where he would get his car and then go pick her up. My day at the Noe Valley Pediatrics office was wrapping up and I was on the phone with a remarkably long winded mom. I tend to be fairly patient, but this woman wasn’t even coming up for air. She was going on and on about something when suddenly she shouted earthquake and the call ended. I confess that I looked upwards and mouthed a little ‘thank you” for getting her off the phone. It took a moment or so until I too felt the shaking. The entire building rocked and rolled. The lights went out. A good bit of the water sloshed out of the fish tank that we had in the waiting room. It was a long 20 seconds. All of us who were in the office ran to the doorways and held on. When it was over I was consumed with only one thought. I had to get to Sandy and Lauren to make sure they were okay.  This was long before we all had cell phones. I had no way of knowing if Sandy was stuck on muni or if he had picked up Lauren before the earthquake struck. There is no question about it. Being away from your child adds a whole new element to any natural disaster. I left immediately for home. Along the way I was struck by how well cars were behaving in a mannerly fashion. Every corner became a 4 way stop since all the traffic lights were out. At some of the bigger intersections, good samaritans were out directing traffic. I made it home safely, listening to the radio and hearing terrifying reports coming in of collapsing highways and bridges. I was doing my best to remain calm. It wasn’t easy. I was finally able to breathe when I saw that Sandy and Lauren were at home waiting for me and that was when I burst into tears. Lauren spent her days at a family daycare in the home of a magical person named Jeanine. ‘Gigi’ lived out by the zoo and tended to 4-5 kids at a time.They took walks, read poetry and did yoga. Everyone should be so lucky to find such a loving and wise childcare provider. In the playroom where they spend much of their time was an ornate telephone that was off limits. The kids all knew the rules. No touching the phone. Jeanine had stepped out of the room for a moment and at 5:04 Lauren took the opportunity to be a little naughty and picked up the forbidden receiver. Sandy had just arrived at Jeanine’s when the shaking started. He was right outside the gate and was able to see Lauren. Her expression was priceless. Oh, this is why you shouldn’t touch the phone! She hurriedly returned the phone to its cradle and looked around to see if anyone noticed what she had done. For years, thanks to her dad, she was pretty convinced that she caused the earthquake. Back at home, being together made the situation much easier to handle. We spent the evening outside with neighbors taking turns listening to radios and trying to get a handle on damage and casualties. Remember my flight the next day? The original 7 am one ended up being cancelled. My 11 am one was the first flight to take off post earthquake. Those days were the good old days when anyone could walk to the gate. My parents were at the gate waiting for us with baited breath. The area was also loaded with reporters waiting to interview the ‘survivors’. My mom had been chatting with one of the reporters. Since Lauren and I were in the front of the plane we were the first to get off. The light bulbs were flashing and we ended up on the front page of the now defunct Pittsburgh Post Gazette. The front page article was full of wild misquotes, but so it goes. It is perfectly normal for the thought of natural disasters to create a hum of anxiety. Different locations seem to have their specific menu of terrors. Here in the Bay Area our big ones are wildfires and earthquakes. The key to dealing with potential disasters in a sensible way is to do some preparation ahead of time. If you have children, then you simply must have a plan. Sandy and I had certainly talked about needing to do that, but it never got off the to do list. This is the nudge for every family that hasn't done so yet, to take care of this now. How will your family reunite if you are separated? Check with schools and daycares to see what their plan is. Remember that cell phones might not work, so you can’t count on them as part of your plan. Landlines are sometimes a better bet, but so many people no longer have those. (As an aside, Sandy, who worked for one of the world's largest telecom companies, says that while the cell phones might not work for calls, there is a chance that texting might still work.) I am not going to completely reinvent the wheel. At the bottom of the post are some comprehensive checklists from some excellent sites, but here are some of the basics that come to mind. Making sure your home is safe and well stocked Anchor furniture to walls,  make sure glassware and delicate objects can’t fall Have an accessible flashlight and plenty of batteries.Where are they? If the lights went off right now and it was dark out, could you find that flashlight? Remember that your cell phones do have a flashlight feature that can help you get situated, but you are likely going to want to not squander the charge on your phone if you have a better option Have enough food. Make sure you have a can opener that doesn't require power. Have unscented bleach on hand. https://www.epa.gov/ground-water-and-drinking-water/emergency-disinfection-drinking-water Have some heavy duty gloves on hand to help you clean up any sharp items that may have broken during the shaking. Have enough diapers, pet food and medications Consider getting a fireproof safe for important documents Uncle Joel's rule... Have cash on hand. Make some of it small bills. There is a good chance that the ATMs won’t be working. We took this lesson from our Uncle Joel who survived Hurricane Andrew in Miami. He had very little cash and without family getting him some funds, he would have had a tough time until the power was restored. Okay.. what if it is a situation where you need to evacuate Don’t let your gas tank go below ⅓ of a tank It is a good idea to have a grab and go backpack full of emergency stuff in your trunk. This might come in handy much more often than you think and not just in a natural disaster. You never know when an extra layer, change of clothes or snack will come in handy. Include some games or activities. In any case, make sure that you routinely restock and rotate supplies. The twice a year clock shifts are a great time to do this. When you are done changing the battery in your smoke detector, take a look at your emergency stash. Get rid of anything that is about to expire and make sure that you update sizes for spare clothes and diapers. This list was just a start. I highly recommend checking out the links below and use them as help you create a comprehensive plan. https://www.ready.gov/earthquakes https://www.cdc.gov/disasters/earthquakes/prepared.html https://www.sfchronicle.com/survival/

Everything you need to know about Fevers 2021

 

Fevers/ When to worry/How to manage

Fevers tend to get parents very worried, but an elevated temperature is only one of the factors that you need to consider when evaluating a sick child. I am actually more interested in your child's overall mood and behavior than I am in any specific number on a thermometer. An adult with a high fever is usually more miserable and needs to be evaluated sooner to figure out what is going on. For kids, fevers are a right of passage. There are advantages for them to get a degree of immunity from all the common illnesses when they are young. All of you parents who caught hand foot mouth from your kids because you somehow avoided it growing up, are nodding vigorously. There are many methods out there for measuring body temperature. I personally don't feel the need to invest in any expensive thermometers. I am generally quite satisfied with digital underarm reading. The important thing is that however you measure it, your thermometer seems accurate. Test it on yourself or other family members and take your child's temp when they are healthy to make sure you trust it as well as to establish what the normal baseline is for your child; 98.6 is not the "normal" temperature for everyone. I don't have a favorite brand. This link gives a good description of some of the options available. https://www.healthline.com/health/baby/best-baby-thermometer#our-picks I have found that some of the ear thermometers tend to read high when there is a fever. If the high temperature correlates with symptoms and your child looks quite ill, then take appropriate action. If your child looks fine, please don't let a number on the thermometer freak you out. Instead, take a deep breath and look at your child! If they are grinning at you and singing, that is not someone I am terribly worried about. Temperatures can be measured in either Fahrenheit or Celsius Here is a quick conversion chart. 98.6 F=37 C 99.5F=37.5C 100.0F=37.8C 100.4F=38C 101F=38.4C 102F=38.9C 103F=39.5C 104F=40C 105F=40.6 For this post, I will be referring to the temperatures on the Fahrenheit scale. However you take it, the route of measurement is important data to your reporting. 99 degrees under the arm is not the equivalent to 99 degrees rectal. Underarm temps can be roughly a degree lower on some kids. I am still perfectly fine using that method. Most of the time I am just getting a sense of the range. There is no clear consensus, but most doctors would consider any temp below 100.4 to be low grade. For any child older than 3 months  As long as your child is active and happy, I generally don't feel the need to "treat" a fever unless it is over 101.5 or so. I am much more concerned about the lethargic, whimpering child who has a normal body temperature than I am the singing child with 104. But, here is: “Nurse Judy's rule’ about fevers: If the fever is over 102 (it doesn't matter how you measure, just be consistent): Treat with proper dose of Acetaminophen or Ibuprofen https://nursejudynvp.blogspot.com/2019/05/tylenolmotrinadvil-what-is-best.html Do a tepid bath or place cool compresses on the forehead, insides of elbows and neck This is not the time for fuzzy pajamas! Get them drinking. Little sips at a time are fine. A Popsicle or ice-chips are good for older kids. If you have a stash, you can offer breastmilk pop. Put frozen milk in one of the mesh feed bags and Voila. When we are trying to push fluids, adding a little splash of juice to their water is perfectly fine at this point; you are doing whatever you can to get the hydration going. re-check the temp in 45-60 minutes. We want to see some improvement by the 45 minute mark, but it can take 90 minutes before you get significant improvement. If the temperature is STILL over 102 after the medication and hasn't budged at all, we are dealing with a fever that needs to be evaluated. If a fever higher than 100 degrees lasts for more than 3 days, even with a happy child, I consider it time to have a look so that we can make sure there isn't an infection source (like ear infection, urinary tract infection, strep throat or pneumonia.)  I would allow five days for low grade temps before taking them in. Fussy kids who are inconsolable need to be seen sooner than that, fever or not. During flu season, sometimes there are kids with fevers that are hanging on for five days or longer. If there is a known virus actively circulating in your area, your doctor may be okay ‘watching and waiting’ for another couple of days before asking you to come in for a visit. This would likely depend on if your little one is managing (drinking, peeing, easy breathing, consolable, fever responds to medications.) Many viral syndromes "wave goodbye" with a rash. Roseola is a classic example. When I have a happy kid with a high fever, it is pretty common at day three for the fever to be gone. Now you have a fussy kid with a rash on your hands, but you also have an answer. https://nursejudynvp.blogspot.com/2014/04/roseola.html Time is the great fixer here, there is no need to be seen. With most rashes, including roseola, when you push on the skin the area should lighten. This is called blanching. A purple rash that does not get lighter when you press is always worth calling your doctor about. Any fever that comes along with a purplish rash could be an emergency like meningitis. Don’t wait to be seen. I remind you that your child’s activity and energy level are still the biggest clues. Generally with something serious it is clear that something is wrong. These kids are not running around babbling and playing. They are sick, and it is obvious. It is useful for you to know that when children are in the process of spiking a fever, it is not uncommon for them to tremble and look shaky. This is normal. Children with fevers may have a higher respiration and pulse rate. When fevers are breaking it is common to have lots of sweating. They can soak right through the sheets!  It is also important to be aware that about 4% of children can have something called a febrile seizure. This is not the same as the trembling that I mentioned above. https://nursejudynvp.blogspot.com/2015/01/febrile-seizures.html Febrile seizures can be terrifying to watch, but they usually stop within 5 minutes. They cause no permanent harm. Trust me, if you have never heard of this, watching your child have a seizure has been reported as the scariest experience EVER. Having the prior knowledge that they do happen once in a while and are generally harmless should help keep you from freaking out. If your child is having a seizure they may have large jerky motions and their eyes may roll back. Make sure their airway is open. It is perfectly reasonable to call 911. Your job is to stay calm.  If your child has had even one febrile seizure, your medical team is likely to be more aggressive with fever control and will advise you to treat even a low grade fever. It is important to talk with your doctor about this so that you have a plan in place that you are comfortable with. Fortunately, most kids grow out of seizures by the time they are 5 years old. If your infant is under 3 months of age, notify your doctor if there is any fever! There are a few common causes: *over bundling.... Seriously, When I was working at Noe, sometimes the new babies would come into the office with piles of blankets wrapped around them even on a warm day. I know that many of us have the tendency to bundle up an infant but the best rule of thumb is to dress them in one layer more than you are wearing. If your baby was indeed over bundled, get some of those layers off and re-check the temp in about 10 minutes to see if they have cooled down. *dehydration... Sometimes if mom's milk isn't in yet, babies can be simply dehydrated and need to get some fluids. This is the time that you need to squirt some milk or formula directly into your baby's mouth. You can use a syringe or a dropper. In some cases the elevated temperature will normalize fairly quickly from some fluids. If there is no obvious cause for an elevated temperature, and it doesn't resolve within 15 minutes, your baby needs to be evaluated. Giving a fever reducing medication to a newborn should only be done under strict guidance from your pediatrician. With the younger babies, it is always better safe than sorry. Certainly there is no down side for calling and checking in with your doctor just to be on the safe side. Some general fever facts: Fevers turn on the body immune system. They are one of our body's protective mechanisms Many fevers can actually help the body fight infection. Fevers that are associated with most viral syndromes and infections don't cause brain damage. Our normal brain's thermostat will not allow a fever to go over 105 or 106. Only body temperatures higher than 108°F (42.2°C) can cause brain damage. Fevers only go this high with high environmental temperatures (e.g., confined to a closed car.) Bonus tidbits from Dr Ted: I have to reiterate everything that Nurse Judy has said above! Fevers are a difficult concept for a lot of parents to wrap their heads around, especially the first time they see one. It’s useful to remember that everybody’s immune system is different, and the exact same virus can cause a fever to 104 in one kid and pass without symptoms in another. An increase in body temperature is the body‘s response to “inflammatory cytokines“, chemicals released by your body's healthy tissues when they are under stress, like being attacked by a virus. Some bodies release more of these chemical signals than others, which is why different bodies have different temperatures to the same viruses. Immune systems also have different abilities to fight off different viruses within the same family, which is why some viruses pass without any symptoms at all in some children and the same virus can wreak havoc in others.  Parents always asked me, “at what temperature do I panic?“ My answer is 106. If you can trust that your child’s temperature is truly at or above 106, using Nurse Judy‘s techniques above, you must go to the emergency room. Anything below that is a question should be based on the child’s appearance.