When your kid is holding the keys and you are locked out!

 

When your kid is holding the keys and you are locked out!

I was hanging out with my daughter Lauren last week when one of her good friends called her to recount a horror story that had just happened. Arielle lives in New York. She had just picked up her almost 2 year old Makai from their lovely little family daycare. When they got to the car, she allowed Makai a few moments of his favorite game, ‘Makai the driver’. He was in the driver's seat, wheel in hand, pretending to drive. Arielle was next to him in the passenger seat. “Okay, all done, time to get in your car seat and let's go home.” She got out of the car, closed the door, walked around the car, and in the split second before she was able to open the other door to lift him out, he clicked the lock button. Could this even be happening? She tried coaching him from outside of the car to unlock the door, but that wasn’t successful and at some point he was done trying and dropped the keys. It was a harrowing 35 minutes for this mom before she was able to get to him. As she recounted the tale to me, she was able to identify the multitude of blessings along with the lessons from this incident. The Blessings It was NOT one of those hot New York days where a high temperature would have made all of this much more critical They were able to see and hear each other. He stayed remarkably calm, which in turn helped her stay calm. There was water and snacks within his reach. He was actually having a fine time. This was a car that required the key to start the engine. Some of the newer cars these days have a simple button that can be pushed to turn the car on. That alone would have added another level of stress! Just a few minutes into the ordeal, the daycare provider's adult son came out and tried various but unsuccessful methods for breaking into the car. Other neighbors and onlookers gathered and tried to help as people noticed the ongoing situation (this was a bit of a mixed blessing) Although her phone and car keys were in the car, she was wearing a small fanny pack that contained her AAA card. How lucky was that?! One of the neighbors finally came up with the brilliant idea to use a laser pointer. They had Makai follow the red light and try to touch it. With that little assist he was actually able to push on the necessary button and get the door open. Of course this was right as the fire truck showed up. Makai was excited that the firemen had come just for him. The Lessons Obviously the big one is that your kids should never be the only one in the car with the door closed unless you are holding the keys With her phone locked in the car, it occurred to Arielle that even if she was able to use someone elses phone, she didn’t actually know the important phone numbers. With smartphones these days, many people are in the same boat. The only phone number that she was able to easily recollect in that moment was that of her childhood best friend. Somewhat amusing but not terribly useful. If you don’t have them memorized, it is not a bad idea to have a list of important phone numbers in a handy place. Of course, if you have access to anyone else’s phone, most of your contacts are stored on the cloud these days. AAA was going to take 45 minutes to get to them even though they knew there was a child locked in the car. If it had been warm out, Mom would have started with 911, but with hindsight wishes she had called them sooner. Are there other places besides the car, where your child can lock you out? Check the locks in your house, such as the bathroom and make sure you have access in case your little one locks themselves in. When all was said and done, Makai was safe, but mom was shaken. She was feeling some guilt and shame that she had let this happen. She also played the inevitable mental gymnastics that we tend to do when a split second would have made a difference. She was oddly comforted when I initially shared, via Lauren, that by no means was she the first parent to have something like this happen. In fact a similar story had actually made it to my safety class curriculum. The safety class was largely created because of situations just like this. When I was working at Noe Valley Pediatrics, I was often the first person parents would call when their children had any type of accident, injury or safety issue. Most of the cases were fairly common such as kids falling from surfaces, or getting scalded when parents spilled their hot beverages. Because I saw the same thing over and over again, and because so many of these things were preventable, I started holding a safety class.  Every once in a while some enterprising children would shake things up and come up with ways of causing mayhem that were new and inventive. As parents called for advice I collected the tales and shared them at the classes so that other parents could learn and prevent.  One child got a gopher bite (don’t let them stick their hands down a hole in golden gate park) Another got a concussion from leaning so far over while sitting in a shopping cart that she ended up toppling the cart (always keep a hand on the shopping cart when your child is sitting in it) A small child was intrigued by the antique brooch that Aunt Josephine was wearing on her blouse. She grabbed at it and sliced her finger  (beware of jewelry with sharp points) One little one got their tongue stuck inside a Barbie dolls head (No easy advice for this one) One child got gum stuck on his eyelashes (first of all, kids shouldn’t be chewing gum until they are old enough NOT to stick it on their eyes, but believe it or not, peanut butter, coconut oil or vaseline are all options for removing it) And there it was: One child locked herself in the car. (never let them be in the car with the doors closed unless you are holding the keys in your hand) The particular incident that prompted me to add it to the safety class happened in the parking lot of Noe Valley Pediatrics. The mom and her child were there for the 15 month appointment.  Raise your hand if your child likes to play with your car keys! This mom had handed over the keys to keep the little one occupied as she gathered her purse, diaper bag etc. She got out of the car, shut the door and before she was able to open the back door, ‘click’ - she was locked out. Sound familiar? The mom involved frantically ran into the office asking for help. I remember as if it was yesterday being out there with other staff members cheering on the toddler “push that big button, no, the big one” as we saw the little toddler hit ‘lock’ over and over. A laser pointer would have been perfect!! We got in touch with dad who worked about 45 minutes south. He was on his way with the spare set of keys, when suddenly she hit the right button, the door unlocked and we got the door open before our little trouble maker could lock it again This was not the first parent to do this, and it won’t be the last. With this little cautionary tale, hopefully it won’t be you. Keeping your child safe for the first several years is akin to walking through a minefield. My safety class was not removing the mines, just giving parents a map so that they could try to avoid them. Having your child hold the keys when the doors are shut and they are alone in the car is a big ‘landmine'. Hopefully this won't happen to you now. If your little one has come up with some creative mischief that should be added to my list, I would love to hear about it! Thanks so much to Arielle for being brave enough to share her story!

Mosquito and insect bites/Zyrtec dosage chart

 

West Nile Virus has been detected in the Bay Area. It is 2022; this should not be a surprise to anyone. What else are we dealing with? Oh yes, Covid is still here, Monkeypox, Polio, headlines in the news about future devastating floods. Can we all just give a loud OY?   Even if they weren’t carrying any diseases, I hate mosquitoes. Yes I am aware that they are part of nature's vast food chain but that doesn't stop my loathing. For the record, it is a mutual dislike and fortunately I rarely get bitten. The rest of my family, both of my daughters in particular, are tasty targets, and are feasted on when given the opportunity.   Of all the mosquito-borne illnesses, the West Nile virus is the one that has gotten the most local media coverage lately. It is thought to have originated in Africa (hence the name.) It has spread throughout the world and it was first detected in this country in 1999. Unfortunately we now have it in most states, including California.   Mosquitoes get this virus from feeding on infected birds and then transmit it to humans. Humans are referred to as "dead end hosts"; they get the virus from being bitten by the infected insect, but then cannot spread it to each other.   It is possible that it can be transmitted from blood transfusions, pregnancy or breastfeeding but there are no known cases of infants who have gotten seriously ill from these transmissions.   The good news is that most of the time it is actually not such a big deal. Children under 5 seem to be at relatively low risk for getting terribly ill, and folks over 50 seem to get hit the hardest. It can be found year round but seems to peak in late summer/early fall. 80% of folks who get WNV have no idea that they are infected and feel perfectly fine. There are probably thousands of cases that go under the radar since we would never consider testing if someone is only showing mild symptoms of a mystery illness. The unfortunate other 20% of infected folks may have   fever, joint pain, muscle weakness, stiff neck, diarrhea, vomiting, swollen glands, photo-phobia (sensitivity to light) rash on the trunk.   Not everyone will have every symptom. Most people showing these mild to moderate symptoms will recover completely, although there are reports that some of these folks can remain fatigued and achy for several weeks. 1% of infected people can get more serious neurological complications including encephalitis and meningitis. It can be fatal for those with serious cases. People with troubled immune systems are at the greatest risk.   The incubation period is usually between 2-14 days after the bite from an infected mosquito (most commonly 2-6 days.) There is, alas, no treatment beyond supportive care. It is thought that most people who have fought off the illness end up with some level of immunity. Keep in mind that any severe headache-fever-stiff neck combination always needs to be evaluated right away. If West Nile virus is suspected there are blood tests that can help with the diagnosis.   Since there is no vaccination at this point, and no treatment, the key is prevention.   Of course right now with Covid circulating, any fever is something that we pay attention to, but if there have been recent mosquito bites, make sure you report those as part of the relevant history. I am not worried about any fever is gone after several days. It is the mystery fevers that are lingering that should get attention.   Prevention is the key when it comes to dealing with mosquitoes.       Make sure that you have intact screens on all windows. If you are getting bites, check for holes or cracks where the insects might be getting in.   Get rid of any standing water that is around your house; do a double check to make sure there are no pots, bird baths...etc. that are places where mosquitoes can breed. The larvae are dependent on water for breeding. Unfortunately just dumping out the water might not be good enough because it won’t dislodge the larvae that might be attached to the side. You really need to give a good scrub. Check out Mosquito Bits and Mosquito Dunks. You can add these to any water features to keep the mosquitoes from breeding.   There tends to be increased mosquito activity during dusk and dawn so that is when most of the biting happens. This seems to be true for the mosquitoes who carry West Nile Virus, not as much for Zika.   Try to wear (keep your child covered with) long pants/ long sleeves etc. Light colored clothing is recommended.   If you are going into a heavy mosquito area, use bug spray on exposed skin and clothing. Mosquito repellent works only on the surface to which it is applied directly. Experiments have shown that they will actually bite skin only four centimeters away from where the repellent is applied, so wristbands or just spraying clothing does not offer full protection.   Some bug experts would rather that you avoid the traditional electric bug zappers. The violet light may be irresistible to some flying insects, (and that zap is such a satisfying noise), but mosquitoes are actually not attracted to the light. Some of the innocent and beneficial insects are the ones getting fried.   Mosquitoes don’t like fans! The nasty insects are lightweight enough that a good breeze may make it hard for them to zoom in on their target. The Off! Clip on has some folks who swear by it. If you are looking for an alternative to the DEET, it might be worth giving it a try (perhaps it is the fan aspect that makes it work…)   If you are seeing mosquitoes around your house, San Francisco's Environmental Health Department will send an inspector to investigate (415-252-3805.) They will check the area around your home (including sewers) to see if they can find any breeding areas.   Alas, long sleeves alone aren’t going to do the trick if you are out in a buggy area. There are plenty of natural products on the market that claim to be repellents, ranging from Vitamin B to catnip. Most of these are generally safe, but unfortunately the scientific studies show that they are mostly ineffective. We have the luxury in the Bay Area of not having some of the more notorious mosquitoes, so the bites are mostly an aggravation rather than a health risk. If you are in San Francisco, it is not a big deal to give something a try to see how it works on your family members. However, If you are traveling to an area where there are more dangerous mosquitoes, I would stick with the strong stuff. No kidding around.    The EPA has five registered insect repellents.    DEET is likely the most well known option. It is the only product labeled safe for infants as young as 2 months old. It comes in different concentrations. The concentration of DEET in a product indicates how long the product will be effective. A higher concentration does not mean that the product will work better; It means that it will be effective for a longer period of time. Therefore, products containing lower concentrations of DEET may need to be reapplied, depending on the length of time a person is outdoors.  Oil of Lemon Eucalyptus is considered one of the least toxic options but interestingly, the age recommendation for it is for 3 years and older.(Natural lemon eucalyptus oil is not the same as Oil of Lemon Eucalyptus) Some people are sensitive to the smell of this, it is worth sniffing it before you buy it.   Picaridin is odorless and is approved for children 6 months (recently lowered from 2 years) and older. Dr. Anne especially likes the Sawyer product.   Avon Skin so Soft Bug Guard PLUS IR3535 Insect Repellent has been around for years but seems to be more commercially available than it used to be (also for over 6 months of age.) It comes in a highly rated product that combines Avon Skin So Soft and an SPF 30 sunscreen   Bite Blocker is a botanical formula that claims to provide protection for up to 8 hours. The reviews mention a strong odor, but otherwise it gets a high rating.   Before applying anything topical to the skin for the first time, do a little test patch on the skin to make sure there is no sensitivity before you widely spritz or wipe on any of these products. You will need to read the labels to see how often you need to reapply. Avoid contact with eyes and keep all of these safely away from kids.    I would also be cautious about getting any insect repellents on the hands, especially if your child is young enough that those hands are going into the mouth a lot. If you are also using sunscreen, apply sunscreen first and insect repellent second.   All of the EPA recommendations are considered safe, and they are clearly better than getting bitten, but at the same time, let’s use them wisely. The EPA has created the following tool to help you find the proper product for you needs   EPA guide to finding the right repellent   Some products are more effective than others for certain types of mosquitoes, so the product you choose might depend on where you are going and what you might be most at risk for. Trusting that someday we will be able to move around the globe again, it is always good to check in at https://wwwnc.cdc.gov/travel prior to any travel.     DEALING WITH A BITE   If the prevention has failed the most important thing is to treat the itching. Scratching at a bite will make it worse. Make sure their nails are trimmed! There is a product called a mosquito zapper that some folks find useful. Young kids might be startled from the noise, but others claim that it is great for minimizing the reaction if you use it quickly.   Over the counter hydrocortisone cream probably works the best, but other topical treatments can include calamine lotion, or mixing up a paste of baking soda with a bit of water. A cold black tea bag compress can also be very soothing. Black tea contains tannins, which seem to help.   Some kids can have enormous reactions. Eyes and ears can be remarkably swollen. Topical treatment won’t be enough for these. Give a dose of Zyrtec or Benadryl right away. Scroll to the bottom for dosing info.  If the antihistamine doesn’t make a difference or if there is fever or severe discomfort, those kids need to be evaluated by a doctor.    If your little one is getting bitten, check the bedroom carefully. Look at the mattress and all the corners of the room; bites could be from spiders, fleas or other culprits.       Zyrtec Dosage Chart The dose of cetirizine depends on age:   ·   6 - 12 months of age: 2.5 mg given once daily (maximum dose 5 mg daily)   ·   12 - 24 months of age: 2.5 given once or twice daily (maximum dose 5 mg daily)   ·   2 - 6 years of age: 2.5 - 5 mg given once daily (maximum dose 5 mg daily)   ·   Over 6 years of age: 5 - 10 mg given once daily (maximum dose 10 mg daily)   Zyrtec comes in a 1mg/ml solution (so 2.5 mg = 2.5 ml). There is also a 10mg/ml oral drops preparation (so 5 mg is 1/2 ml). Make sure you check the strength of the solution.    Benadryl dosage will be the same volume as your Tylenol dose. The liquid says for children 4 and over; we still use it for our younger patients who need it. Benadryl makes most kids sleepy but can have the opposite effect.    If you are interested, Here is some current info on some of the mosquito borne illnesses that have been in the headlines the most in the past year or so.   West Nile Virus https://www.cdc.gov/westnile/   If you see any dead birds, give them a wide berth and report them to 1-877-968-2473 (WNV -BIRD) or online at http://westnile.ca.gov/ That website also will give you the up to date numbers on how many West Nile virus cases there are in California, county by county. It is updated weekly.       Zika https://www.cdc.gov/zika/index.html   Chikungunya https://www.cdc.gov/chikungunya/   Here are some bonus facts about mosquitoes:   Both males and females make that awful whining noise, but only the females bite humans. Mosquitoes are especially attracted to people who drink beer. Mosquitoes love the smell of sweaty feet. Mosquitoes can sense CO2 from up to 75 feet away. Mosquitoes only fly as fast as 1-1½ miles per hour. Some blood types may be tastier than others. O seems to be the favorite, A the least. B lands somewhere in the middle.  Mosquitoes love pregnant women (regardless of their blood type) possibly because they emit a little extra CO2.

Spotlight on Polio

 

August is National vaccine awareness month. Vaccines have become a political football these days. This is both sad and dangerous. It is true that many things in life require a risk/benefit calculation. In the case of immunizing your children, no one who has vaccine hesitancy would be able to convince me that the risks of vaccination outweigh the benefits. I have seen too much with my own eyes. When I was working at the hospitals in the 1980s I saw children routinely die from diseases like epiglottitis. If you have never heard of that, you can thank the Haemophilus Influenzae (HIB vaccine) that babies in this generation get as a routine vaccination starting at 2 months.  Yes it may feel like kids get so many shots these days, but the diseases we are protecting against are real. Recently the spotlight has been on polio. Polio is an infectious disease caused by a virus that is serious and can be life threatening. It can affect the spinal cord causing muscle weakness and paralysis. It is spread from person to person. The polio virus enters the body through the mouth, usually from hands that were contaminated with the stool of an infected person. It can also be passed through respiratory or saliva secretions. In the late 1940’s, polio outbreaks disabled an average of more than 35,000 people a year here in the US until the vaccines became available. Dr. Jonas Salk developed the first polio vaccine in 1955. This is referred to as the IPV (inactive polio vaccine.) A second vaccine was developed by Albert Sabin in 1961. This was vaccine was made with a live but weakened, or attenuated virus. This is referred to as OPV (oral polio vaccine). These vaccinations worked and the disease numbers plummeted! When I was little our family knew many people who had been impacted by polio. My mom was very eager to get us vaccinated as soon as possible. Believe it or one of my earliest childhood memories was that first polio vaccination. Led by my older sister, we had engaged my mother in some heavy duty bargaining to ensure our cooperation for the dreaded doctor visit and for what we assumed would be an injection. Between the two of us we could create a remarkable ruckus. The deal we negotiated was a new Barbie Doll in exchange for being good patients. When we got to the front of the line, we were given a sugar cube with the oral medicine squirted on it. This was so much better than a shot. Mom kept her end of the bargain and we got our dolls. Score!  OPV became the standard part of routine childhood immunization schedules. It was easy to administer and was a bit more effective. The downside was that because it was a live vaccine, the virus could be shed in the stool of the vaccinated patient. If someone who was unvaccinated or immunocompromised came in contact with the poop they could actually get a case of polio.  As the numbers of wild polio declined due to successful global vaccination programs, it turned out that in most of the cases that were occurring were actually caused by the live vaccine.  A vaccine-derived poliovirus (VDPV) is a strain related to the weakened live poliovirus contained in oral polio vaccine (OPV).  In the year 2000, in the US, the decision was made to stop giving the OPV and to transition instead to the IPV, thus eliminating that risk. Many places in the world still rely on the OPV as part of the series. We all have enough on our plates, between covid, monkeypox and climate woes. Polio should NOT be something that we need to add to our worry list; so much effort as well as money has gone into eradicating it. But here we are. Vaccine hesitancy now has the potential for us to regress to much scarier times. So what's going on? There was a recent case in NY of an unvaccinated adult who became paralyzed from polio. The wastewater was able to link it to a strain related to the oral vaccine. The risk for paralysis is the same, regardless of the source. There is concern that this one case is just the tip of the iceberg. 75% of those infected don’t have symptoms but can still unknowingly spread the virus.  For the other 25%, most have symptoms that could be easily overlooked or confused with some other illness. Those symptoms include fatigue, fever, headache, sore throat, stiffness, muscle pain and vomiting. Roughly 1 in 200 infected people become paralyzed. Some of those will die because their lungs are also paralyzed and they can no longer breathe. There is a long incubation period and in some cases it can take up to 30 days before the first signs of illness show up. Combine the delay between exposure and infection with the fact that many people remain without symptoms, and it is easy to see how this virus has an enormous capacity to spread among vulnerable people. Here is the scary part. If allowed to circulate in under- or un-immunized populations for long enough, or replicate in an immunodeficient individual, the weakened virus can revert to a form that causes illness and paralysis. We do NOT want to regress! If most people were up to date with their vaccines, this wouldn’t be nearly as much of a concern, but in some of those counties in New York the vaccination rate for polio is as low as 59%. It isn’t just polio - all vaccinations seem to be down across the board. CDC’s public sector vaccine ordering data show a 14% drop in 2020-2021 compared to 2019, and measles vaccine ordering is down by more than 20%. The national vaccination coverage among kindergarten children during the 2020-2021 school year dropped by about 1% from the previous year - that amounts to 35,000 more children without vaccination documents. When there was a measles outbreak several years ago I came up with this analogy. Imagine that these diseases are like a spark of fire in a forest. If the forest were wet from rain, it might not be an issue. If the forest is dry, then a devastating forest fire can occur. People are the trees. Vaccinated ones are the wet trees and unvaccinated are the dry trees. It’s pretty simple. If enough are protected, then the disease can’t spread as easily. People have become complacent. Others have allowed themselves to be swayed by junk science and conspiracy theories. I know that COVID has made things feel overwhelming and complicated, but please make sure your children are current with the vaccine schedule.