What is in your medicine cabinet? 2023

 

My grandson Sawyer is starting daycare next week. His mommy is getting prepared and asked me about what things she should have in the medicine cabinet.This was a good incentive to update this old post.

Take stock of what’s in your medicine cabinet.

What medications should you have on hand?

If you or your child becomes ill in the middle of the night, that 3 am visit to the local pharmacy may furnish you with some interesting anecdotes about the odd folks lurking in the aisles, but generally it is something you want to avoid. Try to have some basic medications on hand ahead of time. A little preparation goes a long way.

Fever reducers/Pain relief

Acetaminophen and Ibuprofen are the most common medications used for this.

Remember that you never want to give actual aspirin to a child.

Acetaminophen/Tylenol Infant and Children's Liquid are the same

concentration so they are actually interchangeable, but the infant bottle comes with a nifty little measuring system and a spill proof bottle which is safer.  

Acetaminophen also comes as a suppository, which is great for a child who is vomiting or resisting medication by mouth. Suppositories are best kept in the fridge or someplace cool. If they get warm and mushy they are much harder to insert.

Ibuprofen is also known as Advil or Motrin. This medicine also comes in a more concentrated infant form. The infant and child dose are not the same. Make sure you understand your child's proper dose. The above link has a dosage chart

Antihistamines

Benadryl, Zyrtec and Claritin tend to be the most commonly used for pediatrics. These antihistamines would be given for general allergic reactions, itchy skin rashes or insect bites.

The generic name for Benadryl is Diphenhydramine HCL. There is no formulation specifically for infants. The directions on the bottle usually have a caution not to use it for children under 4. Most pediatric offices ignore that and are fine giving to younger patients if indicated. It is always a good idea to check with your doctor to see if they are comfortable with it.

While Benadryl will make most kids (and adults) very sleepy. Sometimes that sleepiness is a good thing!!! But be warned, it also can cause a few patients to be jittery.

Zyrtec (Cetirizine) typically has a more level response, with less likelihood of either sedation or the jitters. There is a dosage chart in the insect bite link above.

Claritin is fine for sneezy allergies, but perhaps not quite as effective for itchy rashes.

All of these come with the option for liquid or chewables.

Tummy issues

If your child is vomiting, you will be glad to have an oral rehydration solution in the house. Poplular options include:

Pedialyte and/or Drip Drop . Breast milk is also great for that, but not everyone is lucky enough to always have it on hand. Pedialyte also comes in popsicle form, which is great for older kids. 

These both come in little packets of powder that you can mix with water. As well as keeping these in your medicine cabinet, they are worth taking along with you on any trips.

Pedialax or glycerin suppositories are worth having on hand If your child is prone to constipation. If days have gone by without a poop, and diet enough hasn't helped to get things moving, these are often the next step. If it is the wee hours of the morning and you have a miserable, grunting and straining kid, getting the poop out is a good strategy.

Eye issues

For young babies, breastmilk in the eye can cure a variety of issues. For older kids and adults, it is worth having Zaditor. It is an over-the-counter treatment for allergic conjunctivitis. It works quickly if allergies are the culprit. I also find that the homeopathic brand Similason is very soothing.

If eye irritation or discharge continues, it might be viral or bacterial. It is time to check-in with your doctor. Most offices will want you seen. Gooey eyes can be a signal of an ear infection, so a visit is the best way to make sure you are getting the care you need.

Stuffy nose

XLEAR nose spray!!!

Mouth sores

If you child is prone to mouth sores or irritations, I find Glyoxide very helpful and seems to help things heal up pretty quickly

You can also do a combo/1 teaspoon Maalox/1 teaspoon of Benadry...apply topically

Respiratory

If your child has a history of wheezing, now is the time to make sure you have asthma medications available. Many of those are light sensitive so you should always mark the package when you open them. If your child uses a nebulizer, the tubing should be replaced every 6 months. If you or your child use an inhaler, the mouthpiece should be rinsed out at least once a week.

Check the directions on your specific medication to see if it needs to be primed. Some need an extra spritz into the air if they haven’t been used in more than a week.

Topical creams/ointments

• Triple antibiotic ointment for cuts or scratches
• Antifungal cream for yeasty rashes or fungal infections
• Arnica for bruises
• hydrocortisone cream for mild itchy irritations

HC cream comes in a variety of strengths. You can get the weakest ones over the counter.

Please pay attention to this rather disgusting factoid:

It is easy for tubes of ointments to get contaminated. If the tip comes in contact with bacteria from a finger or directly from the body...there you go. Yuck! One study that I read suggested that more than half of the tubes of creams and ointments that people have laying around are contaminated with Staph. The best way to avoid this is to make sure that you don't directly touch the tip to anything. Try to keep it sterile. Squeeze the desired amount onto a spoon and then use whatever applicator you want (clean fingers are usually fine.)

BASIC FIRST AID products

Consider getting some self adhesive bandage like Coban/Co-flex. They come in lots of colors and are fairly inexpensive. The advantage of these is that not only do they not hurt when you take them off and your child can’t pull them off without help. Also, your little one can’t eat the band-aid!

Ice packs/warm packs

I suggest that you invest in a child friendly ice pack that you can keep in your freezer. There are loads of adorable ones on Amazon. Holding a soft little penguin or bunny against the booboo might elicit a bit more cooperation.

Having a microwavable hot pack can also be useful. If you don’t want to buy one, you can fill an athletic sock with rice, and that warms up nicely. Another option for a warm pack is to pour some water in a disposable diaper and heat it in the microwave for a few seconds at a time until it is a good temperature.

Keep a bag of Epsom salts on hand. They come in handy for all sorts of things.

Useful Equipment

• Have a working thermometer that you have tested for accuracy before someone actually has a fever. As long as your baby is over 2 months, I am not one who is going to focus too much on the exact degree of the fever, but we do want to get a sense of how high it is.
• Have a syringe or dropper on hand for much more accurate measuring.
• Pulse oximeters have gotten very inexpensive. If you or your child is congested, you can easily check the oxygen level.
• Have a good set of tweezers for removing splinters.
• If you are a hiker, I also suggest having a special tick removal tool.

• Nebulizer if you have asthma in the family
• Humidifier

Storage

Make sure that all your medications are stored in a safe, dry, childproof location (a steamy bathroom is not the best place.) Don't underestimate the ability of a climbing child who knows where the gummy vitamins or yummy medicine is stashed.

Pro Tip: With any of your medications, put a strip of masking tape on the side of the open bottle and sign and date your doses. This will avoid the common incident of parents double dosing their babies. This also will help you keep track of doses when you are sleep deprived. I get plenty of frantic calls from parents who have inadvertently overdosed their kids by giving the medications too often. If there is a concern your first call should be to Poison Control: 1-888-222-1222 

Here is my blog post on poison action and prevention

Boost your Immune system

With the cold and flu season in full throttle I would have the following on hand for the first sign of congestion or a throat tickle

Sambuccol/elderberry

Zinc

Manuka Honey (Not for babies under 1 year)

Make sure you are already getting routine Vitamin D (all year round)

Equipment

Humidifier

Nebulizer if you have asthma in the family

Do a routine check for expired medications. 

Even though I try to stay on top of this I can be occasionally stunned by the old stuff that I find lurking in the back of my own medicine cabinet (it runs in my family.) We sometimes do a contest to see who can find the oldest thing in there. (Without knowing what the topic for this weeks post was, Sandy told me earlier that he cleaned out our medicine chest today and found medicines that had expired in 2018. BTW, 5 years is not even close to things we have found in the past!)

How to get rid of expired medications that you find?

Please don't randomly toss expired medication down the drain or flush it in the toilet. Medicine can pollute the bay and ocean, or be accidentally misused or abused. Wastewater treatment plants are not designed to remove medications or other chemicals in waste-water, so after traveling down your drain, medicine may affect our environment. If you go online, you can easily find a list of places where you can drop off expired meds. If you live in SF, I did it for you.

http://sfenvironment.org/article/safe-medicine-disposal-for-residents

What does that expiration date mean anyway?

In 1979, the FDA required that manufacturers include an expiration date on prescription as well as OTC products. This is the date at which full potency and safety is guaranteed, Usually, that date is roughly 1 to 5 years from the time of manufacture. 

The US military, which maintains large stockpiles of medications for both military and civilian populations for use during an emergency, became very interested in this issue following the 2001 anthrax scare. The cost implications were obvious. Throwing out large numbers of expensive drugs simply because they were past their expiration date was an enormous expense that could potentially be avoided if it was determined that the drugs were effective beyond that date.

To explore this, the FDA analyzed the potency of 122 common medications. The was called the The Shelf-Life Extension Program (SLEP). After vigorous testing of more than 3000 different lots of these drugs, almost 9 out of 10 lots were determined to have more than 90% potency at 1 year past the expiration date. The average extension of this degree of potency was 5 years.

So, while obviously if your child is ill, we don't want to take chances with medications that may be out of date, the bottom line is that in an emergency, expired medications are likely not dangerous (always double check); they may simply have lost a bit of their potency.

Personal Musings/ The end of a startup/What's next!

 Personal Musings/ The end of a startup/What's next!

I look back at my career path to see the stepping stones that led me to where I am today. I had seven years of critical care nursing experience before I had my first child.

Everything shifted when I became a mom. I was working in the pediatric unit of UCSF. With hormones raging, I remember weeping along with the mothers of my patients when their little ones needed to get a new IV or endure a painful procedure. I couldn’t stop thinking about how lucky I was to have my healthy baby. I felt so deeply with the parents who weren’t so fortunate. It was draining. I realized that I was ready to move on from working with severely ill children in the hospital.

I have little doubt that I could have learned to find a balance if I had remained, but I answered a small ad in the paper for a position as an advice nurse at Noe Valley Pediatrics in San Francisco. I ended up staying in that job for 31 years.

As with most new jobs, there is a learning curve. I was so used to working with the rarer and more serious conditions, that it was a huge relief to realize that more often than not, most things are normal and are easily treated. No, that healthy infant with jaundice did not in fact need a liver transplant.

During my time at NVP, I expanded my role beyond being the office advice nurse. I recognized that parents needed something extra. My patients embraced my philosophy that there is no such thing as a silly question. They needed some basic guidance about when they should be worried about something and when they could relax and let time take care of it. People needed a sounding board about so much more than just poop and runny noses. They had questions about behavior, sleep, relationships, and solid foods. They needed a safe place to vent without being judged.

I cultivated deep relationships with many of my patients and families, but I had the desire to reach more people. With this in mind, I started offering a variety of parenting classes. 

I also started writing. It was clear that there were many issues that were very common. The genesis of my blog was frankly a way to avoid repeating myself over and over again.

I must confess that I had some mixed feelings that my posts on head lice and pinworms went viral. It wasn’t exactly the claim to fame that I had been seeking! 

I called the blog Nurse Judy’s approach because while I try to lead with data, I also tend to focus on more natural remedies when possible. Many of my readers tease me that I suggest putting breast milk on everything.

The blog became a hobby with an eclectic mix of topics. It ranged from talking about poop, to stories about my own life and family.

I am blessed to have a very close relationship with my husband and my two daughters. Fortunately they gave me permission to write about them. They got used to being out in the neighborhood with me and having me be recognized, “Oh my goodness, it’s Nurse Judy, are these your daughters? Which one is the one who climbs mountains and which is the social worker?”  At a restaurant once, my husband was actually referred to as Mr. Nurse Judy. Now my delicious grandsons are the next generation of having blogs written about them. 

I retired from NVP in 2019. Sandy and I proceeded to do several months of traveling. Who knew at the time that there was a pandemic looming? We were so fortunate to be able to take that trip when we did.

Within days after I returned home, I received an email from Oath co-founders Michelle and Camilla inviting me to meet with them. Their vision to create something that was going to change healthcare as we know it, energized me and pulled me right out of retirement.

Unfortunately, startups fail more often than succeed and that was the case with this one. It shut down just a week ago. Yes there were tears.

However, ultimately the time I had working with the Oath team was an absolute gift. 

We built a platform that offered support and community to new parents. It was a wonderful several years, filled with deep connections, learning and love. 

I will confess that I never loved the name. It was meant to be based on the Hippocratic Oath, but I spent way too much time clarifying that we were not the right wing ‘Oathkeepers’. We were as far from that as could be. If it ever manages to rise from the ashes, it will certainly be called something else.

It turns out that there is such a thing as a non-toxic work environment and that was Oath. Things that went wrong along the way were celebrated as learning experiences.That frame of mind made sure that nobody was afraid to try something new. Indeed, we had many successes. One thing that is certain is that we helped countless parents feel less alone during the pandemic.

So what’s next for me? 

For now, I intend to continue with these posts. I will still be doing some of my classes on an ‘on demand’ basis. I have some potential opportunities and collaborations that I am exploring. Mostly I plan on being grandma and traveling more with Sandy.

I also am intrigued by the thought of writing a book. Some of you might recall that I was toying with this several years ago. That one was going to be all about poop, rashes, head-lice etc.  While I expect that I will keep those topics going in these posts, that isn’t the one I want to write.

The BOOK that is pulling at me will have a very different flavor. It’s not exactly ghost stories, but it will be telling a collection of random, true unexplainable coincidences. (With maybe some friendly spirits?)

I have shared some of the nutty stories in the past:

https://nursejudynvp.blogspot.com/2021/06/ghosts-and-radioshappy-fathers-day.html

https://nursejudynvp.blogspot.com/2020/09/a-mysterious-story-about-pair-of-socks.html

Do you have your own experiences to share? I would love to hear them.

As I mentioned in a recent post about gratitude, I am thankful for those of you who have stuck with me for all of these years.

Wishing all of you a healthy and happy holiday.

XO

Nurse Judy

Dealing with the long dark days of Winter

 

Dealing with the long dark days of Winter I don’t know about you, but my husband Sandy and I repeat the following on a loop the minute the clock changes signal that we are moving into the winter season. This conversation occurs almost daily. “It feels later” “I hate how dark it is” “Is it bedtime yet?” Seasonal affective disorder is a real thing. People with a history of any mood disorders are the most at risk, but anyone can be impacted by some form of seasonal ‘blahs’. Latitude can be a significant predictor of winter blues because it directly impacts the amount of sunshine that you are exposed to. The further north you live, the more likely you are to feel the effects of the decreased hours of daylight. While classic depression symptoms are often characterized by poor appetite and insomnia, seasonal affective disorder (SAD) is the opposite. It mirrors hibernation and tends to have people both eating and sleeping more. Carbs and a nap, sound familiar? Chinese Medicine and Winter I have always been intrigued when it comes to Traditional Chinese Medicine and its approach to the changing seasons. TCM believes that by harmonizing oneself with the seasons, rather than fighting them, you can stay healthier. There are several key factors: Warm/cooked food. It is important to limit intake of cold and raw foods. Instead double down on nourishing soups and stews. Incorporating spices like cinnamon, ginger, cloves and turmeric can add warmth and comfort. One of my best friends, Anita, who is an acupuncturist in the Denver area, adds that if you are hooked on smoothies consider defrosting any frozen ingredients the night before. Drain well in the morning before adding the blender. Consider adding some of those warming spices to the smoothie. For a list of beneficial foods, as well as more information about Chinese medicine, check out Dr Den’s blog post here. Hunker down and stay warm. As Dr Den Says, take particular care to keep your neck, shoulders, low back and feet warm. Foot soaks can be a really nice way to relax the mind and warm up the body during the coldest months of the year. Soaking feet can be a fun and relaxing family activity! Aside from the footbath, there are lots of microwavable heating packs that you can toss over your shoulders. Turn attention inward Find some creative activities that you can do indoors. This is also a great time to find a new relaxing hobby and to learn how to meditate. For as long as I can remember Sandy and I have been talking about learning how to paint in the style of Bob Ross and his Joy of Painting. Maybe this winter we will finally invest in some easels and some oil paints and see if we can follow directions. Slow down Exercise is very important, but gentle ways to move your body, such as yoga, or walking are better than pushing yourself with extreme aerobics. Give yourself permission to have a “do nothing’ day once in a while. Hygge Across the globe from China, in Scandinavia where they also have long winter nights, they have the concept of Hygge. Hygge is about creating a cozy and serene environment. It also focuses on slowing down, being present in the moment and connecting with loved ones. I notice quite a bit of overlap between that and TCM. To create your nest Use soothing low lights. Break out the candles that have a scent that appeals to you Invest in some soft, snuggly throws and blankets for the couch Put on music that elevates your mood. Make a winter playlist Keep a gratitude journal that helps keep you focused on feeling cozy, rather than the cold drizzle outside If you are using your fireplace, make sure your chimney has been cleaned recently. You don’t want to find out the squirrels have built a nest in there. Also check the air quality to make sure it isn’t a ‘spare the air’ day. Boosting your immune system Just like animals load up on calories and fat before heading into hibernation, we also need to be aware of bolstering our reserves. Dr. Anita adds that we should ignore our tendency to start a diet on January 1. By all means eating healthy foods is great, but wait until Spring to do that cleanse. If you are open to acupuncture or chiropractor, book a session to give a boost to your immune systems! Make sure you have a clean working humidifier, elderberry, zinc and manuka honey on hand in case you end up catching one of the classic viruses that tend to make the rounds during this time of year. There is a connection between mood and Vitamin D. It is tough to get enough from a standard diet and even more challenging to get it from the sunlight in the wintertime. I strongly recommend taking a supplement. Moisturize!!! I know that this isn’t directly related to your immune system, but lots of folks suffer from very dry skin in the winter time and that can lead to itching and eczema flare ups. Action plan for treating SAD Even though it feels tempting, try not to let yourself sleep for longer than 8.5/9 hours. Try to get on a schedule that maximizes the daylight. Usually this means waking up early. At the very least raise the shades and let some light into your room. Getting more light is essential! If you don’t have natural light, there are good artificial light options My sister Amy lived in Alaska for many years and absolutely relied on her alarm clock that gradually lit up the room in the morning. She also made sure to get outside for a daily walk around lunchtime and felt that that made a huge difference. Her sweet big doggie Tenaya, made sure that the walk happened, regardless of the weather. If you are really in a dark place, (pun intended) and none of the above suggestions are feeling helpful, it is absolutely worth checking in with a therapist. There should be NO stigma associated with getting support for your mental health. Some folks will benefit from antidepressants. Hoping that you all can lean into the coziness of the season.

They put WHAT in their mouths? 2023

 

Holiday seasons can be especially challenging when it comes to childproofing. Christmas trees, presents, wrapping paper…..It is hard to stay vigilant 24/7. Pediatricians usually get some pretty interesting calls this time of year.

The fact is, kids like to explore. Many times this involves sticking things where they don't belong. Being fairly oral critters, most of the time the object they are handling gets placed in the mouth. When this happens there are two passages where something might go down.

If it goes into the esophagus, that is the beginning of the digestive tract. It hopefully will make its way down into the stomach, through the intestines and then get pooped out.

If something was swallowed, here are some things to consider:

Is it stuck?

How does the child look? Are they able to take a sip of water? Can they swallow just fine? Is their breathing relatively normal?

If something has gotten stuck in the esophagus they will look uncomfortable, There will be frequent coughing and throat clearing going on. You will know that something is amiss. This will necessitate a visit to the ER.

Is it poisonous?

If you have any doubt about that, call the poison control center

1-800-222-1222 . For more info about dealing with poison, here is my blog post.

Is it potentially germ laden?

Advice nurses get calls about kids eating things that are pretty disgusting. Young infants are the most vulnerable, but usually don’t have the dexterity to actually get something into their mouth without some help. Once they have mastered the hand/mouth coordination skill, they are old enough that a normal healthy gut has good bacteria that can be somewhat protective. If whatever it is that they ingested is going to cause trouble, symptoms will usually show up with tummy aches, vomiting and loose stools within a day or so. Persistent tummy upset will usually warrant a stool test to help us figure out what the culprit is.

Is it a battery?

Any battery can be trouble, but button batteries can be a tremendous hazard because they can be easily swallowed and they seem to be everywhere these days.

Several years ago I got a call from a mom of 15 month old twins. There they were, sitting on the floor with mom's pedometer right in between them. It was open and the battery was gone. Because of the uncertainty involved, we did have to send them to get x-rays. Indeed there it was, that little battery, sitting in the stomach of one of the kids.

In this case it passed safely, but if a battery gets stuck anywhere on the way it can cause a dangerous amount of damage. Please know where all the button batteries are in all of your little gadgets and make sure that your kids have no access to them. Keep a strict inventory and perhaps stick a piece of duct tape across any battery compartments.

Other objects that you need to be wary of are magnets. I am not talking about the little letters that you may have on your fridge. The ones that cause concern are the industrial strength magnets that you may find in some "grown up" toys like buckyballs or jewelry.

If more than one of those get swallowed it can wreak havoc on the intestines and be deadly. Keep them away from your kids!

Water beads

I am glad that these weren’t around when my kids were little. They are little sensory beads that can grow to almost 100 times their original size when wet. They claim to be non-toxic, but they can be very dangerous if swallowed. These beads are associated with thousands of ER visits every year. If the beads are ingested they can continue to grow inside the body. This can cause severe discomfort, vomiting, intestinal blockage and life-threatening injuries.

As an aside, they are probably helping put many plumbers’ kids through college. Your pipes will thank you for not letting these into your home.

Is it sharp?

If it is something that has a point or sharp edge, keep an extra close eye on your child. Feel the tummy to see if it is nice and soft. Look for blood in spit up or drool. Keep an eye on the stools. 

If your child seems to have a rigid painful belly or has any dark, tarry poop or bright red blood they will need to be seen right away.

You may as well laugh

Some of the stories of what kids ingest are worth a giggle once everyone gets the all clear. One episode that I remember was a 3 year old patient who accidentally swallowed one of her Grandma's one carat diamond stud earrings. It did pass through and was retrieved with no harm at all to the swallower. However, Grandma didn't want it back; it was reunited with the mate and is in a safe deposit box waiting until the little girl is 18.

Most of the time, like the earring, it is simply a matter of watching for whatever it was to pass through. I have seen all sorts of stuff get swallowed and pooped out without incident. I think I have seen enough change to put a kid through college. Most coins smaller than a quarter go through fairly easily.

Nurse Judy's 'corn in the poop' tip

Let's encourage a quick passage! Increase the amount of fluids that your child drinks. Perhaps add prunes. If your child is old enough that they are beyond simple pureed food, consider giving some corn kernels (you won't see that in any textbook). Have you figured it out yet? For those of you who need this spelled out, corn kernels are usually fairly recognizable after they have been pooped out. They can act as a marker. That bright yellow kernel of corn can help you track the transit time.

When do we need to start paying extra attention to this 'oral' behavior?

Once in a while just about every kid is going to do some exploration, but if your child is old enough to know better and seems inclined to continue to put non food items in their mouth, this might be a condition known as Pica. Pica is the persistent eating of substances such as dirt or paint that have no nutritional value. This is worth pointing out to your doctor. There might be a nutritional deficit or something else going on. Low iron levels or hight lead levels could be part of the issue.

If the object goes into the trachea it may block the airway and you have a choking situation on your hands, or it could get aspirated into the lungs. Neither is good.

Your child will clearly be having breathing difficulties if this has happened. It is important to note that if someone has a blocked airway, they can not speak or make sounds. They will likely have a color change and look pale or blue.

It is critically important that all parents and caregivers are trained to do a choking rescue. Of course with any emergency you should call 911

Prevention!

To avoid this happening on your watch, do your best to keep little items away from the young kids. Anything that can fit into a toilet paper tube is too small for an infant or young child to be handling. Food pieces should be soft or cut into long strips rather than round pieces.

Encourage safe eating: sitting instead of running around, chewing and swallowing rather than shoving in wads of food. Parents, please model good behavior!

So what about the new devices that can help if your child is choking? These are relatively new and get good reviews. Alas this are not geared to children less than 22 pounds, but might still be nice piece of mind for older toddlers.