Adenovirus

 

I usually include a ‘what’s going around section’ in my weekly newsletter/email. Parents have told me that it is very useful to know what to look out for. There is also some comfort in running with the pack. Misery loves company. For several months now, adenovirus has been on that list. Interestingly, although I have been working in pediatrics for more than 40 years (yikes), unlike RSV, hand-foot-mouth, and slap cheek, adenovirus was not an illness that I frequently discussed. Is it new? Nope! What’s new is the ability to easily do a respiratory panel to identify the actual virus. What I used to refer to as a ‘viral package’ or the ‘creeping crud’ now has a specific diagnosis. So, what is adenovirus? Adenovirus is a family of viruses that has more than 60 types. It is quite common. You've probably been exposed to it at some point in your life. In fact, by the age of 10-years, most children have had at least one adenovirus infection. It can happen year round but tends to be more common in the Winter and Spring. It is very contagious. Symptoms are variable and range from a mild cold to severe illness. Most people don’t bother to test a little sniffle, so it is hard to have accurate data on how common it actually is. The more annoying and serious presentations include: Runny nose and congestion Pinkeye fever Cough Headache Sore throat Muscle aches Pneumonia Ear aches Vomiting Diarrhea This is indeed the ‘viral package’ with a little bit of everything. The most recent wave, as reported by Dr. Ted, was a “pharyngoconjunctival fever,” aka sore throat, pink eye, and fever. Most cases last from 3 to 7 days, but the more severe cases can last for weeks. Like other nasty viruses, there can be secondary infections.  People with weakened immune systems, or existing respiratory or cardiac disease, are at higher risk of developing severe illness from an adenovirus infection. Exposure and spread The onset of respiratory symptoms is usually between two and fourteen days after exposure. When it is gut related (vomiting and diarrhea) it moves a little more quickly and you will see signs within 3-10 days. People are most contagious right before they get sick or within the first couple of days of the illness. Even people with very mild cases can spread it.  The most common ways that it spreads are Close contact (shaking hands) fecal/oral transmission  contaminated surfaces airborne transmission from one infected person to another.  Occasionally it can be spread through water and public pools Testing More often than not the diagnosis is the ‘best guess’ based on the symptoms. Those red eyes are often a big clue. If the patient is pretty sick or has a persistent illness, then your doctor may opt to do a respiratory panel to get a more definitive answer. A stool sample might also give a diagnosis. Blood work is not usually done, unless your provider wants to rule out something else, but it might show an elevated white blood cell count if done. Treatment Most of the time treatment is based on the symptoms and there are no special medications (or magic wands) This includes, fluids, rest, fever medications as needed and a humidifier at night. Soothing eye drops are helpful for the pinkeye and Manuka honey feels great for the throats (only for folks older than a year.) People who are immunocompromised and get a severe version may need to be hospitalized for supportive care. Those folks may have access to antiviral medications. Prevention Good hand washing and wiping down surfaces are important ways to protect yourself from this. Try hard not to touch your face with unwashed hands. Boost your immune system Try to get enough sleep. Vitamin D and ZInc are associated with a healthy immune system. I also like sambuccol/elderberry at the first sign of illness. Thanks as always to the amazing Dr Ted for his valuable input!!

Organizing your stuff

 

Hacks for helping to organize your stuff

Organizing your crap....I mean treasures Since this is the first week of Spring, I thought I would update and ‘reorganize’ this post that I did several years ago. Here are some tips to tackle some of the most common clutter culprits. Toys Try to have an organized system so that putting toys away is straightforward. My dad used to say “a place for everything and everything in its place.” He did NOT follow that adage, but it is a good one. In other words, know where an item came from so that it can be put back where it belongs. If you can’t do that, you possibly have too many toys and you should take some of them out of circulation.   Large toy boxes/trunks are okay for really big items, but those tend to become a dumping ground. You are better off investing in shelves with different bins.  Low shelves are for toys that kids can have easy access to.  Have a designated high shelf area for setting aside toys that need adult involvement.  Take a photo of the toy that lives in the bin and glue the image on. Invest in a polaroid or instant camera so you don’t have to wait to get pictures printed! It’s a great use item to help stay organized and capture memories along the way. This can be a family project. (Great rainy day activity!) Maybe the picture can include your child holding the toy.  There can be a box for little cars, a box for dolls, a box for crayons...etc.  Perhaps have a rule about only 2 or 3 boxes being down at a time until your child shows you that they can manage cleaning up more of a variety. If you have a toddler make sure the additional toys are out of sight. Toddlers have this notion that anything that is in sight must be on the floor with them. This causes more dumping and chaos and less playing.  Art work It is always a delicate balance figuring out what to keep and what to toss when you have a budding artist in your life. You want to value their creativity but there is only so much room on the fridge.  There are picture frames perfect for kids' art. You can easily change the display and they store up to 50 pieces. But even that is finite for a prolific artist When it is time to make room for new art, what happens to the old stuff? The choices are recycle (a much kinder word than throwing out,) save, or give as a gift. If something is getting ‘recycled’, get it out of sight quickly. You don’t want your kid to find their art crumbled in the trash.  Another option is to take photos of the art which can be kept in an album or stored digitally.  School work For the things worth saving, each child should have one expandable file folder per year for things that are flat. My kids had one folder for each grade, as they got older the things that were saved morphed from art to school papers and projects that were keepers. For Lauren, my actress, that was where we kept programs and newspaper clippings. The files have limited space. Have your kids be part of the committee that decides what gets saved. At the end of the year we always had a lot of fun going down memory lane by looking through the folders. At that time we were able to do some further culling; not everything needed to be kept. Barnacles. Life can get messy and it isn’t always the kids who are to blame. My mom used to refer to items that took root in places they don’t belong as barnacles. A barnacle is a form of marine life that is sticky and hard to remove. It finds a suitable surface to attach to and might not move for the rest of its life. The pair of socks that you took off and are on the coffee table for several weeks? Barnacle. The infant swing in the corner that no one has fit in for a year? Barnacle. A good first step to spring cleaning and organizing your home is to find the barnacles. This is often fairly simple and satisfying. It just takes a little bit of attention. If there was a barnacle contest. We win. Photo below! The first thing that people tend to notice when they go into our garage is Brownie, the toddler sized paper-mache gorilla who has been taking up residence on a high shelf there for almost 30 years. “Brownie” was created by Lauren’s first grade class. It was part of a time intensive class project that ended up on display at a local mall. When the school year ended there was a drawing to see which lucky student won the right to keep Brownie for ever and ever. Lauren was the lucky winner. She was beyond delighted. Mom and dad weren’t quite as thrilled. For years, when we would do the occasional garage clean up, she was still not ready to part with him. Now it is as if he is simply part of the garage. Like any good barnacle, he has taken root and we barely notice him unless someone spots him, does a double take and asks the usual "What on earth?..."  The garage is full of many other objects that we likely don’t remember we have and don’t really need. Brownie is just the shining example. At least we can manage to fit our cars in (which probably makes ours better than many). To be fair, if my husband was left to his own devices, the garage would be immaculate. The big clean-up In most couples there is usually one person who is much more comfortable with clutter than the other. Our differences become even more understandable if you look at where we came from. When she died, my mother in law had left everything in perfect order. She had even taken photos of her art and had written down information about each piece, the artist and the story of how she had acquired each piece (such a gift!) Dealing with the things in my childhood house after my parents were gone was the other extreme. Neither of my parents were good at getting rid of things. My father had a workbench full of all sorts of unfinished projects. My mom claimed that she wasn’t a packrat, but she was a kindergarten teacher and as such she had kept piles of worksheets and odd stuff that could come in handy for a future craft project ( think toilet paper tubes, egg cartons and old magazines.) The house was filled with generations of letters and photos, newspaper clippings and the occasional treasure. There were shelves of dusty old books dating back to as early as 1892.  It took my sisters and 3 years to clear through things. Do yourselves and your kids a favor. A little organization is a positive thing.   Set yourself up for Success Oath’s Developmental specialist, Mona from Sparks Wonder, offered some extra tidbits Take on one project at a time, don’t try to do the whole house at once. Start with the most problem areas: toy room? Kitchen drawer? Coat closet Create a story of where items end up. One family had a picture of a little girl in Nepal on the fridge and every time they had to donate an item they reminded their little one that their family friends in Nepal needed some of these items.  Don’t wait to talk about cleaning out or donating around the holidays; this often leads to big feelings about losing toys.  Invest in a label maker. This may have possibly saved my marriage. Before my first boy was born I labeled everything in his nursery drawers. Washcloths, towels, onesies, outfits etc. This way there was no confusion and anyone that wanted to help could find their way around. If you are the partner that likes order, create a system anyone can follow without needing instructions.   More suggestions from the Oath community Oath’s Nurse Alice * We live by stations/"homes" - putting toys/blankets/socks/laundry back in their "homes" before doing screen time, guests coming over, and/or going to bed. Nina, a mom in the Oath community says I’m an organizing fiend and all I have to say is people need to let stuff go! Inability to downsize stuff is a main reason spaces get cluttered. If you are feeling the need to keep everything it will be hard to re-energize a space. LET IT GO! Craigslist is a great place to post free stuff to get it out of your hair. My motto is “Use it or Lose it!” Dr. Alexandra, part of Oath’s Mental health support team shared The "touch it once" rule has been a game changer for me and other folks with executive functioning challenges. I don't always follow it but it makes a difference when I do. The idea with routine or mundane tasks, rather than push it until later, make a decision right away. This has helped a lot with mail, emails, and clutter. Here's more about it if you're curious: https://healthymindsacramento.com/2018/06/24/only-handle-it-once-an-organizational-game-changer-for-adhd/

Poison/Action and Prevention

 

Many years ago, when I was still in college, one of my early jobs was working at a huge warehouse store in Ithaca New York where I was spending the summer. One day, the ringing phone was answered by one of the other employees. There was a sobbing mom on the other end. My young coworker had no idea what to do with the call, so he grabbed me. Maybe because I was in nursing school, he figured that I would know how to handle it. The caller’s child had broken a lava lamp and had possibly eaten some of the content. She had bought the lamp from this store and wanted to know if it was poisonous (spoiler alert, please don’t have one for lunch, but the lava is in fact non-toxic) I had the caller take a deep breath and then I found the number of the poison control center for her (only those of you who were born before the internet would realize that things like finding a phone number, was not the simple task that it is today). That child wasn’t in actual danger, but Poisoning is the leading cause of accidental injury deaths of children in the US. Back in 1961 Congress established National Poison Prevention Week.  It takes place the 3rd week of March. One of the main objectives is so that the public will know what to do in situations like the one above. Aside from highlighting the Poison Control Center it also aims to raise awareness and promote prevention. What is considered Poison? The definition is a substance that is capable of causing the harm or death of a living organism when it is ingested, inhaled or absorbed. The fact is that just about anything can be poisonous when used in the wrong way, in the wrong amount or by the wrong person. It is almost impossible to have a home that has absolutely no hazardous substances in it. In other words... It's a minefield out there Here is an example of what I mean by that. You can be surrounded by things that you pay no attention to until…… Years ago and before the pandemic, I had a little patient who squirted a glob of Purell hand sanitizer onto a cracker and ate it. In this case the child was fine, but it turns out that because the main ingredient in many of these products is alcohol, even a small amount can be hazardous. Since the pandemic, calls to the Poison Control related to hand sanitizer have increased by 79% compared to the previous years. Action  If you have any question about an ingestion or exposure, The first call should be to Poison Control: 1-800-222-1222  The right thing to do if you are worried is ALWAYS to call or check in with them. If you prefer and If it doesn’t feel like an emergency you can also go to the online website for guidance. https://triage.webpoisoncontrol.org/#!/exclusions The Poison control center gets more than 2 million calls every year. More than half of those are from parents who need help figuring out if the substance that their little one got a hold of is toxic or not. When you call them there are things you can do that will help. If possible, bring the medicine or container to the phone to help you answer any questions. They will need to know: Age of the patient Do you notice any symptoms? (if there are breathing issues call 911) How much does the patient weigh?  Are there any general, relevant health issues? Any known allergies? What is the exact name of the product that they ingested or were exposed to? Do you have a sense of how much they took? What is the size of the bottle? This can help them figure out how much your child might have had access to. They will let you know what the next steps need to be. More often than not it is for you to take a deep breath, relax, but take steps to prevent something like this from happening again. In other cases they may have you go to an emergency room. Years ago, families were told to keep Syrup of ipecac on hand to induce vomiting. This is no longer recommended.  Certainly check in with your doctor afterwards. If you call them first, they are likely going to tell you to hang up and call the hotline. That used to happen to me all the time when I was working at the pediatricians office. I was often the first one parents would call.  Here are just some of the items that I referred to the Poison Control center. I was pretty sure that none of them required intervention (and I was correct), but it never hurts to check. Cat poop Play dough Chapstick The little pack of desiccant inside a shoe box that says “do not eat” Lava lamp again (surprisingly popular) Varnish off of an old crib rail The squeaker from inside of the dog's toy Prevention Ideally you are never in the position that you need to reach out to poison control, but keep that number handy! It is important to note that nearly 9 out of 10 unintentional poisonings occur in the home. You may think things are safely tucked away, but kids can climb and get access to all sorts of stuff. It only takes a moment for an ingestion or exposure to happen. Heads up, keep an eye on your brilliant little ones. What you think of as secure one month, may not be as safe as you’d like as they master the ability to open locked doors and cabinets. Here are some of the biggest culprits: Medications. Of course it goes without saying that all medications should be safely stored away. It isn’t a bad idea to go through your medicine cabinet to see what’s actually in there and get rid of things that are expired. What’s in your purse? Many people at the very least have some tylenol or basic remedies in there. Your friend who comes for a visit and leaves her purse on the chair within reach of your curious toddler, is a recipe for trouble. (I got that call!) Watch out for grandma and papa’s house. My house is no exception. Last month, Elliot saw a chewable Tum next to my bed and before I had a chance to react, he popped it into his mouth. "Yum, that was delicious. I want more Tum” Tums are simply calcium, so I wasn’t worried that he had one, but it was a nice little wakeup call not to leave them out. We got off lightly.  I have had multiple patients have much more dangerous situations after playing around in grandma’s bedside drawer. The most extreme case was a child who got ahold of an oxycontin. Grandparents or adults who don’t have kids in the house, often don’t pay attention to this. It is quite reasonable to remind them to take a look and make sure things are out of reach when the little ones are visiting. I just learned about a brilliant hack from one smart Grandma. She told the grandkids that if they ever find something that looks like a pill, if they turn it over to her, they would get rewarded with an M&M or some similar treat. She ended up passing out more rewards than she was expecting. Accidental poisoning can happen and isn't always the kids fault! I once had a young patient who had been prescribed .5 ml of medication to be taken twice a day. The pharmacy made a serious error and wrote 5 ml on the directions. 5 ml is only a teaspoonful and is a reasonably small volume, but in this case it was 10 times the proper dose. The baby did get that first mega-dose. The reason the parent called to check about it, was that the 30 ml that had been dispensed, was meant to be a one month supply. Giving 5 ml every dose would last only 3 days. In this case, the parent caught on that there was an issue pretty quickly. Fortunately the baby was unharmed. The takeaway here is that errors can happen. Always double check! If something doesn’t make sense, looks different, smells different etc, go over the details and directions with your doctor or pharmacist. I also can not even count how many kids have gotten double doses of medication when parents haven’t checked in with each other. “I just gave some tylenol” “Oh No! I gave a dose 15 minutes ago!” I strongly suggest putting a piece of masking tape on all medication bottles and mark down dates and times of all doses. An alternative is to have a physical notebook or a shared document online, where you write down the time and keep track of anything that is given. Gummies Many medications and supplements now come in gummy form.. The upside is that for some kids this form increases compliance. The downside is that some kids may try to get a hold of these and take more than they should. I remember a nine year old patient with a mystery tummy ache. After all the obvious causes were ruled out, at the threat of a trip to the specialist, he confessed that he had been sneaking extra gummy vitamins on a daily basis. Mom had bought a giant cost-co sized container. At some point she would have noticed that they were disappearing, but when you have a larger container of something, it is harder to keep track. Cannabis This can overlap with the gummy category, but Cannabis comes in many forms. In 2021 there were more than 3000 calls to poison control centers about cannabis exposure in kids under the age of 6 inadvertently consuming an edible. That is up from just 207 reports in 2017. This is an increase of 1,375%!!! From 2017-2021, there were more than 7,000 confirmed exposures in young children. Thankfully there were no deaths reported but nearly a quarter of those kids ended up in the hospital. By far, most of these exposures happened at home. Half of the cases involved 2 and 3 year olds. No judgment if you have edibles around. Many adults take them to help them sleep. The essential thing is that they are locked away. Melatonin 5% of calls made to Poison control this year were related to melatonin Toothpaste Fluoride is recommended, but too much can be toxic. Kids should get no more than a pea sized amount. The tricky thing is that kids' toothpastes are made to be enticing to encourage brushing. Make sure you store it away when you are not using it, so that it is only available with supervision. Household goods Anything that looks like candy can be tempting. Items can range from bath salts to colorful deodorizer balls that go into the vacuum cleaner. Some bright colored cleaning products could be mistaken for juice by kids who can’t read labels. All cleaning solvents should be kept in a childproofed cupboard. Keep things in their original containers. Repackaging or transferring them can lead to mix-ups and accidental exposures. Plants It is a good idea to know what plants you have in your home and yard. There are lots of handy little apps that can help you identify them. Once you know what you are dealing with, the link above has a list of plants that you should avoid. Teach your kids that it is never okay to eat a berry, seed or part of a plant without your supervision. Some plants can be toxic when eaten, others can cause irritation from any contact. The biggest culprit for that is poison oak. Inhalation Poison isn’t only something you ingest. Certain things that you inhale can also be considered poisonous Carbon Monoxide - is possibly the deadliest one on the list. It is also the easiest to prevent. It is required that every house or apartment have a working carbon monoxide detector. If you aren’t sure if you have one, please check right now. If you are renting, your landlord is required to provide this. Some cleaning supplies can create toxic gasses when mixed together. Refer to the photo below. A bit of prevention goes a long way! Be as careful as you can out there, but if something happens, you know who to call first!  (I adore you, but it isn't me)

Dental health 2023/When to see the Dentist?/Toothbrushing Hacks

 

Dental Health/When to see the Dentist/Toothbrushing Hacks

Parents often ask about when their child needs to start seeing a dentist. Those questions are commonly accompanied with follow ups about toothbrushes, toothpaste, brushing hacks etc. I asked my favorite SF pediatric dentist, Dr. David Rothman, to weigh in. When is the best time for your child to establish a relationship with a dentist? The current official recommendation is that your child should have his or her first dental visit by age one or roughly six months after the eruption of that first tooth. Dr. Rothman says that for him, that first early visit is less about the actual exam and more for reviewing the current science of oral hygiene and getting you and your child set for a cavity free future. It’s a great time to ask questions and up your knowledge. Surprising things are often shared! During subsequent visits, along with checking your child for dental decay, the dentist will talk to you about cleaning your baby's teeth. They might also talk to you about tooth friendly diets and 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.  One extra perk about routine dental care is that you might walk out of the dentist's office with a new toothbrush!  FINDING A DENTIST There are plenty of good general dentists out there, but my preference is to find one that specializes in pediatrics. Often their waiting rooms, offices and equipment are designed to put your child at ease. As you start your search, knowing how they handle after-hours emergencies is important. Kids have accidents! (somehow these things wait until after standard office hours are over for the day.) Over the years I have had countless frantic parents reach out to me 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 an established relationship with 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. One more consideration is If you have a child with sensory issues or any special needs, ask about what accommodations they have. What about covid? Having regular dental checkups should not be put off due to COVID or flu season. Good dental offices are on the front lines of practices who deal really well with infection control. They have been using masks, gloves and face shields long before this pandemic. There are still some special requirements for hospitals, medical and dental offices including mask wearing. If your child has a compromising medical condition please let the dentist’s office know before you show up and special accommodations can be made. Why is it so important to have routine dental care? 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.  People not going in for their routine dental visits corresponds with an increase in cavities and gum disease. This became apparent during the several years of the pandemic when many folks skipped these important appointments. At the same time, many healthy diet routines went down the drain. The number of kids with cavities went way up. The numbers are improving now that we are slowly getting back to normal but 18% of school aged children still have cavities.    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.  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. Germs love sugar to grow and make their colonies in dental plaque on all surfaces including between teeth (here’s winking at you, floss). In order to prevent decay in our adult teeth, baby teeth have to be kept healthy as well.  Toothbrush options and considerations Training your child from an early age that teeth get brushed is a good way to create good dental habits that will last a lifetime. For 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 can also use 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. As a transition to a toothbrush, some parents find success 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.   When you graduate to a regular toothbrush, there are lots of choices. I asked Dr David if he has a favorite. His answer? The one that you actually use is the winner, whether powered or not! Make sure the one you pick has soft bristles. When you brush, brush very gently. The bristles should barely bend. Brush in circles to prevent damaging the sensitive gums.  Regardless of which brush you use, replace it 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 especially after the child has a cold or strep. 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 or take turns. Ideally, try to brush twice a day and floss once a day (for teeth that are touching). Brushing is supposed to last 2 minutes. That might feel like a long time, but that is how long it takes for the fluoride to have a real effect. Consider putting a little tune on while you brush. This can act as a timer. Seriously, music makes a big difference.  Brushing can be a little more fun and interactive nowadays with some fun toothbrushes and apps. Sonicare-for-kids-sonic-electric-toothbrush   brushdj   brushupgame   DisneyMagicBrushTimer   TinyDentist Chomper chums Some of these apps are pretty high energy. Make sure you don’t let things be too active. Running and jumping around with a toothbrush in the mouth could cause injury. It happens. Focus on positive attention. “Mommy/Daddy are going to help you get rid of those silly tooth germs. Let’s chase them off the teeth with the brush” “Ooh look at how bright and sparkly your teeth look!” On days where they don’t seem to be as cooperative, sometimes a 15 second brushing is going to be all you get. I would try hard NOT to give a lot of negative attention. A small drop of toothpaste with fluoride is better than nothing.  In any case, do the best you can. It is quite normal to have good days and bad days. Toothpaste considerations It is important to use a toothpaste that is non abrasive: 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. Please remember to use an ADA Seal of Acceptance toothpaste to verify safety and efficacy. Be wary or questioning of ones that don’t.  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 increase to a pea sized amount.  While there may be some discussion over whether or not fluoride is safe, the Centers for Disease Control and Prevention clarifies that fluoride is a naturally occurring mineral. When applied to teeth, fluoride strengthens enamel and prevents cavities that can form after eating sugar and other refined carbohydrates. It has been added to some toothpastes and water systems since the 1950s and has tested and proven benefits. Be aware that most water filters remove fluoride to some degree. Bottled waters have little or no fluoride.  Xylitol is another recommended ingredient for dental health. It is found in some toothpastes. While it does not have the same positive impact on the enamel that fluoride does, this natural sweetener is found to help reduce bacteria and strengthen tooth enamel. It is also toxic for pets, so make sure your dogs and cats don’t have access to any xylitol products  Flossing is important too Once your kids have teeth that are close together, flossing is an important part of dental hygiene. This may not actually be an issue until they are 2-3 years old. Just as an aside, our grandson Elliot is delighted by floss. If you aren’t watching him carefully he can pull out yards and yards of it in the blink of an eye. However once he has a piece, he actually lets me get in there and do a little flossing. Elliot also likes to use the little hand held flosser picks. Is he actually accurately flossing in between every tooth? Probably not, but again, it's about habits. I hope he keeps it going! What can you do to keep your child's teeth healthy right from the start?  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 snacking, the saliva isn’t getting a chance to do its job.   It will come as no surprise to anyone that 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!) Carbonated, acidic drinks can be hard on the enamel even if they aren’t sugary.   Regular dental care can actually save you money 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.) Is your child one of the many who has never seen a dentist? Don't waste your time feeling shame or guilt. You can’t manage the past. Do your best starting now to change that. If you are overdue for a dental check up, or realize that your family tooth hygiene regimen could use some improvement, take a step in the right direction. Identify one little baby step that you can take to change that and start today!   Extra tips from the Oath community Andrea shared, What I started when my little one was 2 months old was running a wet washcloth on my son's gums once a day, then when he got teeth I just started brushing them with baby friendly toothpaste. After I brush his teeth, I then let him "brush" his teeth as well Amina likes the Frida Baby toothbrush. She also thinks that having her little one watch the parents brush every night helped establish a solid habit. Being a good example doesn’t stop when they are toddlers. Lindsay says that her 5 year old watches and imitates his parents when they are brushing. This is a great way to show them the right angles and directions. Don’t forget to brush the tongue. Arianna shared: My 19 month old was fighting tooth brushing for a bit. Firstly I made sure to brush her teeth even if she cried or complained about it. She stopped fighting it after a few days. Second, we’ve been practicing words and sounds so we both go “Aaaaahhh” and I brush sections at a time. I give her lots of high fives and positive reinforcement when we’re done. Then I let her suck on it and play with the toothbrush if she wants. Jody V, Oaths speech and language specialist shared At our home we do 2 brushes, one that my son gets to do, and then I get to "double check" and sing the ABC's while brushing his teeth. It allows for some independence while also making sure those chompers get the right scrubbing. He's absolutely loved it since he was a little one...plus side is learning his ABC's while brushing his teeth :). Megan added When my kids were little and had a hard time reaching the sink - it was most fun to let them spit in the tub! They thought it was silly and I could spray the tub down easily! Sometimes adding something novel and fun will help keep the tooth brushing habit easier to maintain. Pauline added  We love Hello Toothpaste for kids! My little one likes to play pretend with me being the “dentist” when she is having a hard time with brushing. I make all the sound effects possible to entertain her (when I'm not tired of course) . We also alternate between two different colored brushes and toothpaste flavors so that I can give her a choice of what color and flavor she would like…it keeps it much more interesting for her. Oath’s Pediatric Nurse Alice really likes the  Banana training toothbrush Thanks So much to Dr. David Rothman for being my go-to pediatric dentist!