Sunscreen 2023/The best way to protect infants

 

Sunscreen guidelines

Everyone who knows me, knows that I can’t resist a good pun. So I loved learning that the National Council on Skin Cancer Prevention designated the Friday before Memorial Day as ‘Don’t Fry Day.’ Hopefully this post will be full of information that helps you avoid sunburns for you and your family. While we need to be a little more protective of our fairest kids, regardless of the skin pigment, everyone should be wary of sun exposure. Sun risks Skin cancer is the most common form of cancer in the United States. More than one million cases are reported annually. Multiple sunburn events during childhood double a child’s risk of developing skin cancer later in life.  Cataracts and other eye damage Immune suppression. Scientists have found that overexposure to UV radiation may suppress proper functioning of the body’s immune system and the skin’s natural defenses. If you don’t care about health, how about vanity? Sun exposure leads to premature aging and skin damage. Up to 90 percent of the visible skin changes commonly attributed to aging are caused by the sun! What about vitamin D? The sun is indeed a great source of vitamin D. Unfortunately the risks outweigh the benefits. It is much safer to get vitamin D through a diet that includes vitamin supplements and foods fortified with vitamin D. If you do opt to get some D through sun exposure, keep it short and do it in the morning. Note that vitamin D is blocked from glass. So while sunshine through the window can give you a burn, it won’t help with your vitamin D levels. Using sunscreen is an important tool in avoiding sunburn.  Figuring out which sunscreen to buy can be a bit challenging. There are several things to sift through. Here is some basic information/options and considerations... Sunscreens are either mineral or synthetic/chemical.  The mineral ones contain zinc or titanium dioxide. These work by reflecting the sun's rays like a mirror to protect the exposed skin  The synthetic sunscreens absorb rays in a chemical reaction that dissipates the heat back off the skin. SPF, or Sun Protection Factor, is a measure of how well a sunscreen will protect the skin from the UVB rays. Quite a few studies state that it is not worth getting any SPF that is over 50. These studies suggest that the higher SPF doesn’t offer a significant increase in protection, just more chemical exposure and a false sense of security.    The UVB rays are the kind of radiation that causes sunburn, damages skin, and can contribute to skin cancer.  The UVA rays are connected to aging skin and wrinkles; they may also have some cancer links.   It is important to protect against both so you want to look for a product with broad spectrum protection.   The use of sunscreen should be routine. Great habits now will avoid those wrinkles and potentially serious skin problems later on. For older kids, using makeup brushes to apply it can be an appealing and effective way to turn this into a habit.   If you can plan appropriately, apply the sunscreen at least 15 minutes before going out. Ideally put it on before the clothing to make sure you don’t miss a spot. For significant sun exposure, sunscreen needs to be reapplied at least every 2 hours. This includes products that claim to be waterproof. Don’t forget to protect the feet, the ears and the top of the head if you have thin or no hair up there. (Better yet, keep a hat on!)   Sunscreens come in several forms. Lotions and sticks are my preferred formulation. With the mineral powders, try to contain the application so that your child doesn’t breath in the particles. I don’t love the sprays because it is easy to miss spots and inhalation can be an issue. They can also be flammable! If you are going swimming make sure you pick one that is waterproof. Consider the impact on the environment. If you are simply hanging out in the park, it isn’t an issue, but if you are swimming in a natural body of water, (especially the ocean), some chemical sunscreens that contain ingredients like oxybenzone and octinoxate are believed to contribute to coral bleaching, and damage the reefs. That is an extra benefit to the mineral based products When you are trying to choose a good brand, it can feel a little daunting. You need to be a careful label reader. There are currently 16 active ingredients allowed in sunscreen! Only two of these 16 ingredients, zinc oxide and titanium dioxide have earned the GRASE acronym (generally recognized as safe and effective.)   At least two of the ingredients, PABA and trolamine salicylate, should be avoided. The FDA has ongoing investigations into the remaining 12 ingredients. The concern is that recent studies have found that the ingredients in some sunscreens are being absorbed at a higher level than previously thought. The fact that an ingredient is absorbed through the skin and into the body does NOT mean that the ingredient is unsafe, but it makes sense to do further studies.  Did your eyes just glaze over? Rather than trying to navigate all of this info, I would simply check in with the EWG. They have done all the work for you and have a list of the safest sunscreen. The Environmental Working Group has listed their best kid sunscreens. Keep in mind that the cost does not necessarily correlate with the better choices.  Please don't stress out if you have been using one that isn’t on the list. Sunscreen ingredients have been used for several decades without reported side effects. Take this new information, and choose good brands moving forward.   Whichever brand you choose, reapplying is essential!! If your child is out with a nanny or friend, don't hesitate to remind them to be on the "sun protection patrol". Trust me, sometimes it seems that sunburns can be just as painful for the grown up who lets it happen on their watch! Set a timer on your watch to go into a shady area every 15 minutes or so to assess the skin and put on another application if necessary. What about babies?  This is probably the question that brought many of you to this post. It is terrific for babies to be exposed to daylight; this can help them learn to know the difference between day and night. But there is a vast difference between daylight and direct sun exposure. Here is the challenge - if you are out and about having a normal life, it is very difficult to eliminate all sun exposure. Obviously shade, hats, umbrellas etc are the first choice. However I get the question about sunscreen on babies all of the time from families who are going on vacation or just want to hang out at the pool. Here is my answer: If your child is under 6 months old and the choice is sunburn versus sunscreen, choose the sunscreen every time! For kids under 6 months, I prefer picking one that is zinc based. Consider that zinc is the common ingredient in many diaper rash creams that we start applying from day one. It is quite safe. Dr. Ted would prefer that you double down on keeping them out of the sun. Shaded strollers are great. But he also reminds patients that babies aren’t vampires, and they won’t melt if their arm comes out of the shadows. It’s all about risk/benefit, and the risk of sunscreen is usually allergic reactions/rashes, which are annoying but preferable to skin cancers down the road. So when there is absolutely no choice, a bit of zinc based sunscreen on the exposed little body part is preferable. For kids of any age, If you are using any sunscreen for the first time, do a test patch on one small area on the thigh or wrist a few hours before sun exposure. If you slather your child with a new sunscreen, spend a day out in the sun and then they break out in a rash, it could be from any number of causes, including heat, sun, the sunscreen or even something they ate. Doing a test patch first can assure you that the sunscreen isn’t the culprit.  Other sun protection tools As I noted earlier, your best bet for preventing sunburn is to stay in the shade when possible and also wear a big floppy hat and loose protective clothing. If you get your kids in the habit early, they are less likely to object to having something covering their head. Set a good example and have the adults in the family wear hats as well.   Not all hats are created equal. Choose a wide brim that gives the neck some protection. Make sure the fabric doesn’t have gaps. A straw hat would not be as good as one with tighter fabric. Letting your child pick out a cute hat that fits the parameters might ensure more cooperation.   Have a parasol or a shade umbrella over strollers and baby carriers. Pay attention to babies in backpacks; they might be getting more exposure than you are aware of. Umbrellas are not foolproof. You can also get sun exposure through glass. Kids sitting inside a car can get a painful sunburn.   Eyes can also get damaged from the sun. Do your best to get your child used to wearing sunglasses. The lighter the eye color, the more sensitive they are likely to be, but everyone should wear eye protection.   Don’t forget about lips! There are lots of lip products with SPF protection. If you know you will be out in the sun, check out some sun protection clothing! Options and technology are increasing all of the time. Lightweight sun protection blankets are a worthy investment. Having one in the stroller or car seat will no doubt come in handy at some point,   Some things can make you extra sensitive Be aware that some medications including some antibiotics such as Bactrim, can make someone especially sensitive to sun exposure. Make sure you are familiar with any medication that you or your children are taking to make sure this isn’t a factor. If you aren’t sure, consult with your local pharmacist.   Time and location can make a difference Sun can do the most damage to our skin between the hours of 10 am and 4 pm, with the most intense rays between 10 am and 2 pm. Reflection from water, sand and/or snow can make any exposure more intense. The link below will lead you to a great little site that can tell you what the UV risk is on a particular day depending on where you are:  https://www.epa.gov/sunsafety As far as location goes, the closer to the equator, the higher the risk. But even in San Francisco with our foggy days, we have to pay attention.  How to manage a Sunburn If prevention efforts have failed? Make sure the person who got sunburned is hydrated. Pedialyte or something with electrolyte is ideal. For mild to moderate sunburns, as soon as you can, do a long soak (at least 15 minutes) in a tepid bath. Adding a couple spoonfuls of baking soda or oatmeal (for the tub) can be soothing. After you gently dry off, apply aloe or calendula to the lighter areas.  For the really painful patches, Dr. Cheung, a San Francisco dermatologist suggests that you forgo the aloe vera and instead apply the 1% hydrocortisone cream that you can get over the counter. Apply twice a day until the pain is gone. Ibuprofen (with food) can also help decrease the pain and inflammation. I have seen some sunburns so severe that they cause blisters. If a larger surface of the body is impacted, it is worth seeing the doctor. Check out the ‘Don’t Fry Day tool kit’ for activities that you can do with your kids to increase their awareness about the need to be safe in the sun

speech and language milestones 2023

 

Speech and Language Milestones

May is National Apraxia Month as well as Better Hearing and Speech Month. That makes it the perfect time to update my speech and language post. For those of you who aren’t fluent in Latin, Apraxia is a speech sound disorder where children or adults have difficulty with the motor planning and programming of the movements and transitions needed to form speech. This is heard as difficulties consistently producing speech sounds or speech sound sequences.  Speech issues and language concerns come in a lot of shapes and sizes. Apraxia is just one of many. Speech and language milestones in general can stress lots of parents out.  Here is my recent post milestones/shmilestones that was mostly an attempt to get parents to relax.   I know that it is SO hard not to compare your kids with others. Many of us fall into that trap. Your friend’s kids or your nieces are one thing, but it can be especially challenging when it is your own kids who are so different from one another.  I wanted to take some time to share my story about my own kids when they were learning to speak. My older daughter Lauren was an early talker. It turned out that she was stringing together sentences quite a while before we could reliably understand what she was saying. The fact that she was actually using real words to communicate became apparent to me one day when she and I were wandering around the zoo. She may have been as young as 15 months at the time. Lauren started to tug on my arm saying “shoofaloff” It sounded like typical babble; I tried to figure out what she was attempting to communicate as we walked. Was it an animal perhaps? Did she want a snack? “SHOOFALOFF” She kept repeating. She was getting upset that I clearly wasn’t following what she was trying so hard to tell me. “SHOOFALOFF” I paused for a moment, happened to look behind us and saw that her shoe had fallen off and was about 10 feet behind us. Shoofaloff was “shoe fell off!” Duh! At that moment I realized that her fairly incessant cute little gibberish was actually speaking. As the weeks passed, Lauren became more and more articulate and I completely took it for granted that we lived with a little talking wonder. When Alana came along, I expected nothing less. Alana (don’t fret, she is a mental health therapist in the SF Bay Area and is quite articulate) didn’t care about reaching milestones (any of them!). She had no trouble at all with comprehension, but her speech was incredibly garbled. By the time she was two, we could still barely make out a dozen words. Fortunately we had Lauren, who translated for her without any problem. PUGUGUGODH might mean “I would like more popcorn please”. Lauren was puzzled as to why we couldn’t understand her sister. This just goes to show that often siblings have almost unfathomable communication skills with each other at a very young age. Eventually Alana had plenty of words, but there were still a few letter sounds that were hard for her to pronounce until she was quite a bit older.  There is a huge range of normal, so when do we need to have our antenna up? There are a few basics to keep an eye on.  I am grateful that I was able to connect with Oath’s speech therapist Jody Vaynshtok, MS, CCC-SLP at Sound Speech and Hearing Clinic to help answer questions and provide support. By 4 months your baby should be cooing and making sounds. If this is not happening, one of the first things we would want to make sure is that your child doesn’t have an issue with their hearing. Babies born in the United States are given a hearing screen at birth, but it is still something to check out if you have any concerns.  Does your baby react to your voice?  Do they look in the direction of a loud noise? Have they had multiple ear infections?  As they get older, can they follow simple commands?  If you are looking at a picture book, can they point to the appropriate picture with your prompt? By 15 months they should be able to speak at least a few recognizable words. These don’t even need to be valid words. Alana couldn’t pronounce Lauren, but she could say Yaya and it was clear that Yaya meant Lauren. To this day, it still does!  Perhaps "da" means dog. As long as they are consistent and communicating, those sounds count as a word. If your child knows some signs, those are counted among their words as well. If you know for sure what they are saying, repeat after them and expand on their utterance. When they see the dog and say “da!” you should say “Yes. DOG!” (repeat) “look at the big dog” (expand.) If they are using a sign, say the word. For instance if they are signing “more” during a meal, say “more” (repeat) and then expand, “eat more peas!” By repeating and expanding , not only are you reinforcing correct production of their words, but you are supporting their language development. Try not to pressure your kids by always asking them to say the specific word (or asking them a bombardment of questions). Instead, let them hear you use the word and wait for a response. Waiting can do wonders! Many speech therapists are looking at around this age to see what communicative intent is occurring (pointing, giving, waving) as these are the building blocks to language. Pay attention to the gestures your child provides.  One of Jody’s favorite resources for gestures is “16 gestures by 16 months”  If your child reaches 18 months and there isn’t any understandable language, this is an appropriate time to get a baseline evaluation from a speech and language therapist. Sure, it is okay to wait a bit longer if you like, but early intervention is always a good thing and the assessment can actually be quite fun. I am a big fan of being proactive. Often the evaluation is covered by insurance. Some services are available free of charge to kids under three. There can be a wait list and there is no harm in getting in line. Here is a link to find your state's early intervention center. By the end of the 2nd year, children should be able to speak roughly 100 words (including a variety of words not just nouns), understand 300, and have some word combinations. They should be imitating 2-3 word phrases and playing around with animal and environmental sounds. My 29 month old grandson Elliot has quite a bit to say. I understand him 90% of the time. Fortunately, our Alexa device generally can’t quite make out what he is trying to get her to do. So far only once has she complied when he tilted his curly head, gotten right up to ‘her’ and said “Alexa, play the wheels on the bus.” We all cheered when the song started to play, followed by the quick realization that we will be in trouble when it becomes easier for the device to understand him clearly. Another wonderful aspect of Elliot's communication is that Lauren has been signing with him from the time he was born. I was completely caught off guard when he was 7 months old. I was babysitting. We were cuddling in the rocking chair. He pointed to my breasts and made the sign for milk. Obviously most people don’t start teaching signs so early. I strongly recommend adding at least the sign for ‘all done’ when you start solids. YouTube is a great source for learning Teaching kids to sign can help mitigate tantrums because you are offering them a communication tool that doesn’t rely on verbal development. It is never too late to start.  The earliest sounds for kids are usually /p/ (up), /b/ (baba), /m/ (mama), /d/ (dada), /n/ (no), /h/ (hi), /t/ (toe), /k/ (ick), /g/ (go), /w/ (wawa).  By the age of 3, kids should have most speech sounds in a variety of word shapes. For example with the sound /p/ we would want to hear it in a variety of positions and word shapes “pa” “pop” “up” “apple”. In addition to making sounds we also are looking for speech clarity. The general rule of thumb is: 25% understood by 1 year 50% by 2 years, 75% by 3 years 100% understood by 4 years.  At 4, some sounds may continue to be distorted sounding (like the cute “wabbit” for “rabbit”) but around this age is a good time to check in with a speech therapist if sounds aren’t quite sounding precise. Recently, speech sound developmental guidelines changed and Jody shares with us that the following ages are when we expect mastery of the sounds (in all positions of words) 2-3 years: p, b, m, d, n, h, t, k, g, w, ng, f, y 4 years: l, j, ch, s, v, sh, z 5 years: r, zh, th (voiced) 6 years: th (voiceless) Stuttering is another concern often expressed by parents of preschool aged children. In fact somewhere near 10% of children aged 3-4 years will stutter, with it being 4x more prevalent in boys than girls. It might be more common in kids who are bilingual. While many of these children will stop having disfluencies (close to 80%), some may need intervention, which at this age can be quite successful.  Families are recommended to seek an evaluation if the stutter has been present for over 6 months, if there is any family history of stuttering,  if the child had a later onset of the stutter (around 3.5 years), if there is any physical or emotional frustration  if there are any co-occurring language concerns.  Finally, Jody shares a few tips with you on how to help enhance language, especially in the littlest learners. Your child learns from every interaction you have together. Let’s learn some ways to enhance those communication opportunities to help your child learn the power of social interactions. Let’s O.W.L: Observe: Body language – action, gestures, facial expressions – learn what is motivating and interesting to your child. Wait: Stop talking, lean forward, look at your child expectantly – your child will take the lead. By waiting you can respond to your child’s signals, play, imitate, interpret and comment. Listen: Pay close attention to all words and sounds – no interruptions, even if you know what they are trying to say. Turn Taking: From body language, cooing, and words, use these tips for turn taking - match the length of your child’s turn. Try to match how much your child says or does by keeping your turns short and simple too. If your child uses one word, use no more than two! Match your child’s pace; let your child set the pace for the conversation. Slow down and wait longer if necessary. This allows your child time to explore, understand, and respond. Match your child’s interest; focus on what your child is interested in. When following their lead, they’ll interact longer. Jody’s Question Challenge: This week you are encouraged to not ask ANY questions of your child (that they can’t answer). If your child is only saying 4 words (mama, dada, up, more), most of the questions you ask them during the day they do not yet have the words to say. This can become frustrating or confusing to them, so let’s see if we cut out the questions if we get more communication from them. Try turning all your questions into comments…so instead of saying “what is that” say, “I see a dog, hi dog”. If you ask a question, don’t fret, answer it back, showing your child what you could respond with. Good luck! If you have concerns regarding your child’s speech and language, bring it up with your pediatrician for a local referral or look into speech therapists in your area through the American Speech and Hearing Association. Enormous thanks to Jody Vaynshtok from Sound Speech and Hearing (she also is the speech expert at Oathcare!) for sharing her valuable wisdom. Sound Speech and Hearing 415-580-7604 Sound is one of the wonderful resources here in SF. They are the one stop shop that can combine the hearing and speech assessment in one visit.  Check out their blog for more information on all things speech and hearing and special “building blocks to communication” videos in celebration of Better Hearing and Speech Month.

Mothers Day 2023/Nurse Judy's real Mom Moments

 

Mothers Day 2023

Mother's Day Musings For many people, Mother’s Day is one of those made up Hallmark Holidays that can hit a wide range of emotions. For lucky families, there is certainly joy and celebration. But, for some it can go from being moderately uncomfortable to downright painful.  It isn’t hard to figure out who might be having a hard time with it; People who never had a mother in their lives or people who have lost a mom. Moms who lost a child, women who couldn’t have children, or women who made the choice not to have kids but perhaps feel a twinge every once in a while. There are also so many wonderful families with no mommy but two amazing daddies. How about immigrant families who are forced to be separated? The list goes on and on. Ouch! My mom died in March of 2017 and I remember absolutely dreading Mother's Day that year. Maybe I was just more sensitive because it felt so raw. Every time I turned on the TV or the radio, there it was, Mother’s Day, Mother’s Day, Mother’s Day. What are you going to buy your mother this year? Where will you take your mother? Show your mother how much you love her. Newspapers, magazines, Muni signs. I couldn’t escape it. My goal this year is to find something about the day that everyone can celebrate Make it a Mother’s Day tradition to tell your kids or people who are important to you, stories about your mothers, grandmothers, and great grandmothers. Did they have some favorite pieces of wisdom? Share them! Did they have some favorite songs? Sing them! Did they have a favorite cookie recipe? Bake it. It doesn’t need to be biological. Who are the maternal figures in your life? Reach out and give them a little acknowledgment . If you are lucky enough to have a mom to celebrate, simply knowing whether or not flowers are something mom would like or not is a statement all on its own. Don’t make assumptions. If you haven't done it already, make this year the one where you fInd out what they actually want. Maybe go on a special outing or just spend some quality time together. Take lots of photos. Memories might be more valuable than jewelry.  But then, consider that for some moms with young kids, having a bit of alone time may be just as valuable. Give that mom the opportunity to take an uninterrupted nap! Or a candle lit bubble bath (remove the bath toys!) I have an additional offering for all of the moms (or dads) out there who are celebrating. Here is an update of an old post where I list some of my hall of fame failures. Nurse Judy the Mom How many of us feel inadequate when we look at other parents who appear to be super mom or super dad. These magical beings seem to manage to handle whatever life throws at them with ease? They never ever make a mistake or lose their temper.  Um, not likely. What you may see on the outside is not always accurate.  For the most part, I am blessed and my kids have made it easy for me to look pretty good. The truth is though, that we all have our moments. If you ask my daughters for the lamest mommy stories, I certainly have my fair share of times that I did something that they didn’t appreciate or a time I embarrassed them. It seems so silly but Lauren recalls an incident at a zoo night when she was around five that still makes her grimace. That evening there were costumed characters roaming around the zoo dressed as animals. Some had instruments. “Mommy, I dare you to ask that Lion to sing 'The Lion sleeps tonight'” Dare me? Silly girl. I caught up with the Lion and made the song request. The Lion’s response was, “Only if you sing with me” Much to Lauren’s chagrin, the guitar-toting Lion and I created a lovely duet of Weem-a-Whopping ‘In the Jungle’ as we wandered all through the zoo. I think the only time I actually embarrassed Alana was the first time I discovered Lemon Drop Martinis at a friend's Bat Mitzvah Party and danced the night away with a large group of tipsy moms. Those things are dangerous! There was also the time that Lauren and I were practicing our karate moves. She practiced some punches on me and then it was my turn. She had a pillow up to her belly for protection but wasn’t in a proper stance. I did my move and she went flying across the living room. I was horrified. She was furious.  But the hands down winner is the time I drugged Lauren and then put her on a horse. Yes, you read that right. We were doing a family vacation up at the Russian River and scheduled a horse back riding session at beautiful Armstrong Redwood state park. My girls and I could count the number of times that we had been up on a horse. Sandy, the New York City boy, was actually an experienced rider. Lauren had a mild cold and her allergies were bugging her, so I gave her a little something to help dry her up and we were off on our adventure. We were in a guided group along some pretty steep trails. Lauren’s horse had a mind of his own and was straying from the pack. To compound things, Lauren was feeling really quite out of it and was having a hard time staying awake. Sandy held back on his own horse to make sure she didn’t get left behind. She managed to keep it together for the several hour experience, but just barely. She could hardly keep her eyes open. I was concerned that she was really coming down with something worse than a cold. When we got back to our cabin, I figured out what the problem was. I had not taken the time to read the box and had grabbed and given her the nighttime cold/ cough medicine instead of the daytime one. The poor girl was sedated! Since fortunately she didn't fall off the horse, we can laugh about it now.  Trust me. Most parents have done some dumb stuff, the photos on Instagram are usually just showing the better moments. If you are human, take it easy on yourself as long as you gather wisdom and learn lessons. (read the labels, be careful when you practice punching) The fact is, we all have fairly different parenting styles. Alana (who I never punched across the room) generously offered to let me share a glimpse of mine.  Here are some excerpts of the actual letter that I wrote to her when she left for college. She was my baby moving out, so this was a big milestone for me as well. Oh Goodness….Dear little Pooh of mine, How is it possible that it is time for the ….letter. Just a blink ago you were my sleeping, spitty, very large baby. First of all, you know (but I will tell you anyway) how very proud I am of you. I must have done something very wonderful and you are my reward. There is no one quite like you. You are a magical person. You never lose a friend, you just keep collecting them. You are fun to be with. You are kind. You are smart. You are wise beyond your years. Of course, no doubt, that is partly due to me (mommy takes a bow.) We will now review the mommy theories of life. The PIE theory (click the link…it is one of my favorite posts) You know the pie theory very well. So we will simply discuss its relevance now. Your pie is changing more drastically than it ever has before. You have pieces shrinking and other pieces dramatically growing. Just be aware that huge pie shifts are exhausting…if life seems overwhelming for a bit it is perfectly natural as the pieces settle into place and you achieve a new balance. (My pieces will be shifting as well, but my mommy piece is always available to be a large as you need it to be) The Stress Point theory Everything in life causes some amount of stress. Obviously some things have way more stress points than others. Sometimes, though, even the littlest thing can tip the scale and move you from mild stress to moderate stress or to completely stressed out (otherwise known as the straw that broke the camel's back.) Starting anything new is worthy of plenty of stress points. Make sure you get enough sleep, especially at first!! Sex, Drugs, Rock and Roll Sex Make good choices…I do not expect you to remain a virgin until you are 30. That would actually be most unfortunate. Just make sure that anything you do is something you will feel good about.    Drugs easy….just say no. Actually just be smart and safe. Alcohol is a drug, and lemon drops taste good…be careful. If you do drink a bit too much, the body can get dehydrated as well as hypoglycemic. Orange juice and graham crackers are good things to eat/drink. Remember: Vomiting all night… Not fun! Know your limit Never let your drink out of your sight Rock and Roll That’s fine, just don’t start liking country or rap Relationships Remember that relationships are learning stations. You will learn what it feels like to dump someone, you will possibly learn what it feels like to be dumped (or at the very least lied to.) You will learn what characteristics you like in a partner and what things you don’t want to put up with. Never regret anything. Cherish the good memories, learn from the bad ones and move on. And the very new theory…partners are like shoes Some you try on  Some you buy Some are comfy, Some just look good, Some will give you blisters if you wear them too long, Some get tight but can be stretched out and worn in (This works doesn’t it!!!) Happy shopping QUICK LIST French onion soup on a first date is probably not a good idea if you want to impress Check your blind spot Floss Use sunscreen Don’t get a job where you need to wear a stupid hat No reality shows (sorry I know this is a tough one) Optical illusions When you get in a disagreement with someone, remember that life is often like an optical illusion, People see what they see, and know what they know. There are indeed white arrows there, but they can’t see the black arrows as hard as they look. (Or they can only see the young lady and can’t see the old crone) Always try to see both images and feel sorry for those obstinate folks that simply can’t Honesty People lie all the time. They think it makes life easier. Lies are heavy to carry around and they often get complicated. It is wonderfully freeing to just tell the truth. It might be difficult for someone to hear, but oh well, they just have to deal. Don’t lie Great saying Love many Trust Few Always paddle your own canoe Easy Mitzvah Call or email your Grandparents. Bambi If the deer discover the magic of Alana (hey all other animals do) don’t feed them, and learn to check your body head to toe for deer ticks. They are tiny and black and look like raised freckles, you can check your scalp by just running your hands through your hair and feeling, you would feel a raised bump (..I bet lots of moms send their kids with letters, perhaps mine is the only one with tick advice?) Have a blast Carpe diem! Seize the day! You are about to start a great adventure. Enjoy every moment! Stop and look at the sunsets! Never ignore a “good sky”. Savor the gorgeous place you are in, Oceans, Redwoods, Deer, Brunch….How lucky are you?!?! I love and adore you. Mommy *********************************************************** Here are some further explanations to help make sense of things Mitzvah A mitzvah is a good deed and I did my share of nagging to make sure my kids made a point of reaching out to their grandparents. I am proud to say that they were pretty good about it, and probably didn’t need quite the amount of nudging that I did. Bambi/ Deer Alana was at UC Santa Cruz, the day we dropped her off, there was a deer standing in front of her dorm as if he was waiting to welcome her. She is an animal magnet; my warning not to pet the deer was necessary. Fifteen years after this letter, Alana has still never lost a friend and continues to collect them.

Managing seasonal allergies

 

Managing seasonal allergies

Seasonal allergies I know of so many friends and patients who are struggling with allergies this spring. I reached out to my favorite pediatric Allergist Katherine Fast to pick her brain on the topic. This post includes What are seasonal allergies? How can you tell the difference between allergies and a cold? What can you do to minimize exposure? What are basic symptomatic treatments? The value of seeing an allergist Seasonal allergies are hitting a lot of folks hard this season. With the climate in upheaval, pollen seasons are starting earlier and lasting longer. Allergy symptoms occur when airborne irritants, or allergens, enter the eyes, nose and throat, setting off an allergic reaction. Since children need to be exposed to an allergen before developing a reaction to it, kids under two years of age are less likely to have issues with pollen. It typically takes at least a season or two before they react, so if a newborns has congestion, we are not going to blame that on seasonal allergies. The tendency to be allergic runs in families, but doesn’t mean you will always be allergic to the same thing. If your little one has eczema they are more likely to be reactive to various triggers. It can be a challenge trying to figure out if you are dealing with allergies, a virus or some kind of infection. There are some clues: With allergies: the mucus from the runny nose is clear there is usually NO fever Many people complain of Itchy faces, nose and eyes. Both eyes are usually equally itchy, and sometimes are a little red Some kids actually get a telltale crease at the top of their nose from pushing at it! There will often be dark circles under the eyes. These allergic shiners occur when congestion in your sinuses leads to congestion in the small veins under your eyes. The blood pools under your eyes and these swollen veins dilate and darken, creating dark circles and puffiness. (These can happen from any type of nasal allergy) It lingers The symptoms come along seasonally How do I know it’s not a virus or infection?  Viral nasal secretions are typically thicker and can be discolored, like green, yellow, or thick white The worst of the symptoms usually clear within 7-10 days If the pinkeye is involved, it can start in just one eye. May have muscle aches, fever, productive cough Dr. Ted’s approach involves immediately figuring out if congestion is due to allergies by doing a strict 7-14 day trial with an antihistamine in any patient age 2 years or older. If congestion clears up quickly with daily Claritin or Zyrtec, and comes back 2-3 days after stopping, you know you’re dealing with allergies. Here are some common sense things you can do to help minimize exposure, which in turn can diminish symptoms Have your child wash their hands and face as soon as they come in from playing outside so they don’t rub pollen in their eyes and nose.  Do a rinse off in the shower or bath before going to bed Check the forecast for pollen levels, and limit outdoor activities when pollen counts are at their highest. Mornings are often the time of day when pollens are worse Avoid hanging laundry outside on a clothesline during high pollen season Put on a new pillow case every night. Hepa filters can be really helpful, but make sure you have a good one.  Your heating, ventilation, and air conditioning (HVAC) system can make a big difference. They have something called a MERV rating, which stands for minimum efficiency reporting value. This tells you how big the pores are and what they will allow through. Old filters will allow almost anything to pass through. If possible, upgrade the filters to a MERV rating of nine or higher. Symptomatic Treatment. Sometimes you just can’t avoid the pollen and need to use some treatments to get relief.  Clearing the Nose Sinus irrigation/Neil Med: For adults and older kids, sinus irrigation/neti pot can be a valuable tool. It is worth a try, but don’t be too hard on your kids if they refuse. Xlear nose spray is a great product and is safe for all ages Nasal steroids now have multiple brands that are over the counter. The nose sprays can actually bring relief to the eyes as well Allergist Katie Fast starts with Budesonide, because it is water based so might be more easily tolerated but Flonase and Nasonex are other good brands. It is important to use them properly. Aim the spray to the outside rather than the middle of the nose. For example, if spraying in the right side, aim to the outer corner of the right eye, and vice versa EYE DROPS If your eyes are really bugging you, start with some natural eye drops such as artificial tears or Similassin. Do NOT get the ones that are focused on getting the red out. If those don’t do the trick. Zaditor or Patanol are good options. Keep the drops in the fridge. The cold adds an extra level of soothing. Oral Antihistamines Zyrtec and Claritin are less likely to make you sleepy and can give full day relief. If you are looking for a list of natural ways to approach allergy treatments, check out this post by holistic Pediatrician Elisa Song The Big Picture My conversation with Dr. Fast left me with an impression that wasn't the initial focus of this post, but after we spoke, seemed blindingly obvious. If you suspect any type of allergy, please take the time to see an allergist. A few years of allergy shots or sublingual tablets may take away or minimize a life sentence of seasonal allergies. If it becomes clear that you or your little one are impacted by grasses/ pollens etc. Reach out before the next season suffering begins again.  Think of it as a gift to your child.