My favorite piece of advice

 

Earlier this week my daughter Lauren shared an instagram post with me. Emily Oster (I am sure most of you are familiar with her) was calling on pediatricians, nurses and caregivers to send her their absolutely favorite piece of advice. But as I am instagram challenged, her post disappeared before I was able to respond.

 Here is what I was going to submit. 

What is the one best piece of advice that you would give to a new parent?

Here is mine:

I have been a pediatric advice nurse for more than 40 years and I love this question. I gave it a little thought and settled on one issue that rises to the top for me.

My biggest piece of advice is actually learning HOW to handle the barrage of opinions and advice that most parents get. There are actually fewer rules that are set in stone than you might think. No situation, baby or family is exactly the same. Parents, grandparents, friends and even pediatricians have their own ideas of what is correct or forbidden.

I tell new parents to expect this and not to be overwhelmed by all of the well intentioned advice that is coming their way.



Gather all the little nuggets. Put them in a little imaginary bucket. You and if you have a partner pick the ones that resonate with you. Your instincts matter. Did it work? Excellent! Did it NOT work so well? Okay, go back to the bucket and see what else is in there.

I actually did this with my own mother-in-law who had strong views of how to do things (understatement)!

This is how I handled her.

“Mom, thanks so much for your opinion, We will definitely put this on the list of things that we might try”

The key here is learning to communicate and work as a team with your partner. There is no better time to start.

Speaking of partners, my husband Sandy told me to add his one favorite piece of advice… Don't drop them! (don't ask why he wanted to add this one ;-) !

Earthquakes and Natural disasters

 

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

Dealing with Bullies 2023

 

Dealing with Bullies October is National Bully Awareness month. There has never been a more important time to teach our children about tolerance and kindness. Bullies can start their habits when they are really young. Now that kids are back at school, they need to be given the tools for how to deal with bully situations. The fact is, kids can be so mean sometimes. I am not sure if it is harder to watch your child be bullied or to be the bully. In my case, for a period of time when our daughter Lauren was four, she was getting routinely picked on by another little girl at preschool. To compound things, this girl was in my carpool. I would drive the kids to school three days a week. Carpool parents - be aware of this astonishing fact. You are invisible. You are privy to all sorts of interactions and conversations that might leave you either horrified or amused as you drive the car full of kids hither and thither. In this case I had to watch Emily torture Lauren every single day, impervious to the fact that I was in the car. As infuriating as it was to witness, I was lucky that at least I was able to see and hear what was going on. This is what I would hear, with mild daily variations: Emily: "Your shirt is ugly" Lauren (clearly upset): "what? why?" Emily: "I have a special thing I brought for show and tell and I am going to let everyone else in the car have a peek except you" Lauren: "But I want to see it too!" Emily: "You can't come to my birthday party" Lauren (even more upset): "Why?"  After a few weeks of this I realized that I needed to stage an intervention. I drew two faces. One was a smiley face with pretty eyelashes. The other was a grumpy frowny face. I then said to Lauren " Which one would you like to be?" I was dealing with a four year old girl, this wasn't rocket science. As predicted she pointed to the smiling image. I touched the grumpy drawing and said " Emily seems to want to turn your smiley face into a grumpy face. I wonder if you could keep the smile on your face on even when someone is being mean. Let's try!" We got out the trusted barbie dolls and did some role playing. (for those of you who saw the recent Barbie movie, our collection absolutely included 'weird Barbie'). We spent a dramatic session as Barbie cheerfully let all sorts of slights and insults roll off her very shapely back. We created an assortment of interesting scenarios. Barbie never lost her cool. I wasn't quite ready to paint Emily as a complete bully. I liked her parents and she wasn't mean 100% of the time. I tried to give her an out. As we put the Barbie's away I said, "I wonder why Emily says mean things sometimes. Maybe she is feeling grumpy herself because she is a little tired." The very next day in the car I was interested to see if all of our practice would make a difference. It didn't take long to find out. Emily: "your shirt is ugly" Lauren (Through the rear view mirror I could see a big fake smile plastered on her face) "Luckily, you don't need to wear it. I think your shirt is pretty." Emily: "you can't see my sharing" Lauren: "I am sure it is very interesting" Emily. "You can't come to my party" Lauren: "I hope you have a fun time" From the driver's seat I watched Emily become more and more confused and upset that her power seemed to be slipping. I refrained from giving an audible whoop and driving into the bushes. And then... Lauren (in a sickeningly sweet voice): "Are you a bit tired Emily?" Emily (grumpy): "NO, I'm NOT tired" Lauren (knowingly): "I think you must be a little tired" No one watching could have accused her of doing anything wrong but she had discovered a way to gently torture Emily a bit, and she was running with it. A few weeks later I was at a school event and I bumped into Emily's dad who drove the carpool the other two days. He said to me, "something is going on in the car that I don't understand". "Oh? What would that be?" asked the innocent mom. "Lauren keeps asking Emily if she is tired and Emily starts getting very upset". Hmm. As you can see, finding one on one time and playing through things can be quite effective. If you can, it is also helpful to identify the "nice kids" in the class. Ask your child who they might like to play with, reach out to that family and try to arrange some play dates outside of school time. If your child can have some solid allies in the social group, it makes it much easier to stand up to, or deal with someone else who is unkind. Keep in mind that it is a rare friend that is completely reliable. They all have days where they "might be tired".  Was Emily actually a bully? Perhaps she was looking for attention or actually just needed a nap. Often young children are really simply trying to figure things out. Nevertheless, if your child is routinely on the either end of hurt feelings, it is worth some attention. Looking for other ways to empower your child? Check out Kidpower. This is a fabulous organization that came out of Santa Cruz. They now have groups and classes all over the place. They have an entire section devoted to dealing with bullying with all sorts of really excellent resources: Kidpower - Bullying If all of your efforts at home don't seem to be taking care of the issue, talk to your school to see if they have any anti-bullying programs in place. There is an inspiring program called No Bully , that got its start in San Francisco. Talk to your school about looking into it.  Keep in mind that most of the time you won't actually witness the bullying. Pay attention to your child's mood and behavior. If you notice any dramatic changes make sure you find opportunities for your child to communicate about what may be going on. Sitting with them in a quiet room before bedtime is a great time to do a daily debriefing about the day. In our family that was a ritual. Let's turn the tables. If you hear that your child is the bully, or you get to see them in action, make sure that you carve out some one on one time to work on some skills. Some kids seem to be bullies because they simply want attention and don't know a better way of making and keeping friends.Talk to them about kindness. Talk about choices. Find one particular situation that you know about and work on that. "You pushed your sister and made her cry. What was going on? Were you mad, sad, frustrated? What were some other choices that you could have made? What should be the consequence if it happens again? What should be a nice treat/ reward if you make a better choice the next time you are in that situation?" If you find that you are having issues on either side of this spectrum that are beyond your scope, the next step may be having a meeting with your child's teacher. Your child may not be directly involved in any bullying but it is the rare child who doesn't see occasional evidence of meanness happening around them. This group of observers are often the kids who can make a real difference. Not only do we want our children to be kind, we also want them to figure out the best way to be brave without putting themselves in danger. Sometimes it takes a certain amount of bravery to play with a child who is a target to the bullies. At the very least talk about reporting any bullying to a grown up or teacher. These days with all the social media, a good bit of bullying can happen over cyberspace. Make sure that kids know that you reserve the right to monitor their online accounts. Until they are ready to pay for their own cell phone plans, it is what it is. Be observant of you child’s moods and behaviors. If they seem sad or are not having as much fun with friends or at school, find a safe moment where they can communicate and you can help them create a toolbox for working through some of these situations.   Kidpower outlines some concrete actions for dealing with this. Kidpower/Cyber bullying Little actions can make an enormous difference to someone.

RSV 2023

 There are still some unanswered questions about the New RSV shots, but with RSV starting to make the rounds, Dr. Ted and I decided it was worth sharing what we do know.

RSV 2023 Every year, severe RSV disease is the number one reason babies under 12 months old have to be admitted to hospitals in the US. November is typically the start of RSV season but it has come earlier for the past couple of years. Last year at this time there were so many cases that nationwide, some children's hospitals were having trouble finding room for all the sick kids. We are currently starting to see an uptick. If you want to track the numbers for your location, click here   This post will review What is RSV? When do you need to worry? Symptomatic treatment How is it spread and what is the exposure period? Tips to prevent Testing The brand new RSV shots for babies  The RSV vaccine for pregnant moms FAQ (including daycare, siblings and nursing moms)       What is RSV disease?   Respiratory syncytial (sin-SI-shul) virus, or RSV, is NOT new. It is a common, seasonal virus that is often simply referred to as an especially bad cold. Nearly all children will get their first RSV infection by age 2. Like most viruses, it ranges in its severity from case to case. Let me repeat - I am sorry to say, but your child is likely to get this! No need to freak out…Keep reading.   RSV often settles in the bronchioles. These are the little airways in the lungs that lead to the microscopic alveoli, the place where oxygen is pulled into the blood. The virus causes these little airways to get clogged with mucus, making it difficult for air to pass. This is part of why the virus is so much worse for younger kids. Their smaller airway gets clogged more easily. Some studies show that somewhere between 25-40% of young infants with the RSV virus will have bronchiolitis or pneumonia. That is a scary statistic, but to balance it out, here is some reassuring data: in the US, 99.4% of kids under 5, and 98.5% of kids under 6 months will not need to be hospitalized with RSV. By far, the majority of cases can be safely managed at home.   You know the wretched colds that knock you flat? Not only do you have a runny nose, sniffling and sneezing, but you also have a harsh, deep cough and fever. That might well be RSV. I actually can almost diagnose it just by hearing the distinctive cough. It is deep, wet and sounds like it hurts.    RSV can come on slowly, unlike the flu that usually has a sudden ‘hit by a truck’ onset. Generally the first signs are runny nose and decreased appetite. The cough comes along a few days later. It is also common to have mild to moderate fevers that can come and go for several days. The symptoms are usually at their peak at the 3-5 day mark, but often last 8 days total. It is common for the cough to linger for several weeks.   Unfortunately RSV is not one of those viruses that is ‘one and done’. Sadly it takes multiple exposures before you develop immunity. Adults don’t get as seriously ill, but they still get it and are in for a miserable week. Most folks get RSV about 8 times until they finally seem to be not as vulnerable! It spikes again in older folks when the immunity tends to wane. It can sweep through retirement communities, so be cautious for the older adults in your life as well. While hospitalizations for RSV are less frequent than those due to flu or covid, the likelihood for invasive ventilation or death from RSV is double the number from the flu and about the same as covid. Fortunately there is now a vaccine for people over 60!   So how do you know if you need to worry? Severe RSV disease symptoms usually include some abnormal breathing but there are some specific things to watch out for.   As Dr. Ted says, “Respiratory distress looks like your kid ran a baby marathon. It’s not subtle, and kids are not happy.” We worry when: The skin is sucking in between or under the ribs with inspiration. These are called retractions. The nostrils might be flaring out, and the baby’s head might be bobbing up and down. The belly might be pulling in and out dramatically with breaths. They might be gasping or grunting There might be a bluish color around the mouth or fingernails There might be coughing or wheezing that feels constant  The rate of breathing is fast. Breaths per minute vary by age. To get a baseline, try counting breaths when your kid is calm. It is fine to do it while they are sleeping. Count for 30 seconds and multiply by 2 See the chart at the bottom of the post for a list of respiratory rates/age.   Check out the Tik Tok that Dr. Ted and I did. Seeing what labored breathing actually looks like is worth 1000 words (if someone had told me a few years ago that I would be doing Tik Tok, I would not have believed them.)   If you are reading this and your child is actually one of the few kids who is not coughing and doesn’t have a fever, I strongly recommend making note of what their normal breathing looks like before they get sick. Lift their shirt and get a baseline assessment.    Labored breathing is usually pretty obvious, but hydration is another big concern that sometimes gets missed. Warning signs include: Dry mouth with cracked lips Crying without tears Urinating less often (smaller volume diapers that are happening a normal number of times per day are okay) A dehydrated kid is almost never playing happily. They usually seem pretty droopy.   It is normal for the appetite to be very off. I don’t even worry if kids lose a bit of weight from a week of pathetic eating. They will gain it back when they are recovered. However if they are not drinking adequately, they may need to get checked to see if they need to get an IV for some hydration and nourishment. Having an elevated fever is a symptom that often gets the parents the most worried. In general my attitude is that fevers are part of the package and can usually be managed with fever reducing meds or a tepid bath. If the fever is higher than 103 and not responding to medication or it is lasting longer than 5 days, then I would want to have your kid checked. This could be a sign that the RSV has turned into an ear infection and/or pneumonia. (103 fevers that respond to medications can usually wait for the next day to be evaluated. Click the link below for more on fever management.) Bottom line - If your child is having trouble breathing, or significant trouble feeding, they may need to be hospitalized for a night or two for fluids, oxygen and observation.    Treatment   For mild cases, time tends to be the great healer. Your medical team can simply suggest the same symptomatic treatment and supportive care that we would do for any bad cold and cough.  Treat the fever as needed     If you need some tips and trick getting the medicine in check out this post   If your child is having trouble eating because of all the congestion, try doing some clearing about ten minutes before a feeding.    To clear the nose, squirt some saline, xlear nose spray or breast milk in each nostril. Next step is to suck it back out with either a Nose Frida/ aspirator or the Neil Med Naspira. I think these products are easier to use than the standard bulb aspirators. Some parents swear by the Oogie bear. This is a safe little scoop that can safely get into the nostril and remove the more stubborn boogers.   It is also helpful to keep their heads elevated. They may be more comfortable on a bit of an incline. Try to raise the mattress a bit. You can do this by putting a towel underneath or place thin books under two of the legs of the crib. For older kids, add an extra pillow. The American Academy of Pediatrics guidelines specify not to raise the head more than 10% when they are sleeping and you are not keeping an eye on them. If they’re napping but you’re in the room keeping an eye on them, you can raise the bed to 30% for easier breathing.   Let them sit in a steamy bathroom, and use a humidifier at night. Increase fluids during the day.   Warm fluids are great. For kids older than a year, honey is terrific. I especially like the manuka honey. Have a little tea party, invite the teddy bears. Boys can have tea parties, too. This can also be a good way to encourage them to drink.   If your little one is having a rough time your doctor may do a one-time trial of a nebulizer or inhaler to see if it helps. Some children may be prescribed steroids.   According to our local pediatric acupuncturist, Dr. Den, at The Acupuncture Den, the actual symptoms are more important than any official western medicine diagnosis. Whether or not it is RSV, a common cold or even teething, if seen in the office early on, a treatment can help the body to heal itself more easily and will also help with symptom relief (non-needle treatment options are available!)   If you don't manage to stop it in its tracks quickly enough, traditional Chinese medicine can still be very helpful as the infection runs its course. Dr. Den keeps high quality pediatric herbal tinctures stocked in her office, and encourages the families in her practice to keep a bottle or two on hand, as they are most effective when used at the first signs of trouble. While some of the tinctures are highly specific, others can be used more generally (when you know your child is getting sick but you’re not sure yet what’s going on). In terms of the common cold, the flu, and RSV, the two tinctures Dr. Den recommends to keep in your medicine cabinet are CQ Jr (perfect for the first signs of illness) and Lung Qi Jr. (if it starts to move into the chest).   For more information about pediatric acupuncture (or grown-up acupuncture!) and/or herbal medicine, please reach out to Dr. Den. She’d love to hear from you!   How is it spread and what is the exposure period? This is NOT spread the same way as COVID which easily spreads through the air. RSV spreads through heavy droplets. An infected person coughs or sneezes You get virus droplets from a cough or sneeze in your eyes, nose, or mouth You have direct contact with the virus, like kissing the face of a child with RSV You touch a surface that has the virus on it, like a doorknob, and then touch your face before washing your hands. According to the CDC, people infected with RSV are usually contagious for 3 to 8 days and may become contagious a day or two before they start showing signs of illness. However, some infants, and people with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as 4 weeks. General common sense   Wash your hands before touching your child. Make sure others wash up too. Clean toys, crib rails, and any other surfaces your baby might touch. Try to keep your baby away from crowds.  Avoid anyone with a cold or fever. Snotty nosed toddlers are the biggest carriers. See suggestions below for dealing with this circumstance. Don't let anyone smoke near your baby. Tobacco smoke exposure can increase the risk of severe RSV disease.   If your child is unfortunate enough to get a nasty case of RSV, it may take a few weeks for the lungs to calm down. Many of them have an extra tough winter season. Every new cold seems to re-trigger the wheeze.    With any cold or illness, your best bet is to pay attention to the first sign of illness. Here is my blog post with my list of things you can do to boost and protect your immune system.   Testing There is a rapid test (a swab to the nose) that many offices can do to see if it is RSV or not. Usually they will test for flu and covid while they are at it. Believe it or not, some unfortunate kids can have more than one of those at the same time! Unless your child is looking really sick, it might not be worth an actual office visit to get an official diagnosis since it doesn't necessarily change the approach. Since RSV is a virus, the treatments are usually simply those listed above. Antibiotics would not be appropriate unless it progresses to a secondary infection.   Prevention An RSV immunization called nirsevimad (Beyfortus) is a novel shot for all newborns entering their first RSV season (historically winter or fall). It gives about 5 months of protection and in full term newborns it decreases the chances of needing to go to a doctor for RSV by about 74%, and decreases the need for hospitalization by about 62%. These numbers are even higher when studied in preemies (29 to 35 weeks).  Beyfortus is not an immunization; it’s a pre-made antibody (it’s been approved as a medication). This is an important distinction, because unlike other childhood vaccines, it doesn’t stimulate the immune system. A typical tetanus shot gives a small piece of the tetanus bacteria to the immune system. In response, the immune system mounts an attack, which leads to the “yucky” feelings we get with shots: achiness, fatigue, sometimes even fevers. Beyfortus, as a pre-made antibody, just gives the immune system the final product. You get to skip all the steps in between, and all the accompanying side effects. The most common side effect is a small rash at the site of injection, which occurs in less than 1% of kids who get the shot.  Who gets Beyfortus? While the FDA approved Beyfortus for all newborns under 1 year of life, the Advisory Committee on Immunization Practices, the government panel that makes recommendations on shots (and whom insurance companies use to decide what to pay for) advised that children under 8 months get it right at the beginning of their first RSV season. It has been studied and is safe to give in the hospital after birth, during the first few days of life.  Here is a timing guide There is also a new RSV shot for adults called Abrysvo (who comes up with these names?) This vaccine is available for folks over 60 who are more at risk for severe RSV.  It is fine to get it at the same time as other vaccines. This shot is also approved for pregnant people. When given to someone who is pregnant the primary goal is to protect the fetus. The placenta loves antibodies, so any immune system activity in mom often goes to the baby ten-fold. When given between 32 and 36 weeks gestation, the RSV vaccine for pregnant people is able to decrease the rate of severe disease in babies by about 80% in the first 3 months of life, and more than 50% after 6 months. Moms can get the RSV vaccine at the same time as others, such as flu, Tdap and Covid. Abrysvo or Beyfortus, which to get, or both? Because nothing is ever simple, in most case the decision needs to be made as to whether or not mom gets the shot or waits for the baby to get it. Pregnant parents are advised to get the RSV vaccine for themselves between 32 and 36 weeks gestation during RSV season because protection takes 2 weeks to pass from mother to baby through the placenta. In most of the country, RSV season is considered to be from September to January. Because of the 2-week delay in immunity for babies, anyone born before 34 weeks, or within 2 weeks of parental vaccination, are all advised to get Beyfortus.  If mom got her RSV vaccine and the baby was born 2 weeks or more later, the baby should not need Beyfortus. A note on payment Beyfortus is a new medication, a monoclonal antibody. It’s not a vaccine. Because of this, insurance companies have not universally agreed upon reimbursement rates. Please check with your pediatrician’s office to see what their protocol is. I will update this post when more information is available.   Frequently asked questions   When can my little one go back to school? Keeping your child home because they have a mild runny nose or lingering cough is not reasonable. However, kids with fevers and/or copious mucus should stay home.   I am nursing, do I need to stop? Can I still be around the baby? Nursing moms who test positive should still continue to nurse their babies. This includes newborns. Just wear a mask and do thorough and frequent hand washing. (and I am so sorry if you are dealing with this.)   Do I need to keep my kids apart from each other? Sigh, this is SO hard. It is almost impossible to quarantine family members. If there is an infant in the house, I would try hard to keep toddlers who have been exposed at least 6 feet apart (sneezing distance) from the baby. No kissing or hugging. Put them in charge of the ‘magic soap’ otherwise known as hand sanitizer. Tell them to make sure that anyone who is having direct contact with their new baby needs to use the magic soap first. Maybe furnish them with a new baby doll that they can cuddle with instead.