The Gasoline Balloons/Mama said there'll be days like this, there'll be days like this Mama said Mama said

 As a grandma who has plenty of opinions, I make an effort to hold on to my thoughts and advice until they are asked for. I may or may not always succeed at that.

What makes it pretty easy to hold my tongue is that I think my grandsons have excellent parents.

This week I watched Lauren successfully navigate one of those situations where she manages to keep her sense of humor and says something along the lines of “Jesus, take the wheel”

The kids were visiting for the week. Adam and I took Elliot to one of those stores on Clement street that are full of inexpensive, imported items. Safety standards are likely nonexistent. For any of you who know a bit of Yiddish, we refer to this as “Schlock,”

We were in the market for things to stick in goody bags for EJ’s upcoming 4th birthday party.

There really wasn’t anything worth getting, but at the last minute Adam grabbed a package of fancy balloons.

When we got to the car, EJ convinced us to give him one of the balloons. We opened the bag and let him select one. As we were driving we noticed a strong smell. After a bit of sniffing, it became apparent that the source of the nasty odor was in fact the balloons. Now in general, balloons often smell a bit like rubber. These smelled more like gasoline.

But Elliot was really enjoying himself.

When we got home we allowed him to blow up a few more and then convinced him to move along to other activities.

The next day Adam left for the weekend to go to a bachelor party of a close friend.

By Saturday, after multiple comments over how horrible the balloons smelled, Lauren made the wise decision to get rid of them. Shame on me for not having that instinct immediately. She didn’t want her son handling anything that smelled so frankly toxic. What’s more, he was putting them in his mouth as he blew them up (sidebar, this almost 4 year old is pretty astonishing when it comes to inflating a balloon.) Add to the equation a baby who was very interested in getting his hands and mouth on them.

So now allow me to set the stage. It had been a stretch of gloomy rainy days. We all had a bit of cabin fever. Elliot was also missing his daddy.

“Where are my balloons?”

“I had to throw them away because they smelled like gasoline”

“But I love my gasoline balloons”

“I know, lovey, but it isn’t good to handle those. We can get other balloons that don’t smell bad”

“NO! I WANT THE ONES THAT SMELL LIKE GASOLINE”

“I never like disappointing you, but sometimes there are ‘nos’ that are health and safety ‘nos’.

“WHERE ARE MY GASOLINE BALLOONS. I AM GOING TO THE GARBAGE TO FIND THEM”

“I threw them in a trash can that isn’t in the house”

“I AM GOING BACK TO THAT STORE TO GET MORE”

“I am afraid they don’t have any more. They had to get rid of them when they realized they weren’t safe.

This went on for a bit. It included Lauren making a call to Adam, who fortunately caught on quickly.

“Hello, is this the store where we bought the gasoline balloons? Is it true that you needed to get rid of all of them?”

“Yes indeed”, said the voice on the phone in some kind of fake, terrible accent. “We had to throw away all the balloons because they weren’t safe.”

Lauren offered many options including running out to a store to get other special balloons. Maybe some that light up? How about balloons with team Spidey or Paw Patrol? Nope, if they didn’t smell like gasoline, they were not going to make the cut.

As this tantrum was going on, Coby, the almost 10 month old was trying to climb up on his mom. Bowie, the 80 pound dog was tossing a ball at her feet asking her to play.

I am a terrible person. I had to add to the chaos by starting to giggle uncontrollably. It was infectious. Lauren and Sandy both started laughing along with me. That did not improve Elliot’s mood.

Lauren is hands down the funniest person I know. If she ever starts to do stand up comedy, the Gasoline balloons need to be added to the routine.

The balloons pictured were survivors of the ‘purge’. How long they stay inside my piano is anybody’s guess.

Wishing everyone a peaceful and happy holiday season and a year absent of noxious odors.

Holiday Angst and Joy/Often they are two sides of the same coin

 Holidays can feel magical for some lucky kids, but by the time most people reach adulthood, those same holidays can stir up a lot of powerful feelings. Not all of them are necessarily positive. In many cases, the holiday season is the absolute set up for potential stress and disappointment. Depending on the person and the family, these feelings are often a mix of joy and dread. Hooray for you if you are an exception.

There is a reason that therapists need to work overtime in December.

Hallmark Christmas movies are an absolute treat, but the fact is, society sets a high bar for how it should be. Sparkling lights, delicious food, getting a pile of perfect gifts, family and friends gathering happily. What could go wrong?

The sad thing is that for many people, if you end up having a perfectly fine day, that isn’t good enough when anything less than extraordinary is apt to disappoint. Writer Rebecca Solnit puts it well. “So many of us believe in perfection, which ruins everything else, because perfect is not only the enemy of good; it’s also the enemy of the realistic, the possible, and the fun.”

It is a great time to focus on small moments of joy that we have within our grasp. Are you feeling low? See if you can dig down and find something that can bring some cheer. Even looking at some sparkling lights, or being cozy inside on a rainy evening. If you are lucky enough to have your kids at home, can you do a family snuggle and tell stories?

This is also a good time of year to remind ourselves to be clear on the difference between things we have control over and those that we don’t.

Gifts

You have very little control over what you receive, but if you pay more attention to what you are giving, you can’t be disappointed. This is a great lesson for the kids.

Start early focusing on how wonderful it is to give. A good gift doesn’t have to be something you buy. Give the gift of your time, or something you make. How about a foot massage to family members? Sign me up.

In case you didn’t see it, here is the post that I recently did about gift giving

Something to keep in mind is that when it comes to gifts, everyone has different wants and needs.

This is the perfect time to remember those “love Languages”

You might also decide to give one big family gift, like an outing or a trip, instead of individual ones. There are no rules.

Another thing that can be tricky might be the timing of the gift. There are many things out of your control including shipping and/or availability of a desired item. The value of the gift should not be dependent on whether or not it ends up under the tree in time. If something is delayed, take a photo of whatever it is and put that in a box or envelope. The actual gift will get there when it gets there. I remember some years when people were ready to take out an extra mortgage in order to get a hold of tickle me Elmo or a Cabbage patch kid. Try not to get caught up in that. Take a deep breath.

Family

Some families have complicated dynamics that can be very stressful. If this is you, please know that you are by no means alone. Try to focus on the things that you love and appreciate about each other rather than the things that you disagree with. If it is at all possible, maybe have an agreement ahead of time to leave politics at the door.

If you are lucky enough to have a family that you want to be with, and it is the togetherness that is what counts, forgive me for this suggestion, but the actual holiday maybe doesn’t need to be the exact time of year that you gather. There is something very freeing about avoiding travel when the rest of the world is also fighting to get to their destinations and paying twice as much to get there.

I know plenty of people who celebrate a week early or later. There is nothing wrong with that! (If you are reading this from a long line in a crowded airport, maybe consider this for next year.)

My friend Brittany, who is a wise therapist, adds that it is important to be cognizant if this is the first holiday/Christmas since a loved one passed. If you have experienced loss, it is okay to initiate dialogue about how you miss the friends and/or family members who are no longer with you. Try to tell stories and share happy memories instead of avoiding their absence.

Traditions

Take stock of your holiday traditions. Believe it or not nothing actually needs to be set in stone. You get to choose which ones are achievable or not and which ones bring you joy. Is there something on the list that should no longer be on there for whatever reason? Cross it out! See if it is missed. Identify which things matter and which things simply cause stress and don’t add value. Talk to the kids and find out which things matter the most to them.

Food tends to be an important part of any holiday culture. Making a family recipe or special meal can make you feel close to relatives even if you are far away from each other. Bring the laptop into the kitchen and cook or bake together on zoom.

You can also adopt new traditions. Have a virtual sing along with friends and family near and far, watch the Twilight Zone marathon. Reach out to people in your lives who may not have friends and family around.

Last year we started the tradition of taking Elliot out in search of fun holiday lights. Watching his enthusiasm when he spots pretty ones is the best.

“These are the most beautiful lights I have seen in my entire life!” says the almost four year old.

Moving forward, forge traditions that feel positive and are easy to achieve.

Maybe your kids will be the ones who grow up without any holiday angst!

Here are some past Holiday related posts that you might want to check out

Holiday safety tips

Talking to your kids about Santa Claus

Pertussis and Walking Pneumonia/ Both of these are making the rounds

 Dr. Ted has been seeing quite a few patients with nasty coughs this season.

We decided to address two of the main culprits here; walking pneumonia and whooping cough. (There is a trifecta of sorts going around. RSV numbers are also up, Here is the link to the post we did on that just a couple of years ago)

Pertussis and walking pneumonia are similar in that they are both very long lasting and very annoying. They do have some key differences.

Pertussis

Commonly known as whooping cough, pertussis is a very contagious respiratory illness caused by a type of bacteria called Bordetella pertussis. These bacteria attach to the cilia (tiny, hair-like extensions) that line part of the upper respiratory system. The bacteria release toxins, which damage the cilia and cause inflammation.

Historically there is a population-level cycle associated with whooping cough. It seems to peak every 3-5 years or so, and we are currently seeing a bump in numbers. Preliminary data show that more than six times as many cases have been reported as of November 23. 2024 compared to the same time in 2023.

Vaccination

Fortunately most kids are vaccinated. It is routinely given as part of the standard shot schedule. The P in the Dtap and then later in the Tdap stands for Pertussis.

The vaccine does a pretty good job of preventing death and severe disease. Unfortunately it only partially decreases transmission and vaccinated people can still get sick, but it is usually a much milder case.

Even though most kids in the USA get the protection, it remains one of the leading causes of vaccine-preventable deaths worldwide. According to a CDC 2014 publication, there were an estimated 24.1 million pertussis cases and 160,700 deaths in children younger than 5 worldwide. By far, most of the deaths occur in young infants who are either unvaccinated or haven't had at least 2 shots in the series.

Babies routinely get their first vaccination for this around 2 months of age. The primary series is given at the ages of 2, 4, 6 and 12-18 months, and again before kindergarten entry. Unfortunately, significant protection isn't achieved until the 4th shot at the 12-18 month visit. The four doses gets them up to 75% protected. This goes up to ~90% after the 5th dose (known as the booster.)

Thankfully, ever since the state law imposed vaccination entry requirements for school, we don’t have many patients trying to avoid getting this immunization. Back in the day, I did have some parents opt out for a variety of reasons. Most of them deeply regretted it and confessed that watching their kids suffer with the months of coughing spasms was torture. The shot is well tolerated and it makes no sense to pass on it. I have deep concerns if the vaccination ever stops being required.

The Tdap (Tetanus/Diphtheria/Pertussis) vaccine was licensed in the US in 2005 for people over the age of seven. Because babies are so vulnerable to this illness, current practice recommends giving all pregnant moms a Tdap (with every pregnancy). This immunization should be done in the third trimester between 27-36 weeks. Studies have found that since this program began there has been a 75 percent reduction of infant pertussis hospitalization and a 46 percent reduction of any infant pertussis cases. That is enormous progress.

For folks who will have a newborn in their lives, if it has been more than 2- 3 years since you had the shot or the actual illness you should get another booster. The immunity wanes. Researchers claim that three out of four babies who get pertussis get it directly from family members or caregivers. It is essential that all close family contacts have current vaccine protection. This means partners, grandparents, caregivers and siblings or anyone who anticipates spending lots of time with your new baby. This way everyone will be able to remember the date of their most recent tetanus shot; it will be right around your baby's birthday!

If you have family members giving you push back about this, (sigh, people can be so disappointing) they are welcome to keep a mask on at all times. Unlike COVID, which is airborne, pertussis is spread by respiratory droplets, so masks actually work to slow the spread.

Symptoms

This illness usually starts with a week or two of a runny nose and cough. There may or may not be a low grade fever. Those little snot nosed kids don’t always look terribly sick, but they are quite contagious.

This is why, when you have the option, please keep anyone with a cold from being around your infant. We never know if it is going to turn into something worse.

At week two, the cough becomes much more troublesome. The patient will often have coughing fits….and I mean FITS!! This is spasms of coughing for minutes at time that make even the hardiest person feel like they can't catch their breath.

Patients may or may not have a high pitched "Whooping" sound with the cough (hence the name). Some folks will vomit after these coughing fits or pop blood vessels in their face. Sweating, gagging and choking episodes are common. Some people cough so hard from this that they can break ribs.

Remember, these symptoms may all be much more mild in people who have been vaccinated, but the overall pattern of the coughs coming in deep sporadic fits throughout the day (not just at night) remains the same.

Babies often don’t whoop because young infants often do not have the intercostal (rib) muscles required to cough. Instead, they might just stop breathing briefly or seem really lethargic. They can look cyanotic from the lack of oxygen. It is scary!

For both the vaccinated and unvaccinated, this cough lasts and lasts and then lasts some more. In Chinese medicine this is referred to as the "Hundred day cough" and they aren't kidding. This is a miserable illness for anyone, but for young infants pertussis can be deadly.

Plenty of adults get this and don’t get a diagnosis. It is not on the radar for many adult doctors.

Exposure

People who have been exposed to whooping cough will usually start showing symptoms 7-10 days after the exposure and are contagious by the time they give that first sneeze. Remember, this disease is spread by respiratory droplets, so mask wearing and hand washing are very effective at decreasing exposure.

Testing

Unfortunately, testing is far from perfect. There isn’t a rapid test that will give you immediate answers, and waiting for results is not ideal. Testing requires a deep nasal swab (nasopharyngeal), and results often take 3-5 days to come back. Most doctors who suspect Pertussis are likely to start treatment right away, especially if there is a young baby in the household. But according to public health departments, it’s recommended that anybody with a high enough suspicion for a test should be treated automatically (before results come back). Then, presuming they might have the disease, it’s recommended that they stay home from school or work until they’re done with the course of antibiotics. More on treatment below.

Treatment

Treatment usually involves 5 days of antibiotics like azithromycin or clarithromycin, but these are mainly to prevent the spread to others since antibiotics don’t do much to shorten the course of illness once the cough has set in. The good news is that after you’ve finished 5 days of antibiotics or you’ve had symptoms for 21 days (whichever comes first), you’re no longer contagious to others. Therefore, if you’ve been sick for 22 days, you can probably skip the testing as well as the antibiotics. Testing is simply for data purposes, it won’t really change anything. The stick up the nose is not particularly comfortable.

Symptomatic treatment is similar to what you would do with other coughs. This includes a cool mist humidifier and drinking plenty of fluids. The extra moisture in the air can really make a difference with the pertussis cough, so if you don’t have one, a humidifier is a good investment. Smaller more frequent meals may help make vomiting less of an issue.

Inhalers, steroids and cough medicines don't seem to be of much use alas, although honey (Manuka if you can get that) might be soothing. Remember that babies who are less than a year old can’t have honey yet.

Smoke exposure will make things much worse. Skip the campfires.

Walking Pneumonia/Mycoplasma Pneumoniae

We wanted to include a section on walking pneumonia, because it’s another reason you might have a months-long deep cough that doesn’t seem to be getting better. The numbers for it are also up enough that it is getting some media attention.

Symptoms

This is more of a slow-burn infection that settles deeper in the lungs. It typically causes a lingering, dry cough, fatigue, and sometimes low-grade fever. It can leave you feeling out of breath. Unlike pertussis, it doesn’t release toxins but instead, it directly invades the respiratory lining.

Testing

If the section above about pertussis testing left you feeling unsatisfied, then get ready for the ultimate disappointment. There are very, very few commercially available tests for the causative agent, mycoplasma. Physical exams will sometimes show little signs through the stethoscope, but that’s not consistent. You can get an x-ray of the lungs, but that also doesn’t always pick it up. So we’re left with the story, symptoms, exposures, and good guesses.

Treatment

Like pertussis, treatment usually involves antibiotics like azithromycin or doxycycline, which actively target the bacteria and usually help symptoms resolve faster (unlike pertussis). For those who really resist taking antibiotics, time is the great healer and it will go away on its own…eventually. While the vast majority of cases resolve without treatment, immunocompromised individuals can have some serious sequelae.

Whooping Cough vs Walking Pneumonia

How can you tell the difference between these two diseases? In summary, from a physiological standpoint, the big difference is that pertussis mostly affects the upper airways and is toxin-driven, while mycoplasma pneumonia targets the lower airways and works by directly infecting cells. Both can be annoying, but walking pneumonia tends to be less dramatic and more sneaky. The patients don’t always feel super sick but just kind of ‘off’. The cough here is more nagging and dry, usually without the violent fits of pertussis. Your child might seem tired, have a sore throat, or complain about mild chest pain. Fever tends to be low-grade or not even there. It’s actually most common in older kids and teens because mycoplasma pneumoniae, the causative agent, likes to circulate where kids are packed together—schools, sports teams, etc. Kids with asthma or other chronic respiratory issues are more likely to get hit harder if they catch it.

While vaccines exist to prevent pertussis (hello, Tdap!), as of yet there are no vaccines available for Mycoplasma pneumoniae.

Dr. Ted’s advice:

If your child’s cough has been dragging on, especially if it’s dry and disruptive at night or after activity, or if they’re looking more tired or out of breath than usual, those are good reasons to check in. Whooping cough can feel more urgent because of how intense it gets. Always worth a quick listen to those lungs or a swab to rule things out. Follow up with your pediatrician if you think something’s up!

It's gift giving season......But I have some thoughts

 The internet has me pegged as a Grandma and I am getting daily targeted ads about things I should buy the grandkids.

I actually found myself unable to resist buying a little battery operated poop toy that you can play hide and seek with. It makes farting noises to give clues.

EJ thinks it is funny, but it was probably an unnecessary purchase.

When I am spending time with my grandsons, the thing that I am reminded of is that they don’t actually need too much stuff.

Sawyer still doesn’t do screen time, but he sure loves the TV remote.

At nine months Coby is more excited by finding the mother lode of tupperware than most of the other toys that are scattered around, and at almost 4 years old, EJ can spend a shocking amount of time thriving with an empty tissue box and a roll of scotch tape.

It is certainly the time of year to update this post from several years ago:

The Best Present is usually your Presence

Good parenting requires twice as much time and half as much money.

This is the season for gift giving, but we all actually could do with a lot less stuff. The best present I think that families can give to each other is the gift of self (otherwise known as time and attention.)

For kids who are old enough to understand, give a certificate that promises a special activity that you might do some time in the future. For older kids, escape rooms are a ton of fun (they now have some virtual escape rooms available if you don't feel up to going in person.) A membership to one of the local museums or the Exploratorium is another good gift to give to the family.

It is great for families to do outings altogether, but one-on-one time is so important if you can manage it. Mix and match so that you make sure that everyone gets special time with one other family member. Make sure to include one on one time for you parents as well.

The list of Nurse Judy's inexpensive and creative activities has some old and new ideas.

• Collect and decorate rocks with colorful paints and glitter for a rock garden. This is a great one to use as a reward for good behavior. When your child sees the pretty rocks, they will remember that they earned them.

• Make a collage. Old magazines and old photos are great for this activity.

• Make a musical instrument. Use your imagination: a shoe box with rubber bands can be a guitar; glasses filled with different levels of water make different tones; tapping different surfaces with chopsticks makes different sounds.

  If you are lucky enough to have real instruments, Let them play!

• Go on a 'use all your senses' walk. What do they see, smell, hear, and feel? (This is also a great way to practice mindfulness, which everyone can benefit from!)

• Make personalized place mats. Take some family photos, glue onto cardboard, and cover with clear contact paper. Kids will love to use these with meals.

• Create a scavenger hunt walk. Plan a list ahead of time of thing to find...like a dog, an airplane, or even a girl with purple hair (or if you live in San Francisco you might be able to add some more unique items to the list -- a memory comes to mind of a younger Lauren loudly calling attention to the naked man painted gold, while Alana somehow managed to completely not notice him).

• Go on an ABC hunt. Find things that start with all the different letters...or find the actual letters on signs and license plates. This is a great game in a supermarket or on a car ride.

• Download free coloring pages from the internet. With a little searching, you can get a picture of just about anything.

• Draw with chalk. Make a hopscotch board.

• Make your own play dough. You can find the recipe online.

• Make a fort using the couch cushions,

• For a special occasion, set up the tent and have a backyard camp out (During the kids last visit, Sandy and Elliot set the tent up in the garage) It is actually a good thing to air them out once in a while.

• Write a story and illustrate it together.

• Decide on a recipe and bake or cook something. Kids will often try foods more eagerly if they helped with the cooking. Let them help sprinkle in different spices and be the taste-tester.

• Have a tea party. Invite the dolls, and get out the good china that you never use.

• Trace your hands and feet and color them in.

• Have some down time while watching a video or a special TV program. There are some lovely educational TV programs and videos out there.

• Play a computer game. Don't be afraid of controlled use. Children that don't learn how to be comfortable with computers at a young age are at a distinct disadvantage in this high tech culture.

• Okay, now put that screen away and get some fresh air! Families can play some sports outside. Find a patch of grass, a basketball hoop or one of the city tennis courts and get active.

• Blow bubbles.

• Playing board games with the family is the stuff that great memories are made of.

• There is little out there that is as much fun as a giant box to get inside of . If you buy a new appliance or see a neighbor buying one, ask for the box.

• Make a rain gauge and weather station. If it does rain, get out the galoshes and find some big puddles to jump in.

• Play dress up. In my opinion, every house needs a good dress up box, (after Halloween is a great time to pick up costumes and things on sale)

• Read!

• If you can manage to make it work, try hard to have at least one meal of the day sitting down with the entire family. Have everyone say a little about their day. Having one child help with cooking a special dinner, including making and decorating a menu is a great way to have one on one time.

• Take advantage of where we live; there are always fairs, festivals and museums that are going on.

• Make a scrapbook with keepsakes and photos of all the fun activities

• Unless you are using the phone or tablet as part of the activity make sure you put them down and be fully engaged in what you are doing (emails can wait)

  For Those lucky enough to live in or near the Bay Area, here is my list of quirky, only in SF things to do.

• At the start of the pandemic, my daughter Lauren created a list of fun, at-home improv activities you can play as a family. Even though, thank goodness, the pandemic is over, this list is something to keep for a rainy day

• Fort Funston: Bring some dog treats and take a walk. You are pretty much guaranteed to see lots of fuzzy friends to pet. If you are lucky you will see hang gliders. (Free)

• Take a ferry ride. The route from the Ferry building to Jack London square is super easy, and there are snacks and a bathroom available!

• Turrell Sky dome: For this you need an admission to the De Young museum. Many folks have no idea that this magical place exists. Go out to the garden by the cafe and follow the path and signs down to the sky dome. Once you are in there, make sure you sing and listen to the acoustics

• The camera below the cliff house: Lots of folks don’t bother stepping in there, but it is worth it. The Camera Obscura gives a real time 360 view of the surrounding area. It is only open when the weather is clear. It isn’t free, but it is reasonably inexpensive

• The Wave Organ: This is an old exploratorium exhibit that remains at the end of a jetty behind the St Francis Yacht club. When the tide is right (good luck, I have rarely been there are the right time) pipes will play music. It is an enchanting place regardless, especially if you are there when no one else is out there. It is free

• Musee Mecanique - If they love it there...consider earning points for future play there

• Labyrinth down at Land’s End is worth checking out.

• Walking tours are free and plentiful. These are a fun way to get outside and learn a little history of the city.

• The Gingerbread house in the lobby of the Fairmont Hotel is worth a trip. It is only there until the New Year. This is free unless you opt to splurge on the very expensive tea.

• I love the Stairway walks of SF book. If your child is old enough that they don't start asking to be carried half way through the walk, these are a great family activity.

• Sing-a-longs at the Castro Theatre (currently getting renovated, but hopefully these will start again in mid 2025)

• Volunteer as a family.

• Groupon and todaytix are great ways to find the deals out there!

• https://www.sftourismtips.com/san-francisco-with-kids.html

• https://tripswithtykes.com/free-things-to-do-in-san-francisco-with-kids/

If you are not in the Bay Area, do a little searching to find your own local treasures

Happy Holidays. Go out and make some wonderful memories!