Mothers Day Musings/My goal is to find something about the day that everyone can celebrate

 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, it can be a special day of 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 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 grabbed, and gave 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.

Alana claims that a runner up might be the time I sat back and let my kids and some friends scamper around Alameda beach collecting jellyfish.

No one got stung, not all jellyfish are toxic, but I fully admit to questionable judgement.

I am now starting my list of “Grandma screw ups”. I have been fairly well behaved, but there was a time when I was taking baby Elliot for a walk and I let him smell a beautiful yellow flower. Somehow the center of the flower stained his face yellow. It took days to fade. Lauren was not amused.

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, avoid handling jellyfish and be aware that some flowers can stain)

Happy Mother’s Day to all who celebrate.

To everyone else, be grateful that all the commercials will soon be over until next year. Of course Father’s Day is just around the corner…..

Do you know how your grandparents met?

 After my mother died, when we were at the family house sorting through old letters, I came across a pile of correspondence between my mom’s parents. These were love letters, filled with personality and pet names; sweet and funny treasures. As we were reading them I was struck by something. Somehow, I didn’t know the story about how the two of them had met!

How is it that my sisters and I didn’t know that story? The loss of my mom pierced through me with the stark realization that there was no one left to ask.

There was something nagging in my brain and fortunately it came to me. Back in 1987 my grandmother had done an oral history project with the National Council of Jewish Women. I had started to listen to it shortly after she died in 1995 but her loss was too fresh and hearing her voice got me too emotional. Life happened and the existence of those tapes was forgotten.

But now I remembered! I did a quick internet search and there it was. There are two hours of grandma being interviewed. The story of how she met my grandfather was included.

Fast forward.

As some of you know, I am writing a book. It is NOT the Nurse Judy collection about fevers, poop and rashes. Instead it is a collection of weird stories, spooky serendipity and a shout out to my quirky family. Messages from beyond? Maybe.

One of the stories in the book is about my grandmother. She was born in downtown Pittsburgh. Her name at birth was Gertrude, but we remembered her telling us about how her name was changed to Flora. To us, she was Grandma Fuffy.

The story goes that when she was young, disease struck the family. One of her older sisters perished and Grandma was very ill. As was the custom at the time, her family changed her name in order to fool the angel of death. (It worked?)

Recently, my sisters and I were trying to see if we could remember what illness it was; we were split between possible Typhoid or Diphtheria (Hooray for clean water and childhood vaccinations, I can’t imagine the horror of losing children to those illnesses)!

That week I had a vivid dream. My grandmother was telling me that the information that I was seeking was available to me.

I decided to listen to her interview again. This time hearing her voice surrounded me like the coziest of sweaters and filled me with warmth.

Once again my question got answered. It had been Typhoid.

Of course I listened to the full two hours. What a treasure. It stops abruptly in the middle of a story, the cassette tape was over. I wanted so much more, but am grateful for what I got.

It is possible that many of you have quick little videos of parents, grandparents and older relatives and friends,

But do you have the stories?

Make it happen. Most folks are delighted to take a trip down memory lane with you. Even people with diminished memories often can happily recount tales from when they were young. Capture the history.

Being able to hear my grandmother's voice feels like a gift from the universe.

Don’t wait.

Here I am on Grandpa Asher’s lap. Marjie is sitting next to Grandma ‘Fuffy’

(shockingly…and I kid you not, this is only about 14 years before I met Sandy)

Thanks for reading Nurse Judy’s Substack!

Crib Safety/AAP guidelines for SIDS prevention

 

The American Academy of Pediatrics has clear guidelines reviewing the best safe sleeping practices for babies. It is hard to believe that it has been just about 30 years since the ‘back to sleep’ recommendations were first instituted. That change made a measurable difference and cut the SIDS incidence by roughly 50%. The annual number of sleep-related deaths has remained steady since then. Unfortunately that case count is still too high. There are still approximately 3,500 infant deaths every year here in the US.

These incidents usually occur when an infant with an intrinsic vulnerability to SIDS is placed in an unsafe sleep environment.

The most common risk factors include:

• Male sex

• Prematurity

• Low birth weight

• Genetic factors (There is some preliminary research that has found a link between certain enzymes and SIDS, but it is in the very early stages)

• Race (non white babies tend to be at higher risk)

• Under 4 months

• Prenatal exposure to drugs, nicotine or alcohol

• Second hand smoke

Obviously, aside from the smoking, most of these are not in your control. So, what is in our power? That is what the guidelines are all about.

Here are some considerations for creating the safest sleep situations.

Back to sleep is basic.

Generations ago, kids were put to sleep on their tummies. Grandmas knew that they slept more soundly that way. Here’s the thing. It is actually better for infants to be having lighter sleep for the first couple of months. Because the sleep isn’t quite as deep, babies can rouse more easily if they have unmet needs. Believe it or not, the goal at this age is not to get your baby to sleep through the night. They need to wake up to feed. Ideally a baby wakes up periodically and then can settle themselves back to sleep without too much assistance. The safest position is on their back, not on their tummy or their side.

Some parents worry about choking being more of an issue in that position. In fact, healthy babies naturally swallow or cough up fluids. It is an evolutionary reflex. Babies may actually clear such fluids better when sleeping on their backs.

Infants don’t have very good head control, so another benefit of them being on their back is that they are less likely to smoosh their little faces into the mattress.

Make sure they are getting some regular tummy time.

That head control will improve more quickly with your help. You can start this within the first couple of days. Even having them lay on top of you, for several seconds bobbing their little heads up, counts. The amount of time per session can increase gradually. This supervised time is so important for strength and development. It also can help you avoid a flat head (positional plagiocephaly). Here is one of my blog posts on that topic.

Once they can roll, it is common for parents to stress because all of a sudden babies have the ability to flop onto their tummy. Please note, it is not reasonable for you to stay awake and keep flipping them onto their back. Your job is to place them on their backs and make sure the crib is safe. Keep doing plenty of tummy time and floor exercise. This will help them work on the skills so that soon they have more control.

The AAP recommendation is for babies to sleep in the room with the parents, preferably for at least the first six months. They want you in the room but not the same bed.

The guidelines are clear about co-sleeping. The AAP gives that a big no.

I understand that this is a tough one, I know that in many cultures folks sleep in a family bed. Unfortunately the statistics are jarring. The risk of SIDS is 10 times higher when sleeping with someone who is impaired because of their use of sedating medications, drugs, alcohol or simply exhaustion. Show me a new parent who isn’t exhausted…

It isn’t just a risk at night time. The risk of SIDS is up to 67 times higher when sleeping with someone on a couch or soft armchair or cushion.

By all means snuggle them to pieces when you are awake, but when you are at risk of dozing off, they are safer in their own little bed.

The guidelines also advise parents to take steps to ensure that the baby doesn’t get overheated.

They are not hothouse flowers. A cooler room is better than a hot one. It is interesting that the risk for SIDS is higher during colder months. This is likely because in the colder weather, caregivers might be tempted to use extra blankets or clothes. Over-bundling may cause overheating, which elevates an infant’s risk for SIDs. The ideal temperature for babies is between 68 to 72 degrees fahrenheit or 20 to 22 degrees celsius. Of course, having said this, keep in mind that babies all over the globe with less resources live in much hotter climates without AC and do just fine. Don’t freak out if the room reaches above the ideal temperature. Focus on things that are in your control.

It is common for infants to start off in the smaller infant bassinets before moving into a full sized crib. The safety consideration for bassinets and cribs are the same.

Some of the infant beds, like the snoo, have movement and sound to help soothe them. There are no safety issues with those, just make sure that any infant sleep product is JPMA certified (Juvenile Products Manufacturers Association).

When it is time to move into a full sized crib, you want to look for that same JPMA certification. Older models might not meet the current safety standards. It is essential to get one with stationary sides. The older cribs used to have rails that you could lower. This was easier on your back, but no longer considered safe.

If you do have an older model, double check with the cpsc.gov to make sure there are no recalls associated with it:

https://www.cpsc.gov/Recalls?combine=cribs

By law, the production date of a crib must be displayed on it and on its shipping carton. Take a photo of that so you have it for your records. Check for any obvious safety hazards. Slats should be no wider than 2 & 3/8 inches wide. If you buy a crib online, get your ruler out and measure any openings immediately when it arrives at your home. Check for sharp edges and protruding screws, nuts, corner posts, decorative knobs, and other pieces that could catch your baby's clothing.

The mattress should fit tightly in the crib with no gaps. If you can place more than two fingers between the mattress and the crib frame, the fit isn't snug enough.

Here is one list of best mattresses for that is updated regularly

Use a tightly fitted sheet. There is nothing wrong with a quality hand-me-down sheet as long as the elastic at the corners is still strong. Test the sheet, whether new or used, by pulling up on each corner to make sure it doesn't pop off the mattress corner.

There should be nothing else in the bed. No stuffed animals, pillows, blankets or crib bumpers. I confess that my kids had a crib full. Lauren used to have long conversations with her Winnie the Pooh bumpers. Those days are gone.

Infants can be kept cozy in a swaddle until they start to roll. At that point I would switch to a sleep sack. There are many good brands that meet the current safety criteria. There are several good brands, such as the HALO or Woolino, which aren’t too hot or too cold. The weighted swaddles, including the Merlin, are not on the AAP list for safe sleep products.

The mattress should be a firm, flat surface. If they are at an incline they can slide down and there is a risk of suffocation.

The new guidelines specifically state that devices such as car seats, strollers, swings, infant carriers and infant slings are not recommended for routine sleep, especially for infants younger than 4 months. These infant seats and carriers are fine if you need to have the baby hanging out in the room with you during a wake window.

I am going to permit a loophole and say that for a closely supervised nap these are still okay, just not at night. Supervised means that you are keeping an eye on the baby as they sleep, not completely engrossed in another activity or taking a nap yourself.

Flat is best, but if you have been reading my blogs these past years you know that if your little one has a cold or congestion, I have always suggested putting them on a little bit of a slant. You can still do that by putting a little towel under the mattress but now it needs to be more subtle. The angle should be no more than 10%.

The new guidelines also suggest avoiding the use of home cardiorespiratory monitors as a strategy to reduce the risk of SIDS. The concern is that they might provide a false sense of security.

Breastfeeding is ideal. Being a good parent is NOT about how you feed your baby. Not everyone is able to nurse. But, data shows that breastfeeding reduces the risk of sleep related infant deaths. During the first 2 months, feeding at least partial human milk has been found to significantly lower the SIDs risk. If your baby got any at all during those early attempts, that might make a difference. If you do produce enough milk and can manage to nurse at least for the first 6 months, that is consistent with the AAP recommendation. Of course, if you can make it through the first year with some breastmilk as part of their diet, that is even better.

Pacifier use is associated with reducing risk.

I have no issue with a baby falling asleep with a pacifier in their mouths. I would not force it, if they don’t seem to want one. I would also try hard NOT to get into the habit of replacing it every time they fall out.

As kids get older, there are fresh safety issues to consider. Make sure the mattress is at the lowest level so that your little one can’t climb out. Make sure the crib isn’t near any wires, lamps, window shades or cords that they can reach.

The good news is that once they are a year old, I am fine letting them have a little comfort object in the crib with them like a lovey.

You might feel like you are in the dark tunnel of sleep deprivation right now, but babies grow fast. I know it can feel overwhelming and a bit terrifying when they are little and at their most vulnerable, but there are actions listed above that can help keep them safe. Blink and they will be asking for the car keys, Then you will have a whole new set of things to worry about!

Nurse Judy’s Substack is free. I have no current plans to add a payment option. But feel free to pass these along and share.

Lessons from my Mother

 

Yesterday was my mom’s birthday. I always miss her, but obviously I am thinking about her even more than usual this week. I also am spending the week in Pittsburgh with both of my sisters. Mom would be thrilled to have us all together. We have made a pact in advance not to talk politics, in order to keep the peace.

I would like to honor her memory on her birthday this week by refreshing this post that I wrote a few years ago, and pass along some of the life lessons that she taught her children, grandchildren, friends, and students.

Having a sense of humor is imperative.

Reach past the grumpy countenance to find the person behind it. My mom had a private little game: how long would it take to get on “kissing terms” (as she called it) with people she met? She was pretty hard to resist, and even the most sullen security guard at the bank would break out into a sunny smile when they saw her.

Take the time to reach out to people. Mom was a letter writer. She stayed in steady contact with older relatives and friends who were otherwise alone. If someone was ill, they would get a card or a call.

Take a moment to give positive feedback. So often people write notes to complain. My mom took the time to report a job well done. She had cancer in the last years of her life, and I remember going with her to her chemo appointment once when I was visiting home in Pittsburgh.

She was hugged by everyone we encountered and knew most of the people by name. She brought seeds from her garden to share. We were called back to get her blood drawn. The phlebotomist reached into her drawer to show me a letter that my mom had written to the facility, telling them how caring and skillful this woman was. She still had the letter, many years later.

The valet parker pulled out a similar letter when we went down to get the car. Those letters meant a great deal. The fact they had been kept, rather than tossed, speaks volumes.

Wonder about things. Mom was known far and wide for her storytelling ability. She could have a roomful of energetic kids quiet and hanging onto her words within a moment. If she saw something odd, like a pair of shoes left at the playground, it would be fodder for a story. How did those shoes get there? Who left in such a hurry -- and why? You don’t have to follow a script. Her stories would take random and unexpected turns. No story was ever the same. There was always an underlying theme of kindness.

You CAN teach an old dog new tricks. My younger sister is a National Park Ranger. My parents took full advantage and turned most of their vacations into opportunities to visit the parks where Amy was working. Mom was exceedingly proud that for her 60th birthday she got her first pair of hiking boots. Stay active. When she could no longer go for walks, she did chair yoga or got on her stationary bike.

Find a way to relax. She was a reader and read an assortment of genres, but she unashamedly plowed through the Harlequin romances. You know the ones with the shirtless, muscled, long haired Fabio types on the cover? Yep. Those. She always had one in her purse. I bought her a couple from her favorite author, and Amazon has never let me forget it. (if you ordered this, you also might like…..)

Be self aware and recognize your own needs. Mom was very social, but in her mid-adult years she realized that she needed to carve out some alone time. She became a morning person. She used to say that the dawn belonged to those who chose it. She relished her quiet time while the rest of us were still asleep.

Get involved. Mom was the block watch captain. Her front porch was a popular gathering spot. It is also no surprise that she was the girl scout and brownie troop leader. She also became the go-to accompanist, playing piano for all sorts of school shows. Well after her retirement, you could find her helping neighborhood kids with their reading skills.

Give your kids the opportunity to learn an instrument. Both of my parents were amateur musicians. I confess that I took it for granted that there was often chamber music going on in my living room. My mom thought that it was a special gift to play an instrument that could be part of an orchestra. I only learned piano. My older sister Marjie, played all sorts of things and sat next to my mom in the cello section for the local Gilbert and Sullivan troupe. (My dad sat right in front of them playing the violin.)

Have a family pet (say yes to the stray that finds you.) Unless there are horrible allergies, let your children grow up with the love of a pet. My childhood house had cats, birds, fish and gerbils. Marjie attracted strays like a magnet (and still does), and somehow they were allowed to stay.

Don’t be a pushover. If you see an issue, say something or do something about it. Yours might be the voice that ultimately makes the change happen. Potholes? Speed bumps? Mom wasn’t shy about taking her letter writing to her congressman or newspapers, and oh by the way, the congressman and the mayor?... Kissing terms!

Vote. It was ingrained in me early that you should never skip an election, regardless of how insignificant the issues might be. Our right to vote is sacrosanct. Some of my earliest memories are accompanying my parents to the voting booth. When she was no longer able to get out of the house, she had an absentee ballot.

Be kind to the earth. Mom was an avid gardener. Her favorite plants were her “silver dollar” money plants. She would pass out the seeds to anyone with a garden.

She also hated waste, She could spot potential treasure or art projects in the most mundane items. Egg crates, old calendars, etc. were never thrown away. My parents were recycling many years before it came into fashion. Of course this was a double edged sword when it was time to clear out the family home! There likely was an actual double edged sword in the basement...right next to the hoop skirt.

“Don’t be too hard on yourself.” She was never too worried about perfection. Giving a good effort, rather than a successful outcome, was what mattered. “It is what it is, and you do the best you can” is a motto that I continue to live by.

In that vein, mom herself was, of course, not perfect. She could hold a grudge like nobody’s business. I can still hear her saying “When I turn off, I turn off.” No more kissing terms for THEM.

In an interesting twist, this was just as important of a lesson as all of the others. From it, I learned the importance of forgiveness. Releasing all the negative energy is something I find essential.

Here is a lesson from me...turn the mad into sad, turn the anger into disappointment, bank any wisdom earned from the interaction, communicate as needed (or not), and then move on. It is my pleasure to forward her ripples of positive energy. The world is in dire need.

I asked my sisters, daughters and nieces to take a peek at this list to see if there was anything glaringly missing. Alana laughed out loud when she thought about the list she would have to make if she was creating her own “lessons from mom.” I did have a very specific collection of “strong suggestions” for my girls that had a very different flavor than the list above. My list included:

No getting on a reality tv show

No taking a job that requires the wearing of a humiliating hat

Don’t eat French onion soup on a first date

When you are driving, make sure to check your blind spots

Floss every day

And a few other easily R (X?) rated suggestions that are not suitable for sharing in this venue!

What would your kids have on their list of ‘wisdom from you?

Nurse Judy’s Substack is free. I have no current plans to add a payment option. But feel free to pass these along and share.

How is your Micro-World? Don't take the good stuff for granted.

 The sleep post that Dr. Ted and I are working on is a work in progress. It is going to be quite awhile before we are even close to wrapping it up. I do appreciate those of you who chimed in with sleep questions and wisdom.

In the meanwhile, I am going to shift my attention to a different topic..

It was my birthday this week.

For those of you who incorporate doing the Wordle as part of your daily routine, the answer for the word on my birthday was CURSE (thanks wordle, but I refuse to accept that. Nope. Not even close!

The world does seem to be full of horrible things. But there are fabulous things as well. The problem is that the horrible things are the ones that create most of the noise, capture our attention and of course, make the headlines. It is pretty easy to forget to notice the wonders that are around us.

It is hard to remember to find moments of joy when you are aware that so many people are having really difficult times. It is also human nature to not really pay attention to things that work the way they should. Like most people, I tend to notice when they are broken or not working.

It brought to mind a quick story of how we take things for granted.

Many years ago, I was walking our beloved golden retriever Java. This was when she was pretty young and exuberant. I was holding the leash in a very foolish manner and it was wrapped around my little finger. (Lesson to dog owners…don’t do that!) As we were going down some steep steps, Java started to pull me. She may have spotted a squirrel and she was off and running. As I jerked back to avoid being pulled down the stairs, my pinky snapped. Ouch indeed! Anyone who has suffered an injury to a finger or toe knows how especially painful those can be.

The reason that this tale of woe is at all relevant is to illustrate a point. I was much more impacted by a broken pinky finger than I ever could have imagined. I had never given much thought to this particular digit. Of course it was my right and dominant hand. Without the ability to bend that finger, I was not able to hold a pen, or more importantly since I was still actively working in my job as a nurse, I was not able to give shots for many weeks.

Go ahead and try to pick up a pen and write something while your little finger stays straight, It’s exceedingly awkward.

My lesson today is first of all to be mindful of all the things that are working well. If you don’t have a headache, sore throat or congestion, hooray! Can you walk without pain? Pay attention. We usually only notice when there is an issue.

Secondly, if you are dealing with tough stuff as many of us are this year, don’t let the difficult things completely eclipse the lovely stuff that is still surrounding you. Listen to music, go someplace and be wowed by nature

This week I decided to focus on my personal corner of the universe, and give some appreciation for things that I can sometimes take for granted. How lucky am I to have a warm and loving family! It warmed my heart that old friends and acquaintances reached out with birthday wishes

It is fun to be methodical and to go through a little checklist of my senses. What brought me joy?

Seeing: Spring blossoms. So many gorgeous colors.

Hearing: My grandsons laugh and giggle. The sound of music as Lauren and I actually had a peaceful moment to play some piano duets.

Smell: The aroma of the ‘birthday’ cookies that Elliot helped make.

Taste: Yes… they were delicious

Touch: Snuggles

Things to look forward to: My husband and I have some exciting trips planned.

When people ask me how I am doing these days, my response is, “My micro world is really lovely”

There is good stuff. You can find it. You just need to pay attention. It can be something as simple as taking a page out of my sister-in-law Barbara's book and grabbing a martini and watching reruns of the Big Bang Theory

While you are at it, pay a bit of homage to that all important pinky!

And the bad stuff? Remember to differentiate between what is in your control and what is not. Even small, positive gestures and kindnesses can help move things in the right direction.

Feedback request for upcoming Sleep Post

 Dr. Ted and I are ready to roll up our sleeves and tackle one of those topics that parents almost always have questions about. It might actually be the number one issue for many.

Can you guess? Or are you too tired?

The answer is sleep.

It feels like your baby is up every hour and you completely forget what it feels like to sleep through the night.

Blink. They were finally sleeping a little bit better, but they just turned four months old and ugh…. just ugh.

Blink. You now have a toddler. You can’t figure out a nap schedule and bedtimes are a complete nightmare.

Blink. Your child is a bit older now. You are sleeping deeply when you get the sense that something is amiss. You open your eyes to see your little one kneeling by the side of your bed staring you awake. They had a bad dream and want to join you in your bed.

Blink. Your teenager is having trouble with insomnia. You don’t know how to help them.

Our intent is to do a post that addresses issues and answers questions about sleep through the ages.

So as we embark on this project we are asking for your input.

What are some of your most pressing sleep related questions? Do you have pearls of wisdom, things you have tried that have worked well that you would like to share?

The goal is to combine current data, common sense, nonjudgmental guidelines along with wisdom from the ‘hive mind’ to create a post that is a helpful resource to many.

I would love to hear from you. Feel free to comment or shoot me an email Nursejudysf@gmail.com

Urgent Care vs Emergency Room

 One of my readers wrote to me with a request. She was never quite sure when she should go to urgent care vs an emergency room….could I write a post that reviews the guidelines?

We wish that we could give you a straight answer! Some urgent care facilities can suture up a wound, do an x-ray and/or start an IV. Others will send you to the emergency room for those same services depending on the age of the patient.

There doesn’t seem to be consistent standards out there. But a little preparation in advance can help you navigate through the confusion.

Seeing your primary doctor should be where you try to start.

• Routine check ups are the opportunity to have your doc get to know your child.

• Chronic issues (anything lasting longer than a month) should also be managed by your regular doctor unless there is an acute change and you need to be seen urgently. Those often require continuity. Labs and referrals can't be managed as effectively by someone who sees you only once.

• Refills should be handled by the office of your primary care provider. Pay attention if you are running low on something and request a refill at least a week in advance. Please Don’t wait until Friday afternoon.

But Murphy's Law generally seems to make certain that the fever spikes, or the vomiting starts, right at 5:01 pm when the average doctor's office turns their phones off.

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Also, we get it that sometimes the hours and location of an urgent care feel much more convenient.

In any case, it is important to be familiar with your after hours/urgent care options.

Waiting until you or your child is ill is not the best time to start learning about what choices exist in your area.

Do some research

• Start by asking your regular doctor’s office if there is an urgent care that they are associated with.

• How late are they open?/Do they do walk-ins or schedule appointments?

• Are there after hours advice nurses available?

• Where is the closest emergency room? Is it staffed with pediatricians?

• Does your insurance plan have a preferred option that won’t cost as much?

• If you are traveling, plan ahead and figure out local options for care before the trip.

Once you have some Urgent care options give them a call and ask them a few questions. Most will deal with general illnesses, but you also want to know:

Do they do sutures?

Do they do IVs? This is exceedingly rare for pediatrics.

Do they do X-rays?

Can they remove a jelly bean from the nose or ear?

Will they help assess a head injury?

And here is the most important follow up… Is the answer still yes if you have an infant or toddler? Some places who don’t blink about treating a seven year old are very quick to show you the door and send you to the ER if your child is younger than that.

Things to keep in mind if you need to be seen at urgent care

Know the exact names and dosages of any medications the patient is on. If possible bring them with you or take a photo of the container.

Have an accurate timeline of the illness. It is a good habit to start a shared document when your kid gets sick. This way caregivers can track symptoms, timing of medications etc. That document will be a useful history for any medical professional who you end up seeing.

Request that the urgent care send a report to your primary doctor.

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Here are some of the most common reasons that people go to urgent care.

When available, I’ve included blog post links that may be helpful in helping you figure out if you need to be seen.

Fever (read more)

✅ Urgent Care: Almost always ok, except for noted exceptions
🛑Emergency Room: If Temperature is over 106 or baby is under 2-3 months

Respiratory Illnesses (read more)

✅ Urgent Care: Good place to start unless there is severe respiratory distress
🛑Emergency Room: The post linked above describes what respiratory stress actually looks like.

Ear Pain (read more)

✅ Urgent Care: Can usually tend to the majority of ear issues.
🛑Emergency Room: Only if there is marked, severe swelling around the ear/skull (This won’t be subtle!)

Vomiting / Diarrhea (read more)

✅ Urgent Care: Unless you suspect dehydration. Although it never hurts to check, most urgent cares don’t do IVs.
🛑Emergency Room: If an IV is might be needed, the ER is the right choice.

Abdominal Pain

✅ Urgent Care: Check for constipation or gas which are the most common culprits
🛑Emergency Room: If unable to walk or jump due to the pain

Allergic Reaction/Hives (read more)

✅ Urgent Care: Hives without any of the signs below are OK
🛑Emergency Room: If hives are associated with trouble breathing, coughing, vomiting, diarrhea, or lip/tongue swelling, or if an Epi pen was needed. After the use of epinephrin, supervision is needed to make sure that symptoms don’t rebound

Rashes (read more)

✅ Urgent Care: Virtually all OK, with one rare exception listed below
🛑Emergency Room: If there is a fever along with a rash that is purplish and doesn’t get lighter when you press on it go to ER immediately. If patient is acting confused call 911

Injuries - Body (read more)

✅ Urgent Care: Call ahead to ask about x-ray availability and stitches if you suspect they may be needed. Dislocated Elbow (nursemaids) is usually an easy fix at urgent care. A mild sprain can possibly wait until the next day, Rest/Ice/Elevate and (arnica) if it it is still painful in the morning, get it checked out
🛑Emergency Room: Many gaping wounds and obvious fractures need the ER

Injuries - Head (read more)

✅ Urgent Care: If it was minor and none of the red flags are presented, Urgent care may be able to offer reassurance
🛑Emergency Room: If there was a fall from up high, or very fast and sudden impact (i.e. air bags went off in a car), loss of consciousness or vomiting, it is safest to get them thoroughly checked out in the ER

Urinary Tract Infections (read more)

✅ Urgent Care: Almost always OK, except ↓
🛑Emergency Room: If associated with a fever in a young infant under 3 months

Sore Throat (read more)

✅ Urgent Care: Almost always OK, except ↓
🛑Emergency Room: If unable to close the mouth or turn the head, with high fever and excessive drooling

Swallowing / Inhaling Foreign Bodies
(read more: swallowing, foreign bodies)

✅ Urgent Care: Good to call in advance to check. Many urgent cares will remove deep objects out of ears/nostrils but others will not. It may actually depend on who is working the shift. ( Dr. Ted is a superhero when it comes to getting things out and stitching things up, not everyone is so willing)
🛑Emergency Room: If any signs of distress. If the swallowed item was possibly magnets, button batteries or water beads those can be especially hazardous, but anything that could cause a blockage needs to be assessed and dealt with. If actively choking call 911

Pink Eye (read more)

✅ Urgent Care: Almost always OK, except ↓
🛑Emergency Room: If the skin around the eye is entirely red and swollen with pain and fever

Burns

✅ Urgent Care: If first or second degree.

🛑Emergency Room: Burns on the face, neck, hands, feet or genitals are generally more serious. Any potentially third degree or burn covering a large area of the body needs to be seen in ER and may be require being transferred to hospital that specializes in burns

Poisoning (read more)

🛑Urgent care not the right option.

✅Call poison control: 1-800-222-1222. They may direct you to the ER

Seizure

🛑Urgent care is Not the right choice
✅Go to ER. If this is the first time, it is appropriate to call 911

Behavior / Psych

🛑Urgent care not the right choice.

✅ You can call 988 but they will likely direct you to head to the ER. especially if you are dealing with a minor.

Bonus link

What should you have on hand in your medicine cabinet

Enormous thanks to amazing designer Nancy Elle who helped us try to make the text behave.

Thank you to Sawyer for being one of my favorite models.

And Bella, this one’s for you!

Measles 2025

 You may have heard the term herd immunity.

This is my best way to describe what we are talking about.

Imagine a forest. After a rainstorm, the trees are moist. A spark is unlikely to cause much damage. If the trees are dry and brittle, that same spark can cause a raging inferno quickly.

People who are unvaccinated are like dry trees. The more of them there are, the more danger there is of more damage to the surrounding area. If the fire is strong enough, even some wet trees don’t stand a chance. Some people (such as babies, and people with cancer or other immune compromise) can’t be vaccinated, and can’t help but be a ‘dry tree’.

Herd immunity is when at least 95% of people have the vaccine-induced protection.

We shouldn't need to be writing this post! Measles was eliminated in the US in 2000. It is horrible to see the news about the current rise in cases.

Measles, also known as rubeola, is very contagious

This virus is so virulent that ninety percent of unvaccinated people will catch this virus once they are exposed. What is even more alarming is that it can remain on surfaces or even in the air for 2 hours after someone has sneezed or coughed! If someone travels on a plane while they are contagious...that is a potential nightmare. One of the reasons that it spreads so easily is that people are contagious as early as 2-4 days prior to showing any signs of the virus and may remain contagious until the rash is gone, or 4 days after the symptoms are all clear.

How the measles rash spreads on the body

The measles rash follows a characteristic head-to-toe spread.

1. Incubation Period (7–14 days after exposure)

• The measles virus enters through the respiratory tract and replicates in the local lymph nodes.

• It then spreads through the bloodstream to various organs, including the skin.

• No symptoms appear during this phase.

2. Prodromal Phase (Days 1–4)

• Before the rash appears, the child develops high fever (up to 104°F), cough, runny nose, and red eyes.

• “Koplik spots” (tiny white spots on the inner cheeks) sometimes appear 1–2 days before the rash.

3. Rash Stage (Days 4–10)

The rash appears as red, blotchy spots that spread in a predictable pattern.

Day 1: Face and Neck

• The first spots appear around the hairline, forehead, and behind the ears.

• The rash spreads downward to the neck and upper chest.

Day 2: Torso and Arms

• The rash extends to the trunk, upper arms, and thighs.

• Individual spots start merging, forming confluent patches.

Day 3: Lower Body and Extremities

• The rash spreads to the lower legs and feet.

• By this point, most of the body is covered.

4. Recovery (Days 6–10)

• The rash starts to fade in the same order it appeared (face first, then torso, then legs).

• As it resolves, it leaves behind a brownish discoloration and fine skin peeling.

If you have a happy child with a rash, our guess would be that it isn’t measles. People with measles will look sick and likely have a high fever. The rash will not be one of the first symptoms.

Complications are frequent

They range from ear infections to pneumonia, encephalitis and/or seizures. 1 in 5 people are hospitalized after infection (roughly 1 in 4 when just looking at kids), often with pneumonia or brain swelling. 1-3 out of every 1,000 cases are fatal. Take a moment and reflect on what that means. This is a serious illness. This is not one of those illnesses to wish your child would catch in order to get natural immunity.

Vaccination

The routine measles vaccine is combined with mumps and rubella and is referred to as the MMR. The individual components have not been available separately for many years. The first MMR shot is routinely given to patients between 12-15 months and again between 4-6 years.

Why do we wait so long before giving that first MMR protection to babies?

Assuming that the birth mom has been fully vaccinated (or less likely has had the actual measles) infants are born with passive immunity to the disease. This immunity starts to wane and is considered mostly gone by the time the babies are between 12 and 15 months. If a child is vaccinated when they are younger than a year old and still have some maternal protection, the vaccine does not seem to be as effective for long term protection.

For the second dose there is the option of combining it with the chickenpox vaccine called Varivax. That combo vaccine is called Proquad or MMRV.

Just one dose of the MMR vaccine is thought to be 93% effective. The second dose is given just to catch the occasional person who didn't get effective immunity from one dose and bumps the effectiveness up to 97%. It can be given earlier than 4 years, but I am not too concerned about the timing of the second dose as long as patients have gotten the first one.

If you are traveling to a high risk area, the CDC will suggest getting the second shot early. The 2 shots simply need to be given at least 28 days apart and after the age of 1 year.

The MMR is a live vaccine and it is true that in some rare cases the reaction can be a little rough. Interestingly, most kids are just fine the day of the immunization. Typically the reaction comes along between 7-21 days after the shot. This reaction may include high fever and rash. This is not thought to be contagious. It usually lasts only a day or so.

Kids with severe egg allergies don’t need to worry about the MMR vaccine. Even though the vaccine is made using chick embryo cell cultures, it doesn’t actually contain significant egg protein. Studies have shown that even kids with a history of anaphylaxis to eggs can get the MMR safely without any extra precautions. The only vaccines where egg allergy is a concern are some flu vaccines and the yellow fever vaccine (which isn't routine anyway).

Before routine use of the measles vaccine, there were about 500,000 cases of measles in the United States each year, and about 500 deaths. Measles also led to about 48,000 people being hospitalized and another 1,000 people being left with chronic disability from measles encephalitis. Study after study has shown that there is no link between the MMR and autism, but there are still some folks reluctant to give their children the vaccination.

In July 2016, SB277 was signed into law. It is now a requirement that all children attending schools in California have the measles vaccine unless they have a medical contraindication. Since the law passed, I have seen a steep increase in vaccination rates. This law probably has saved lives.

Most schools just require 2 doses after the age of a year and don't care a bit about the timing.

Outbreaks

The CDC defines an outbreak as “a chain of transmission that includes 3 or more cases linked in time and space.” As this post is written, in February of 2025, the numbers are increasing. We are seeing an outbreak in a rural pocket of unvaccinated children in Texas. The CDC is currently updating its page monthly, so it is challenging for us to give you exact numbers. If you’re traveling to the South, check the local news sources before you go.

Travel considerations

Unfortunately, measles remains a common disease in many parts of the world. Each year, an estimated 128,000 people die from measles. Take a moment to recognize what a huge number that is! Quite a few countries and popular travel destinations have experienced measles outbreaks in recent years, including countries in Europe, Israel, India, Thailand, Vietnam, Japan, Ukraine, and the Philippines. This is only a partial list. Before your next trip, check your destination and CDC’s global travel notices.

If you do travel, pay attention to your health for 3 weeks after you return to make sure you didn’t bring this home.

Infants can get the vaccine early for travel or exposures

If you are traveling to a high risk area or there has been a possible measles exposure, the vaccine can be given as early as 6 months. You need to be aware that this early shot can’t be counted on for lasting protection. Your child will still require two shots after the first birthday. Your insurance company also might refuse payment if the shot is given outside of the routine schedule, but this is less likely if your doctor “codes” for the shot to be given due to travel or exposure.

If your child is over a year and has had only one MMR so far, go ahead and see about getting them their second shot early if you are going to one of the higher risk countries (or Texas).

It takes about 10-14 days to get any significant protection from the first MMR. Hence planning is important.

Hepatitis A is one more vaccine that can be given early for travelers.

Several years ago when I was working on my very first measles post, one of my adult friends said to me, "We all got measles and survived, what is the big deal?" My response was, "It is true enough that the vast majority of folks who get measles will recover intact and have lifelong immunity. However, one to three kids out of 1,000 will die; many more than that will be permanently harmed. That is too many when we are talking about something that can be prevented. That 1 child out of 1,000 matters."

Remember, that babies are vulnerable “dry trees.” We all need to do our part to keep them safe.

Extra note for adults - depending on when you were born, your original vaccination may or may not be still providing protection. You may have been given only 1 shot, a one time common practice; you may have been given an inactivated virus shot, which was also a long ago common practice; or if you were inoculated in the 1960s, you may have been given a relatively ineffective vaccine because of now-known manufacturing problems. The best way to make sure is to have your titers measured, or you can do what I just did since we will be traveling internationally later this year, and simply get a booster. Talk to your doctor about the best option for you.