Building and Protecting your immune system

My background is in western medicine but my patients over the years have been on the receiving end of advice from me that includes some more natural or holistic suggestions.   This post in particular strays a bit from the basic western medicine path and includes a combination of conventional wisdom, along with some anecdotal remedies shared with me by healers from a variety of modalities. Some of the things that I suggest can be found, as my husband laughingly describes it, down the “placebo aisle” of the local drugstore, but as we are in the full throes of a variety of illnesses, many families are ready to try anything.   My kids grew up with my husband's grandma’s recipe fondly referred to as Muggala Guggala, (see below for recipe*) I imagine many families have their own health rituals. As long as you are not ignoring a condition that warrants medication such as asthma inhalers or antibiotics, there is little harm in exploring some natural options. Who knows, you might find something that helps.   Good Hand Washing is the cornerstone to staying well.   If you were out and about in a crowd of sniffling,coughing people make sure you scrub up and change your clothes as soon as you get home. Try not to touch your hands to your eyes. I just did my post on habits. If you are someone who is constantly touching your face, this might be a good habit to try to conquer. Recently, in the news, was a story about how Purell and hand sanitizers are NOT as good as soap and water. Those are convenient to have as a back up when you are out and about, but as soon as you are near a sink, scrub up.   Getting enough sleep is essential. If kids seem tired, you might need to start the bedtime routine a bit earlier. For older kids and adults make sure you limit the screen time for at least an hour before going to bed. Most experts suggest longer than that, but I accept that it often isn’t that realistic. Sleep tips Nutrition Make sure you and your kids are getting enough Vitamin D. Many folks have vitamin D levels that are significantly below where they should be and would benefit from a daily supplement .   Make sure you are getting enough Iron. Magnesium, iron and vitamin D are all connected to sleep as well as to a healthy immune system. (Magnesium also helps with pooping.)   I don’t love to binge on most vitamins, but a multivitamin that has A and C is especially important during the cold and cough season. Check out Ester C. This is an exclusive form of vitamin C that is designed to give round the clock immune support. Sandra Roddy Adams, my chiropractor, gives this a big thumbs up.   Zinc is an important cold fighter and some studies show that it can decrease the duration of a cold by 50%. Zicam lozenges are what I like. I actually think that the generic orange flavor tastes the best. These work better if you catch it early! With any zinc product, it might be best to take with something in your stomach to avoid nausea. Kids need to be old enough to safely take a lozenge or chews   I asked my cousin Sam, who is a retired family practice physician if he had any favorite supplements. Echinacea, ginger, garlic, myrrh, cayenne, vitamin C, vitamin B6 and bioflavonoids all made his list. For the grown ups out there, he recommended a Source Naturals Wellness Formula that has a lot of the good stuff in one capsule.   More and more experts are suggesting that having a healthy gut is essential to the immune system. My friend Sari is a craniosacral therapist in Arizona. When I reached out to pick her brain about this post she concurred with me that many current studies are finding that having a healthy gut is essential to the immune system.   Probiotics are good for any age For newborns The product evivo is a good one to look into.   Oil of oregano is thought to be a great immune booster. I would recommend this for grown ups or kids over 6 who are very cooperative. It has a very strong taste and causes some oregano burps but can work pretty well   Omega 3s are mostly found from eating fish, but most people probably don’t get as much as they should. This supplement makes it to most of the lists as a worthy supplement.   Local honey has antioxidants and is thought to be helpful for the immune system. Dr. Anne was the one who added this to the list. She actually adds honey to her coffee! I tried it and it isn’t bad. Remember that infants under one year should NOT eat honey   Chinese Medicine As I mentioned in a post several weeks ago, I was poised to fall into the abyss and was coming down with a cold and cough. I ended up getting an acupuncture treatment and started taking some herbs. The cold ended up quite mild and didn’t go down into my lungs.   There are some Chinese formulas that are very safe and effective. Choosing which one to use isn’t easy without the advice of an expert. The right herbs depend on exactly what type of cough is going on. Chinese herbs are not a one size fits all answer. Our local acupuncturist Den Bremond in Noe Valley is also an RN. She is a lovely resource for not only helping build that immune system, but also helping you get back to health if you are already ill. theacupunctureden.com   My amazing friend Anita is another acupuncturist on my team of healers. I wish she was local, but she is based in Colorado. She encourages warming foods for her patients. These keep the internal temperature up. Viruses prefer the cold environment. She suggests that drinks be room temperature or warm/hot. Don’t add ice to drinks. Use warming spices and herbs such as garlic, cinnamon and cloves. Soup is always good! Here is a bonus acupressure point good for boosting the immune system: acupressure point stomach 36   While staying warm and eating and drinking warm foods is good when you are sick, there are studies that suggest that for healthy folks who are trying to stay that way, doing a cool water rinse at the end of your shower can be an immunity booster. Herbs and Homeopathy Sambuccol is at the top of my list when it comes to my personal self care. This is an elderberry base, fairly widely available that has some scientific studies backing up it’s immune boosting properties. (Even Sandy doesn’t scoff at this one.) I actually start taking these the moment that I feel the scratchy throat feeling that makes me worried that I am starting to come down with something.The earlier you start, the better it works. The bottle says for children over 2. The UK version gives the dosage for over 1.   oscillococcinum  These are homeopathic sprinkles that I refer to as fairy dust. I don’t understand homeopathy, but many folks swear by these. I take a tube every time I fly. Sandy tried to figure out what’s in them and the only ingredient he recognized was duck liver.   Echinacea This herb is on many folks list of remedies. The studies have been mixed as to whether or not it works. Make sure you are a label reader when getting this supplement   Reflexology My friend Oran is a wonderful healer who lives in Israel. Both of my daughters had moments during their travels there when they showed up on her doorstep with various illnesses and she nursed them back to health. She has the ‘No White’ rule when people are sick. No white sugar, no white flour and no dairy. All of those can contribute to inflammation.   Environment It is very important to avoid secondhand smoke. If you are someplace where the air is dry, or in SF you have turned the heat on, consider using a humidifier at night. Make sure you keep it clean and turn it off during the day. Running it 24/7 can create a mold situation. Another breeding ground for germs in your house is the pet food bowl. Your pet’s food bowl could actually be making you and your family sick if you don’t wash it frequently. A study by NSF International showed that pet food bowls ranked as the fourth dirtiest place in the house. Regardless of if you feed your pet dry or wet food, the bowl may have a residue that can harbor bacteria like E. coli and Salmonella. I am guilty of this one but Sandy has it covered. When our grand-dog Bowie is over, he scrubs out the bowl every time he leaves!   It is fairly common for parents to call the doctor, incredibly frustrated when their kids seem to be sick all the time. It makes sense when you think about it. If they are depleted from illness number one, when illness number two comes around they are more vulnerable. Everyone is being exposed to so much this season. Unfortunately most viral syndromes simply take time. Antibiotics are NOT useful for a virus.   If you are stuck in a cycle of catching one thing after another and the above suggestions haven’t helped, explore your options and see if you can keep your child out of daycare for a week or so. Sometimes that break makes a big difference. Don’t forget to swap out the toothbrush or put it in the dishwasher.   * Muggala Guggala - 1 cup milk, 1 Tbsp of butter, 2 Tbsp honey - heated in a saucepan.

Flat Heads/The Importance of Tummy Time

Once upon a time, people had their babies. They lived in multi-generational homes with lots of support. Life was simpler. Now we are surrounded by gadgets and high tech contraptions. Many of us have less family around. There seem to be more rules. Some of the new rules are science based, including the very important ones about safe sleeping. In 1992, the American Academy of Pediatrics initiated the "back to sleep" program in order to try to combat Sudden Infant Death Syndrome. Since this program began, the rate of SIDS has decreased by over 40%. An unintended consequence though was the number of babies who have flat heads from spending so much time on their backs. Nice round heads are becoming a real rarity. This flat head condition is called plagiocephaly. Statistics claim that It occurs about once every 300 births, but I think more babies than that have at least mild cases.  Interestingly, little boys are twice as likely to have issues with this, and right side flattening is more common than left. Many babies with plagiocephaly were predisposed to it because of their position in utero.   Newborns' skulls have a lot of plasticity, so they are pretty susceptible to external pressure. Up until about six months of life, the skull is naturally thin and flexible. It can easily change shape. It turns out that if you drop a cell phone on your baby’s head it will actually leave a little dent!  Yes that is a real call that I got from a frantic mom. (Don’t worry his little head is fine.) Positional plagiocephaly does NOT affect brain growth or development, and by ages 4-6 months, most heads have developed a normal shape. But early intervention and recognition can speed up the rounding process and hopefully keep things from getting worse. Babies  don’t have a lot of motor control during their early months, so they can’t always easily re position themselves. Babies who do tummy time will have an advantage. Tummy time should be started early and often. It doesn’t need to be hazing. Even one minute at a time can count. The first tummy time can be within their first couple of days. Start by having your baby simply lay on you. Don’t worry about the cord (you most likely aren’t that firm of a surface.) Tummy time is an excellent way for them to develop muscles and work on their head control. It is also great for their digestion!    Even though Infants lack head control, they should be able to turn their heads to either side at rest. Some babies, particularly those with shortened neck muscles may develop a more serious kind of flattening. You may hear this condition referred to as torticollis. If you find that they don’t easily move their head from side to side easily I would suggest a visit to a Physical Therapist or Chiropractor. It is never too early for an evaluation.    There are little steps that you can do right from the beginning that minimize your baby having one favorite side. You would be surprised how many parents don’t recognize the fact that their babies heads are a bit tilted. Try to  give each side equal attention: Make sure you swap feeding positions. Offer objects from either side. Alternate directions on the changing table. Consider changing the position of the crib or the orientation of the baby in the crib to reduce the baby’s tendency to look in the same direction. When awake and supervised, prop the baby onto one side with a foam wedge or a towel rolled lengthwise along the baby’s back. Change positions when feeding, carrying, and holding the baby. Provide supervised upright play as soon as the baby has upright head control. During quiet alert times, also encourage mid-line control. Place their hands together and have them look straight at you. Jennifer Maeder, a local lactation consultant and Tummy Time Method provider adds: Parenting today includes the use of a lot of ‘containers’ - equipment such as swings, bouncy seats, car seats, and other infant containers to help hold babies in our modern world. Another influence is ‘containment,’ or the over reliance on excessive swaddling with products like the SNOO and restrictive swaddling blankets. Too much of this can have a negative effect on hip development and inhibit movements vital for optimal breastfeeding and maybe even neurodevelopment. I’m all for making parenting more manageable, but consistent, daily tummy time is essential to counter these practices that decrease natural floor time that is key to supporting motor and sensory development.    If your baby struggles to enjoy tummy time, has plagiocephaly, torticollis or other asymmetries, or you just want to optimize postural development and a healthy nervous system function (including digestion) - daily, consistent tummy time (3-5 sessions per day, 4-5 waves per session) can help. Remember, we frequently expect babies to learn to self regulate quickly. Babies need practice to succeed. The interaction between parent and baby in tummy time provides the chance for connection, interaction and play. Check out this video for a step by step how to on “tummy time waves” from neonatal occupational therapist and founder of the Tummy Time Method!, Michelle Emanuel:   Tummy time method For anyone interested in finding out more, or having a little coaching, Jen holds her Tummy Time Method classes at www.noevalleylactation.com check them out! As Jen mentioned, pay attention to  places where their little head is up against a hard surface. The crib is the main culprit, but anywhere you put them down for a bit counts. Anytime that the baby doesn’t have their heads in contact with a firm surface is a bonus!   Sandra Roddy-Adams, a San Francisco based chiropractor who does cranio-sacral works on a lot of babies, weighed in on the importance of tummy time. https://www.chirodirectory.com/chiropractors/CA/San%20Francisco/Dr-Sandra-RoddyAdams-073220   Supervised tummy time is important because babies begin developing their cervical lordosis (neck curve) around 3-6 months. This curve is formed as the baby begins to lift his/her head. This helps train the surrounding postural muscles and enhances visual awareness. A noticeable flattening of the base of the skull (occiput) or a spine out of line, can also interfere with tummy time and development. If the birth was challenging or if you begin to notice some things like the base of the skull not changing/rounding, difficulties nursing on one side, or a continued head tilt on one side in the car seat or stroller, bringing them sooner than 3 months to see if a gentle adjustment is needed to align their spine can help create symmetry and ease in their bodies and brains. I actually recommend that babies get their nervous system/spine checked as newborns. (I am also a huge advocate of wearing your babies in slings.)   It is not recommended that babies have a pillow for night sleeping, but I am fine with one of the memory foam infant pillows for changing tables. There are quite a few options for this available on Amazon. Janet Green Babb, a SF PT,  ( http://developmentalprogressions.com/home/ ) says that one product that her clients have found helpful is a pillow called Mimos Baby Pillow.   She suggests to parents that they should feel their baby's neck, shoulders, arms with gentle massage. This can give  information about symmetry. She agrees that if there are any concerns, it is important to begin therapy early to develop a home program of stretches and exercises.  She has a list of gentle exercises that she shows parents how to do at home.   If all of your tummy time and intervention have not been as successful as we like, the next referral will be to the craniofacial or neurosurgery team for an evaluation. Either of those specialists  might end up sending you along to the pediatric orthotist team. The orthotists do some scanning (no radiation) and become part of the team that is monitoring your child’s head shape. In some cases, the kids may end up with helmets. Insurance companies vary greatly with their coverage of helmet therapy. The orthotist team at UCSF is top notch. Although helmet therapy is usually not started prior to 5 months of age, there is little downside to having a referral sooner. For those of you interested in further details about the cranial helmet remolding process, see the information in my old post; the link is at the bottom. Although we sure do see a lot of kids with flat heads, very few of them end up needing a helmet.   Annie, one of my mom’s whose son ended up requiring a helmet, shared her story and wisdom. Her little guy is a second child with a mellow temperament so she wonders if that led to a bit more time hanging out in his infant seat. Her doctor repeated the need for tummy time at each visit, but Annie thinks that with a bit of hindsight, if she had seen a helmet in her future she would have been more aggressive with it. At 2 months she did end up at the chiropractor who loosened up the neck muscles. These treatments made a big difference in his favoring one side over the other, but this little guys head was seriously flat and keeping him off of it did not seem to be helping as much as we needed it to. Annie adds a healthy dose of perspective: “There are worse things, We are fortunate to live in a place where this can be fixed.”     For more information about Helmets or local resources check out my old post on this topic: https://nursejudynvp.blogspot.com/2017/03/flat-headsphysical-therapychiropractor.html

Thumb sucking/nail biting/ dealing with habits

Habits

Most of us have habits. Some are good. Some are irritating. Some can be harmful. During my years as an advice nurse, I have had countless conversations with parents who were at their wits end due to their kids nail biting and/or thumb sucking. When it comes to children's habits, those are possibly the first that come to mind. For the record, the American Academy of Pediatrics doesn’t feel the need to intervene with thumb sucking until a child is over five. Your dentist might not agree, but thumb sucking isn't usually a concern until a child's permanent teeth come in. At this point, thumb sucking might begin to affect the roof of the mouth (palate) or how the teeth line up. The risk of dental problems is related to how often, how long and how intensely your child sucks on his or her thumb.I usually try to get a start on it when they are about four. The first day of kindergarten or when other transitions are taking place are not a good time to tackle a comforting behavior. Other kids come up with some pretty creative nasty habits that make the parents of the thumb sucker consider themselves lucky. One of the more unusual was the 4 year old who wouldn’t stop licking shopping carts (yuck!) If your older child is consistently putting non food items in their mouth, that behavior can be related to low iron or even an elevated lead level and is worth checking out.   Is it your new year's resolution to tackle your child’s habit? Here is a truth - nagging doesn’t work. In fact, giving a lot of negative attention to a habit might even make it worse. The most effective way to address a habit is to work on it as a team, which means that your child has to be involved and motivated to make a change. Change will only happen when your child is willing to take an active role with the problem solving. Maneuvering so that you can even have this discussion with your child without them shutting you down is easier said than done. You need to find the magic opportunity. I like to share the “supermarket analogy” for this. Many of the parents who have picked my brain about parenting issues have heard this one before, but it is worth refreshing. Imagine your child is the checkout clerk at a supermarket. You are the shopper. There you are, putting the items on the conveyor belt and the checker is systematically scanning them. But then, you aren’t sure quite what the issue is, but something you placed on the conveyor triggered something. The clerk made the abrupt choice to close the line mid transaction. It doesn’t matter that you are not finished, you haven’t paid, or that you have ice cream melting in the cart. There will be no more shopping at this moment. This lane is closed. In spite of this, many of us still stand there, putting more and more items on the belt. We are wasting our time of course. There will be no transaction completed right now. The parents of teenagers are probably nodding. Whenever you want to have a conversation that has an agenda or a teaching moment, you need to find the right moment. Make sure the “line is open”. You might need to use the express lane (or pick one short topic.) If this is a pattern, try to figure out if you recognize what triggers the line to abruptly shut down and approach that subject delicately. It is tricky, but it can be done. When is your child most likely open for a ‘transaction’? Maybe broach the subject when you are in the car, taking a walk, or sitting on the side of the bed during bed time. One-on-one time is usually best if you can manage to carve some out of your schedule. Allow your child to be involved in the choice of whether or not they want to invite other family members or wise friends to the brainstorming. Before you even start the 'habit discussion' consider reading a general book about habits. Berenstain Bears and the Bad Habit, is a good one.   In this classic, Mama Bear explains what a habit is by comparing it to her pushing the wheelbarrow back and forth between the shed and the garden. Over time the wheels have made a deep rut. It is easy enough to wheel the barrow on that well worn track but it would take some effort to push it in any other way. As Mama and Sister walk along to the garden, they talk about the habit in question. Sister Bear nibbles her nails. They brainstorm together about a solution. Reading a book or telling a story about habits is a great launching point for the discussion. Identify the habit that you want to address. Point out other folks you know with different habits so your child doesn’t feel singled out. Do you have habits that you are willing to address and deal with at the same time? What are some of the consequences of the habit? Downsides of nail biting or thumb sucking could include broken and irritated skin, germs, crooked teeth, teasing from other children... Keep in mind that talking about germs can be a slippery slope for some sensitive kids. We don’t want to end up with Lady Macbeth on our hands by terrifying them about living in this germ filled environment. Find a middle ground. There are indeed germs in our world. We can’t get rid of all germs, but good hand washing and keeping our hands our of our mouths is important for everyone. Freaking them out by teaching them about pin-worms should be reserved for older kids. What is the benefit of breaking the habit? Pretty nails, no broken skin, no teasing, less risk of germs. Sore fingers can hurt! What is a good reward to work towards if they succeed? A special outing is my favorite. It also might work to earn points towards a bigger ticket coveted toy or game. What are some ideas that you might come up with to help break the habit? In the Berenstain Bear book, they start the day giving Sister Bear 10 pennies that she will need to give back through the day every time she is caught nibbling. Sometimes the act of having to give something back is indeed more effective than the promise of earning it. There are some products you can apply to make the fingers taste nasty, but I only like to use those when the child has agreed that they are motivated to stop the hand to mouth habit and want to give that a try. A jingly bracelet might serve as a reminder. Having lots of healthy crunchy snacks available to chomp on can help too. When you first start out, small goals might be easier to attain. Maybe a sticker can be earned every hour that they succeed in remembering to keep their hands out of their mouth (or whatever the habit is that you are working on.) Talk about mindfulness. One simple mindfulness exercise is to take a deep breath. Think about where your hands and feet are. Tighten them and then relax them. Take another deep breath. This is good for any habit, but especially for those that involve the hand in the mouth.   Make an agreement about how your child would like you to be their cheerleader. Do they want you to verbally remind them when you see them failing? Do they actually have the power to ask you to stop with the nagging? (This might be you own habit!) They might be relieved to have the power to take your frequent reminders off the table. How about a finger snap,a quick whistle or a tap on your nose if you see them doing the habit? What is their preference? Don’t forget about positive reinforcement for times when you notice they are NOT doing the habit. Experts support that positive reinforcement is one of the best ways to reinforce behaviors. Obviously you don’t need to overdo this by making comments every minute, but giving attention for progress can go along way. Not all habits are bad ones of course. Think of some good ones that you might all want to work on this year! Practicing gratitude and thinking about things in our lives that we should be grateful for is a great one. It is by no means automatic.

Holiday Safety checklist 2019

This week's topic Holiday safety list 2019

Have you thought of everything? The lights are twinkling and the radios are playing the holiday tunes. People are putting up the holiday decorations. It is time for the holiday safety post.Take a moment to give this a careful read. There may be some things that hadn't occurred to you. For most people, the holidays are a time for celebration. That means more cooking, home decorating, entertaining, and an increased risk of fire and accidents. For every aspect of holiday celebrations, I can tell you the story of a patient who called with a related accident. It is not my intent to scare folks with my tales. As I tell parents who attend my safety class, if you know ahead of time what accidents can happen, you have a way better chance of avoiding them. I have seen some wild and improbable things over the years. Baking cookies is just one example. A patient's mom called to tell me that her 10 month old had sustained a burn on his hand. She was holding him in the crook of one arm as she removed the cookie sheets from the oven. As she recounted, he turned into a cartoon character with a telescoping reach and he was able to stretch across her body and grab a hold of the piping hot tray. Simple solution: don't hold your child when you are working with hot stuff in the kitchen. Their arms are longer than you think. If even one accident has been prevented, this post was worth it. Candles are another hazard. It was a winter evening many years ago in a cabin at Lake Tahoe. Dr. Jessica and family lit some holiday candles and went to sleep. Somehow one of the candles ended up burning a hole through a plastic mat that was on the table. Luckily the smell of burning plastic woke them up before any real damage was done, but it was a frightening lesson. This was a vacation rental. In this instance, there seemed to be no working smoke detector. She had no idea if and where there was a fire extinguisher. There are several obvious lessons here. Never go to sleep with candles or a fireplace still burning. Get acquainted with the safety features of any place your family is staying.     Below are some safety considerations for dealing with the holiday season ahead. Some of these may seem like common sense but there might be a few tidbits in here that I am betting you haven't thought about. Beware of button batteries. They are everywhere nowadays in all sorts of small electronics (and musical cards) and can be quite hazardous if swallowed. Take time in advance to do a mental inventory of items that you have around that may be powered by these. Put a piece of duct tape over the battery compartments to make sure they can't fall out. Certain holiday plants like poinsettias can be mildly toxic (especially to someone with a latex allergy). You may not have them in your own house, but if you are visiting a friend or even a supermarket make sure little hands don't grab the pretty red leaves and put them in their mouths. Be very careful transporting hot food to a holiday potluck. I have patients who have been burned from hot food spilling on them in a car. WARNING TO PET OWNERS! One of my patients had a tragedy several years. An eight year old healthy dog got into a wrapped package that was filled with chocolate. The amount ingested proved to be too toxic for this little dog to handle and they didn't make it. Please don't let this happen to you. Make sure that any mystery packages are nowhere near where a pet can get to them. Christmas tree checklist: When purchasing a live tree, check for freshness. A fresh tree is less of a fire hazard Cut 1-2 inches from the base of the trunk immediately before placing the tree in the stand and filling with water to ensure absorption. Don’t add chemicals that might be toxic to kids or pets. A dash of plain 7 up can help keep the tree healthy. check the water level daily to avoid the tree drying out When purchasing an artificial tree, look for the label "Fire Resistant" Never use electric lights on a metallic tree. The tree can become charged with electricity from faulty lights and a person touching a branch could be electrocuted. Place your tree at least 3 feet away from all heat sources, including fireplaces, radiators and space heaters Make sure the tree is steady enough that it can't be pulled over by a toddler. You may need to attach it to something solid. Trust me, trees get knocked or pulled over. Older kids running around can cause this issue, it isn’t just toddlers. Trim your tree with non-combustible or flame resistant materials. Before using lights outdoors, check labels to make sure they have been certified for outdoor use. Make sure all the bulbs work and that there are no frayed wires, broken sockets or loose connections. Plug all outdoor electric decorations into circuits with ground-fault circuit interrupters to avoid potential shocks. Strings of lights and garlands are a staple of holiday decorating, but they can also pose a strangulation hazard. Avoid trimming the tree with things that look like candy which may pose a temptation to the kids. Keep sharp, glass or breakable ornaments out of reach of small children. Holly berries and other small decorations can be choking hazards. Don't overload extension cords; make sure that your extension cords are high quality. If you are going to use your fireplace, make sure that you have the chimney checked and cleaned if it has been awhile since you built your last fire. (make sure that it isn’t a spare the air day) http://www.sparetheair.org/stay-informed/todays-air-quality This is not a safety issue, but it is worth mentioning. Is your child exhibiting any new allergy symptoms? Take a minute to consider whether or not they started during the holiday season. Trees, scented candles and other seasonal extras can trigger some allergies. Hanukkah doesn’t fall on the same date every year since it is based on a lunar calendar. Many folks laughingly refer to it as coming either “early or late”. It also has more spelling variations than any other holiday. This season the first candle will be lit on the evening of December 22nd. Make sure that all candles are safely out of harm's way. The menorah should be on a glass tray or aluminum foil. Make sure candles are not close to wrapping paper. Don't go to sleep with candles still burning. Don't leave the matches or lighters hanging around. If you are frying latkes (fried potato pancakes that are a holiday tradition, yum) make sure that no one gets splattered by oil Never leave the hot oil unattended  Remember that adding water to a grease fire will make it worse! Baking soda is okay, but a fire extinguisher is best. Make sure you know where it is and how to use it. Kwanzaa may be the safest of the holidays, (no hot oil or stressing the electrical outlets) but there are still candles involved, so make sure they are placed in a safe place and toddlers don't have access. If I missed any holidays, let me know! I will add them to this post in the future. This is also a great time to test your smoke alarms and carbon monoxide detectors!!! Stay safe and have a wonderful holiday season.

The Best Present is your Presence 2019

The best present is your presence

I saw a bumper sticker some years ago that said: Good parenting requires twice as much time and half as much money. So true! 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. 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. This includes 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 they see 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. Go on a 'use all your senses' walk. What do they see, smell, hear, and feel? 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. Go on an ABC walk. 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. 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 really special occasion, set up the tent and have a backyard camp out (or as we once did, set it up in the house!) 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 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. 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 you child is old enough that they don't start asking to be carried half way through the walk, these are a great family activity. Volunteer as a family Sing-a-longs at the Castro Theatre (Thanks to JD and family for this addition)  Groupon and Goldstar and great ways to find the deals out there! Happy Holidays...go out and make some wonderful memories!  If you have something that you think would be a good addition to this list, let me know!

The Power of story telling 2019

My mom could go into a room full of chaos. “Once upon a time..” she would start in a steady calm voice. It wouldn’t be long before everyone in the room was hanging on her every word; whatever they had been in a snit about a moment ago was forgotten. She would then take her audience on a magical journey with a story that she often made up as she went. If it were a classic tale, you could count on her to take dramatic liberties. I don’t believe she told any story quite the same way twice. In her kindergarten classroom she would have her students shut their eyes as she told her tales. "Use your imagination", she would tell them. "I am thinking of a big black dog, he has 2 floppy ears. He also has 2 tails and 3 eyes!" One distinct recollection of a time when mom’s storytelling saved the day comes to mind. My younger daughter Alana had several friends spending the night. In one of my bigger lapses in good “mommy judgement” I had rented a movie that I thought they would all enjoy. It turned out to be fairly dark and scary (always pre-screen, don’t rely on faulty memory of what may or may not be appropriate.) One of the girls started to cry and some of the other girls started to get sad and upset. A few of them wanted to stop the movie, but of course most of the others wanted to keep watching. The situation seemed like it could go downhill quickly. Fortunately my mom was visiting. She took control, turned off the movie and started to tell stories. These weren’t toddlers; they must have been about ten. They sat raptly listening to story after story. The evening was saved. Books are wonderful too, but in truth, they also are not quite the same as a story. A story is yours to tweak as you please. Stories are powerful mediums for working through issues. Folks who have asked me for parenting advice over the years know that using stories is a favorite tool. For as long as I can remember I have been counseling parents to create a fictional child with a similar name. Talk about what that parallel child has been going through. This tends to be a very non threatening way to talk about all sorts of issues. Once upon a time there was a little girl who had an “owie” ear. The doctor had given her some medicine to make it better, but when she tried the medicine it tasted yucky.”.... Once upon a time there was a little boy who didn’t like to stay in bed…… Once upon a time there was a little girl who didn’t want to go to school... Once upon a time there was a little boy who liked to put pieces of cheese in his nose…. These stories are great ways to launch into a dialogue about all sorts of positive and/or negative ways that the protagonist can deal with  a variety of situations. This is an excellent problem solving technique. When I was working on this post, I mentioned the storytelling theme to one of the wise mamas in my life. She immediately referred to these as “Annie Stories”. It turns out that back in 1988 this was quite the thing, and there was a book about how to use this method: https://www.amazon.com/Annie-Stories-Special-Kind-Storytelling/dp/0894805282 I use storytelling at work on a regular basis. Many of our savvy parents who know that they have a “shot phobic” patient on their hands, will make sure that they schedule the visit when Josie and I are both there. Josie is my amazing medical assistant who has been my ‘right hand’ at the office for many years. I can’t even count how many times I have been called into an exam room where a crying, or cowering child is terrified of a “dreaded shot”.... I start my story: “Once upon a time there was a patient who was so big. He played football for his high school. He was bigger than me, he was probably bigger than the grown up in your house, he was really big...and he was really scared of getting shots." At this point 90% of the kids are now still and listening to me talk. Yes,  they might be huddled on their parents lap, or on the floor under the chair. They are probably not making eye contact, but I have their attention. “He wasn’t afraid of getting bumped around on the football field but he hated shots. He was so scared of them that he would try to hide. He tried to hide inside the garbage can, but he wouldn't fit..”   Now 99% are listening and some are almost laughing. From here I am able to start a dialogue with them about why we are giving the shot. “It is magic protection so that if certain germs get inside of your body, you won’t get sick.” We talk about the fact that we wish there was a less yucky way to get the protection and that it is really normal for lots of people to be scared of shots. We talk about the fact that being brave is trying hard to hold still and it is still really okay to cry and yell if they need to. As soon as they are ready, Josie (the best shot giver in the country) has already gotten it done. It all starts by engaging them with a story. Not everything has to have a purpose. Sometimes stories are just for fun If I happen to be taking a  walk outside and see something unusual such as  a pair of shoes sitting by themselves on a street corner, I can’t help to think to myself. Here is a story. How did those shoes get there? Take turns telling the same story. Families can have a wonderful time creating a collaborative tale. Another wise Mama tells me that she used to have her kids give her three things that they wanted the story to include; perhaps a special name or a certain feeling. Our kids these days are both blessed and cursed with the enormous choices of digital wonders. I am not opposed to limited use of regulated tech time, but it should not be in place of plain old imagination. Recent studies show that books and stories started young have a real impact on brain development: http://well.blogs.nytimes.com/2015/08/17/bedtime-stories-for-young-brains This Black Friday, as people run around to shop for all kinds of new technological marvels, don’t forget to “power down” and be thankful for the magic moments that you capture as you snuggle with your kids and simply tell a story. "Once upon a time......

 

Election time/get your kids involved

VOTE!! This post is geared for families with kids who are no longer infants. It is that time of year. Our mailboxes are filled with flyers telling us to vote yes on this and no on that. The phone is ringing and if it isn't the IRS, it is possibly the recorded voice of a celebrity telling you why to support a candidate.Television and radio spots are election related. Many give a collective sigh of relief when election day comes and goes. But take a moment and remember what it’s all about. It was drilled into me at an early age that voting matters. I have early memories of going with my parents to their polling place. Knowing something about the issues and people running for office is our responsibility. Of course growing up in Pennsylvania was quite a bit different than the robust California ballots that we are faced with here. Having to figure out how to vote on all of the propositions can be overwhelming. Let your kids see the process. Invite friends over to talk about the issues. It is a great way for them to to see that many of the ballot measures are multifaceted and often not black or white. How do you weigh all of the arguments? How do you sift through all of the information to find the points that sway you the most? How do you deal with friends and family who are of different opinions. How would they vote if they were eligible? Why? There are so many talking points and lessons to be learned. If you vote by absentee ballot, have your kids help you fill them in and put them in the mail. If you go to the polls, take your kids with you. And wear your "I Voted" sticker proudly.