Managing Motion sickness

 

Managing Motion sickness

I have had quite a few questions about motion sickness recently. Many people are doing some summer travel, but others have issues with this in their general day to day getting around. I did a post on this topic several years ago, but there are some new things to try, so I am updating and rerunning it. Here are some general facts.   Females are more likely affected than males.  People who suffer from migraines tend to be especially susceptible.  While the majority of people who have the most issues with this are between 2-12, some younger babies seem to have trouble as well. I know some unfortunate parents who have babies that vomit every time they go out in the car.   I feel the need to add that even for the kids who get carsick, I do not recommend forward facing car seats until kids are two. The risks of injury in case of an accident are too great.   If you know in advance that motion sickness is an issue, here are a few natural remedies that you may want to try. If you are someone who deals with this a lot, you will have plenty of car rides ahead to do your experiments and see what works for you.   Getting fresh air by having a window open is the first course of action. Do some distraction by playing a game that has your child looking out the window. Experts say to specifically look at the horizon. For those kids who are not super sensitive, you can play some 'I Spy' games. See if you can find interesting license plates or different colors or letters on signs. Don't sabotage your trip by bringing along trip activities that have your child focusing on things inside the car. Even the best passengers might be fine until they start reading or looking at a phone or map.   Most kids do best when their tummies are not too full or too empty. Little crackers to snack on might be useful.   There are wristbands that provide pressure to some acupressure points that seem to give relief. You can find these on Amazon; there are several brands. A popular one is called sea-bands. They come in multiple sizes and colors. Otherwise simply massage the wrist and lower arm area. The magic spot is located on the inner arm about 1.5 inches above the crease of the wrist, between the two tendons there.   There is a new generation of wristbands that emit an electrical impulse that may help with motion sickness. As a bonus, these may also be something to consider to help with morning sickness: Emeterm wrist bands   Ginger seems to be very helpful. For older kids, there is a ginger gum specifically made for nausea (also available on Amazon). Find your favorite ginger cookie or candy; Trader Joe's has a wide assortment. Of course don't give anything to a young child that might be a choking hazard. Check out ginger lollipops (often marketed towards pregnant women.)   Motion Eaze is a topical aromatherapy that some folks swear by. You just dab a drop behind the ears and it provides relief within a few moments. Don't do this one for the first time before you embark on a long car ride. The smell is fairly pungent and other folks in the car might have a hard time with it. If you prefer not to apply a scent directly, there are several essential oils that have been found to help with nausea. Peppermint, spearmint, ginger and lemon are all on the list. Consider letting your child choose the favorite scent. You can apply a few drops to a cotton ball and put it in a baggy. The kids can take sniffs whenever they feel the need.   There are many homeopathic motion sickness remedies. Boiron is the brand that I am most familiar with. As with many homeopathic remedies, they get mixed reviews. Homeopathy does seem to be the ticket for some folks, and is unlikely to cause trouble as long as it is used as directed. It might be worth a try. My husband likes to cry "placebo." I say, "Bring it on, whatever works!"   MQ motion sickness patches More in the possible placebo category, these patches are for kids or adults, four and over. There are over 7 thousand four and five star reviews for these herbal patches, but the directions are clearly written in an "English is the second language" fashion. Based on the large number of positive reviews, I would have no trouble giving these a try.     Medications If you are going on a long car ride, plane ride or boat trip and you have struck out with the natural remedies there are some medication options. Benadryl is an antihistamine that often works quite well for motion sickness. It comes as a liquid. The bottle directions are for children over the age of 6, but most doctors are comfortable giving it to younger kids. The dose usually agrees with the tylenol dose volume. For instance, kids over 22 pounds would get 5 ml or one teaspoon. Always check with your own doctor's office to see what their policy is. Benedryl makes most kids sleepy, but don't count on that. It gets some kids hyper. You probably don't want to find that out on a cross country flight.   Dramamine is another choice. It is an over the counter medication specific for motion sickness. Children 2-6 years of age can take ½-1 tab; children 6-12 years of age can take 1-2 tabs. These chewable tablets can be repeated every 6 hours, no more than 3 doses in a 24 hour period. Start with the smaller dose first to see if it works. Giving the dose 30-60 minutes before travel is recommended. For kids over 6, Bonine is another reasonable choice. This medication can be given at the first sign of nausea and is less sedating.   For patients over the age of 12, if all else has failed, some people use a scopolamine patch. This is a much stronger prescription medication that I would never use as a first line drug. Some of my motion sensitive older patients have found these valuable for cruises. (Tuck this information away for the future when taking a cruise is not an absurd notion.)   Luckily, motion sickness is something that kids tend to grow out of except for an unfortunate few. If you or your child have chronic motion sickness issues, it can be eye related. Cover one eye for several moments to see if the symptoms ease. If this works, you may have something called vertical heterophoria. It is worth having a consult with an eye doctor.   More and more experts are starting to pay attention to the connection: https://www.healthline.com/health/glasses-for-motion-sickness   Some people with chronic motion sickness have also gotten relief from chiropractic treatment and /or acupuncture   Regardless of what does and does not help your particular case, if you are on a car ride, assuming the kids are old enough to comply, have them try very hard to give you as much warning as they can. Ideally they should try to get in the habit of warning the driver at the first twinge of discomfort. The initial signs are usually paleness, yawning and restlessness. They may feel a little sweaty. This is quickly followed by nausea and vomiting. With enough warning you might have time to pull over and get them out of the car for a couple of moments until the motion sickness eases. Being stoic is not a good plan; it usually backfires.   In my car, I actually kept barf bags in the glove compartment. I used to collect unused ones from my airplane travels. They may come in handy. If you don't have an actual barf bag, have a container or plastic bag that you can whisk out at a moment's notice.   Your trunk should be prepared:   A change of clothes (don’t forget socks) A clean towel A plastic bag for putting the soiled clothes in Some wet wipes A lollipop to get the yucky taste away Febreze for cleaning off the seats (you will bless me) Extra water and hydration tablets (or pedialyte packets)   While kids are usually the ones most apt to barf in your car, motion sickness can afflict any of us at different times. I hope that some of these tips can help you out.   I remember my days as a carpool driver. One of my little passengers had Emetophobia (fear of vomiting) and would quite literally open the car door and leap out if anyone so much as made a gagging noise. It kept things interesting!

The magic and importance of play

 

The magic and importance of play

“Play is often talked about as if it were a relief from serious learning. But for children, play is serious learning. Play is really the work of childhood,” Fred Rogers, aka Mr. Rogers. Screen time is a fact of life for most of us. Don’t get me wrong, while I am well aware of the official guidelines, there is no judgement from me for families who get a bit too much. It is safe to say that my kids got WAY too much, but they also balanced it out with lots of play and crafts. This post is not about limiting screen time. It is about being mindful that you give your kids opportunities to play and use their imaginations the old fashioned way. My sister Marjie and I were less than 2 years apart. Amy was six years younger and sometimes would be allowed to join whatever activity we had cooked up. Thanks to Marjie’s over the top imagination we never were at a loss for odd games to play. The earliest one that I can recall was “Ann and Martha stick toilet paper on the wall” Marjie would show up in my room in the middle of the night and help me climb out of my crib. We would bring our dolls (Ann and Martha) into the bathroom where we would wet pieces of toilet paper until they would stick on the wall. I think we would tell stories about whatever shape they were. That game is actually one of my earliest memories, although the memories are pretty vague. My parents were oblivious to our night time activities. My mom always wondered about the scraps of toilet paper that she would find all over the bathroom floor, because of course, they would dry up and fall off the wall during the night. It wasn’t until years later when we were discussing childhood games in her presence that the mystery was solved. Another of the stranger games that I can recall all these many years later was ‘Crawl’. We would toss assorted clothes and ‘dress up’ costumes around the room, make the room pitch black and crawl around attempting to put on all the clothes that we came across. Shirts could become pants, underwear would go on the head. When the lights turned on we would crack ourselves up.  Marjie and I also created our own board games. They were convoluted and creative to say the least. These included  The Mahaly brain game (Our precursor to Trivial pursuit) The ‘low crotch game’ (this one had the loser run up and down our street wearing a pair of very low crotch pants that had shown up in a box of hand-me-downs The ‘Go Kiss my sister’ game (don’t even ask….) My mom watched with amusement, as long as we were safe, but there was one game that she absolutely hated that we referred to as “taste this” and which she ultimately banned. ‘Taste this’ was something we played when we were quite a bit older. It involved one person being blindfolded and the other players pulling out an assortment of various foods or condiments. The blindfolded person would choose a number 1 through 4. Each number corresponded with a mystery food that the person would need to taste and then try to identify. There would usually be one positive, two neutral, and one horrible choice. There was an element of honor involved. You absolutely had to taste whatever you picked...no cheating. Mom forbade us from playing the game following that one time when I was blindfolded and threw up all over the kitchen after making a poor choice and getting a heaping spoonful of mayonnaise in my mouth (you would have vomited too!) We made the mistake of telling our kids about this one, and poor mom had to deal with the generation of grandchildren playing ‘taste this,’ when the cousins would gather at grandma’s house. Lauren read this post as I was writing it and recalled getting a mouthful of coffee grounds, but on the other end, gave her cousin a spoonful of the liquid from a jar of gefilte fish. The game was banned yet again. No worries, the band of cousins created their own set of unique games. When my daughters were young and playing with each other at home, if there were any games that caused vomiting, they flew under my radar. I started thinking about all of this because the other day Sandy and I took a long overdue stab at clearing out the storage room behind our garage. Both my girls joined us in helping us decide what old toys and games were worth saving. What a trip down memory lane! There were bins of crafts, costumes, board games and well loved toys. Among the treasures is a huge bin of beanie babies with the tags still on. (One of these days we need to figure out if those are worth anything). There was a doll house that Sandy had made out of old wine crates. The walls were covered with wallpaper from a wall paper book and carpeted with remnants. That was a great project, but the house was a bit worse for wear from sitting in the storage room for 20 years, so it didn’t make the cut for things we are saving.  Some classic toys that survived their years in storage will now get to be played with again by little Elliot. So here is today's message. Please make sure that your kids have lots of opportunities to play, create their own games, and use their imaginations. If you don’t have a Marjie in your lives for whom no props were required, have some basics that games can be built around such as: a doctor's kit, a toy cash register, dolls or stuffed animals. The dolls that we made for our wine crate doll house were made out of pipe cleaners and felt. Expensive toys with lots of bells and whistles are not necessary. You can also get your kids started with some Improv games . Click the link in the last sentence for a list of these that my daughter Lauren, who is a teaching artist, complied at the beginning of the pandemic. If your kids don’t have siblings to play with, try to connect with other friends who have kids of similar ages. Once kids are older than 2 years or so, there is no real substitute from the learning and growing kids can get from interactive play.

Things we take for granted

 

Things we take for granted

The world is full of horrible things and fabulous things. The problem is that the horrible things are the ones that make all the noise, capture our attention and of course, catch the headlines. It is pretty easy to forget to notice the wonders that are around us. This week I was taking a walk and I decided to focus on, and give some appreciation for things that I often take for granted. I started with the fact that I can easily walk several miles. I am blessed that I am within walking distance of Golden Gate Park and that day my destination was in fact the botanical gardens. I went through the checklist of my senses. There was plenty of beauty to see. Along the way I couldn’t help but find joy at watching a dog deliriously playing fetch with a stick.  The flowers that I passed along the way were stunning. Each lawn was worthy of stopping and marveling at. The colors are miraculous.It got even better once I got to the park. If you are in SF, get over there (but beware of coyotes!) I could hear birds; I felt a nice breeze. I delighted in some fog, knowing that so many friends of mine have been struggling with heat and humidity. Next it was time to focus on smelling. I was sniffing and not smelling anything for a block or so. The first odor I was able to identify was cigarette smoke, courtesy of a guy who was sitting in a parked car. I was glad to have confirmation that my nose was indeed working. Happily, a block later that smell was replaced by the wafting aroma of baking cookies.  I confess that I usually don’t bother to pay attention to things that work the way they should. Like most people I only 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 (I learned that lesson!) and it was wrapped around my little finger. As we were going down some steep steps, Java started to pull me, I jerked back and my pinky snapped. Ouch indeed! (For the record, finger and toe injuries are especially painful due to all the nerve endings) 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 finger. 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 doesn’t work. My double 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! 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 (the botanical gardens are a great option.) Seek out a delicious and comforting aroma; you can light a candle or even bake some cookies. The good stuff is easy to find, you just need to pay attention to it. 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!

Ghosts and Radios/Happy Fathers Day

 

Ghosts and Radios

My dad was the youngest of four brothers. These brilliant men were all physicists and they all played the violin. Someone once referred to them as the vio-physicists; I loved that. Sadly, my dad ended up with dementia and even though he was the youngest, he was the first of the four brothers to die. We lost him in 2007 at the age of 80. His older brothers remained sharp and mostly healthy for many years. The third youngest, my Uncle Melvin, is 99 and doing great. The year after daddy died there was a large family party for his second oldest brother Elmer’s 90th birthday in Houston. The remaining brothers, along with my sisters and every one of my first cousins decided to gather. The Jewish term for a happy occasion is a 'Simcha'. This translates to happiness. In our extended family, people make it their business to travel far and wide for these events. There were multiple generations in attendance from all over. It was wonderful being together, but my dad’s absence was like a gnawing toothache. He left such a gap. It was a lovely weekend. Houston is an enormous sprawling city, so getting from place to place was a bit of a hassle. This was before google maps or Waze and we spent more time than we wanted getting lost. We were constantly calling Sandy back in San Francisco to get out a map and navigate for us. On the last day of the trip, we were on our way to a BBQ at the home of Uncle Melvin. I was in the car with my mom and both of my sisters. My older sister was driving. We were having a conversation about how much we missed dad, but somehow felt his presence. We all realized that while we were talking, Marjie had missed the exit. We immediately started giving different directions to poor Marjie. “Go straight, go right, go left” At the SAME moment, with all of us shouting out, we realized that the car radio was now blasting. Rap music was pulsating. It was cacophonous. There was no way we would have been able to talk over that. Marjie reached over to turn off the radio. “Did any of you turn that on?” None of us had. The radio had simply turned on. It happened right when we were thinking about dad. “Dad? Was that you? Rap music? Really???? That’s the best you could do?” We found our way to Uncle Melvin's and of course we were all buzzing about how the radio had seemed to spontaneously turn on. They all looked at us sideways. I don't blame them. If I hadn't been in the car I would have had a hard time believing it. During the course of the afternoon, I asked uncle Melvin what the classical station was, so that we could listen to that on the way to the airport. My dad would have preferred classical to rap, hands down. “That would be 88.7 of course” A few hours later, when we returned to the car, the radio was already on as soon as we started the engine. I know that we had turned it off when we left the car. It was no longer tuned into the rap station. It was set on 88.7. Vivaldi was playing. Wow, so had someone snuck the keys away from Marjie, gone into the car and changed the station? I didn’t think so. I really felt like this was a hug from my father. It didn’t need to make sense, my heart was full from it. Later that week, my cousin shared an article about uncle Elmer, the birthday boy that had been written in a local paper.. In the interview, he recounted that when he and his brothers were young, someone had given them an old broken radio. It had become their hobby and passion to fix it and learn all about how it worked. This started them all on the path that lead them to become scientists. This was the first I had learned about my dad’s early fascination with radios. It made me feel even more certain that I had gotten a message from him. Several days later when I was back in San Francisco, my dear friend Melanie came over for tea. She was a pathologist and scientist to the core. I told her the story of the radio that seemed to turn on by itself and she smiled gently. “If it makes you feel good to believe that it was your dad, that is fine, but I think somehow, something turned it on. Maybe somebody nudged it without realizing it. There is usually an explanation. She headed home but called me later that day. “Uncle! I concede!” “Excuse me?” “I was driving home from your house and I swear to you, my radio was suddenly playing. I know I didn’t turn it on” Well done Daddy!!! If one accepts that spirits are energy and are looking for ways to communicate, radios continue to be easily managed by my dad. When Alana was away at school, her radio routinely turned on without human touch. It still happens, but he has moved on to cell phones. Mine is completely possessed and makes calls at random without being touched. 

Air safety for your classroom, office, or home

This post is a collaboration between me and Dr Anne's husband Sri.. 

All of these wonderful links are courtesy of Sri's hard work. We are approaching another potentially scary fire season. During last year’s wildfire season, on some days, San Francisco experienced some of the worst air quality in the world. There was one day when the daylight sky was an eerie dark orange. It felt like something out of the ten plagues. 

Fingers crossed that there won’t be a repeat of that, but in any event it is better to be prepared. That means it is time to make sure you have a good supply of N95 masks that fit properly, as well as adequate Hepa Filters (air cleaners) for your home, school, daycare, and office.

 I know from past experience that once it is apparent that there is smoke in the air, the availability goes down and the prices go up. Just the thought of it is anxiety producing, but simple wishing won’t keep us safe. 

Records show air quality (PM 2.5) severely deteriorated in the Bay Area between August to October, and around August is when essentials (HEPA, N95) became hard to find. This year the fire season could start earlier, so the time to prepare is now before the rush. Parents, teachers, and principals at San Francisco schools need to know that if they work together they can likely get HEPA air purifiers in classrooms, but they need to act quickly before the start of the fire season when HEPA filters run out of stock. 

 It’s not only about smoke from wildfires. Fresh air ventilation from outside is one of the best ways to reduce viral transmission such as Coronavirus by aerosols. However, access to fresh outdoor air is not always feasible during wildfire season when the source of the aerosol (PM 2.5) is from outdoors. In such situations, a good HEPA filter is not only helpful for smoke, but can also reduce viruses in the air, especially in shared spaces like classrooms and offices according to the CDC and SF Department of Public Health. 

 This is important because kids will be returning to in person learning in the classroom but many schools in San Francisco do not have HEPA filters. If they do, often these portable units are tagged as “most popular” or “Amazon’s choice,” but tend to be vastly underpowered for the size of the classroom.

 Dr. Anne’s husband Sri decided to take some action when he discovered their children’s school had inadequate HEPA filters in the classrooms. Because HEPA filters were not in the school budget, he took it upon himself to collaborate with other like-minded parents at the school and convince the parent’s association to raise money to get them purchased. Given past difficulties in fundraising for other causes at the school, the parents association leadership had doubts they could fund HEPA filter upgrades for the entire school. But to their surprise, within a week, 23 families (5% out of 400 at the school) plus one anonymous corporate matching donor funded the necessary HEPA air purifier upgrades for every classroom exceeding the original goal. This shows there is broad community support for air safety. It is nice to know that most people can agree on something! 

 A common mistake that people make is to use a HEPA air purifier that is too small for the size of their room so ends up not having the intended effect. Sri created a calculator to help people figure out how large of a machine they need in each classroom and for the entire home, school or office. It is not surprising that many teachers at his kids' school had assumed the HEPA filter they already had was good enough. Also because they were so busy with numerous other duties, few teachers had responded to the initial request asking whether they wanted to upgrade the HEPA filter in their classroom. It was not until he sent a follow up message with the attention-grabbing subject “VERY IMPORTANT -- THANK YOU FOR YOUR CONSIDERATION” and pointed out unless teachers responded affirmatively to the request the parents association would not upgrade their HEPA unit that every teacher in the school confirmed they wanted the upgraded HEPA unit in their classroom. 

 In addition to helping me with this post, Sri put together the following list for parents who want to take action. It is amazing how much positive change even one or two active parents can make in a school! If you are a parent and concerned about air safety and interested in helping your child’s school get some HEPA filters Sri recommends the following steps: 

 Contact the principal and explain the need for adequately sized HEPA filters in each classroom Estimate the size of HEPA filters needed for each classroom and for the entire school by first measuring the size of the classrooms and use the calculator. 

 Check and confirm with each teacher 1:1 that they will accept and use the upgraded HEPA filter in their classroom (or not). In each case of principals and teachers don’t equate non-response with a “no”: Without bringing the issue to the attention of the primary stakeholders (parents, principals and teachers), and operators (teachers) of the HEPA filter units, many of them may be unaware and miss out on the opportunity for cleaner air. However, for such an important issue as HEPA filters, it is critical to provide both informed consent and receive a response from each and every stakeholder rather than to assume non-response is a ‘no.’ They may simply be busy and not have had the time to understand and respond. If necessary write to them with all caps to get their attention: “VERY IMPORTANT -- THANK YOU FOR YOUR CONSIDERATION” 

 Work with the parents in the school to fundraise for the HEPA air purifiers. Consider using a need-specific fundraiser to rapidly raise funds from the parent community rather than general fundraisers. Contact them via in-person and online networks at your school (e.g. ParentSquare). 

Seek funds from matching corporate donors as well. Get creative. 

 Important: In shared spaces like classrooms or offices if the HEPA air cleaner to control Coronavirus particles accumulation in the air it is very important to override the “auto” setting and set the HEPA air filter’s fan speed to the maximum speed (or if max speed is too noisy then then the next one down) because the built-in sensor does not detect Coronavirus particles.

 Sri can be reached by email at sri@patientknowhow.com if you have any questions. He will also hold a Q&A session on on June 17 at 4pm (Zoom link https://us02web.zoom.us/j/83869310710) These days it feels like we have so little control on all the things swirling around us. It is nice to have something actionable that you can do. Go out and kick some butt!!! Even if you are not up for the Butt Kicking, at the very least take care of your own needs and make sure you get those masks and filters now.

This is nothing to kid around about. Recently published research from UC San Diego says the effect of wildfire-specific pollution on respiratory health is up to ten times worse for children (particularly for children aged 0 to 5 years) compared to other sources of smoke.

https://pediatrics.aappublications.org/content/147/4/e2020027128.long

How to make sense of the ever changing covid guidelines

So many parents are struggling to navigate the tricky balance as some of the quarantine restrictions are lifted. I have gotten many questions about this. 

Having kids that are too young to be vaccinated and little ones who are too young to comply with masks, makes it even more complicated and stressful. As wary as we might be about normalizing, many folks have not seen their extended families since 2019 and are busting to finally visit important people they have been separated from. Zoom is a poor substitute for an enormous, in person hug.

 I started out looking for answers by asking an expert, my friend Dr. Bob Wachter who has been a respected voice during this pandemic. He shared a recent podcast. Here is the link if you want to listen to the hour. It is worthwhile. https://podcasts.apple.com/us/podcast/toolkit-safe-or-not-safe-summer-edition/id1504128553?i=1000517710799 

Dr. Bob had two very bright epidemiologists as his guests. The striking thing about listening to them was that they were grappling with the questions of travel, mask/no mask...etc. and they didn’t always agree on how they would answer some of the questions. Alas, there are not always clear answers. 

Every family is unique. People have various levels of concern as well as different levels of risk. Interestingly these don’t always correlate. I know of some at risk families who are fairly bold and families who are really at minimal risk but remain extremely cautious. 

 This is not going to come as news for folks who have read my previous posts, but as usual, it comes down to a risk/benefit analysis. Think about this - I have so many parents who are really nervous about having their babies start eating solids. They are worried about choking. If they had their way, they would only feed pureed food for the first several years! Obviously that isn’t a reasonable choice. Kids need to learn how to eat and chew. Parents need to learn the safest ways to feed and how to do a choking rescue maneuver if needed. 

 In the same vein, there might be some risk involved in leaving the safety of your quarantine bubble, but kids need to be social. Keeping them at home is not an option that I would agree with.

 In an effort to reach a larger audience, Dr. Ted and I did a live Instagram event on June 3rd, and I will do a little summary here for those of you who were not able to join us. 

I am not going to address all of the specific questions that we tackled; instead I will review the basic guidelines that I have used to find the answers. 

 As we grapple with the choices here are some things we know: 

 Outdoors is safer than indoors when it comes to Covid transmission You are unlikely to get COVID from a surface; it spreads from close person to person transmission. At the beginning of the pandemic, I know people who left mail and packages untouched for 72 hours as if they were radioactive. The data came in pretty conclusively that that was unnecessary. No one seems to be doing that anymore. Of course people can still pick up other nasty germs from surfaces, but that is not the focus of this post. 

 Handwashing a great. Make sure you use soap and water for 20 seconds. If you are using hand sanitizer use at least a dime sized amount. No, you don’t have to follow your kids around and wipe down their hands every second, but I would do a good wash when coming in from outdoors and also prior to every meal. 

 Most kids who end up getting COVID are not terribly ill. While there is the very scary multi system inflammatory syndrome, it is incredibly rare. Vaccinated people are mostly safe from getting severe illness or dying from Covid.

 Keep in mind that prior to covid, we frequently made the choices to travel during flu season. The risk to young kids is similar. In some instances influenza is actually harder on the little ones. 

 No person’s situation is exactly the same as another's. If you opt to be more cautious and want to keep your mask on, there is no need to apologize or defend yourself. 

 As you look at the risk benefit here are essential questions that will make a difference in the answers. Are eligible people in your family fully vaccinated? 

 Are there family members who are at high risk? 

 How are the numbers in your area? 

My advice to someone in the Bay Area would differ from that to someone in Brazil or India. Find a trusted resource where you can keep tabs. Everything could change if a new variant comes along or numbers spike up again. 

 To close, I love gathering pearls of wisdom from sources that I trust. Emily Oster just did an article about this same issue. For data lovers, she is fabulous, but one thing she said that really resonated with me was that people ask “should I be worried?” She suggests that that is the wrong question. Instead people should ask if there is an action that they can or should take that is different from what they are doing. Once you figure out what feels like the best path for your family, march on down it, knowing that you made the best choice at the time. 

Choosing to be worried is a choice that will only leave you feeling helpless. I know I know, easier said than done. https://emilyoster.substack.com/p/family-planning-unmasked-offices My mom’s favorite piece of wisdom is always worth repeating. “It is what it is, do the best you can.” Gather the data, and don’t get frustrated if the data changes as new information surfaces. Make the choices that feel best for you.

Talking to your child about homelessness

In Memory of Roosevelt. 

 Many years ago, when I was still working at Noe Valley pediatrics, I was sitting at my desk, (more than likely talking to someone about their child’s poop). A frantic passerby rushed into the office. She told us that someone had fallen and was bleeding profusely, and thought that since we were a medical office, perhaps we could help. 

My medical assistant, the amazing Josie, had the sense to grab some gloves and gauze, and we rushed out to see what was going on. There were several other people already at the scene assisting an elderly woman who was on the ground. 

As luck would have it, one of the helpers was a doctor. She was holding pressure to the wound with a nice, large towel that another passerby who was on his way to the gym happened to have with him. (Any Hitchhiker’s Guide to the Galaxy fans out there? Always carry a towel!) 

Somebody else had already called 911. This supportive group of onlookers were holding the victims purse, talking to her, and keeping her calm until the ambulance arrived (a disappointing 11 minutes wait). 

 While I never did get a follow up report and hoped that the accident victim was okay, I was struck at the time by how quickly a group of people acted like caring human beings and got involved. They put their busy lives on hold for the moment and stayed on the scene until it was clear that they were no longer needed. 

Sadly, this response is not something to take for granted. The streets of San Francisco often are filled with people who need help and we all walk past them, myself included. It doesn’t always feel safe to intervene. Mental illness and drug use are real issues. So sometimes it is scary, or overwhelming, or we have nothing to give, or we want to choose carefully how we do give, and choose not to offer random handouts. 

Regardless of the reason, walking past someone who is on the ground simply feels wrong! Having a child with us often compounds this issue. What do we say when we see people who are so much less fortunate than we are?

 THE CONVERSATION

 I think it is safe to say that anyone living with a child in an urban area is likely to get the question at some point.

 “Why is that person lying on the street? 

Why don’t they have a home? 

Why? Why? Why???” 

 Consider putting some thought into your answer now so that you can be prepared with a response that you feel comfortable with. Beware, words are powerful and kids can make connections that are not intended. 

If a child hears you point to poverty, job loss, or illness as the simple cause for homelessness, they could worry that if someone they love gets sick, or complains that they are having trouble paying a bill, they might end up on the street too. 

Kids under five need to be reassured that they are safe, that they have a warm bed and plenty of food. Keep the discussion age appropriate. 

You can wait until they ask, rather than initiating the conversation. A simple “they don’t have a place to live” might be enough. 

They will learn quite a bit simply by seeing your actions and reactions. 

 Five to eight year-olds are transitioning to seeing themselves as part of a community rather than having the world revolve around ‘me’. They are becoming interested in solving the problems they see. Beyond reassuring them that they are safe, invite them to ask questions and think about options. 

Just like every single person is unique, every situation is different and everybody has their own story. Your answers might include talking points such as 

 Poverty: Maybe bad luck; no money, no job in combination with no family or friends to help, not enough housing. Societal marginalization also plays a part (sadly, society isn’t set up the same way for all people from all walks of life). 

The recent pandemic and its economic impact has made the situation even worse. 

 Mental illness: Maybe the person is not well. Bodies can get sick and so can minds. Often there is medicine that can help make things better, but some people get so confused that they don’t know how to get help. Drug use: Medicine can be very good when it is used for the right reasons. Some people use drugs they shouldn’t use and may have ended up not being able to make good choices. If the opportunity presents, taking the time to hear the personal stories of a homeless person can be pretty impactful and remind you that everyone has a name and is somebody's parent/child/sibling/....... 

 In any case, it is important not to make sweeping generalizations. The goal of this discussion is to cultivate feelings of empathy and action, not shaming.

 We want to help, but Safety First! The Neighborhood Emergency Response Team ( NERT) holds classes, free to the public, to train us for how to deal with an emergency such as a large earthquake. They spend several weeks teaching people how to help, but NERT's first rule is the most important one: Don’t go in to rescue someone if it feels unsafe. 

If someone who looks like they need help call 311 and report it. How can we prepare our children for these inevitable encounters with people who are homeless? While we want our kids to have compassion, this same rule needs to be taken to heart here. 

If you are walking and have any concerns that an interaction with a stranger on the street could pose a danger, then walk right by.

Most of you have probably heard this tale, but if not, now it is time for the starfish story (now known as the sea star) 

A young girl was walking along a beach upon which thousands of starfish had been washed up during a terrible storm. When she came to each starfish, she would pick it up, and throw it back into the ocean. People watched her with amusement. She had been doing this for some time when a man approached her and said, “Little girl, why are you doing this? Look at this beach! You can’t save all these starfish. You can’t begin to make a difference!” The girl seemed crushed, suddenly deflated. But after a few moments, she bent down, picked up another starfish, and hurled it as far as she could into the ocean. Then she looked up at the man and replied, “Well, I made a difference to that one!” 

 We can’t help everyone, but even simple kindness can make a difference for one person. Most people appreciate even the gesture of a smile, but here are some more tangible things that you can do with just a bit of planning.

 First of all - don’t assume anything, ask a person if they would like the help. 

 Have some extra socks to hand out 

Give small containers of hand sanitizer 

Get some Starbucks cards or gift cards that can be redeemed for food 

Donate part of an allowance to a homeless shelter 

Restaurant portions are so big, perhaps split your meal and box it up before you start eating and give it to someone on your walk back to the car. 

Somebody with poor teeth might not be able to eat that bagel; don’t be offended if your gesture is rejected. 

 Birthdays and holidays are a great time to talk about how fortunate we are. 

Some kids ask their friends to donate to a non-profit instead of getting presents, or do a “toy-purge” – giving outgrown toys and games to charity before receiving new presents. 

 Alas, the cure for homelessness has proven to be elusive, but we can brighten the day of one person at a time with some simple kindness and teach our kids how to have compassion. We can also learn a lot from our children. 

Thanks to my daughter Alana, who is now a social worker, my family had a warm relationship with an older gentleman who spent his days on the sidewalks of West Portal. About fifteen years ago Alana was still in high school and had left the local movie theater on a dark drizzly night waiting for her dad to pick her up. Roosevelt decided to wait with her because she shouldn't be out ‘alone’ and they began a friendship that lasted until his recent passing. He called her bright eyes and tossed his cane in the air and ran into her arms for a big hug every time he would see her. RIP Roosevelt. We will miss your smile.