Febrile Seizures 2022

 

Febrile Seizures

Are you familiar with febrile seizures? If you aren’t brushed up on your Latin, The word febrile refers to having a fever. Someone who is afebrile has a normal body temperature. For parents who have no idea that these exist, the first time it happens it is often described as one of the most horrifying moments of their life. Awareness helps. It is by no means a fun experience, but it is nowhere near as terrifying as it appears. General statistics indicate that seizures happen in about 4 -5 % of all children. If you have a family history of them, this puts your child at a bit of an elevated risk. Most of the time the first febrile seizure happens between 6 months and 3 years. Typically kids completely outgrow them by the time they are five. These seizures are NOTassociated with epilepsy.  The symptoms may range from smaller tremors to large jerky movements. The eyes may roll back. Some kids actually lose consciousness. It is common for kids to seem quite drowsy and "out of it" for a period of time right afterwards. Please note that It is very common for kids who are in the process of spiking a fever to look quite pale and seem a bit trembly; that is NOT usually a seizure. The seizures themselves do not usually lead to any ongoing medical issues, but care needs to be taken to make sure the child doesn't sustain an injury or choke while they are seizing.  If you see your child having a seizure your primary job is to keep them safe. Immediately remove them from any water, ledges, traffic...etc. If your child is laying down, turn them on their side. Don't stick anything in their mouths. Make sure their airway remains open.  Do not try to put them in the tub or give fever medications when they are in the midst of a seizure! Link:  Basic seizure first aid Febrile seizures usually come on when a fever is in the process of shooting up rapidly, but it is NOT the fever that is causing the seizure; the trigger is whatever is causing the inflammation. That being said, it is rare to have them associated with a temperature under 102. Febrile seizures usually last less than 2 minutes. If you are able to stay calm enough, take a look at a clock, watch or phone to get a sense of the time. If a seizure is lasting longer than a minute (especially if it is the first time) it is perfectly appropriate to call 911. If the seizure is short and your child seems stable you don't need an ambulance, but you still should get them some medical attention right away.  One of the things you want to figure out is the source of the fever. Viral syndromes are the most common cause, but the medical team will want to have the other suspects ruled out (ears, throat, lungs, urine.) Once your child has had one febrile seizure, they have a lower threshold and unfortunately it can happen again. It is important to keep in mind that fevers are the body's way of fighting an infection. As long as a fever is lower than the 101 range and the child seems happy, I generally tend to leave the low grade temps alone and not treat. This was not the case with my seizure prone patients. I was in the habit of being a bit more aggressive with those little ones.  I learned recently that there is new data about this. It turns out that while this might make your child more comfortable, it isn’t likely to prevent subsequent seizures. In any event, have the correct medications on hand and make sure you stay up to date with the proper dosage for your child’s weight. Dr. Ted’s Research: Those recent studies that show that keeping the fevers down won’t necessarily prevent recurrent seizures can be hard to wrap your head around. This is a good example of something called a “true-true-unrelated phenomena." In these kids something is causing inflammation. It is the inflammation which is causing the seizure. The same inflammatory process is causing the fever. It is NOT the fever causing the seizure. Sometimes the seizure actually occurs before the fever. In any case, as Nurse Judy mentioned above, keeping the fever down doesn’t seem to alter the potential for having a seizure.

Tick bites 2022

 

Tick Bites 2022

Ah, the twisted thinking of an advice nurse. For most folks, spring brings to mind warmer weather, longer days, lovely flowers...etc. Me? I think, "Here comes tick season." Ticks can be an issue all year long, but the nymphs are born in the spring. These tiny little ticks are the ones most likely to transmit diseases. There are many varieties of ticks out there. The ones responsible for the majority of disease transmission are the deer ticks. If you want to impress folks at your next cocktail party, our local deer tick is identified as the ixodes pacificus. Although only a small percentage of tick bites are harmful, Tick Borne diseases can have a major health impact, so we need to pay attention. There are multiple types of bacteria responsible for tick borne illnesses. Ticks here in California are known to transmit several different diseases, including Lyme. The rates for tick borne diseases are higher in California than previously thought. A study from 2021 found that about 4% of the ticks tested positive for Lyme. Interestingly that also found that there were plenty of ticks close to the beach! The key is prevention. If you are going to be playing or hiking outdoors near woods or grass, spray the clothing with the bug repellent Permethrin. This is okay for anyone over 2 months of age. Use Deet on exposed skin, avoiding hands, eyes, and mouth. If you are looking for more natural remedies, here is a list of essential oils that are associated with insect control: Lavender - This smells sweet to us but bugs tend to hate it. It can repel mosquitoes, flies and other insects. Lemongrass - this essential oil comes from tropical lemongrass. It has a nice citrusy scent. It is a natural flea and tick repellent that can be sprayed directly on the skin. Eucalyptus - use this alone or along with citronella oil to keep bugs away. According to the Journal of Medical Entomology, eucalyptus extract can reduce tick bites. Lemon - Some lemon essential oil can work against fleas and other bugs. Dilute it and spray it on your clothing and and skin. PennyRoyal - this is a member of the mint family. It is toxic to insects. Be wary of this one.Pregnant women should avoid handling this essential oil because it has been linked to miscarriage. Sorry to say, as much as I love the natural remedies, none of the above are going to work as well as the DEET. If you are going to be walking or hiking try to stay in the middle of the path. Avoid wood piles and logs. Light colored long sleeves and long pants are recommended. But let's face it, on a hot day we are not going to have our bodies covered completely, so here is the deal.... Everyone needs to get a naked head-to-toe body check after a walk in the woods, or a romp in the grass! If you are camping, do a full body check daily. Ticks can hide in out of the way places on your body. Don't forget to check the scalp. If you are dealing with thick darker hair, you can rub your fingertips along the scalp and feel for any bumps. Check between the fingers, toes and behind the ears. Check armpits and belly buttons as well. You need to be very thorough. Many of the ticks are very tiny and hard to see. Be familiar with little moles and freckles so you can recognize a new spot which might be a little tick. Doing a daily body check is a good habit in general. If there are any new rashes, bites or bruises, you will have a timeframe for when they showed up. If you are returning to your home after a hike, use a lint roller to do a quick pass over your clothes. You may be shocked at what you collect from that. Then take off all clothing and put everything in a hot dryer for 60 minutes to kill any wandering ticks.   Don’t forget to check the car seat! it is very important to remove any ticks as quickly as possible. For Lyme disease, the tick generally needs to be on you for more than 24 hours to be a concern. The bacteria that causes Lyme migrates from the tick's gut to its salivary glands before the pathogen can be transmitted. One infectious disease expect at UCSF says that might be 36 hours! If you do find a tick, please stay calm. I have vivid memories from my time at NVP of a mom carrying her toddler into the office. She was screaming (the mom, not the kid) "HELP ME GET THIS THING OUT OF MY BABY!" There was a large tick attached behind her little one's ear. It looked like a Star Trek alien. It was indeed freaky, but put on a brave face for your child. Arachnophobia is appropriate in this case. Ticks are indeed arachnids (the spider family). For the record, the big ones are usually wood ticks and those are not the ones that carry Lyme. The best way to remove a tick is with tweezers or a special tick removing tool. Grasp the tick as close to the skin as you can and firmly pull up and away. Do not twist. This is not the time to try any of the folk remedies such as Vaseline or a burning match. If you own a dog or go hiking frequently, do yourself a favor and get one of the tick removing tools. You can get them from any sporting good or pet store. Amazon has a ton of different brands. Once the tick is out, clean the area with an antiseptic soap. Apply a dab of Neosporin and then keep watch on the area to make sure there is no infection. Okay, We got a tick bite. We removed the tick, but now what??? I am going to have you keep your antenna up for at least 30 days. If there is any odd rash, flu like illness, aches, or fever it is important to notify your doctor. They will want to know the date of the bite, and if possible the region where the tick came from. Any recent travels could provide important data. Unfortunately the blood tests for tick borne diseases such as Lyme are not all that helpful. Frequent false positive and false negative results minimize their usefulness. The tests become more accurate several weeks after the bite, Decisions about when to treat are best made earlier. Testing the tick might make more sense than testing the patient. Keep a little baggy in your backpack or diaper bag. This way you have a place to stick any ticks that you remove.  The Sonoma County Health Department will identify the tick for free. This tells you if it is the type you need to worry about. They can also take it a step further and test it for Lyme disease. The fee for testing is $36 (such a deal.) They don't test the ticks for other illnesses. They do the testing every Thursday and they will have the results by Friday. They say that about 1-3% of the ticks test positive. https://sonomacounty.ca.gov/Health/Public-Health/Laboratory/Lyme-Tick-Test/ 707-565-4711 In Marin they will also test the ticks: https://www.marinhhs.org/public-health-laboratory-services Read the instructions on their website for how to send the tick. Ah, but there are other experts who don't agree that testing the tick is worth the effort. A tick testing positive doesn't mean it was on long enough to transmit a disease. A tick testing negative for LYME might be infected with an illness that we can't test for yet It is possible that there was another tick on the body that you didn't find. Here is the bottom line. Regardless of whether or not you get the tick tested.... Watch the person who has been bitten very carefully for the next 4-5 weeks. A bulls-eye rash around the tick bite site and/or any type of flu symptoms would be a concern. Some of the less frequent tick borne illnesses might have a more diffuse rash. Not everyone gets all symptoms. If there are any suspicious symptoms speak to your doctor. They may opt to do a course of antibiotics. There are new guidelines that emerged in August 2019. In the areas where Lyme is endemic, they may now give a single prophylactic dose of doxycycline. Doxycycline can be associated with tooth discoloration, so it isn't used unless suspicion for Lyme exposure is high. Prophylaxis can be started within 72 hours of tick removal. They don't wait for symptoms to show up. We don't want to treat every tick bite with antibiotics for obvious reasons.  It is a balance. We can't keep our kids in a box. Go out there and enjoy the hike, but then do that thorough body check and you should be fine. Carefully brush out your pets as well!

Horrible Headlines/ We somehow need to 'parent' through it.

 

Horrible Headlines

I can't remember a time when we were not dealing with tough issues. Climate change, gun violence and divisive politics are examples that come to mind. Then along came the pandemic. That alone has had so many parents feeling like they were treading water for the past two years. It is exhausting. Your plates are full. Now there is a war taking center stage. Really? People have reached out to me to ask for advice. Many feel like they have reached their breaking point. How do you manage getting through the daily routines when current events make most of us want to curl up in a ball? Is there a way to completely insulate your kids from all that is going on? The first obvious step is to protect your kids from graphic news stories as best you can. Don’t have the TV droning on in the background of your lives. Are you watching the news from your laptop when they are nearby? That counts. Alas, your children don’t need to be watching tv to know when parents are devastated by things going on out in the world. Kids often pick up on the fact that something is “not right.”  Don’t waste too much energy trying to act as if there is nothing wrong. Talking about things out in the open is so important. It does more than pave the way for future conversations. Honest communication keeps things from feeling like there is a bad secret. As Mister Rogers says, "Anything mentionable is manageable" In any event, avoiding tough conversations won’t make the issue go away.  If your child seems completely oblivious, there may be no need to bring things up. If your child is more intuitive that is a different story. If you think they have a sense that something is amiss, then it is worth addressing it. You could start by asking your kids if they heard that something difficult is going on. Allow them to tell you what they have heard or seen. Make sure any discussions are age appropriate. I wish I had the perfect way to explain what is happening in the world right now. There is no way to make sense of war.  Because so many of us are feeling helpless, so I am sending out this little reminder  There are some things that are within our control and some things that are not. We need to be able to identify which is which. Things Out of our control Others being kind Others being honest Others forgiving us Who likes us The family we were born into The color of our skin Past mistakes Natural disasters Death Taxes Power hungry dictators Lets focus on things that are in our control. Being kind Being honest Friends we choose Taking care of ourselves Working hard Apologizing Asking for help How we respond to others What we do in our free time Volunteering our time (if you have a surplus) Donating to a worthy cause (if your own needs are met) Seeking out joy Yesterday I walked up to the top of Twin Peaks with my brother-in-law Richard. At the beginning of the pandemic we used to pop up there a few times a week. It has been months since we did that walk. This time there was a bit more huffing and puffing on my part. I am thrilled with the fact that my body graces me with the ability to get up there without passing out. For that hour I tried to turn off any negative thoughts. Richard has the habit of pointing out the gorgeous plants and flowers that we pass. And then there is the spectacular view which is a reward all by itself. How can I feel contentment when the world is in so much turmoil? How can any of us? Because we must.  By no means should we afford ourselves the luxury of ignoring what is happening in world these days. It is essential to listen, pay attention, learn and support each other. Allow yourself to feel heartache over current events out there in the macro world. How can you avoid it!  But parents, if you can, put some limits on it. Let your kids witness that you are still letting some light into the dark. If your microword is intact, revel in that. Find the joy. That is an essential lesson all by itself. For more resources on talking to your kids about the situation in Ukraine. Check out this post from Plinkit

Talking to your kids about differences

 

Talking to your kids about differences

You are in line at the supermarket. “Daddy, why does that person have only one arm?" "Why does that person talk funny?" "What happened to that person's hair?" The questions or statements are usually quite loud. You and your child are suddenly much more entertaining than the National Enquirer. It may make an amusing anecdote some day, but in the moment it feels awkward and embarrassing. Having some discussions ahead of time can be useful. These chats can start with conversations about how everyone is the same and different. How are people different? They might have different hair, different colored skin, different language, different sizes, different families, different beliefs and different abilities.  How are people the same? Everyone needs to eat, sleep, breathe and poop. Most people want to have a friend. It is a great exercise after noticing that someone is different to follow up with finding things in common. There are some awesome children's books out there that can be an excellent resource.  One that Lauren reads to Elliot is aptly called Same but Different. There are many with the similar theme.  Also make sure to talk about what things actually matter! Having someone who is kind is much more important than how tall they are. Society places way too much value on appearance. Wouldn’t it be nice if we could change that? Talk about how everyone has things that they are good at. Someone who can’t see might have exceptional hearing. Expose your kids to people who don’t look like you. Make sure that the books you read have many colors and ethnicities represented. When you draw, make sure you have crayons in all the lovely shades of skin that make up the human race. While there is certainly a time and place for everything, where kids are concerned, it is more often when we refuse to talk about something that it becomes dangerous or scary. One anecdote that I have shared in the past stems from a walk down Haight street many years ago. It was mid October and my family was shopping for Halloween costumes. A man walked past us. He was painted shiny gold from head to toe. Other than that, he was completely naked. Sandy, Lauren and I did a little double take. Alana walked right by and didn’t even pay any attention. That right there is the definition of someone who was born and brought up in San Francisco! The world would be so much duller if everything was the same. Variety makes things so much nicer and more interesting This conversation doesn’t even need to start talking about people. When you take a walk, point out all the different kinds of flowers that you see. Some are big, some are tiny. The different colors are fabulous. They all have different smells. Some have thorns. The message here is simple. It would be a shame if everything were the same. So many things in the news today are a stark reminder that human beings become tribal very easily. ‘Us versus Them’ is all too common of a theme. I would like to think that kids aren’t born that way. Hatred and intolerance are taught. Young children are drawn to people who look like themselves. Dr. Ted has some interesting data on this at the end of the post. It is the adults in their lives who need to give the message that it is safe to connect with others. Teach your kids to have curiosity and respect for the cultures of others. Don’t forget to enrich them with your own culture and traditions. Tolerant, curious, and open minded kids are the hope for our future. Alas there is nothing simple when it comes to the discussion about race. Obviously the deeper and difficult topic of racism needs to be age appropriate.   If we ever want real change, it is essential that parents start from the very beginning to teach our kids to accept and celebrate others, rather than fear and vilify someone who is not exactly like them. February is both Black History Month and the month when Chinese New Years celebrations take place, so it feels like a great time to pay attention to this issue. Oh, and the supermarket situation? Maybe your child will be like Alana and not notice! But the conversation ahead of time could be: “Some people are happy to talk about what makes them different. Some people are not. It is important to make sure that we don’t make someone feel awkward. If you see something that you have a question about, let me know and when we get home we can see if we can find answers together.” This topic can feel triggering for many people, here are some extra important words from Oath's Therapist Brittany Williams.  Brittany’s Tidbits:  When we become parents we do not stop being human. That means our ability to subconsciously react does not magically disappear. If given the choice, most people would always prefer to respond with consciousness than to subconsciously react. One way to decrease the gap between the two experiences is by increasing mindfulness.   Take a moment to check-in with yourself and mindfully listen to how you organically responded as you read this article. If you aren’t sure I encourage you to re-read the blog and this time, tune in and listen to what surfaces from within. What thoughts did you see cross your mind? Did you move close to a stress response (hold your breath, tighten your fists, clench your jaw, etc.) at any particular part? Perhaps you disagreed or were perfectly aligned? Maybe even a past experience came to mind. How did you interact with this material? Did you skim verses slowly digest?  Whatever comes up for you, use this intel to deepen or adjust your own level of comfort with differences. Perhaps engage with a trusted confidant, mentor, or mental health provider if you feel that would be helpful. Taking the time to do this can decrease your odds of reacting and increase your odds for responding during those supermarket moments. Lastly, a gentle reminder for all parents when you find yourself parenting from a triggered or reactive state: Your reaction is not because your child is behaving a certain way or has said something socially or otherwise inappropriate. Your reaction is always because of what that behavior means to you, and that is triggered from your own past experiences.         Dr. Ted’s Research Soon after young infants develop the ability to recognize faces, research shows that they can distinguish between faces of different colored skin. This can be as early as 3 months, but is usually most apparent between 6-9 months. You can imagine why this skill is advantageous from an evolutionary psychology perspective: we want to be able to determine who’s in our “tribe.” However, it’s not till much later (around ages 3-5) that children gain the ability to describe differences between themselves and others, such as gender qualities, the construct of race, and so on. This is the prime age to teach acceptance of variability, and kids tend to be very receptive to it!

How to make fish a safe part of your child's diet

 

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Trying to navigate good nutrition can feel so challenging. It feels even more essential to have solid information if you are pregnant or feeding your children. The messages seem to shift frequently enough to make your head spin. Soy, gluten, sugar, rice, eggs, coconut oil.. Are there really magically healthy foods out there? Even more importantly, can certain foods really impact our health negatively? Fish is one of the more confusing ones. Most people agree that eating fish is a really good source of protein, vitamin D as well as two omega- 3 fatty acids, DHA and EPA, that aren’t abundant in other foods. In fact the 2020 dietary guidelines from the USDA and HHS specifically call for making sure that fish and seafood are included in a healthy diet. According to the American Heart Association,  while there are plenty of supplements on the market, they are not quite as good as the real thing. Unfortunately, these days many types of fish are contaminated with mercury. Mercury is a problem for people of any age but it can have a greater impact on unborn and young children. This is because it can act as a toxin that inhibits natural growth of the brain and nervous system. Elevated levels can lead to neurological and developmental delays according to the Environmental Protection Agency (EPA). Of course fish are by no means the only source of potential mercury contamination. Old Thermometers, fluorescent light bulbs, cosmetics, older dental fillings and some water can all be unwitting sources. Most of those can be avoided if you are paying attention. Fortunately water can be effectively filtered, (boiling will not do the trick). Alas we have no way of removing mercury from our fish, so we have to choose the safe ones to eat. Some fish have a much higher concentration of mercury than others. Some of the biggest culprits are farmed saltwater fish such as the yellowfin, Albacore and Ahi Tuna.  If you want to go deeper and get solid information about where all that mercury is coming from, click this link https://anglers.com/news/mercury-in-fish/ The fish that you choose makes all the difference. There are new guidelines available to help you navigate this. https://www.fda.gov/food/consumers/questions-answers-fdaepa-advice-about-eating-fish-those-who-might-become-or-are-pregnant-or There are several excellent guides to take with you to the market https://www.nrdc.org/stories/smart-seafood-buying-guide https://www.seafoodwatch.org/ Based on their mercury levels, fish are grouped into: Best choices oysters, salmon (wild and Alaska, canned or fresh), sardines, scallops, shrimp, squid, and tilapia. Good choices Atlantic croaker, Atlantic mackerel, catfish, crab, crawfish, flatfish (flounder and sole), haddock, mullet, pollack, and trout. Fish to avoid bigeye tuna (often used in sushi. This is not the stuff in the can!), Gulf tilefish, king mackerel, marlin, orange roughy, shark, and swordfish. Women who are planning on getting pregnant, those who are pregnant or breastfeeding and young children should NOT eat anything from the last category. Canned tuna is tough to figure out and it depends a bit on who you ask. I wasn’t able to get consistent recommendations. In 2014 Consumer reports went as far as suggesting that pregnant women avoid it all together, but for young kids, it likely falls in the middle category and is fine to have on a limited basis. The albacore (sadly this is my preference) has 3 times more mercury than the chunk light. The advice is to give 2-3 servings per week of the best fish or 1 serving a week of the good fish. A serving is considered 4 ounces for anyone over the age of 7. For kids 4-7 the serving size is 2 ounces. No parental guilt if you give fish from the middle category! Since most of us don’t have a food scale in the kitchen, a good trick is just use your palm. An adult size palm is roughly 4 ounces. Don’t make yourself too nuts trying to weigh and measure the portions. Any parent knows that kids will eat what they will eat, and some of it is going to be tossed on the floor and fed to the happy pets. Be aware that fish makes it to my list of high allergy foods. When you give it for the first time, make sure you keep an eye on your child. Severe reactions will generally show up within an hour.  Thanks so much to COTY the bass guy for motivating me to do this post! Ironically, bass didn’t show up on the list. I asked him about that! He told me that since bass is typically found in murky conditions, it gives them a muddy taste based on what they consume. While taste might not be the best, health-wise, it is perfectly safe to eat.

Croup 2022

 

Croup

Croup is making the rounds.  The official name is Laryngotracheitis. For obvious reasons most people simply refer to it as Croup. Much of the time Croup is viral rather than bacterial; antibiotics are not an appropriate treatment. This illness causes inflammation in the upper airway. The air passages in the throat narrow due to the swelling. This often leads to breathing that is noisy and sometimes labored. Croup is so common that it was actually one of the first illnesses that I addressed in a blog post many years ago. It tends to afflict patients between the ages of 6 months - 6 years, but anyone can get it. Many seasonal viruses can lead to infections in the respiratory tract such as Croup. The most familiar ones include RSV and parainfluenza. Now it seems that the Omicron variant of Covid-19, is on that list. Omicron settles higher up in the respiratory tract rather than deep in the lungs, so that makes sense. Having Covid involvement does not impact the treatment. Take comfort in the fact that doctors are quite familiar with this and know what to do! Croup is quite contagious. Usually kids will start showing some symptoms within a day or two after the exposure. Some children who get exposed to this virus will end up with the symptoms of the common cold. Others get the classic croupy cough. (Think Darth Vader) There are actually two distinct presentations. Many patients will start off with a cold, sore throat, hoarse voice and mild fever. This progresses to the deep barky cough. Most kids are sick for 4 - 7 days. It is normal for the cough to linger for a week or so even when they are otherwise on the mend. Others have acute spasmodic croup. With this, it is typical for the symptoms to start without warning in the middle of the night. Your child may have seemed fine when they went to sleep but then they wake up in the wee hours sounding like a seal. This can freak out a lot of even the most hardy parents. Your job is to keep your cool and do your best to keep your child from getting any more agitated. Head into the bathroom and run a hot shower. Sit there in a steamy room (you don't need to be in the actual shower) and sing in a soft voice. See if you can get them calm. It is time to head to the emergency room if your child is excessively drooling and has a tough time swallowing, seems agitated, or breathing is getting more labored or is showing signs of “stridor” at rest (when not agitated or crying). More than half of the time, your child will be dramatically better by the time you get to the ER. Somehow getting out in the night air is quite helpful. The spasmodic type of croup usually lasts about three days. The kids seem to be almost normal during the day but the cough comes back at night. Take a deep breath, the first night is usually the worst. Running a humidifier during the night is often very helpful. If you are nerdy enough to have a hygrometer, 50% humidity is the sweet spot. For mild cases rest, steam and fluids will get you through. For more severe cases your child will likely get a dose of steroids that will calm things down. Dr. Ted’s Tidbits Croup can be really overwhelming for my patients. As soon as they hear a barky cough, they’re sprinting to the doctor’s office.  The barky cough just tells me that there is swelling in the larynx and trachea, which is almost always due to one of a multitude of viruses. That in and of itself, does not always need treatment, but you can call your doctor to ask what they think. I’m the most curious about stridor, the high pitched noise that can be heard when breathing in. I recommend looking up stridor on youtube videos. This happens when the swollen tissue collapses inward during inspiration, and always needs a call to the doctor.

Keep a Journal 2022

 

Keep a Journal

It’s the first week of the New Year. This is often the time when people find themselves making all sorts of plans for how to generally improve aspects of daily life. And then there are most parents who don’t want to hear about resolutions. Getting through the day intact is a win. Having five minutes of privacy when you poop would be an even bigger win (dream on). I hear you. All those grandiose plans about cutting down on sugar and screen time don’t end up lasting all that long anyway. But for any of you who are feeling ambitious, I have a suggestion for one resolution that is fairly easy to keep. This will be useful and has the potential to bring plenty of smiles in the years ahead. Start keeping a journal! Sure, we all take a lot of photos and movies these days, but there is nothing like the written word. If you haven’t done it from the beginning, it is never too late to start. Having things written down can be a valuable resource. I am not advocating keeping a list of every time your child pees (yes there are parents who do that; you know who you are) but knowing how often your child has had strep throat, an ear infection or any significant illness can be quite handy. Especially if you have more than one child, it is often easy to get things mixed up. I have had more than one patient who has said, “I know one of my kids got a rash on Amoxicillin, I am just not sure which one.” I actually started keeping a general journal when I found out that I was pregnant for the first time. Clearly you don’t need to write things daily, but keeping track of milestones and fun things that kids come up with can create a wonderful database of stuff that you are sure to refer to and enjoy as your children grow. My journal unfortunately does have some huge gaps, when I never got to it; just do the best you can. Keeping record of milestones and illnesses alone makes keeping a journal worth the effort, but immortalizing memories and anecdotes is what makes it fun and even more valuable. We have tracked all kinds of odd statistics. My daughter Lauren has been on 428 flights. My youngest daughter Alana has been on 287. Two of Lauren’s flights were skydiving expeditions and both of my girls have managed to be at the controls flying a private plane. (This mom knows how to feel somewhat proud and somewhat horrified at the same moment.) Yes of course we are tracking my grandson Elliot who is already up to 9 flights! If you give me a moment I can also retrieve all sorts of random facts, like the first movie they ever saw in a movie theater and when they lost their first tooth. Is there something fun about the milestone? Write it down!  For Elliot, I was lucky enough to be with him when he crawled for the first time. He didn’t seem all that interested in getting from point A to point B and Lauren had just invested in a little crawling ‘master class’ from a physical therapist that she follows on instagram. As those things go, buying it was the only thing necessary, because the crawling happened before she had a chance to even look at it. We were playing in their living room when the baby spotted a small but nasty little piece of a chewed up dog toy a few yards away from him. You could almost see his little brain working as he locked on that target and off he went. He never looked back, and as is often the case, most of his early destinations were not towards the little toys that we would shake enticingly. But let him spot a little piece of fuzz, and he was off on a mission. What started out as my personal musings written in a notebook, morphed into a family journal when I transferred it to a word document. If you like you can create a shared document that both parents can add to. Google drive worked for us, but there are tons of apps out there that would do just as well. (Make sure you backup any important documents!) In our journal (both kids share the same one) daddy’s voice was written in italics. My husband Sandy had the wonderful habit of documenting conversations. The following was from when Alana was seven and daddy was picking her up from school: Alana: I'm doing a picture in reds and pinks. Sandy: Why? Alana: Because Van Gogh had a red period. Sandy: You're learning about Van Gogh? Alana: Yeah. And then I'm going to do a painting in different shades of blue. Sandy: Why Alana: Because Van Gogh also had a blue period. Sandy: Well that's terrific. Alana: And Miss Price is going to bring a real artist to class so he can teach us. Sandy: Well that will be very exciting. Alana: But it won't be Van Gogh because he's dead! In our case I am delighted that we were able to track early milestones like first words and motor skills. Over the years random facts like teachers names, the revolving door of boyfriends and life events have all been documented. One of my favorite posts recounts about the time that 5 year old Lauren and I took a family ceramics class at the local Randall museum. At the start of the first class, the instructor had everyone get a feel for the clay. We stretched and pulled it into all sorts of shapes. As we played, the teacher asked ”Who knows where clay comes from?” Lauren was never shy. Without missing a beat, she called out the answer in a loud, authoritative voice. “Cows! Clay comes from cows!” There was a moment of stunned silence as all the grown ups at the table did our very best not to break out in laughter. “Hmmm”, said the teacher, handling it very nicely. “Great guess, but it actually comes from the earth.” Cows?? I remember that being one of the hardest giggles I ever had to stifle. Laughing in the face of my five year old was not something I wanted to do. Kids do come up with some wonderful stuff. Another one that became part of family lore was the time that 3 year old Alana bit her sister: Mommy: “Alana, why did you bite your sister?! You know you shouldn’t bite!” Alana: “I forgot not to.”  That “I forgot not to” line still comes up every once in a while. When does it stop?? My kids say never. They especially insist that I keep up with their flight tallies! (We still count every take off.) You might be dealing with any of the more challenging aspects of parenting like sleep deprivation, the “terrible twos” or teens that are giving you a run for your money. Warning - time zips by. Blink and they are out of the nest. Carpe Diem! The online journal is a great way to capture moments forever. Grandparents might want to start their own version. A new friend that I met on my recent trip recounted an experience. Her twin grandsons were visiting. Clearly she wasn't in the habit of locking the bathroom door. One of her 5 year old grandsons showed up in her bathroom while she was in the shower. He was wearing a hat and carrying a fishing pole: “Grandma, You need to stay where you are for a bit. There is a triceratop in your bedroom, but don’t worry about it, I’ve got this.” Capture your moments!!