Tips for giving medicine/A useful list of considerations when giving any medication

 

Tips for giving Medication

Parents have to pick their battles. Sometimes things aren’t so important. Does your child insist on getting the favorite but dirty shirt out of the hamper and wearing it for another day? Not such a big deal. I am a big believer of the “Don’t sweat the small stuff” way of thinking. I am also a fan of discussion and compromise when appropriate.  But once in a while, you need to establish that you are the ultimate decision maker, especially when there are health and/or safety considerations. Most of the time, the ‘medication battle’ is one that you need to win. Let's assume that your child has a condition that needs to be treated. If this is the case, have a firm but loving attitude. (Think Mary Poppins and her spoonful of sugar.) Make it clear that you mean business. Your child will be getting the medicine, one way or another. This is not a choice. For young infants, take advantage of their natural sucking reflex. There are some useful products available to help administer meds: Frida Baby Dr Brown If they are resisting, use the following technique. Hold them at roughly a 45 degree angle. If they are flat they are more likely to aspirate. If they are sitting up too high they can spit. Getting the right angle makes a big difference. Wrap them in a blanket (think straight jacket!) This will keep them from being able to use their arms to knock the medicine away. A syringe is much more effective than a spoon and is better for measuring. Make sure the numbers haven’t worn away. Dr Hurd suggests asking the pharmacy or your doctor's office for a fresh one at the first sign of any wear. Squirt a small amount into the side of the cheek. Keep the chin elevated. Give a tiny bit at a time and wait for a swallow. The key to this method is not giving too much at one squirt. For a 5 ml dose of something I would break it up into 10 squirts of .5 each time. Here is a rather amusing TikToks of Dr Ted and I demonstrating the technique Accept the fact that your child may be crying and screaming throughout the process. It usually gets easier. Allow yourself ample time for this. If you are rushed, you will be more stressed and apt to get aggravated. This method can be used with any age as needed. The only kids that can beat this system are the ones that learn how to vomit. Okay, what are your options if you have a vomiter on your hands? If your child needs antibiotics, sometimes they can get an injection. ( As tempting as it might be, please do NOT use getting a shot as a threat) If you are trying to get in a dose of fever reducers, suppository form might be your best option. If you have an especially challenging kid on your hands, see if there is a compounding pharmacy near you. A good compounder can make medications in different flavors such as grape, strawberry, marshmallow etc. Other meds can be made as liquids, suppositories or topical gels. My compounder of choice is Eddie Lau over at Feel Good Compounders. The phone is 650-898-8221 or info@feelgoodcompounders.com Be aware that compounds need an in-state prescription even for over the counter medications. Ideally you don’t need to use force. For kids who are old enough to reason, give them some choices: What would they like to drink after the medicine?  Should we have the pharmacy add a flavor? Would they like to try holding a lollipop and taking a lick after each squirt? If they cooperate and do their best to get the medicine down, make sure to give them lots of positive feedback! Don’t wait until your child is sick to teach them about cooperation with medicine. Try doing some role playing ahead of time. I have several approaches. Make it a game with some role playing. Have one cooperative stuffed animal and one stuffed animal (or doll) who is not going to take that medicine without a fight. The cooperative doll says things like, “ I know this tastes a little yucky, but it is really important and it will help make me feel better". You then respond, "I am really proud of you for being so cooperative." For the challenging doll, wrap the arms in a blanket the way you may have to with your child. say, "I am sorry that this is so hard, but it is very important for you to take this medicine." You might also let them pretend to be a parent who has to give the medicine to the uncooperative doll. Don't make it easy. Role reversal can give both sides some insight. If you don’t have the energy to put on a show, you can simply tell a story.  “Once upon a time there was a little boy named Gus who had an ear infection. He needed to take medicine, but it tasted yucky and it made him scared to try. His mommy gave him some fizzy juice and every time he took a bit of the medicine he quickly took a sip of the juice. He was so proud when he took it all, and soon his ear started to feel all better!" Incentive or rewards You can always have a standard sticker chart. Or if you are feeling more creative, another reward method is to make it possible to earn 10 pennies per dose. This will appeal to all the future business people. Put the money on the table. It is theirs to lose. Remove a penny for every 30 seconds that passes without cooperation. Kids hate seeing something concrete being taken away. If your child is old enough, this is a great math opportunity. A 10 day, twice daily course of antibiotics can be worth 2 dollars (adjust the reward however you choose.) Role playing, rewards and giving some choices will only go so far. When it is medicine time make it clear that any discussion will last no more than 5 minutes. Set a timer. When time is up, they can either cooperate or be wrapped up and given the medication in the method I describe above. When the kids realize you mean business they often stop the vigorous fighting after a few doses. If they think they can change your mind, they will continue to struggle. Here is an assortment of other tips, tricks and considerations. Not all medical records communicate as well as I would like. If your child is on any medications, take all of the meds with you (in the original containers) to your doctor's visits. If you can’t take the actual medication, at the very least take a photo. This is especially helpful in an urgent care situation when they don’t know your child or their medical history. Make sure you understand any medications that your child is taking: Dosage Storage Interactions with food or other medications Should it be taken on empty stomach or not Any special issues with sun exposure? Do NOT hesitate to ask your pharmacist, advice nurse or doctor if you have any areas that need clarification. If the dosage or quantity seems odd to you, ASK!!! I have seen medication errors avoided because the parents were savvy enough to express concern. Check your child’s body and skin before you give the first dose of a new medication. This way there will be a clear timeline if a rash shows up. Don’t try to sneak medicine into a larger volume of food or drink. Your kids will know it is there. If they do end up taking only part of it, you will have no real idea how much of it they got.  Your kids are not necessarily putting on a show. Some medications are really bitter. The generic ones are often the biggest culprits.  Make sure to do a thorough teeth brushing after taking a liquid medication. Many of them are syrupy and full of sugar in order to increase compliance. If your kid constantly fights taking liquid medications, consider trying to teach them how to swallow pills. You would be surprised how some really young kids can have success. Start with tic tacs or other small pieces of candy. See if they can swallow one. If they fail, oh well. They have a piece of candy in their mouth. If they can’t swallow it with water, try putting it on a spoon tucked into some yogurt or jelly and see if it goes down. Remember you are doing this with your child’s involvement. No sneaking things. Don’t lose their trust over something like this. You are on the same team, trying to help them feel better. Once they manage to get the tic tac down, ask your doctor what pill forms are available. Some children take a daily medication or vitamin pill and quite like them. Dr. Hurd cuts the gummy vitamins in quarters. Her kids have a positive association with taking something daily and there is no fussing involved. The problem can be when they like them too much! I remember a 9 year old patient who had a mysterious ongoing stomach ache. After some questioning, it turns out that he was helping himself to a handful of gummy vitamins daily. It is important to have all medication and vitamins stored safely in a childproof container. When I was a kid, my mom had our chewable vitamins tucked on a high shelf in our pantry. I have clear memories of my sister Marjie and I climbing on a stool to get them down and have “vitamin parties” . I firmly place all blame on my older sister here. She was usually the one with all the grand ideas. Fortunately we limited ourselves and didn’t have any consequences that I am aware of. Remind your children that medicine and vitamins are NOT candy and can only be given by a grownup. (I imagine that my mom did that….) Realize that that might be useless and take a moment to evaluate how ‘childproof’ your situation actually is, in case you have a little Marjie. If there is ever an overdose concern, call the Poison Control center. Poison Control number for California is 1-800-222-1222 Measurement guide Measuring Spoon Metric (1 mL = 1 cc) 1/4 teaspoon = 1.25 mL 1/2 teaspoon = 2.5 mL 3/4 teaspoon = 3.75 mL 1 teaspoon = 5 mL 1 ½ teaspoons = 7.5 mL 2 teaspoons = 10 mL 1 tablespoon = 15 mL 1 ounce = 30 mL Special shout out to Dr Sophia Hurd for doing a read through and adding some extra pearls.

April Tuesday

 

Today is April Fools Day. It brings to mind a story that always makes me smile. When Lauren was in first grade her class worked on creating calendars. She painstakingly entered family birthdays, holidays and special events that were important to her. She proudly showed us all of her work and we looked through the decorated months. April proved to be the most interesting. On April 2nd of course, she noted my birthday, but on April 1st, (which fell on a Thursday that year) she had carefully written in April Tuesday. Huh? “Lauren, this is a beautiful calendar, what is April Tuesday?” “ You know, April Tuesday, when we play tricks.” Oh! April Fools day! All this time, she had heard April Tuesday!  “April Tuesday” what a clever brain you have, I can understand how April Fools Day sounds like April Tuesday! And sometimes it is on a Tuesday!" For the record, in my family, April first has been April Tuesday ever since.  Another classic from Lauren came to our attention when we were on a family car trip. We were doing some singing when we realized that the lyrics to the classic song Puff the magic Dragon had gone through some changes. ‘Noble kings and princes would bow whene'er they came’ had become “ noble dooble princes would bow wherever he came” In the very next verse, ‘A dragon lives forever, but not so little boys’ was turned into ‘ a dragon lives in butter’ It was hard not to chuckle. Lots of families have stories of things that their kids hear and pronounce in novel ways. Here is the tricky part. Parents need to tread carefully. There is a big difference between laughing ‘at’ someone and laughing ‘with’ someone. Some kids love telling jokes, putting on a show and eliciting a giggle from their audience. Other kids are more sensitive and could get their feelings hurt if you end up laughing at the odd things they come up with. Know your kid, If they are able to have a good time with it, have a good laugh together. If not, write it down. Someday I assure you that they will love looking back at some of their own personal Mondegreens. If you haven’t heard that term before, a Mondegreen is a term that writer Sylvia Wright came up with in a 1954 essay in which she tells about how she misunderstood a line from The Bonnie Earl O’Murray. The correct line was “laid him on the green’ She heard this as ‘Lady Mondegreen’. This one little error became the term for these butchered lyrics. If you google it, there are quite a few lists of common misunderstood words to songs. If you are in need of a laugh, some are quite amusing. (My all time favorite is from the Beatles Lucy in the Sky with Diamonds. Instead of the real words, “The girl with kaleidoscope eyes”, people have heard “The girl with colitis goes by.”) Before I end this post, I want to make one more note about April Fools Day. I would love it if parents had a conversation with their kids about tricks in general. In an effort to teach our kids to be kind, there is a simple question - will a certain trick make someone laugh or cry? If the answer is not clear, maybe that trick is not such a good idea.

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.