It is suicide prevention awareness week. That makes this an appropriate time to address the stigma of mental illness.
I can’t cure it and I can’t fix society's shortcomings, but just perhaps I can touch the people who read my posts. Sometimes just getting the conversation started can make it less taboo and that is a reasonable first step.
The elephant in the room is Mental Illness.
Here is a startling statistic: According to the World Health Organization, one in four people will be affected by a mental health concern at some point in their life. Either you or someone close to you has dealt with or is currently dealing with this issue. You might not even be fully aware of it! There is often so much reluctance to be open about it.
Parents call me dozens of times a day to talk about physical illness. Sure, if they are calling from work, they might talk in a hushed voice if we are discussing diarrhea or an itchy penis, but there is no shame involved. Okay, perhaps head lice and pinworms have a wee bit of shame (they shouldn’t) but there is generally no stigma associated with physical ailments. I hope you get where I am going with this.
I also get the other calls. These parents are often so tentative as they reach out to share their concerns regarding depression, anxiety, or symptoms related to their child's mood or behavior. When I tell them how often I have these discussions about my teenage patients, most parents are a combination of surprised and somewhat relieved to need feel quite so alone. I am grateful that those who have known me for many years trust me enough to have the harder conversations. How is it that we have managed to suppress the acknowledgement about how common it is?
Think about our bodies. We all deal with a variety of illnesses or discomfort. Many things are mild enough that they don’t impact our daily routine. A mild sniffle probably won’t keep you home from work or school. Some little acute illnesses come and go. Some illnesses are more chronic but can be managed with medication and treatment. Regardless of what is going on, we allow ourselves to talk about it.
Mental illness has some similarities in that it has an extreme spectrum. It can be mild enough that folks can go about their daily life without letting on to the families and co-workers that they are struggling. Some could describe this as ‘managing’, but what an awful burden this places on the person who feels the need to struggle in silence.
Some mental health issues are more chronic. Life is being impacted. These folks need treatment and/or medication. With the correct medication or therapy, many folks are functioning just fine.
Find me someone who never gets anxious and depressed! You likely can’t. We all get a bit out of whack at times. If we are able to talk about it before it overwhelms, that has to have some merit.
There are certain small actions that we can take in our families and circles of friends to try to rid ourselves of the stigma.
Make sure you find the time for the conversations to happen.
With our children, let feelings be okay. ANY FEELINGS.
If someone is crying or feeling sad, don’t diminish it with a simple “ it will be okay, or don’t cry”
As a parent, I know what is is like to watch someone who we love have to deal with this. My daughter Alana suffered from some anxiety when she was in college. Until we figured out what was happening, she had a few difficult years. Alana was having a feeling of chronic “throat tightness.” This lead to the occasional feeling of breathlessness and she would wake her up gasping for air. Sleep deprivation followed. This created a spiral that understandably lead to anxiety.
Fortunately we were able to make the connection that gluten was significantly involved in her symptoms. Alana is a bit unusual in her approach. She widely announced to the world that she was having anxiety issues. Her friends responded. Shockingly high numbers, she hadn’t realized, were in therapy or already on meds. They barraged her with suggestions of various tools that had helped them. Coloring books, tapping, meditation, hypnosis. Some things gave some moments of relief, but in her case the underlying physical cause needed to be dealt with first. A wise friend once said.”You are only as happy as your least happy child”. I find that to be all too true. In the midst of her anxiety waves, I would feel like I had a fist clenched inside my gut.
My daughter is fortunate that she ultimately had something that she has some control over (although she points out that being super allergic to gluten sucks.) She is also a rare person that she never allowed herself to feel isolated or shamed.
After college, Alana went on to work for several years as a counselor and trainer at the SF Suicide Prevention hotline, before getting her Masters in Social Work. After graduating, she worked for several years in a community mental health center with clients of all ages. She acknowledges that as a therapist now, her firsthand experience with anxiety gives her extremely valuable insight.
Here are some tips that she shares:
The internet is full of some really solid suggestions.
If you are concerned that you are seeing behaviors that are impacting daily life, please be open to therapy. My opinion? Everyone would probably benefit from therapy. Therapy equals tools...who doesn’t need tools? Sometimes you might need to try a few different providers before you find someone who feels like a good fit. Don't give up.
A good therapist can help you identify an issue that might need further treatment. They might advise seeing a psychiatrist to get started on some medication. Medication is not always necessary but in some cases can help achieve the balance that is lacking.
The American society for suicide prevention states:
Although there is no single cause of suicide, one of the risks for suicide is social isolation, and there’s scientific evidence for reducing suicide risk by making sure we connect with one another. We can all play a role through the power of connection by having real conversations about mental health with people in everyday moments – whether it’s with those closest to us, or the coffee barista, parking lot attendant, or the grocery store clerk. It’s also about the connection we each have to the cause, whether you’re a teacher, a physician, a mother, a neighbor, a veteran, or a suicide loss survivor or attempt survivor. We don’t always know who is struggling, but we do know that one conversation could save a life.
I love to take urban walks with my friends. One of my walking partners is my amazing friend DeeDee. Not only does she pick up litter from the sidewalk and stop to ask anyone who is holding a map to see if they need directions, but she always has her antenna up to see if there is someone out there in need of that one conversation or outreached hand. She was moved by the story of a man who survived a suicide attempt from jumping from the Golden Gate Bridge.
This brave man is sharing his story widely in the hope that he can help others. He talks about the day he jumped. He had told himself that if someone had noticed him and said, “Hey, are you okay?” he likely wouldn’t have gone ahead with it, at least that day. Instead, although he was surrounded by many, he felt completely alone. Finally someone spoke to him.
“Hey, can you take our photo?”
He jumped.
Ever since she heard that story, if DeeDee sees someone alone and looking sad, she stops and reaches out.
“Are you okay?”
SF Suicide Hotline 415-781-0500
If you would like to take a class in Youth Mental Health First Aid here is a link: https://www.mentalhealthfirstaid.org/.../course-types/youth/ |
There are so many different factors to consider when facing most of the common parenting issues. The Nurse Judy approach is a combination of many years of medical experience, a desire to treat things as naturally as possible, a large dollop of common sense. email nursejudysf@gmail.com to be added to my weekly email list
Friday, September 14, 2018
The stigma of mental illness
Friday, August 31, 2018
Anaphylaxis/Epipen options
Anaphylaxis/Do you need to carry injectable epinephrine?
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Anaphylaxis is a very severe allergic reaction that can occur within moments of exposure to an allergen. People can die from this if it isn't treated. It can be triggered by an allergy to a particular food (peanuts or shellfish are among the most common), biting or stinging insects (like bees), medication (like antibiotics), latex (the type of rubber many balloons are made from) or a variety of other allergic triggers. Allergic reactions occur when the body mistakenly identifies something as harmful and overreacts. With anaphylaxis, this reaction can be life threatening. Symptoms usually start within seconds or minutes of the exposure, but there are exceptions. Once in awhile, a reaction can be delayed by several hours. This of course makes it much harder to figure out the culprit.
In an anaphylactic reaction there may be different parts of the body involved.
The first time that someone has a severe allergic reaction is very frightening. Unfortunately subsequent reactions can be even more severe. It is essential to recognize symptoms that need immediate attention.
Several years ago, a patient in our practice had been given yogurt for the first time.The child’s face began to swell and she started to have labored breathing. Mom’s first instinct was to call me; I redirected her to call 911 immediately. If it feels like an emergency situation, 911 beats the advice nurse. Of course, we want to be kept in the loop and help with any follow up. This child turned out to be severely allergic to milk. Interestingly she had no trouble with breast-milk. It is very important that folks figure out what the trigger is so that the you can try to avoid future reactions, although there are cases that remain a mystery.
Knowing that your child is at risk for anaphylaxis is very unnerving to say the least. It is very important to educate your child (age appropriate) and all teachers and caregivers about how critical it is to keep your child from being exposed to the allergen.
One case comes to mind of a school aged patient who was at Costco with some friends. The child was allergic to nuts. The friends parents allowed him to taste something from one of the samples. They had done a cursory check of the ingredients and thought it was safe. It turned out the the knife used to cut the samples had also been used to cut something with nuts, and the child ended up in the ER. Some kids are so sensitive that cross contamination (in this case, the knife) can cause a full reaction.
Here is another story of one of our patients with an anaphylactic reaction:
This little 9 month old was already teething and fussy, which complicated things. She also is prone to eczema, so rashes are not unusual. The family had had a recent checkup and had come home motivated to increase solids and calories to fatten up their slender child. Dinner that evening was some Chinese take out. Our little patient was offered bits of foods from the various containers. They didn’t offer any foods that struck the parents as obviously new, but one of the containers was a shrimp dish. Although the baby didn’t actually eat any shrimp, she started to get very fussy and swiping at her face and ears.
After several moments of excessive fussing from no overt cause, mom and dad opted to give her a bath and start the bedtime process. When they removed her clothing they saw that she was covered with hives. At that point they wisely opted to go into the ER. It had been about 20 minutes since the food. The baby was fairly inconsolable and her face and ears were swelling. Luckily she did not appear to be having labored breathing (that would be a reason for a 911 call.) Once in the ER she vomited. She was given epinephrine and kept overnight for observation. She was singing and happy the next morning with no seeming ill effects. The current plan is to avoid any mystery foods and follow up with an allergist within a few weeks. The family will have an epipen on hand just in case.
As a caution, I recommend to try all first time foods when there is time to observe for a little while to make sure there is no reaction. Giving something brand new and then putting a baby straight to bed is not a good plan. This is especially important with high risk foods like nuts, milk, eggs, shellfish, and any medication. It is also a good idea for every household to own Zyrtec liquid (scroll down for dosage chart.)
If your child is old enough,talk to them about the fact that just about everyone has a little something special going on, and it their case they need to be careful about whatever their trigger is. Check out this book, available on Amazon. Perhaps pick one up for the class and make sure the teacher reads it out loud. No Nuts for Me
Make certain that any babysitters or friends caring for your child know what allergens are potential hazards so that they can be certain to avoid them They should also have an injector handy just in case.
If you go to a restaurant, ask to speak to the chef so that you know the restaurant understands the importance of avoiding the ingredient in question. In serious cases, you might want to call ahead to make sure they are willing and able to accommodate you.
If your child has any mystery reaction to something, it is worth having a visit with the doctor so that we can help pinpoint the cause. In some cases we will refer you to see an allergist. Mild allergic reactions can be treated with a dose of Zyrtec or Benadryl. Keep in mind that Benadryl might make some kids sleepy and it could muddle your assessment. For an anaphylactic reaction epinephrine is the only first line treatment. It relaxes the muscles in the lungs to improve breathing. To quote Dr. Fast, a local allergist, “Epinephrine is what saves lives. It is never wrong to give epinephrine."
One of my mom readers shared her story with me after this post first went out. She recently spent five days in the hospital due to an allergic reaction. She had 4 of the 7 symptoms (including full body hives), but was NOT given epinephrine early because she wasn't having respiratory distress. It took several days to get the allergic reaction under control. Not only does epinephrine help with the respiratory distress, but it lessens the release of the chemicals that are causing the reaction in the first place. The world health organization would agree with Dr Fast that using epi early is a "no Brainer" https://www.ncbi.nlm.nih.gov/
Auto injector options
Epipen comes in 2 strengths. The junior (0.15mg) is for anyone under 66 pounds. Anyone over 66 pounds gets the full adult strength (0.30 mg) .Epipens have been in the news due to high cost and recent shortages. If you have an epipen, check out the lot numbers, some of them have extended their expiration date
May 2019 update The avilailability of the epi pen junior has been very spotty. Auvi Q is available directly from the website.
Auvi Q is a competing product that I always preferred. I liked it because it is flat and easy to stick in a pocket. It also actually talks you through the steps. When you are in the midst of a patient having a reaction, that can be more helpful than you would imagine. It was recalled several years ago due to trouble with the needles. I was thrilled to find out that AuviQ is available again, and believe it or not...drum roll please…. It has a ZERO copay to anyone with commercial insurance or a household with income less than $100,00.00.
Auvi Q comes in 3 strengths:
You have several options.
You can go to the Auvi Q website and download the prescription. Have your doctor sign and fax it over to them and they will deliver it directly to your door: https://www.auvi-q.com
The customer service phone number is on the website and I found them extremely helpful.
Of you can now get the Auvi Q at your local walgreens. They signed an agreement just this week (July 2019)
Regardless of which one you use, the auto-injector should be administered into the upper outer thigh. It can be given through thin clothing. The leg should be restrained and the injector should be held against the thigh and then compressed, rather than jabbing it.
In the case of a severe allergic reaction, give the immediate dose of epinephrine but then head over to the ER for some observation. It is possible for the symptoms to rebound. This is called a biphasic reaction. Hours after a patient seems stable, the symptoms can flare up again. Since it is always better safe than sorry, keeping a close eye on the patient is essential for the next 24 hours
Children with reactive airway disease and/or eczema are more at risk for allergic reactions, but they can happen to anyone.
No, of course not everyone needs to carry around epinephrine, but it is SO important to recognize the symptoms and act quickly if you are concerned about the possibility of an anaphylactic reaction.
There is a law, SB 1266, effective January 1, 2015, that mandates all schools keep an epinephrine auto-injector on hand and that someone on site has been trained. Check with your child’s school to make sure that they are complying.
Zyrtec Dosage Chart
The dose of cetirizine depends on age as below:
Zyrtec comes in a 1mg/ml solution (so 2.5 mg = 2.5 ml). There is also a 10mg/ml oral drops preparation (so 5 mg is 1/2 ml). Make sure you check the strength of the solution.
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Friday, August 17, 2018
Dealing with Motion Sickness/Something new on the horizon
It is not unusual for us to get calls from folks who have a child or family member that suffers from motion sickness. 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. We have some unfortunate moms who have babies that vomit every time they go out in the car.
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.
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 chose 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.
Hylands and Boiron both make a homeopathic motion sickness remedy. As with many homeopathic remedies they gets 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!"
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. Benedryl is an antihistamine that often works quite well for motion sickness. It comes as a liquid. The bottle says for children over the age of 6, but in our office we do use it for younger kids. The dose usually agrees with the tylenol dose volume. 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.
Luckily, kids do tend to grow out of it...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. My favorite eye expert in this is Dr. Vincent Penza
Some people with chronic motion sickness have also gotten relief from chiropractic treatment.
There is a new product on the horizon that got my attention. The media is abuzz about special glasses that have been reported to be real game changers for folks who have tried them.
Unfortunately, I haven’t been able to find out how to get them in this country quite yet. If you are interested, it seems that pre ordering a pair is possible if you have connections in Europe who are able to send them to you.
In the meanwhile, if you or a family member suffers from this very annoying ailment, See if any of these other methods will help you out until those magical glasses become available
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. The initial signs are usually paleness, yawning and restlessness. They may feel a little sweaty. This is quickly followed by the 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)
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!
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Friday, July 27, 2018
Drowning Prevention: Appoint a Water Guardian!
This is the time of year that many of my families are traveling. Anytime you are away from home, there are a range of safety issues that can arise. When you get to your vacation destination, do a basic assessment as soon as you arrive. Are there smoke and carbon monoxide detectors? Do you know where the fire extinguisher is? If you are visiting older relatives, are any of their medications safety out of reach? Are any unfamiliar pets comfortable with children?
Think like a toddler. What type of trouble can they get into? Can they open the doors on their own?
Water danger is one of the more essential considerations. If you are going anywhere that has a pool or is near water of any sort, you need to be aware that drowning can happen in just a few inches of water and it can happen quickly!!! According to the CDC drowning is now the most common cause of death in children under the age of four (excluding congenital issues)
We had a scare with one of our families a few summers ago. Several adults and children were enjoying a day at a friend's pool in the East Bay. They got out of the pool to have some lunch. Some of the oldest kids started to bicker. While the adults turned their attention to the squabble, a one year old got back into the pool unnoticed and submerged. Thank goodness another of the adults looked up, noticed, and was able to get her out and perform CPR. The little girl is perfectly fine, but this was terrifying for everyone. Dr. Karen Makely, one of the wonderful urgent care physicians over at St. Lukes, says that sometimes having a lot of adults around lends a false sense of security. Consider having each adult take turns being on a shift as the designated lifeguard.
It is so important to be aware that a person who is drowning usually does not thrash about and call attention to the fact that they are having trouble. They can slip silently under the water without being noticed until it is too late. Even if your child has proven themselves to be solid swimmers, you need to stay actively focused and engaged on watching them like a hawk while they are in the water.
Nurse Lainey sent me this link last week Levi's Legacy and I am going to do my part to spread the word. Many parents are on high alert when they are actively at a poolside but the danger doesn’t end when you are inside.
Levi's Legacy tells a heartbreaking story of a child who slipped out of the vacation home, made it out to the pool and drowned as the parents were busy doing some preparation for a family evening outing.
The important message here is that the lifeguard shift does NOT end when you go inside.
If you are staying anywhere with a pool, make certain that your child has absolutely no access to the pool area when there is no adult present. Hotels or apartments with fountains need to be treated with caution as well. If you do have pool access, there are a variety of pool alarms and safety monitors on the market. Some devices are little gadgets that your child wears around their wrist. Alarms and monitors may add a layer of safety but I would warn you not to have a false sense of security. Someone needs to be on duty. Take turns. Appoint a water guardian. On duty mean no distractions (that means your cell phone. Put it down, you can do it.)
Monday, July 23, 2018
A pet safety tip: Java and the Bologna
Java and the Bologna
Last week I got a call from a parent of a fairly young child who was bitten by a friend’s dog. The toddler was feeding the dog and a finger got in the way. Anytime there is food, a young person, and an animal, I am worried that inadvertent nibbles might happen. In this case, there was nothing malicious and the doggy was current on it’s shots. Anytime a bite breaks the skin, we want to keep an eye on it, but you might be surprised to know that human bites are more of a concern for causing infection than a dog bite.
This made me recall the tale of my old girl Java. The sweet golden wearing the nurses cap who decorates my blog was my family’s beloved dog. We had her for twelve wonderful years. Time zooms along; she would have been 19 years old this July. I still miss her deeply. The pet owners out there understand.
Towards the end of her life, she was a happy girl, but was moving pretty slowly. Instead of bounding across the grass to chase her favorite ball, we would toss the ball a paltry few feet and she would be satisfied with that. One day, she and I were playing the “old dog” version of fetch at the end of the grassy part of Midtown terrace playground.
All of a sudden her nose gave a twitch and my old girl absolutely flew across the park to the children’s play area where two women were giving a group of young children a snack. The kids were lined up on a bench about to eat what turned out to be bologna sandwiches. No one was more surprised than I was that Java could run so fast. I might add her that in her 12 years, although we were misguided dog owners who let her eat way too much “people food” (she loved pizza) bologna was uncharted territory for her.
Java had reached the picnic before I even figured out what was going on. By the time I had gotten to her, she had already stolen the first sandwich, wolfed it in one happy gulp and was about to get a second. There was total mayhem. The group had every reason to be seriously annoyed, but let me make it clear, these were not dog lovers under any circumstances.
I arrived just as one of the women grabbed her little girl’s hands holding the sandwich as Java was trying to snatch it. A finger got scratched and there was a drop of blood. More panic ensued. I got Java on her leash and profusely apologized. Java was as waggy as could be, She could smell another full bag full of sandwiches and was hoping for more. She was ‘bologna delirious’ and I just needed to get her out of there.
I assured the adult women that Java’s shots were up to date. I showed them her license, gave my phone number and suggested that I remove her from the scene, take her home (we lived across the street) and I would come back with band aids, Neosporin (and some lollipops). I told them I was a nurse. I would be right back.
I said to the kids, “The silly dog was not being a good girl. She wanted to steal your sandwich, which is a bad thing to do, but she certainly didn’t want to hurt anyone or scare you.I am sorry that that happened”
I dragged my reluctant dog home, grumbling at her the entire time, “I can’t believe you did that!!” I threw together some first aid stuff and rushed back to the park as quickly as I could.I was gone for no longer than five minutes.
Are you kidding me? As I got there, I could see red lights flashing from an ambulance and several fire trucks. They had called 911. The park happens to be across the street from a firehouse, so firetrucks hadn’t had to travel very far.
In fact, the firemen mostly all knew Java and me from years hanging out at the park. I arrived as one fireman was convincing the still distraught women that they probably didn’t need to go to the ER. He looked at me and rolled his eyes. The family ended up accepting my cuter band aids (although there was almost nothing to see on the little finger and no more bleeding.)
I thought that was the end of the story, but the Oscar Meyer gang also reported the incident to animal care and control. Poor Java was under house arrest for several weeks...Oh the indignity. We all took to calling her Kujo!
Even though a 911 call was wildly out of proportion, I really was horrified that this happened. Java was a gentle dog who loved all people, but especially loved kids. As is my way, I looked for the lessons. Should I have had her on a leash? Perhaps, but that wasn’t the lesson I came away with. Instead I started teaching the “Java Rule” at my safety classes
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As you are teaching your kids about safe interaction with pets, keep these guidelines in mind.
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Friday, July 6, 2018
Speech milestones/Local speech therapy resources 2018
Please see updated post May 2023
My older daughter Lauren reached her verbal milestones at a young age. It turned out that she was stringing together sentences quite a while before we could actually understand what she was saying. The fact that she was actually using real words to communicate became apparent to me one day when she and I were wandering around the zoo. She may have been as young as 15 months at the time. Lauren started to tug on my arm saying “shoofaloff”
It sounded like typical babble; I tried to figure out what she was attempting to communicate as we walked. Was it an animal perhaps? Did she want a snack?
“SHOOFALOFF” She kept repeating. She was getting upset that I clearly wasn’t understanding what she was insistent on telling me. “SHOOFALOFF”
I paused for a moment, happened to look behind us and saw that her shoe had fallen off and was about 10 feet behind us. Shoofaloff was “shoe fell off!” Duh! At that moment I realized that her fairly incessant cute little gibberish was actually speaking. As the weeks passed, Lauren became more and more articulate and I completely took it for granted that we lived with a little talking wonder.
When Alana came along, I expected nothing less. Alana (no need to fret about her, she graduated top of her Master's program and is currently working as a therapist) didn’t care about reaching milestones (any of them!) She had no trouble at all with comprehension, but her speech was incredibly garbled. By the time she was two, we could still barely make out a dozen words. Fortunately we had Lauren, who translated for her without any problem.
GUGUGUGGODH might mean “I would like more popcorn please”. Lauren was puzzled as to why we couldn’t understand her sister. This just goes to show that often siblings have magic communication skills with each other at a very young age. Eventually Alana had plenty of words, but there were still a few letters that were hard for her to pronounce until she was quite a bit older.
There is a huge range of normal, so when do we need to have our antenna up? There are a few basics to keep an eye on. By 4 months your baby should be cooing and making sounds. If this is not happening, one of the first things we would want to make sure is that your child doesn’t have an issue with their hearing. Babies born in California are given a hearing screen at birth, but it is still something to check out if you have concerns. Does your baby react to your voice? Do they look in the direction of a loud noise? As they get older, can they follow simple commands? If you are looking at a picture book, can they point to the appropriate picture with your prompt?
By 15 months they should be able to speak at least a few recognizable words.These don’t even need to be valid words. Alana couldn’t pronounce Lauren, but she could say Yaya and it was clear that Yaya meant Lauren. To this day, it still does! Perhaps "da" means dog. As long as they are consistent and communicating, those sounds count as a word. If your child knows some signs, those are counted among their words. If you know for sure what they are saying, repeat after them and expand on their utterance. When they see the dog and say “da!” you should say “Yes. DOG!” (repeat) “look at the big dog” (expand.) If they are using a sign, say the word. For instance if they are signing “more” during a meal, say “more” (repeat) and then expand, “would you like more peas?
By repeating and expanding , not only are you reinforcing correct production of their words, but you are supporting their language development
Michelle Geffen, a speech therapist at Jennifer Katz, Inc., advises not to pressure your kids by always asking them to say the specific word. Instead, let them hear you use the word and wait for a response. Waiting can do wonders!
If your child reaches 18 months and there isn’t any understandable language, this is an appropriate time to get a baseline evaluation from a speech and language therapist. Sure, it is okay to wait a bit longer if you like, but early intervention is always a good thing. I like to be proactive. Often the evaluation is covered by insurance.
By the end of the 2nd year, children should be able to speak roughly 100 words, understand 300, and have some word combos. They should be understood by close family members 50% of the time.
The earliest sounds for kids are usually Pa Ba Ma Na Wa Ka Ga. By the age of 3, kids should have most speech sounds. Ruth White, a local speech therapist, counsels that if the majority of folks can’t understand most of what your three year old is saying, an evaluation is advised. On the other hand, it is not uncommon for many otherwise articulate kids to distort some of the more difficult sounds such as l, r, s, sh,ch, v, z, th. These sounds may actually not be fully mastered until age 7 or 8. Ruth reminds parents that there is a wide range of normal.
Even though we know that some sounds aren’t perfected until later, 4 or 5 is a reasonable age to check in about articulation issues.
Bailey Levis, owner of San Francisco Speech and Fluency Center, receives many calls from parents who are concerned that their pre-school child might be stuttering. Many children will have some amount of disfluencies, (e.g. “Um um um, I want...I want...I want some ice cream”) in their speech, but only some of them will show signs of stuttering. Some red flags for early signs of stuttering include tension or frustration if/when words get stuck, more than 2 repetitions (e.g. “cuh-cuh-cuh-cookie”), or if there are other family members who stutter. Whether or not you observe any of these red flags in your child’s speech, if you have any concerns, Bailey recommends seeking out a speech therapist who is comfortable working with stuttering. With early intervention, the likelihood of complete recovery is very high.
Frequent ear infections or fluid in the ear can impact your child’s early language skills so it is important to work closely with the doctor if this is an issue. We may send you along to an audiologist or ENT to be part of the team.
Of course, keep in mind that there is a huge difference between hearing and listening. I can’t tell you how many young child failed to follow the directions with our in-office hearing test, but when I quietly whispered “ would you like a sticker?” they heard me just fine.
One of my favorite in-home hearing tests is an active listening game. Tell your child to whisper a word to you (perhaps the name of an animal.) Then you quietly whisper a word back to them. Make sure they can’t see your face so that there is no lip reading. If you have any concerns that the hearing isn’t as sharp as you think it should be, get them checked.
Jodi Vaynshtok from Sound Speech and Hearing Clinic shared her explanation of the different aspects of communication skills that a speech language pathologist addresses:
Listening: In order to use the correct speech sounds, and understand/use language, a child must build upon their listening skills. This includes detection, identification and comprehension of spoken words. Listening therapy helps children learn to detect and interpret sounds, allowing their learning system to develop speech and language skills appropriately.
Speech: This is often what people think all speech therapy sessions consist of – the production of sounds that make up our words and sentences. Speech involves the coordination of articulators (i.e. jaw, lips, tongue, vocal folds, vocal tract and respiration), divided into three areas: articulation, voice and fluency.
Language: A child’s language can be split into two domains. The information they understand (receptive language) and the language they use (expressive). Language therapy can concentrate on spoken, written or non-verbal communication. Goals can target vocabulary, grammar, formulation of sentences, following directions, and reading comprehension, just to name a few! A child’s ability to correctly understand and use language can affect their behavior, academic and social success.
Jodi also shares some tips for enhancing communication and language. Your child learns from every interaction you have together. Let’s learn some ways to enhance those communication opportunities to help your child learn the power of social interactions. Let’s O.W.L:
Observe: Body language – action, gestures, facial expressions – learn what is motivating and interesting to your child.
Wait: Stop talking, lean forward, look at your child expectantly – your child will take the lead. By waiting you can respond to your child’s signals, play, imitate, interpret and comment.
Listen: Pay close attention to all words and sounds – no interruptions, even if you know what they are trying to say.
Turn Taking: From body language, cooing, and words, use these tips for turn taking - match the length of your child’s turn. Try to match how much your child says or does by keeping your turns short and simple too. If your child uses one word, use no more than two! Match your child’s pace; let your child set the pace for the conversation. Slow down and wait longer if necessary. This allows your child time to explore, understand, and respond. Match your child’s interest; focus on what your child is interested in. When following their lead, they’ll interact longer.
Four S’s
I am grateful to the speech therapists who took the time to share their wisdom with me about this post!
Below is a partial list of some excellent resources that we have in the SF area. For some folks finding someone in their insurance network is of primary importance. For others it is location and availability. You won’t go wrong with any of the folks on this list.
Sound Speech and Hearing 415-364-8774
Sound is one of the wonderful resources here in SF. They are the one stop shop that can combine the hearing and speech assessment in one visit. They also have the option of having Mavis, the animal therapy pup at the visits ( it doesn’t get better than that.)
Check out their blog. Below is a recent article about children's headphones
Bailey Levis 415-496-6757
Bailey@SFStutteringHelp.com
Bailey does all sorts of general speech therapy for all ages but is top notch for stuttering issues. He offers a free 30 minute consultation.
Jennifer Katz Inc. 415-550-8255
This popular practice has several locations and has been taking care of my patients' speech therapy needs for many years. They have expanded to several locations. They also work with many insurance plans, which is a bonus. Their team includes feeding therapists.
In addition to their individual speech-language sessions they have a wonderful small group program called TheraPlay. TheraPlay is a language-based therapy group that is highly structured with an array of carefully planned activities targeting social skills, speech and language development, pre-academic, fine and gross motor skills. The groups are lead by a speech language pathologist and an aide with a maximum capacity of four children per group.
Jennifer Katz, Inc. is happy to let you know that they will be doing their More than Words program . More Than Words® is a parent training program for children with social communication and language delays that provides parents with practical tools on how to support their child’s communication and social development during everyday routines. More Than Words® was developed by expert speech-language pathologists and is grounded in extensive research and evidence-based practices. More Than Words® is an amazing program that will complement the services you are already providing to families. Some of the valuable things parents will learn when they attend the More Than Words® Program
• What motivates your child to communicate
• How to use your knowledge about your child to set appropriate and realistic goals
• How to make interactions with your child last longer
• Tips for using pictures and print to help your child’s understanding
• Strategies for how to talk so that your child understands you
• Strategies for developing your child’s play skills
• Ways to help your child make friends
*Registration is due August 30th
Ruth White 415-225-6152
Ruth has a private practice but is also an instructor at SFSU in the communicative disorder clinic and currently run graduate clinics there.
SF Speech Therapy 415-404- 8343
SF Speech Therapy is a small, family centered private practice in Diamond Heights. It provides speech, language, and feeding therapy to people of all ages, with a particular emphasis on early intervention for the very youngest San Franciscans. Therapists at SF Speech Therapy have specialized training in a number of areas, including infant and toddler language, articulation, stuttering, voice disorders, and the Sequential Oral Sensory (S.O.S.) approach to feeding. There are both English and Russian speaking therapists on staff, and home visits are offered. To get a feel for the practice, check out the blog and website below. Appointments can be made by calling Teresa Newmark at 415-404- 8343 or by emailing,Teresa.Newmark@gmail.
Northern California Speech and Hearing 415 -921-7658
Shannon Kong and Sara Spencer 415-469-4988
Shannon Kong, MS, CCC has been renamed to Seven Bridges Therapy (www.SevenBridgesTherapy.com) and they now have offices in SF, San Mateo, and Oakland. They specialize in working with children 5 and under as well as children with autism but see children of all ages!
Sara Spencer, continues to see children ages 6 and up under her company name, Sara Spencer and Associates. Same addresses in SF and San Mateo. They continue to work hand in hand as they always have (since 2000).
Tulips Speech 415-567-8133
tuLIPS Speech Therapy has exciting news. After 7 years on Union Street in Cow Hollow, they have opened a 2nd location on Castro Street in the heart of Noe Valley! tuLIPS Speech Therapy offers speech and language therapy, social skills groups and their very popular Talking tuLIPS program. They have an amazing neuropsychologist on staff who offers neuropsychological testing and they work closely with a wonderful occupational therapist. tuLIPS Speech Therapy is now accepting new patients. Call them today and ask about their complimentary speech and language screening!
Lauren Van Burkleo 415-633-6648
UCSF Audiology 415-353-2101
For our patients using any of the UCSF pediatric specialty clinics, including audiology, a referral is needed before they will make an appointment. If you are interested in meeting with them, let your doctor or nurse know. We can send a referral over and they will contact you to get something scheduled.
Talking time/Speech and language therapy Devra Posner 415-326-6199 Devra@talkingtimetherapy.com |
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