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.

Pain and Fever reducing medications/ How to choose the right one

 

Acetominophen and Ibuprofen

It should go without saying that none of us want to give our kids medication unless it is necessary. I also always like to see if there are some natural remedies that can help us out. Many low grade temps will resolve with some cool compresses and a tepid bath. Of course there will be times that we need to move to plan B and break out the standard over the counter fever medications.   There are several options available for infants and children. Acetaminophen is most often found under the brand name Tylenol, ibuprofen manufactured under the names Motrin or Advil. Generic brands are acceptable. At the end of this post you will find a dosage chart to refer to as your child grows.   The charts tell you how many milligrams of each medication your child needs. This is usually based on the child's weight. The different concentrations can be confusing. Let's go back to school for a moment for a quick review.   If you take a 500 mg Tylenol tablet, crush it and then dissolve it in a teaspoon (5 ml) of water, you will have 500 mg of Tylenol. If you take the same 500 mg tablet and dissolve it in a cup of water (240 ml). You will still have 500 mg. It is simply in a different concentration.   The first step is to see how many milligrams are appropriate for your child. Your next step is figuring out what volume of fluid will deliver the proper dose. That will depend on the concentration of the medicine.   Infant and Children's Tylenol have the same concentration of 160 mg/5ml. The only difference is that the infant bottle comes with a handy syringe for accurate dosing. The infant Tylenol used to be more concentrated but that formulation is no longer on the market. It is still important to read the label to make sure you know exactly what you are giving.  For kids over 6, there is a fairly new dissolving powder pack that works well.   Acetaminophen is usually given every 4-6 hours. Too much Tylenol can be toxic to the liver, so it is important not to exceed the recommended dose.   Ibuprofen still has both infant drops and children's liquid. These are NOT the same concentration. It is important to pay attention to which medication and dose you are giving. The infant formulation is about twice as concentrated. Ibuprofen is usually given every 6-8 hours. It can cause tummy upset if given on an empty stomach. This is challenging for sick kids with poor appetites. Ibuprofen is an anti inflammatory, so it is a better choice for treating an injury.   For fevers, I don't have a strong preference between acetaminophen or ibuprofen. Ibuprofen does tend to last a little longer which makes it a good choice for a night dose.   Both of these medications come in a variety forms. Liquid is the easiest choice for the youngest kids. As they get older, many prefer chewable tablets. Acetaminophen also comes in a suppository form. This is very useful for a child who won't cooperate with oral medications. It is also a valuable option for someone who is vomiting. For kids over 6, there is a fairly new dissolving powder pack that is easy to give.     Eddie, from the Feel Good Pharmacy, offers options that you can't get in a standard drugstore:   ibuprofen suppository acetaminophen or ibuprofen gummies dye free/preservative free suspensions Compounded products need a prescription even though the medications are over the counter. He also can only ship within California.   If a fever is lasting longer than a few days in a row, it is worth getting seen by your doctor. If you are dealing with a stubborn fever and have a diagnosis, it is okay to alternate the medications. An example of this would be:   9 am Tylenol   12 noon Advil   3 pm Tylenol   If the fever is staying under control, spread out the doses:   9 am Tylenol   1 pm Advil   5 pm Tylenol     Medication errors happen more often than you can imagine. Consider putting a piece of masking tape on the bottles and mark off times and dates of dosages. This can help sleep deprived parents keep track of when they gave what. It also alerts partners if a dose was recently given by another caregiver. This is a good habit with antibiotics as well. Another option is to keep a notebook nearby and document your doses there. Figure out which method works best for you and make sure that all the caregivers stick with the plan.   It is worth having a syringe on hand for accurate measuring. These are easily available at any pharmacy or online.   When it comes to medicine, some folks are under the assumption that less is better and try to give partial doses. This doesn't usually do the trick. I like to use an analogy here. Imagine that you are trying to fix something on the roof. To get up there you need to climb a ladder. You must climb high enough to actually get on the roof. Climbing halfway gets you nowhere aside from hanging on a ladder. With medicine, you need to give enough to be efficacious (enough to get you all the way up to the roof.)   In some cases your child might respond to a smaller dose. If that is the case, by all means give the smallest amount that you can get away with. In my experience, most kids need the full dose to achieve relief. The correct dose adjusts with your child's weight. That dose that the Dr. gave you when your infant came in for their first shots? It is not going to cut it for your 25 pound toddler!   Keep in mind that neither of these medications work instantly. It is common to have to wait at least 30 minutes or so before you notice any relief or decreased fever.   Most of the time, acetaminophen and ibuprofen are safe to give with other medications.   Be careful if you are giving any of the multi-symptom cold remedies. Many of these already have the fever reducer as one of the ingredients; you don't want to double dose.   A little bonus tip is that the benadryl dose is generally the same volume as Tylenol.   If your child is under 3 months of age, and you feel that they need any medication, check with your doctor's office. Any young infant with an elevated temperature needs to be evaluated.   If your child is teething,those symptoms can linger for weeks at a time. I try to reserve Tylenol and/or Advil for occasional use. Getting a good night's sleep if your child is having a ridiculously fussy day seems reasonable once in a while. There are many other comfort measures to try first.   Teething Blog post

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!!

Your child has covid/ when do you need medical intervention?

 I was actually going to take this week off, but I know of multiple families who have had their kids test positive for Covid this week. This post is for all of you families who are actively dealing with a sick kid or who have been exposed.

When to worry!!!!

One of the hardest things for parents to learn is the very important basics of ‘When to Worry’ about an illness. Everything feels like it has higher stakes in this pandemic world that we are currently living in. Whether your child has Covid (any variant), Influenza, Rsv, Roseola, and/or any nasty virus du jour, there are certain things that I want you to pay attention to. Respiratory distress If your child is struggling to breathe they need to be seen, it doesn’t matter if they have a fever or not. When someone is working harder to breathe you may see the tummy going in and out more than usual. The breathing is more rapid. They may be making grunting or wheezy noises. The nostrils might be flaring. You also might see something called retractions, which is when the skin below the throat and around the ribs looks like it is sucking in.  Someone with breathing issues may look pale. For people of color, you can assess this by checking mucus membranes, nails or the palms. For a mild to moderate cough, see if sitting in a steamy bathroom brings some quick relief. If not, they need medical intervention. Warning sign: A baby having a hard time feeding and taking breaks for air Reassuring:  Feeding well What to do in advance: If you pay attention to what the baseline is, it will be easier for you to recognize trouble. If possible, before they are ill, get a sense of what your baby’s normal breathing looks like.  Actually look at their breathing, what does it look like when they are well? When they are calm, count their respirations. Fever If there is a fever higher than 101.5 give medication and wait an hour. You can also do cool compresses and lukewarm baths. Make sure they are not over bundled. If the fever has not budged, check in with your doctor or urgent care. These days if the fever is higher than 103, most practices will send you directly to the emergency room. What to do in advance? Have a thermometer that you trust. Before there is an illness, take everyone’s temp for several days at the same time of day to establish a baseline. Fever blog post Inconsolable If your child is crying inconsolably I am going to tell you the same thing I would tell the parent of a newborn. Is the diaper too tight? Do they possibly have a hair wrapped around a finger or toe? (that is more common than you might think), did they get an insect bite? Do a full body check to see if you can figure out the cause of the fussiness. If there is obvious source, even if there is no elevated temp, go ahead and give a dose of Tylenol or Motrin. Make sure you know the proper dose. Many times, fussiness can be caused by something as simple as severe gas pains. If you sense that this might be a possibliity, add a dose of simethicone to the mix. It certainly is not going to hurt and can possibly make a big difference. January looks like it might be a tricky month with so much illness making the rounds. Rather than feeling overwhelmed, try to focus on things that are actually in your control. What to do in advance? Get anyone who is eligible fully vaccinated. Have a stash of reliable masks. Make sure you are stocked with food and medications including pedialyte Make some soup and freeze it in reasonable portions Take steps to boost your immune system

Travel Tips part two/Managing the flight

 Most parents have travel stories that stay with us, kind of like a battle scar. Here is one of mine.

Many years ago when my daughter Lauren was two, I got creative as I was planning for an upcoming flight as a solo parent. I had seen a craft in a magazine (long before Pinterest existed) where a necklace had been made of cereal and I thought that this seemed like a fabulous thing for an airplane trip. Unfortunately, not all ideas turn out to be good ones. Lauren and I strung some Cheerios onto elastic and she proudly wore her new necklace onto the plane. Soon after take-off Lauren decided to eat some of the Cheerios. I noticed with some dismay that as she bit off a Cheerio, some would go into her mouth while other parts would shoot off like little spitty projectiles. They were landing (unnoticed by anyone but me) on just about everyone within three rows of us. As soon as I realized what was happening, I tried to see if there was a way for her to nibble them off without making a mess. When that didn't work, I tried to take the necklace off to make it easier or to have her stop eating them at all. But as mentioned, she was two. My choices were clear - tantrum on the plane or unsuspecting fellow passengers having little pieces of spitty Cheerios in their hair. I opted for peace (besides, ignorance is bliss, right?)

Of course, now, in the days of Covid, those mini projectiles would have been viewed to be almost as dangerous as nuclear material. Fortunately, things were a bit more innocent then. A spitty Cheerio was just yucky, not infectious

My post this week is full of tips for managing your trip. Cheerios necklaces, understandably, didn’t make the cut. Hopefully the collection of tips that I did include are much more useful than the cheerio debacle!

Managing the Trip

"When is my baby old enough to fly?"  When I was working as the advice nurse at NVP, this was a very common question. There is no simple answer without considering a multitude of factors. Parents might make the valid choice to fly earlier than they might otherwise do in order to see an aging relative or deal with a family crisis. Consider this, adopted babies might fly within the first few days on their way to their new home. It isn’t always black and white. In ordinary circumstances, I would prefer to have the babies wait until they are at least 2 to 3 months of age and have had their first set of immunizations (keep in mind that the first shot does NOT give full protection against some serious illnesses, but it is a start.) The size of the baby as well as the time of year are also factors.  Even before covid I was always paying attention to what illnesses are circulating. During an active influenza season, I would think long and hard before taking a young baby on a plane. It isn't unusual for there to be some type of health alert circulating, so keeping current on the news is important. It is always worth keeping an eye on the CDC travel guidance https://wwwnc.cdc.gov/travel Regardless of how old your child is, if you are planning a trip here are some tips and things to keep in mind. One of my wise readers suggests that if you are traveling out of the country it is worthwhile to register your journey with the state department https://step.state.gov/step/ . Great idea! COVID If your child is at an age to get vaccinated for COVID, do it ASAP, it takes time for the immunity to take hold. Regardless of vaccine status, getting them used to wearing a mask is important. Do some work on this ahead of time. As soon as they are old enough to cooperate, do some mask wearing around the house for longer and longer stretches at a time. Find a reward or sticker incentive that might help. Poke around on the internet. There are some cute videos that help encourage mask wearing. Do some play with the teddy bears wearing masks. People often ask for my recommendation on the best masks. The answer is whichever one they are willing to keep on! It might take some trial and error to find a mask that works for your child. Of course a good fit and adequate filtration are what make any mask effective. Moms, Eliezah, says that her two-year-old has done well with Rafi Nova, Andy & Evan, and Cat & Jack brands that taper and have metal at the nose. Mom and author, Alexandra shared that her daughter Emma has been wearing the Evolve Together KN94s and with the ear loops tied they fit great. If you have a mask that you love, please let me know. Airlines are actually doing a pretty good job at trying not to be vectors for the virus, but it is a good idea to wipe down the areas around your seat as soon as you board the plane. Try to do as much snacking before the flight to avoid eating on the plane, but that being said, do not stress about it if you little one wants to munch on something. Staying sane during the journey is an important consideration. Managing the flight. Keep in mind that a car seat is the safest place for your child. It is worth checking with your carrier to review their guidelines. I remember a trip I took years ago. I was sitting next to a mom with a very young baby. She was so worried about the possibility of getting evil looks from the other passengers that she had actually brought ear plugs to hand out to the people sitting around her. What she didn't have was anything to soothe her baby in case of discomfort. Please always make sure that you have Tylenol or Motrin with you on the plane (not packed away in your suitcase). It is okay to bring small bottles of the medication through security. They need to be smaller than 3.5 ounces. I don't tend to give it ahead of time, but I am quick to medicate during the first sign of fussiness.   Does your child suffer from Motion sickness? Click to review my post on that topic.   I often get questions about the use of Benadryl. This is an option for a child who is over 8 months with a long flight ahead. It helps dry up any congestion and makes 90% of kids who take it deliciously sleepy. Aha, but what about the other 10% you might ask? It turns those little darlings into hyperactive, wild hooligans. You do not want to find out on the plane that you are the parent of the 10%. Look for children's liquid (generic name is diphenhydramine). There is no such thing as ‘infant’ Benadryl; Labels will not usually have directions for children under 4. Instead you are faced with that largely unhelpful “check with your Doctor” Here is a Hack. Benadryl dose is the same volume as the Tylenol dose. In my years of practicing, I have found that most pediatricians I have worked with feel comfortable prescribing it to younger kids, but I always suggest checking with yours own pediatrician for their opinion. Once you have the green light, you may want to give a test dose a few days prior to the trip to make sure it is a viable option for you. My goal is for parents to have the tools with them to deal with an unhappy child. Don't give any medication unless it is necessary. While I would usually err on the side of less medication, Benadryl and Tylenol/Motrin can be given at the same time. Ear issues Many babies and children may have trouble with their ears. For the younger ones, try to nurse or have them feeding during takeoff and landing. Sucking on a pacifier may be helpful as well. Have a lollipop or chewing gum for older kids. Ayr saline gel is a nice thing to have along. A dab at the base of the nostrils can moisturize the dry air and make breathing easier (use it for yourselves as well.)  If you have a child with a history of ear trouble, have some of the little gel heat packs in your bag. You can activate them as needed and the warmth feels great to a sore ear. You might also try bringing a baggy of cotton balls soaked in garlic oil. You can ask the flight attendant to pop them in the microwave for 5 seconds to warm them up (feel them to make sure they aren’t too hot). Make sure that baggy stays sealed or everything you brought with you will smell of garlic. For adults and older kids, you can equalize the pressure by holding the nose and gently blowing until the ears pop. Gently please.You don’t want to cause more trouble by forceful blowing. Supplies Take WAY more diapers with you than you think you need for the trip. I was on another flight once when we sat on the tarmac for three hours. There was an unfortunate family behind me who had planned on a short little trip and was out of diapers long before we even took off. It wasn't pretty. Plan accordingly. Many folks automatically bring a change of clothes for their baby. It is also worth bringing an extra outfit for yourself. If you have a long flight ahead of you with a child on your lap, it may come in handy (I learned that one the hard way and sat for several hours covered with poop.) Changing your baby on the plane can be a challenge. It is helpful to create little changing packs in advance. Pack up several individual gallon ziplock bags with a diaper, wipes and whatever else you use with a change. This will prevent you from having to take the entire bulky diaper bag with you into the tiny bathroom. You can't count on airlines giving you any reasonable snacks, so it is important to bring along enough provisions in case of delays. It is okay to give things that feel a little like a treat, but be warned, having your kids amped up on sugar during a flight is NOT what you are going for. Activities Download some activities or shows ahead of time for your laptop or tablet. None of us want to overdo screen time, but if you have managed to keep it special, a long flight is the perfect time to make use of this tool. Don't forget about the old fashioned low tech options! If you are visiting family, actually print out a bunch of photos of the people you are going to see (what a concept). You can use these for all sorts of art projects on the plane. Make a paper doll family by gluing the faces onto popsicle sticks. Besides keeping them busy for a stretch, this activity also can help your kids recognize folks that they don't see too much of. Wikki sticks are also a great activity to bring along. They are lightweight and not too messy. Reusable stickers will stick on the window. Don't bring anything that will make you sad if you lose it in between the seats. Which brings me to the next point. Protect the Lovey, blanket or stuffed animals that come on the trip! Deciding which security items come along on your travels is a big decision. If your child has a favorite blanket that they snuggle with, losing something on the plane or even in the hotel sheets can be a nightmare. Jet Lag Time zones are tricky. Staying hydrated and getting fresh air are essential. Sunshine is a bonus. My best suggestion is eat when you are hungry, sleep when you are tired and just do your best. Just know that even the best sleepers may have a period of needing a sleep training tune up when you get home. http://www.reflexandmore.com/en/articles-heb/25-english/articles/21-jetlag The link above has wonderful information for dealing with jet lag.  Melatonin https://nursejudynvp.blogspot.com/2019/06/melatoninis-it-useful-is-it-safe.html As long as it is really just a few doses, I would have no worries about putting this in your toolbox. You can have lots of fun while you are away and it is wonderful to see family. But, in my opinion, if you are traveling with children under the age of seven, don't call it a vacation. It's not. It is a TRIP (we used to call our visits to the various grandparents the "bad bed tour.")  A little preparation goes a long way and remember that some of the more challenging moments make for the best stories!