Friday, July 16, 2021

The magic and importance of play

 

The magic and importance of play

“Play is often talked about as if it were a relief from serious learning. But for children, play is serious learning. Play is really the work of childhood,” Fred Rogers, aka Mr. Rogers.


Screen time is a fact of life for most of us. Don’t get me wrong, while I am well aware of the official guidelines, there is no judgement from me for families who get a bit too much. It is safe to say that my kids got WAY too much, but they also balanced it out with lots of play and crafts.

This post is not about limiting screen time. It is about being mindful that you give your kids opportunities to play and use their imaginations the old fashioned way.

My sister Marjie and I were less than 2 years apart. Amy was six years younger and sometimes would be allowed to join whatever activity we had cooked up.

Thanks to Marjie’s over the top imagination we never were at a loss for odd games to play. The earliest one that I can recall was “Ann and Martha stick toilet paper on the wall”
Marjie would show up in my room in the middle of the night and help me climb out of my crib. We would bring our dolls (Ann and Martha) into the bathroom where we would wet pieces of toilet paper until they would stick on the wall. I think we would tell stories about whatever shape they were. That game is actually one of my earliest memories, although the memories are pretty vague. My parents were oblivious to our night time activities. My mom always wondered about the scraps of toilet paper that she would find all over the bathroom floor, because of course, they would dry up and fall off the wall during the night. It wasn’t until years later when we were discussing childhood games in her presence that the mystery was solved.

Another of the stranger games that I can recall all these many years later was ‘Crawl’. We would toss assorted clothes and ‘dress up’ costumes around the room, make the room pitch black and crawl around attempting to put on all the clothes that we came across. Shirts could become pants, underwear would go on the head. When the lights turned on we would crack ourselves up. 

Marjie and I also created our own board games. They were convoluted and creative to say the least. These included 

  • The Mahaly brain game (Our precursor to Trivial pursuit)
  • The ‘low crotch game’ (this one had the loser run up and down our street wearing a pair of very low crotch pants that had shown up in a box of hand-me-downs
  • The ‘Go Kiss my sister’ game (don’t even ask….)


My mom watched with amusement, as long as we were safe, but there was one game that she absolutely hated that we referred to as “taste this” and which she ultimately banned.

‘Taste this’ was something we played when we were quite a bit older. It involved one person being blindfolded and the other players pulling out an assortment of various foods or condiments. The blindfolded person would choose a number 1 through 4. Each number corresponded with a mystery food that the person would need to taste and then try to identify. There would usually be one positive, two neutral, and one horrible choice. There was an element of honor involved. You absolutely had to taste whatever you picked...no cheating.

Mom forbade us from playing the game following that one time when I was blindfolded and threw up all over the kitchen after making a poor choice and getting a heaping spoonful of mayonnaise in my mouth (you would have vomited too!)

We made the mistake of telling our kids about this one, and poor mom had to deal with the generation of grandchildren playing ‘taste this,’ when the cousins would gather at grandma’s house. Lauren read this post as I was writing it and recalled getting a mouthful of coffee grounds, but on the other end, gave her cousin a spoonful of the liquid from a jar of gefilte fish. The game was banned yet again. No worries, the band of cousins created their own set of unique games.

When my daughters were young and playing with each other at home, if there were any games that caused vomiting, they flew under my radar.

I started thinking about all of this because the other day Sandy and I took a long overdue stab at clearing out the storage room behind our garage. Both my girls joined us in helping us decide what old toys and games were worth saving.

What a trip down memory lane! There were bins of crafts, costumes, board games and well loved toys. Among the treasures is a huge bin of beanie babies with the tags still on. (One of these days we need to figure out if those are worth anything).

There was a doll house that Sandy had made out of old wine crates. The walls were covered with wallpaper from a wall paper book and carpeted with remnants. That was a great project, but the house was a bit worse for wear from sitting in the storage room for 20 years, so it didn’t make the cut for things we are saving. 

Some classic toys that survived their years in storage will now get to be played with again by little Elliot.

So here is today's message.

Please make sure that your kids have lots of opportunities to play, create their own games, and use their imaginations.

If you don’t have a Marjie in your lives for whom no props were required, have some basics that games can be built around such as: a doctor's kit, a toy cash register, dolls or stuffed animals. The dolls that we made for our wine crate doll house were made out of pipe cleaners and felt. Expensive toys with lots of bells and whistles are not necessary.

You can also get your kids started with some Improv games . Click the link in the last sentence for a list of these that my daughter Lauren, who is a teaching artist, complied at the beginning of the pandemic.

If your kids don’t have siblings to play with, try to connect with other friends who have kids of similar ages. Once kids are older than 2 years or so, there is no real substitute from the learning and growing kids can get from interactive play.

Friday, July 9, 2021

Things we take for granted

 

Things we take for granted

The world is full of horrible things and fabulous things. The problem is that the horrible things are the ones that make all the noise, capture our attention and of course, catch the headlines. It is pretty easy to forget to notice the wonders that are around us.

This week I was taking a walk and I decided to focus on, and give some appreciation for things that I often take for granted.
I started with the fact that I can easily walk several miles. I am blessed that I am within walking distance of Golden Gate Park and that day my destination was in fact the botanical gardens.

I went through the checklist of my senses. There was plenty of beauty to see. Along the way I couldn’t help but find joy at watching a dog deliriously playing fetch with a stick. 

The flowers that I passed along the way were stunning. Each lawn was worthy of stopping and marveling at. The colors are miraculous.It got even better once I got to the park. If you are in SF, get over there (but beware of coyotes!) I could hear birds; I felt a nice breeze. I delighted in some fog, knowing that so many friends of mine have been struggling with heat and humidity.

Next it was time to focus on smelling. I was sniffing and not smelling anything for a block or so. The first odor I was able to identify was cigarette smoke, courtesy of a guy who was sitting in a parked car. I was glad to have confirmation that my nose was indeed working. Happily, a block later that smell was replaced by the wafting aroma of baking cookies. 

I confess that I usually don’t bother to pay attention to things that work the way they should. Like most people I only notice when they are broken or not working.

It brought to mind a quick story of how we take things for granted.

Many years ago, I was walking our beloved golden retriever Java. This was when she was pretty young and exuberant. I was holding the leash in a very foolish manner (I learned that lesson!) and it was wrapped around my little finger. As we were going down some steep steps, Java started to pull me, I jerked back and my pinky snapped. Ouch indeed! (For the record, finger and toe injuries are especially painful due to all the nerve endings)

The reason that this tale of woe is at all relevant is to illustrate a point. I was much more impacted by a broken pinky finger than I ever could have imagined. I had never given much thought to this particular finger. Of course it was my right and dominant hand. Without the ability to bend that finger, I was not able to hold a pen, or more importantly since I was still actively working in my job as a nurse, I was not able to give shots for many weeks.

Go ahead and try to pick up a pen and write something while your little finger stays straight, It doesn’t work.

My double lesson today is first of all to be mindful of all the things that are working well. If you don’t have a headache, sore throat or congestion, hooray! Pay attention. We usually only notice when there is an issue.

Secondly, if you are dealing with tough stuff as many of us are this year, don’t let the difficult things completely eclipse the lovely stuff that is still surrounding you. Listen to music, go someplace and be wowed by nature (the botanical gardens are a great option.)

Seek out a delicious and comforting aroma; you can light a candle or even bake some cookies.

The good stuff is easy to find, you just need to pay attention to it.

It can be something as simple as taking a page out of my sister-in-law Barbara's book and grabbing a martini and watching reruns of the Big Bang Theory

While you are at it, pay a bit of homage to that all important pinky!

Friday, July 2, 2021


July 4th 2021

Last year with the pandemic in full swing, the holiday was a bit quieter, but this year I see people slowly getting back to normal.
I am updating my old July 4th safety post. Most of these tips have kept their relevance. I have made notes where things seem like they need an update

The phone calls that I get following the July 4th holiday are fairly predictable so here are some tips that can help you all have a safe & healthy holiday weekend.

Since some of the holiday festivities may involve large crowds, I have some recommendations for dealing with situations where you might find yourself in a throng of people. Dress your child in bright clothes that stand out from the pack. Take a photo of them before you set out, so if heaven forbid you get separated, you have a current picture to pass around that shows exactly what they are wearing. Another sensible and creative idea is to write your phone number on your child's wrist and cover it with liquid band-aid to make sure it doesn't wash off. (2021 update - I personally still would not want to be in a large crowd of strangers, even outdoors!)

Make a solid plan with your older children. What should they do if they lose sight of you? Where should you meet up? This is a good time for the : 


Will it be loud? Loud music and fireworks can be damaging to your child's sensitive ears. Consider getting some ear protection if you are going to be someplace that can put hearing at risk:

Please be very careful of fireworks. If you are skipping the organized shows and planning on setting them off yourself, make sure your kids don't have any access to the fireworks or matches ahead of time. Do an inventory and know exactly what you have on hand. Keep the kids at a safe distance during the actual fireworks. Have a bucket of water or a hose nearby. (2021 - with such a dry season PLEASE avoid setting off any personal fireworks!)

Try to keep your pets indoors with windows closed. There are items such as the Thundershirt or medications that you can give them if you know your animal has a tough time with the booms of fireworks. Stressed out animals need to be observed especially closely with any interactions with your children and babies.
(2021 - my poor grand-dog, Bowie who is an enormous fierce looking shepherd/husky mix, is absolutely terrified of fireworks and we will be dog sitting this weekend… wish us luck!)

If you are in San Francisco chances are you probably don't have to worry about the heat. When my kids were growing up, our July 4th fireworks watching usually included warm blankets, hot chocolate and lots of thick fog. I remember one year when Lauren was 3 or 4 and we were driving to a vantage point, she saw a traffic light through the fog. "Is that a firework? It's beautiful!" Ah, our San Francisco babies.

For those of you escaping the city make sure you stay well hydrated and protected from the sun.

Get in the habit of doing a skin sun exposure check at least every 30 minutes (more frequently for fairer kids) to see if it is time to reapply the sunscreen. Be very wary about applying any of the aerosol sunscreens around a heat source (like a grill.) These are flammable and there are horror stories out there about terrible burns that have occurred.

Let's move our discussion over to grills. I was watching the news and a story came on about the hazards of metal bristles coming loose from utensils that are used to clean your grill. These metal strands may get lodged into pieces of food. People have been reporting mouth injuries and worse. Happily, that is one call that I have never gotten, but it seemed like a caution worth sharing. Check your utensil brushes to make sure there is nothing loose. While you are at it, check the grill surfaces to make sure there are no pieces of any foreign objects that can get stuck in the food.

Make sure your child can't get anywhere near any type of grill. The danger begins from the moment you light it and are waiting for it to be ready, until long after the cooking is done and you are certain it is completely cool.

If you are cooking meat, make sure that it is thoroughly and safely cooked. Food borne illnesses don't just love under-cooked meat; other foods can transfer the bacteria also. Pay attention to any picnic foods that will be out of refrigeration for several hours:

If your picnic/meal is outside and you will be spending time in grassy, wooded places, make sure you do a head to toe check for ticks once back inside:

Ticks are rampant right now. Finding them early before they have been attached for a couple of hours will vastly decrease any concern about disease transmission.

No, it is not okay to keep your child in bubble wrap; that isn't my intent. Go forth and have a festive, fun and safe holiday. Happy 4th of July!

Friday, June 25, 2021

Sun Protection 2021

 

Basic Sunscreen information

Sunscreens are either mineral or synthetic/chemical. The mineral ones contain zinc or titanium dioxide. These work by reflecting the sun's rays like a mirror to protect the exposed skin
 
The synthetic sunscreens absorb rays in a chemical reaction that dissipates the heat back off the skin.
 
SPF or Sun Protection Factor is a measure of how well a sunscreen will protect the skin from the UVB rays. Quite a few studies state that it is not worth getting any SPF that is over 50. These studies suggest that the higher SPF doesn’t offer a significant increase in protection, just more chemical exposure and a false sense of security. 
 
The UVB rays are the kind of radiation that causes sunburn, damages skin, and can contribute to skin cancer. The UVA rays are connected to aging skin and wrinkles; they may also have some cancer links. It is important to protect against both so you want to look for a product with broad spectrum protection.
 
If you are using sunscreen for the first time, do a test patch on one small area on the thigh or wrist a few hours before sun exposure. If you slather your child with a new sunscreen, spend a day out in the sun and then they break out in a rash, it could be from any number of causes, including the sunscreen, heat, sun, or even something they ate. Doing a test patch first can assure you that the sunscreen isn’t the culprit. 
 
For older kids, the use of sunscreen should be routine. Great habits now will avoid wrinkles and potentially serious skin problems later on. Some kids may like applying it with makeup brushes.
 
If you can plan appropriately, apply the sunscreen at least 15 minutes before going out. Ideally put it on before the clothing to make sure you don’t miss a spot. For significant sun exposure, sunscreen needs to be reapplied at least every 2 hours. This includes products that claim to be waterproof. Don’t forget to protect the feet, the ears and the top of the head if you have thin or no hair up there. (Better yet, keep a hat on!)
 
Sunscreens come in several forms. Lotions and sticks are my preferred forms. I don’t love the sprays because it is easy to miss spots and inhalation can be an issue. They can also be flammable. 

With the mineral powders, try to contain the application so that your child doesn’t breath in the particles. 
 

 
The cost does not necessarily correlate with the better choices. 
 
If your child is out with a nanny or friend, don't hesitate to remind them to be on the "sun protection patrol". Trust me, sunburns are just as painful for the grown up who lets it happen on their watch!
 
If you or your child does get burned, Dr. Cheung, a San Francisco dermatologist suggests that you forgo the aloe vera and instead apply the 1% hydrocortisone cream that you can get over the counter. Apply twice a day until the pain is gone. Ibuprofen (with food) can also help decrease the pain and inflammation. I have seen some sunburns so severe that they cause blisters. If a larger surface of the body is impacted, it is worth seeing the doctor.
 
Be aware that some medications including some antibiotics such as Bactrim, can make someone especially sensitive to sun exposure. Make sure you are familiar with any medication that you or your children are taking to make sure this isn’t a factor.
 
Multiple sunburn events during childhood double a child’s risk of developing skin cancer later in life. (skincancer.org)
 
While we need to be a little more protective of our fairest kids, regardless of the skin pigment, everyone should be wary of sun exposure.
 
Ignoring the need for sun protection, unless you live in a cave, is simply not an option. Even in San Francisco with our foggy days we have to pay attention.
 
Obviously your best bet for preventing sunburn is to stay in the shade when possible and also wear a big floppy hat and loose protective clothing. If you get your kids in the habit early, they are less likely to object to having something covering their head. Set a good example and have the adults in the family wear hats as well.
 
Not all hats are created equal. Choose a wide brim that gives the neck some protection. Make sure the fabric doesn’t have spaces. A straw hat would not be as good as one with tighter fabric. Letting your child pick out a cute hat that fits the parameters might ensure more cooperation.
 
Have a parasol or a shade umbrella over strollers and baby carriers. Pay attention to babies in backpacks; they might be getting more exposure than you are aware of. Umbrellas are not foolproof. You can also get sun exposure through glass. Kids sitting inside a car can get a painful sunburn.
 
Remember that eyes can also get damaged from the sun. Do your best to get your child used to wearing sunglasses. The lighter the eye color, the more sensitive they are likely to be, but everyone should wear eye protection.
 
Don’t forget about lips! There are lots of lip products with SPF protection.
 
Sun can do the most damage to our skin between the hours of 10 am and 4 pm, with the most intense rays between 10 am and 2 pm. Reflection from water and/or snow can make any exposure more intense. The link below will lead you to a great little site that can tell you what the UV risk is on a particular day depending on where you are:
 
 
Location matters. If you are traveling to someplace like Mexico or Hawaii you have to be even more careful than you would need to be here in SF. If you know you will be out in the sun, check out some sun protection clothing! Options and technology are increasing all of the time. There are even some sun protective, light weight blankets that some folks swear by.
 
Even if you are very careful, if you are out enjoying life, it is very difficult to eliminate all sun exposure. If your child is under 6 months old and the choice is sunburn versus sunscreen, choose the sunscreen every time! Keep in mind that some of my preferred products are zinc based. Zinc is the common ingredient in many diaper rash creams that we start applying from day one. It is completely safe.
 
Be a careful label reader. There are currently 16 active ingredients allowed in sunscreen! Only two of these 16 ingredients, zinc oxide and titanium dioxide have earned the GRASE acronym (generally recognized as safe and effective.)
 
At least two of the ingredients, PABA and trolamine salicylate should be avoided. The FDA has ongoing investigations into the remaining 12 ingredients .The concern is that recent studies have found that the ingredients in some sunscreens are being absorbed at a higher level than previously thought. The fact that an ingredient is absorbed through the skin and into the body does NOT mean that the ingredient is unsafe, but it makes sense to do further studies. 
 
 
Recent media attention about sunscreen has identified a concern about benzene. During a routine audit of consumer goods, it was found that 78 of 294 of the products tested were contaminated. Benzene is a toxic chemical that should be avoided. Benzene is not an actual ingredient so even if you read the labels, this is easy to miss. The list of products found to be contaminated is here:

 
The list starts on page 12 of the report.

Rather than trying to figure out if the one you have is on the list, I would suggest focusing on the shorter list of safe products and just use one of those.
 
 
I do NOT want people reading about that and deciding that they would rather have unprotected time in the sun. I also don’t want anyone freaking out if you have used a product that is not as safe.

Please don't stress out if you haven't been using the better sunscreens. Sunscreen ingredients have been used for several decades without reported side effects. Take this new information, and choose good brands moving forward.
 
One more thing to keep in mind when picking sun protection is the environmental impact. If you are simply hanging out in the park, it isn’t an issue, but if you are swimming in a natural body of water, (especially the ocean), some chemical sunscreens that contain ingredients like oxybenzone and octinoxate are believed to contribute to coral bleaching, and damage the reefs. That is one more reason to stick with the mineral based products
 
Remember:
 
  • BEST is shade
  • Next best is a safe sunscreen
  • If no shade is available and you can not avoid sun exposure, use whatever sunscreen you have with you (just this once, but after reading this post go ahead and order one of the safer options.)
  • The worst option is sunburn.

Friday, June 18, 2021

Ghosts and Radios/Happy Fathers Day

 

Ghosts and Radios

My dad was the youngest of four brothers. These brilliant men were all physicists and they all played the violin. Someone once referred to them as the vio-physicists; I loved that.

Sadly, my dad ended up with dementia and even though he was the youngest, he was the first of the four brothers to die. We lost him in 2007 at the age of 80. His older brothers remained sharp and mostly healthy for many years. The third youngest, my Uncle Melvin, is 99 and doing great.

The year after daddy died there was a large family party for his second oldest brother Elmer’s 90th birthday in Houston. The remaining brothers, along with my sisters and every one of my first cousins decided to gather. The Jewish term for a happy occasion is a 'Simcha'. This translates to happiness. In our extended family, people make it their business to travel far and wide for these events. There were multiple generations in attendance from all over. It was wonderful being together, but my dad’s absence was like a gnawing toothache. He left such a gap.

It was a lovely weekend. Houston is an enormous sprawling city, so getting from place to place was a bit of a hassle. This was before google maps or Waze and we spent more time than we wanted getting lost. We were constantly calling Sandy back in San Francisco to get out a map and navigate for us.

On the last day of the trip, we were on our way to a BBQ at the home of Uncle Melvin. I was in the car with my mom and both of my sisters. My older sister was driving. We were having a conversation about how much we missed dad, but somehow felt his presence. We all realized that while we were talking, Marjie had missed the exit. We immediately started giving different directions to poor Marjie. “Go straight, go right, go left”

At the SAME moment, with all of us shouting out, we realized that the car radio was now blasting. Rap music was pulsating. It was cacophonous. There was no way we would have been able to talk over that. Marjie reached over to turn off the radio.

“Did any of you turn that on?”

None of us had. The radio had simply turned on. It happened right when we were thinking about dad.

“Dad? Was that you? Rap music? Really???? That’s the best you could do?”

We found our way to Uncle Melvin's and of course we were all buzzing about how the radio had seemed to spontaneously turn on. They all looked at us sideways. I don't blame them. If I hadn't been in the car I would have had a hard time believing it.

During the course of the afternoon, I asked uncle Melvin what the classical station was, so that we could listen to that on the way to the airport. My dad would have preferred classical to rap, hands down.

“That would be 88.7 of course”

A few hours later, when we returned to the car, the radio was already on as soon as we started the engine. I know that we had turned it off when we left the car. It was no longer tuned into the rap station. It was set on 88.7. Vivaldi was playing.

Wow, so had someone snuck the keys away from Marjie, gone into the car and changed the station? I didn’t think so. I really felt like this was a hug from my father.

It didn’t need to make sense, my heart was full from it.

Later that week, my cousin shared an article about uncle Elmer, the birthday boy that had been written in a local paper.. In the interview, he recounted that when he and his brothers were young, someone had given them an old broken radio. It had become their hobby and passion to fix it and learn all about how it worked. This started them all on the path that lead them to become scientists.

This was the first I had learned about my dad’s early fascination with radios. It made me feel even more certain that I had gotten a message from him.

Several days later when I was back in San Francisco, my dear friend Melanie came over for tea. She was a pathologist and scientist to the core. I told her the story of the radio that seemed to turn on by itself and she smiled gently.

“If it makes you feel good to believe that it was your dad, that is fine, but I think somehow, something turned it on. Maybe somebody nudged it without realizing it. There is usually an explanation.

She headed home but called me later that day.

“Uncle! I concede!”

“Excuse me?”

“I was driving home from your house and I swear to you, my radio was suddenly playing. I know I didn’t turn it on”

Well done Daddy!!!

If one accepts that spirits are energy and are looking for ways to communicate, radios continue to be easily managed by my dad. When Alana was away at school, her radio routinely turned on without human touch. It still happens, but he has moved on to cell phones. Mine is completely possessed and makes calls at random without being touched.

 

Friday, June 11, 2021

Air safety for your classroom, office, or home

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Friday, June 4, 2021

How to make sense of the ever changing covid guidelines

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 As you look at the risk benefit here are essential questions that will make a difference in the answers. Are eligible people in your family fully vaccinated? 
 Are there family members who are at high risk? 
 How are the numbers in your area? 

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

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

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