Flu vaccine info 2026/2027

 Scroll down for tips for the shot phobic

Influenza is one of the world’s deadliest vaccine-preventable diseases.

The flu is no joke. Even a mild case can be completely miserable. The aches, the coughing, the chills, that horrible feeling that you don’t want to be touched…Nobody wants to get this.

Every year, it kills more children in the United States than meningococcal infection and whooping cough combined. It can also lead to serious complications such as bacterial pneumonia, ear infections and sinus infections. It can worsen chronic medical conditions, such as congestive heart failure, asthma or diabetes.

Back when we were in the midst of the pandemic, there were actually several years of lighter than average flu activity. It isn’t rocket science. When people avoid crowds, wear masks and wash their hands, things don’t spread as easily.

As the world moved out of pandemic behavior, we briefly saw a couple of years with severely increased flu activity but it has mostly returned to a normal pattern.

The 2025-2026 season was considered moderate. The CDC reports that last year, from from October 1, 2025 through April 11 2026 there were:

• Between 31 and 54 MILLION Flu illnesses

• Between 380,000 and 780,000 hospitalizations

• Between 23,000 and 78,000 deaths

• 191 confirmed influenza-associated pediatric deaths. Approximately 85% of these were children with known vaccination status, who were eligible and were not fully vaccinated.

As you can see, even in a ‘moderate’ year, there were lots of people impacted.

We suggest a reframing of the point of flu shots.

Getting the vaccine is not just about keeping you or your children from getting seriously ill. It is about minimizing spread within your family and community. It means protecting people who are vulnerable, including infants under 6 months who are too young to get the shot.

In the best case scenario, the vaccine will prevent you from getting sick. At the very least, it will alleviate severe symptoms and decrease spread to family members. The point of the shots is to increase antibodies to give your immune system a leg up. It is not, nor has it ever been, to guarantee an infection-free winter.

Here’s a fun fact: a severe case of flu is often much more contagious than a mild case. A shot that perhaps only minimizes the symptoms of illness, even if it doesn’t completely prevent infection, is still doing its job.

In addition, flu vaccines can reduce the burden of flu illnesses and hospitalizations on our health care system.

Keep in mind that babies need two shots the first year

Kids can start getting the flu shot at 6 months. If you have a baby at home who is too young to get vaccinated, please take extra care to make sure that all the household contacts are protected so that you don’t bring the virus home.

Anyone who is under the age of nine, and is getting the flu vaccine for the very first time, needs to receive two doses of the vaccine in order to be considered fully protected.

• The two doses need to be separated by at least four weeks.

• The first dose “primes” the immune system.

• The second dose provides immune protection.

It is confusing, even some doctors aren’t really clear.

We will use our dear friend Nancy as an example. Her baby turned six months at the end of the season last year, so she only got the one shot.

Since she didn’t get 2 in one season, little Sofia needs to get two this year.

Why are two doses necessary?

Over the years we have seen patients who have had only their first shot come down with a significant case of the flu. One dose will not fully protect them.

Scientists designing the flu shot want to choose a dose that is as low as possible, to decrease side effects, while still working to create protection with antibodies. This means that the doses we use on everyone is pretty small. In order for a body to make adequate protection, it needs to see the same dose twice to build antibodies. After that takes place, one dose is sufficient to trigger those old immune-system memories.

Bottom line: If your child has ever had more than two previous doses of any flu vaccine, they only need one this year. If this is their first time, they will need two

Pregnant and nursing moms can and should get the shot.

Women in their 3rd trimester may pass along some of the protection to the baby in utero, so even if it is a bit on the early side, it is worth getting the shot prior to delivery.

If you are pregnant or have young children, double check before you get the shot to make sure yours is preservative free. 93% of the supply this season is, so it shouldn’t be an issue. All “prefilled syringes” are preservative-free in the US.

Flu Shot Timing

It takes about 2 weeks for the shot to take effect.

Since we never really know when the flu season will start with a vengeance, getting your child vaccinated early in the season is your best bet. This usually means a September or October shot, in anticipation of a fall spike. As soon as a baby turns 6 months old you can get them started with their first dose since they need two doses to be fully protected. That means you can get started as early as late August for the first shot and do September booster.

The shot’s peak protection is within 6 months of administration. Immunity wanes after that, but it’s not as if it falls off a cliff. Some protection persists for some people longer than 6 months. Since we can’t predict when the season will be at its worst, it is still best to get protected close to the beginning of the season.

Another factor is that It is impossible to predict possible delays and shortages with the supply, which do happen. The safest way to prevent having an issue with a potential shortage is to get the shot in September, October or early November when there is usually plenty available.

What’s covered in the shot this year?

Every year the disease trackers do the best they can to predict which strains of the virus will circulate and try to match the flu vaccine to the anticipated strain. Typically the vaccine changes from year to year. Some years have better matches than others. Even when they don’t get it exactly right, the shot seems to protect from more severe illness.

For any of you who actually pay attention, this year the trivalent flu vaccines for the 2026–2027 season contain three updated strains: an A/Missouri/11/2025 (H1N1)pdm09-like virus, an A/Darwin/1454/2025 (H3N2)-like virus (egg-based) or A/Darwin/1415/2025 (cell/recombinant), and a B/Victoria lineage virus.

Shot Side Effects

It does seem to vary a bit from year to year, but most of the time the reactions to the flu shot are quite mild. It is common to have a low grade fever and some soreness at the injection site.

Remember that a day or two of aches and a bit of fever is still better than a full-blown case of the flu.

“But the flu shot always gives me the flu.” – This is something we hear from patients all the time, and it’s a perfectly understandable feeling. What’s happening here?

Oftentimes, people will, for one reason or another, delay getting a flu shot until later in the season, say, November, when they hear that flu cases are raging. Remember, it takes the shot 2 weeks to become effectively protective. If you get the shot when flu numbers are already high, due to its significant contagiousness, there is a very high chance you’ll get infected from your community before the shot could do anything to help you. Because the shot does not contain a live virus, it is biologically impossible for it to create a disease or infection.

For others, the body’s immune system mounts such a strong response that it can feel like the flu, but we promise you that the influenza virus infection itself would have been way, way worse.

We believe you when you say that you have been unlucky enough to get sick when you have gotten the shot. Believe us when we say we still think you should get it.

Shot Contraindications/Allergies

There are very few true contraindications to a flu shot. They are:

• Age <6 months

• Prior severe allergic reaction to an influenza vaccine

Precautions, not contraindications:

• Guillain-Barré syndrome within 6 weeks of a previous influenza vaccine.

• Moderate or severe acute illness, with or without fever. Mild URI, low-grade fever, antibiotics, etc. are not reasons to withhold vaccination.

Importantly, none of the following are contraindications to an injectable flu vaccine. As a matter of fact, it is recommended that these people especially get the shot: egg anaphylaxis, asthma, pregnancy, immunocompromised, household contact with an immunocompromised person, or taking aspirin.

And once again, because we get this question a lot: a mild illness does not affect how well the body responds to a vaccine, so a little cold is not a reason to put it off.

It is generally a good idea to keep a close eye on your child for at least 30 minutes after the shot. If they seem to be having any breathing issues or exceptional fussiness they should get checked out immediately.

With more than 30 years experience of giving thousands of flu shots, Nurse Judy has only seen one serious reaction (treated in the ER and completely recovered).

Tips for the immunization visit

A little preparation ahead of time for either the flu mist or the shot can make a world of difference.

The flu mist is an option that is approved for healthy, non-pregnant people between the ages of 2-49. This is a nose spray, rather than a shot.

To tell you the truth, getting a 2 or 3 year old to cooperate with something being squirted in their nose can be more of a challenge than the 2 seconds it takes to do the injection.

If you can practice with a little saline in the nose at home, you will have a much better chance for success. If you can’t get them to do this in the safety and comfort of your home, save yourself the trouble of trying in the office and just opt for the shot.

For the injection, get out the doctor’s kit and do a little playing.

There are also loads of little videos that you can watch in advance. I have one link here - Daniel Tiger gets a shot, but do some homework and see if you can find one that might resonate with your little one.

Make sure you give appropriate choices, such as which arm they want the bandaid, or what kind of treat they might get. Dr. Hurd pops a gummy or piece of chocolate into her kids mouths right after the shots and they are a big fan. No fussing at all.

When you are negotiating with your child, be clear that whether or not to get the shot is not one of the choices!

When you go in for the appointment it is helpful if your child is wearing short sleeves or clothes that will allow them easy access. Perhaps bring an ice pack with you and give yourself a bit more time for some icing in advance. The shot usually doesn’t hurt too much but an ice pack gives some kids a little boost of confidence.

You might also order a product called a Shot Blocker or the Buzzy Bee from Amazon and bring it with you. These little gizmos have helped a few of my ‘shot haters’ have an easier experience.

We have found that there is no age limit to people who are terrified of shots. Some parents are so upset by the sight of a needle that they can’t be in the room when their kids get vaccinated. If you are one of those, see if you have the option of having a partner be the adult on duty.

Wishing you all an influenza free year. Now go ahead and make an appointment!

For frequently asked questions, here are a couple great resources from the CDC.

Thank you to Nancy for weighing in. It is always a treat to have you collaborating with us!

Thank you Dr. Coby for being my model!

Mom and dad, we found you

 Sandy and I went up to Mendocino to celebrate our 43rd anniversary. We had a magical time.

We stayed at a wonderful place called Mendo Bungalows (highly recommend)

We laughed out loud when we came back to our room after a day of wandering the headlands to find some fancy chocolate, a bottle of wine and a card that said “We found you! Happy anniversary.

This tradition started right after Lauren married Adam. Our daughters had always been sweet about anniversaries, but the addition of Adam into the family elevated the game to an entire new level.

In August 2018 several days after their wedding, Sandy and I opted to sneak away from all the visiting family members for a one night ‘staycation’.

We purposely told no one where we were staying.

When we checked into the Argonaut hotel, we were handed an envelope with a note. We had been upgraded.

Every year they managed to track us (before airtags and apple devices made it so easy)

One year we ended up at Scomas at the wharf. This restaurant has walls filled with autographed photos of various celebrities. By our little booth was a photo of an old 60’s band called the Goofers. We had never heard of them. On this anniversary we sent a clue. We took a picture of the ‘goofers photo’ and sent it along to the family chat.

We were very impressed when a special dessert was brought out by the waiter with the message “They found you”. This involved them actually calling places and asking if they had a photo of the Goofers on the wall.

The funniest was probably last year.

We were going on a safari. We had stopped for 2 nights in Amsterdam to break up the long trip and to adjust to the new time zone.

They had our itinerary. So when we got a note from the kids that we would be getting something delivered to the hotel, we weren’t terribly surprised. We WERE caught off guard by the TEN pounds of assorted chocolates, chocolate covered nuts, fruits and clusters.

There were some glaring problems

Ten pounds of anything was not welcome. We tend to try to travel light

It was August and warm. Chocolate melts

We were wondering if it was even legal to transport these items into Africa.

We called the kids, laughing. “We love you very much, and thank you of course, but what were you thinking?”

The answer was, “There may or may not have been a bit of a language barrier.”

In any case, we made lots of new friends at the hotel by widely sharing the bounty.

As I mentioned, I have an airtag in my wallet, so tracking us no longer required much sleuthing, but this year we were not staying in a standard hotel, so even if they found us, I didn’t think there was anything much they could do with the info.

I underestimated.

Alana ended up shmoozing with a person who was working at the desk. This lovely Michelle, actually went into town to pick up some anniversary treats for us.

So here is an extra thank you to Michelle at Mendo Bungalows.

And to our kids, you are the best. Thanks for the love, the laughter and the celebrating.

Talking to your child about inclusion

 How boring would it be if flowers came in only one shade? Or, all food tasted the same? What if there was only one genre of music?

We should celebrate that differences can make things more vibrant.

I was inspired to do this post when last year, my grandson Elliot’s sweet public school hosted their first Ability Awareness Fair. This is my daughter Lauren’s wheel house. She actually founded a company called Inclusive Arts.

Her mission centers around supporting opportunities for folks with disabilities to enjoy and participate in creative and performing arts.

Most frequently she is hired to offer workshops about what inclusion can look like in practice, in a wide variety of settings, including schools.

Her thesis statement is this: Everyone experiences the world in different ways.

No bodies are exactly the same when it comes to size, shape, strength, what they can and cannot do, and no brains are exactly the same either. One way that our brains might be different from others is how we respond to the different sensory inputs around us.

If you are talking to your child, or a group of kids, take a quick poll:

Hearing: Raise your hand if you like to listen to loud music. Say “shhh” if you prefer things a little on the quieter side, or need silence to concentrate.

Sight: Do you like being in a place with lots of bright flashing lights? Or do they make you want to close your eyes? (Hello Chuckie Cheese, Dave & Busters or the Chase Center during a Valkyries game)

Touch: Give yourself a hug (or massage!) Do you like the feeling of pressure on your body?

(Lauren has trained EJ to give a really excellent back rub)

Some people might hate the feeling of a tag on their clothes, etc… while others don’t even notice.

Smell: How sensitive are you to a yucky smell? The tolerance for this varies greatly. The parent who claims that changing a stinky diaper is torture, might really be having a hard time.

Taste: Are you open to tasting an array of flavors? Spicy food?

For older kids, you can start to teach them about the additional hidden senses our bodies have. This would include vestibular (balance) and proprioception (our awareness of where our body is in relation to itself and the things around it)

Explain that all these differences — our senses, what makes us feel stressed, what makes us feel calm, even how we communicate with others — are called ‘neurodiversity.’ Break the word apart: Neuro means relating to the brain and diversity relates to differences. All brains are different. There is no such thing as one right way to think or act or communicate, and no such thing as a wrong way either.

Ask kids how they prefer to calm down when they feel stressed. Everyone has a different way to soothe themselves.

Now that kids are back in school, it can be useful to dig deeper into these conversations in a safe place where your kids have permission to name things they noticed and ask any questions without fear of judgment.

It’s a good time to remind kids that everyone is different. They might have different hair, different colored skin, different language, different sizes, different families, different beliefs and different abilities.

When it comes to disability and neurodiversity, you can ask if they noticed any differences in the way students behaved, listened, moved… Continue the dialogue about how being different doesn’t mean bad.

It is a great exercise after noticing that someone is different to follow up with finding things in common.

Everyone needs to eat, sleep, breathe and poop. Most people want to have a friend.

From there, it can be really valuable to start talking about empathy, and what it might mean to be inclusive when it looks like maybe a difference is making something harder for a student.

Since Lauren has hands-on experience teaching about inclusion and neurodiversity to general education students, she immediately offered her services to EJ’s school. She supported them in developing a program that would be appropriate for transitional kindergarden - 5th grade students.

The ability awareness fair had 3 separate stations, each focusing on a different aspect of neurodiversity:

• Different Ways to Communicate,

• Tools for Bodies and Brains,

• Inclusive Play and Adaptation.

In each station they had activities to demonstrate what inclusion might look like for students with different needs, and also took time to let the students brainstorm their own ideas for how they might modify activities in different scenarios:

How might you play catch/tag/yard games with someone who uses a wheelchair?

How many different ways can you think of to give someone directions if they are deaf or hard of hearing?

How many different ways can you communicate that you have an unmet need (hunger, need to use the bathroom, etc…) without actually using words (signs, gestures, pointing, images, etc…)?

How can you show up as a friend?

When highlighting how difference is valuable, it’s crucial to not chastise someone for a difference of opinion, especially when it usually simply comes from a knowledge gap.

Lauren emphasizes the importance in these conversations of letting the young people have ownership over their ideas, and not shutting down any of their suggestions. When she asked a question about if it’s fair to let someone use a tool that might make a task easier for them, and a student said it felt unfair, instead of lecturing them on why they are wrong, Lauren simply asked more questions, and invited the other students to offer their input.

While of course EJ was thrilled to have mommy in his class, for everyone else, the Ability Awareness Fair far exceeded expectations.

After the event, when she reported back to me about how well it went, I was struck by how essential this is.

Regardless of where you fall on the political spectrum, inclusivity shouldn’t be a dirty word. If we can teach our kids at this age to be sensitive to differences our world would be a better place.

Are you interested in bringing a program like this to your kids’ school? Lauren would love to hear from you.

I am so grateful to Lauren for helping me get this one written and for making the world a better place for so many people.

Back to school adjustment tips 2026

 

When I was little, school started after Labor Day. It is hard for me to get used to the fact that August is now the month when many kids are going off to school. For some this is the first time. That’s a big deal.

And now my oldest grandson EJ is starting kindergarten. I join with all the other parents and grandparents out there asking, “Where does the time go?”

Doing some preparation ahead of time can be very valuable and can smooth the way.

If you read last week’s post, remember the ‘you are the coach’ analogy.

Doing some prep in advance can be valuable, but the actual moment where you watch your child march off to a new daycare or preschool or school is ‘game time’.

Some kids go off with a smile and wave; you win!

This is Alana on her first day of Kindergarten. She didn’t even spare us a backwards glance.

Others weep and you need to pull them off your body as they clutch at you in desperation.

Above is sweet EJ and his cousin Noam from a few years ago on the first day of preschool. Oy.

You end up leaving them in their new situation feeling like you have somehow failed. Welcome to being a parent. You lost this round but there are many rounds ahead that will be more successful. Keep in mind that many of the kids are putting on a big show, and are feeling stressed and sad for the moment. Most of them calm down shortly after you are out of sight and end up having a fine day. You, on the other hand, will feel like you have a fist clenched inside your gut.

Or do what Sandy did when he took Lauren to her first day of preschool. He left her crying with her new teachers and then went to the side of the building, hid in the bushes, and watched through the window. Lauren was fine in about 5 minutes but those were among the toughest 5 minutes of his life!

The teachers can be an essential part of the team helping with this adjustment period. Check in with them for a reality check. They can tell you how your little one fared once you are out of the picture (assuming you weren’t hiding in the bushes to see for yourself). If you feel like your child might need a little extra help separating, talk to the staff about what options they can come up with. Sometimes a little extra loving attention can be very helpful

One friend or familiar face can make a huge difference.

Do you know anyone who is in your child’s class? Maybe arrange a little date, or facetime for them to connect before the first day. If you don’t know anyone in the class, once school begins, ask your child to identify a few other children who seem nice. Reach out to those families and try to arrange some playdates outside of school hours. Social connection is so important.

In an ideal world, schools are a place where your child will be exposed to people of different colors, cultures and genders.

If you want to check it out, here is an old post: Talking to your child about differences

Below are some coaching tools

Tell stories or read

Your kids will love to hear stories about what your first day of school felt like. Or you can make up a story about another child who is going through similar situations. If you aren’t feeling particularly creative, you don’t need to be the one to make up the story. There are loads of wonderful ‘back to school’ books. It is easy to find a list online, but if it is possible, support a local book store.

Lauren loves an app called Goldminds. It is a great way to unwind at the end of the day, and they have lots of back to school content.

Make a list of some of the more common feelings that people might be feeling when they start a new school:

• Happy

• Sad

• Nervous

• Excited

• Tired

• Hungry

• Lonely

• Missing home

• Confused

• Bored

• Proud

I am feeling______________.

Maybe illustrate some flash cards for kids who aren’t reading yet.

You don’t need to limit it to one emotion.

Identify some things, good and bad, that might be triggering the emotion:

• I learned something new

• I made a friend

• I helped someone

• Someone made a face at me

• Someone wouldn’t hold my hand

• Someone wouldn’t share

• I didn’t like my lunch

• I am scared of the toilet (more common than you might think)

• I am having trouble with a skill that others seem to be able to do with ease

I am feeling ______________ because_______________

If the feeling expressed is a negative one - mad, sad, nervous, and you were able to identify a source, now is the time to talk about possible things that might help.

You can do so much through simple playing

Try some play sessions with a couple of dolls or stuffed animals; one is bravely heading off to school and proudly tells all about it after they are home. The other is having a much harder time. Talk about some things that may be tools that the brave bear is using or might help the scared bear.

Maybe the bear tried:

• bringing something like a scarf that smells like home.

• wearing a necklace with a photo.

• finding a little smooth round stone that you both rub some energy into and they can keep it in their pocket.

• writing a little heart or doodle on their arm and covering it with liquid band-aid.....

• Maybe the bear practiced saying goodbye several times, like a dress rehearsal

Do they want to give one or more of those a try?

Communication is so important!

Try to carve out a time where you can talk about the day. You want a captive audience. No screens for either of you. Bedtime, or when you are in the car might be your best shot.

If you are able to do a family dinner, that is also the perfect time for conversations.

This is a great opportunity to review tomorrow’s schedule and list any special things that are coming up that the family might be looking forward to.

Avoid the “How was your day? Fine” trap. Get in the habit of doing a little checklist.

• Tell me something you learned

• Tell me something that surprised you

• What was the silliest thing that happened?

• What did you do that was kind?

Teach your child the concept of a Mitzvah

This is the Jewish term for doing a good deed or act of kindness. Getting in the habit of at least one “mitzvah” a day is something to strive for. They can tell you how they did. Any simple kindness counts.

Other considerations

• Is your child up to date on their vaccinations and check ups? If you aren’t sure, call your doctor’s office sooner than later to get things scheduled and make sure you have any needed health forms.

• It is essential that you make sure you are able to pick up your child on time, especially those first couple of weeks. If you are going to be late, have an alternate trusted adult who can be there. Make sure that the school has all of the current cell phone and emergency contact numbers.

• Lots of studies show that eating a healthy breakfast makes a big difference. Have a breakfast plan and clothes picked out the evening before to avoid stressful confrontations.

• Make sure your child is not overtired. Start bedtime early enough that they are getting the sleep they need.

• Lots of kids will NOT pee or poop at school. Lauren is pretty sure that Elliot didn’t use his preschool bathroom for the first month (at least). Accidents happen. Make sure they have a change of clothes. For most of them this eases as they get more comfortable, but some stubborn kids will rather hold on to their poop rather than go on a toilet they don’t like. Keep an eye on this. When they get off their routine, some kids can get pretty constipated before you realize what is going on.

In conclusion

You never know when your child will decide to make transition to school a “thing”. Some children who never had issues will decide that this is the year to challenge you.

One ex patient of mine shared an anecdote. The parents had made quite the big deal of the first day of kindergarten and the child went in without a hitch. The trouble occurred that evening when the little 5 year old realized that this school business wasn’t an isolated event and she had to go back the following day.

Even if you are one of the lucky parents who’s intrepid child marches into their new situation without a backwards glance, it is perfectly normal for you to be deeply impacted by these milestones that signal the passage of time and that your child is growing older.

Lauren reminded me of a cartoon that I used to have taped on the wall above my desk. It was a sketch of a doctor, a nurse, a mom and a baby. The baby was about to get a shot. The caption was “You had better hold her close, she might cry.” The next frame was the nurse hugging the crying mom as the baby got the shot. Yes, this is likely to be just as tough on you as it is for your child!

Temper Tantrums/Tips for managing them

 My grandson Coby is a strong willed two and a half year old. Yes he is the one who recently ate a penny.

He likes to try to remind his parents that “you’re not the boss of me!”

Suddenly, tantrums are an almost daily occurrence, so I decided to update this old post.

It is the rare parent who doesn’t have to deal with temper tantrums. The behaviors include crying, yelling, aggression, and/or defiance. If your child is simply screaming at you, consider yourself lucky. Be aware that some stubborn kids will hold their breath until they actually pass out. (That is the body’s way of taking back control and getting them breathing again; not fun!)

You are not alone. On average, children aged 18 to 60 months have at least one daily! While the frequency of tantrums declines with age, the older kids can keep them going for quite a bit longer.

Let’s start with one of my favorite analogies.

Being a parent is like being the coach of a sports team. The real work is the preparation before the game when you learn and practice the plays. More work can be done after the game when you review how your team fared and work on any changes that need to be made.

During the actual game, you might be able to chime in to make little adjustments, but for the most part, unless someone is getting injured, you simply get to watch. This is not the time to effect any real teaching or change.

Recognizing the difference between “game time” and effective coaching opportunities is critical.

If we follow my theory, transition times, mealtimes, getting out of the house in the mornings and bedtimes are considered game time. You can’t do any effective coaching or teaching during these moments.

In the midst of the storm, your best bet is to just get through it as calmly and creatively as you can.

Here’s an example of a “game time” situation. Many years ago when my kids were little, I was a solo parent on a flight, returning home from grandparent/family visit. My sister Marjie had bestowed each of my daughters with a “my little pony” gift to entertain themselves on the flight. Alana, the two year old, had chosen the pink one, and Lauren ,the five year old, was happy with the blue one. Midway through the long flight, Alana wanted to make a trade. Lauren wasn’t interested and quite within her rights, she soundly refused. Alana was usually a fairly mild mannered child, but I could see the tantrum brewing and she was about to cause a serious disruption. I did a quick negotiation with Lauren: “Hand over the blue pony now, and when we get home they are both yours.” Lauren took only a second or two to recognize the value of this and gave Alana the blue pony. Crisis averted. This wasn’t the moment to teach about sharing, or fairness. This was game time. Get off that plane intact. If we had been at home I may have handled it quite differently. It is absurd to think that you will handle a tantrum in the middle of a crowded public area the same way you would in your home. Home field advantage???

If the warning signs are clear, by all means, do your best to ward off an impending meltdown. However, once your child has already entered the meltdown zone, it is time to change tactics.

There is a popular parenting book that counsels parents to get down on the child’s level and loudly evoke their inner caveman by chanting “You are mad, you are mad, you are mad mad mad!”

If you see a parent engaging in this, it is tough not to roll your eyes a little bit, but the premise is actually a solid one. When your kid is having a tantrum, acknowledging that you are trying to understand what is going on in the first step.“You seem mad, sad, frustrated etc” may be exactly what your child needs to hear.

Think about it this way, if you told me that you have a headache and I responded by discussing the weather, it would not be very satisfying. Distraction is all well and good, but not until they get it that you are trying to understand what has them so upset. Validating a feeling is not the same thing as giving in to an unreasonable request.

If they are seriously out of control, try to hold them close, get them on your lap and wrap your arms around them so that they can’t thrash around. Make shushing noises. Keep it simple. This is not the time for lots of words. Those come later.

Preventing the meltdown in the first place is obviously preferable.

Okay, maybe it’s unrealistic to completely eliminate them, so perhaps the goal is to just lessen the occurrences.

When you are dealing with frequent tantrums, see if you can figure out what is setting them off. Look for patterns.

Do they need food?

Many parents realize that kids get more fragile when they are getting hungry. Try having little snacks on hand and pay attention to any cues that give a hint that things are about to head south.

Are they tired?

If tantrums are frequent, you need to examine your child’s nap/sleep schedule. Make sure that they have adequate Iron and Vitamin D intake; both of those can impact mood and sleep.

Are they frustrated by something?

Here is where the coaching in advance comes in. Remind them of some tools that they might be able to call on.

For kids over 3, see if they can recognize their own warning signs before losing control. This is a tool that will serve them so well for their entire life. Perhaps create a song together that they can sing when they are approaching a tantrum stage. Mr. Rogers has a song about dealing with mad feelings:

What Do You Do with the Mad that You Feel?

Any time that you see your child get calm without losing control give them loads of positive feedback.

Problem Solving

Problem solving activities can be the ‘monday morning Quarterback’ after a situation has happened.

Don’t attempt this if they are tired, hungry or simply not in the mood.

Effective coaching only happens when you have a calm moment, talk about what went wrong. See if they can help plan a better way to deal with it the next time.

Step one is always identifying the problem. Break it down to a small but manageable issue. Rather than the diffuse “fighting with sister”, get down to a very specific issue, such as “sister won’t share the yellow crayon.”

Step Two is talking about some choices one might have in that situation. Some are good choices, others not so much. They all make it to the list. Adding a silly one is just fine and makes this feel more like a game. Choices could include:

• Using a different color;

• Using words and asking sister nicely to share (may need to wait a minute for her to finish coloring her own yellow parts.)

• Asking a grown up for help;

• Start screaming;

• Grabbing the crayon;

• Draw a frowning face on your hand with a black crayon;

• Use your “walking away power” and take some deep breaths.

Hopefully with some gentle guidance they can identify the more positive choices on the list.

Problem solving exercises are very empowering for your child. The age range for when kids are able to take part in these is fairly variable, but they will all get there.

Kids can also get a lot out of a well told story. Create two little children that you can tell tales about. They are the same age as yours, with very similar family circumstances. One tends to make good choices and the other also gets into trouble often. Allow your child to chime in and talk about why these other children had a tantrum and what they ended up doing about it. Kids do much better talking about these very relatable characters than they do about their own actions. Once they come up with a plan for the made up child, you can bring it back around; “Maybe you could try that also.”

Even the best kids have occasional meltdowns. Do NOT let your kids beat up on you. This might be the time for you to calmly use your own,”walking away power” if you are able to do so safely. This is a good message and a good consequence. Later on you can talk about how you are choosing not to stay in a situation where you might get hurt. Typically, kids are looking for some attention. You leaving the room is rarely the action they were going for.

All tantrums can be turned into learning experiences for you and your child. Stay calm and be consistent.

During a recent visit with the kids, I got to brush off some of these tactics that I haven’t needed in quite awhile.

I was able to avert a tantrum shockingly well.

Coby, using drawer handles as a ladder, managed to scale up the bathroom cabinets to reach a tall counter where the medicines were kept. Spiderman watch out. I was fascinated and a bit awed by his climbing abilities. I was making a mental note to warn Lauren and Adam that it’s time to store medications in a safer place.

Coby had achieved his target, took hold of the tylenol and informed me that he was going to have some of the ‘chewing’ medicine. I removed the bottle from his possession and informed him right back that alas, he wasn’t able to have some.

I could see the tantrum brewing. He started to yell, but then actually stopped, mid squawk when I said loudly, “YOU REALLY WANT THAT MEDICINE”.

In a sad but calm voice he said, “Yes”

I was able to tell him we would ask his mommy later. A bit of distraction and we moved along.

Full disclosure, Lauren says that doesn’t always work with him, but it is certainly worth a try!

She usually finds the ‘walking away power’ to be the most effective. Coby pathetically chases after her almost immediately. “I want to say ‘sorry’. I need a hug”

It is fascinating how different kids and their temperaments are. Thankfully 5 year old Elliot can go a long stretch in between meltdowns, but lord have mercy, when he is mad about something, he runs head first into the red zone with no intention of getting out of it until it is fully on his terms.

Lauren and Adam tried every approach under the sun with him, including all the gentle parenting techniques — they validated his feelings while setting boundaries around screaming and aggression, they tried to sit with him and wait it out, they offered dozens of unique ways to sneak some deep breaths in, and nothing worked with him.

The only thing that eventually got EJ out of these zones was the ultimate bluff — Lauren and Adam concocted a mythical babysitter named ‘Kevin’. If screaming and thrashing continued, mommy and daddy would have no choice other than taking him over to Kevin’s house.

They framed it as their version of walking away power: “if anyone is ever yelling at you like this or trying to hurt you, we hope that you leave that situation and go someplace safe. When you are screaming at us and trying to use your body to hurt us, we are not okay with this and are using our walking away power. You can hang out with Kevin and play with him until you find your calm with us.”

They made it very clear that Kevin is not a punishment — he is a very fun babysitter with lots of great toys and good snacks. Several times they went so far as to put EJ in the car and drive to ‘Kevin’s house’ (he very conveniently lives nearby to wherever they might be). Once parked outside, they would ask EJ if he was ready to find his calm, and thankfully he always was, and never actually called their bluff.

Likely you all have quite a bit or ‘trial and error’ opportunities to see what works best for yours.

And later… When you can find your sense of humor, jot down what set them off. Gasoline balloons anybody?

You will all get a kick out of it in a few years.

Thank you to Sawyer for being my model.. This was the trifecta: tired, hungry and jet-lagged!

Mosquito Bites/West Nile Virus Prevention tips/Dealing with bites/Zyrtec dosage

 

West Nile Virus Is Picking Up Across California

Early surveillance suggests this may be a more active season than we’ve seen over the past couple of years. It can be found year round but tends to peak in late summer/early fall. So even though some cases are expected, health officials are finding substantially more infected mosquitoes and birds than at this point last summer. This often serves as an early warning before human cases begin to increase later in the season.

It seems like a good time to update our mosquito post.

Even if they weren’t carrying any diseases, we hate mosquitoes. Yes we are aware that they are part of nature’s vast food chain but that doesn’t stop our loathing. For the record, it is a mutual dislike and fortunately we both rarely get bitten. The rest of our families? They are tasty targets, and are feasted on when given the opportunity.

West Nile History

Of all the mosquito-borne illnesses, the West Nile virus is the one that has gotten the most local media coverage. It is California’s most common mosquito-borne illness. It is thought to have originated in Africa (hence the name.) It has spread throughout the world and it was first detected in this country in 1999. Unfortunately we now have it in most states.

Transmission

Mosquitoes get this virus from feeding on infected birds. They then transmit it to humans. Humans are referred to as ‘dead end hosts’; they get the virus from being bitten by the infected insect, but then can not spread it to each other.

It is possible that it can be transmitted from blood transfusions, pregnancy or breastfeeding but there are no known cases of infants who have gotten seriously ill from these transmissions.

Incubation Period

The incubation period is usually between 2-14 days after the bite from an infected mosquito (most commonly 2-6 days.) There is, alas, no treatment beyond supportive care. It is thought that most people who have fought off the illness end up with some level of immunity. Keep in mind that any severe headache-fever-stiff neck combination always needs to be evaluated right away. If West Nile virus is suspected there are blood tests that can help with the diagnosis.

Symptoms

Fortunately, most people (around 80%) who become infected never develop symptoms. In fact, There are probably thousands of cases that go under the radar since we would never consider testing.

The unfortunate other 20% of infected folks may have

• Fever

• fatigue

• headache

• joint pain,

• muscle weakness,

• stiff neck, diarrhea,

• vomiting,

• swollen glands,

• photo-phobia

• rash on the trunk.

Not everyone will have every symptom. Most people showing these mild to moderate symptoms will recover completely, although there are reports that some of these folks can remain fatigued and achy for several weeks. 1% of infected people can get more serious neurological complications including encephalitis and meningitis. These are almost always adults over 55 or folks with compromised immune systems; it can be fatal for those with serious cases. Children under 5 seem to be at relatively low risk for getting seriously ill.

Prevention

Because there is no vaccine or specific treatment, prevention is the best protection:

• Empty standing water around your home every week (flowerpot saucers, buckets, kiddie pools, clogged gutters, bird baths).

• Use an EPA-approved insect repellent when spending time outdoors, especially around dawn and dusk. (there is a list of these below)

• Dress in long sleeves and pants if you’ll be outside when mosquitoes are most active. Light colored clothing is recommended. There are plenty of mosquito prevention clothing on the market.

  Here is nurse Judy rocking her safari hat. (How nerdy does it get?!?)

• Make sure that you have intact screens on all windows. If you are getting bites, check for holes or cracks where the insects might be getting in. If your little one is still getting bitten, check the bedroom carefully. Look at the mattress and all the corners of the room; bites could be from spiders, fleas or other culprits.

• Get rid of any standing water that is around your house; do a double check to make sure there are no pots, clogged gutters, kiddie pools, bird baths...etc. that are places where mosquitoes can breed. The larvae are dependent on water for breeding.

• Unfortunately just dumping out the water might not be good enough because it won’t dislodge the larvae that might be attached to the side. You really need to give a good scrub. Check out Mosquito bits and mosquito dunks. You can add these to any water features to keep the mosquitoes from breeding.

• There is often increased mosquito activity during dusk and dawn so that is when most of the biting happens. This seems to be true for the mosquitoes who carry West Nile Virus, not as much for Zika.

• If you are going into a heavy mosquito area use bug spray on exposed skin and clothing. Mosquito repellent works only on the surface to which it is applied directly. Experiments have shown that they will actually bite skin only four centimeters away from where the repellent is applied, so wristbands or just spraying clothing does not offer full protection.

• Some bug experts would rather that you avoid the traditional electric bug zappers. The violet light may be irresistible to some flying insects, (and that zap is such a satisfying noise), but mosquitoes are actually not attracted to the light. Some of the innocent and beneficial insects are the ones getting fried.

• If you have a garden, consider planting some of the plants that mosquitos tend to avoid. This includes lavendar, citronella and basil.

• Mosquitoes don’t like fans! If you are looking for an alternative to the DEET, the insects are lightweight enough that a good breeze may make it hard for them to zoom in on their target. Check out products such as Off Clip on Fan.

• If you are seeing mosquitoes around your house, see if your local health department will check the area around your home (including sewers) to see if they can find any breeding areas.

• Report dead birds to California’s West Nile surveillance program: 1-877-968-2473 (1-877-WNV-BIRD), or at https://westnile.ca.gov/report. They help public health officials monitor where the virus is circulating.

Alas, long sleeves alone aren’t going to do the trick if you are out in a buggy area.

The EPA has five registered insect repellents.

• DEET is likely the most well known option. It is the only product labeled safe for infants as young as 2 months old. It comes in different concentrations. The concentration of DEET in a product indicates how long the product will be effective. A higher concentration does not mean that the product will work better; It means that it will be effective for a longer period of time. Therefore, products containing lower concentrations of DEET may need to be reapplied, depending on the length of time a person is outdoors. Despite common concerns, DEET has been studied extensively and has an excellent safety record when used as directed (it’s not great for the ecosystem, so use DEET wipes when possible rather than spraying). One practical note: DEET can damage some plastics and synthetic materials (such as certain eyeglass frames, watch faces, or phone cases), so apply it before handling these items and wash your hands afterward.

• Oil of Lemon Eucalyptus is considered one of the least toxic options but interestingly, the age recommendation for it is for 3 years and older (natural lemon eucalyptus oil is not the same as Oil of Lemon Eucalyptus). Some people are sensitive to the smell of this, so it is worth sniffing it before you buy it. This is the main ingredient in Repel brand spray.

• Picaridin is odorless and is approved for children 6 months (recently lowered from 2 years) and older. Unlike DEET, picaridin will not dissolve plastics, synthetic fabrics, sunglasses, or fishing lines. Common brand is Sawyer.

• Avon Skin so Soft Bug Guard PLUS IR3535 Insect Repellent has been around for years but seems to be more commercially available than it used to be (also for over 6 months of age.) It comes in a highly rated product that combines Avon Skin So Soft and an SPF 30 sunscreen

• Bite Blocker is a botanical formula that claims to provide protection for up to 8 hours. The reviews mention a strong odor, but otherwise it gets a high rating.

  All of the EPA recommendations are considered safe, and they are clearly better than getting bitten, but at the same time, let’s use them wisely. The EPA has created the following tool to help you find the proper product for you needs

  EPA guide to finding the right repellent

  Note: If you are also using sunscreen, apply sunscreen first and insect repellent second.

Regardless of what you try, before applying anything topical to the skin for the first time, do a little test patch on the skin to make sure there is no sensitivity before you widely spritz or wipe on any of these products. You will need to read the labels to see how often you need to reapply. Avoid contact with eyes and keep all of these safely away from kids.

We would also be cautious about getting any insect repellents on little hands, especially if your child is young enough that those hands are going into the mouth a lot.

Some products are more effective than others for certain types of mosquitoes, so the product you choose might depend on where you are going and what you might be most at risk for. It is always good to check in at https://wwwnc.cdc.gov/travel prior to any travel.

There are also plenty of natural products on the market that claim to be repellents, ranging from Vitamin B to catnip. Most of these are generally safe, but unfortunately the scientific studies show that they are mostly ineffective.

DEALING WITH A BITE

If the prevention has failed, the most important thing is to treat the itching. Scratching at a bite will make it worse.

As soon as you notice a bite, giving a dose of cetirizine (Zyrtec) as quickly as you can manage, can help reduce the itching and may lessen the amount of swelling that develops. It works best when given early. 1% hydrocortisone applied early can be similarly helpful, and the combination of Zyrtec or Claritin plus topical hydrocortisone is often more effective than either alone for symptomatic relief.

Hydrocortisone cream probably works the best, but other topical treatments can include calamine lotion, or mixing up a paste of baking soda with a bit of water. A cold black tea bag compress can also be very soothing. Black tea contains tannins, which seem to help.

Be aware: some kids can have enormous reactions. Eyes and ears can be remarkably swollen. A super swollen eye along with symptoms of illness needs immediate medical attentions, but if you child seems fine other than the swollen eye, it is usually a bite. Topical treatment alone won’t be enough for these. Hopefully, the early dose of antihistamine will help. Scroll to the bottom for dosing info. It is worth being seen if the you don’t see improvement.

Zyrtec Dosage Chart

The dose of cetirizine depends on age:

· 6 - 12 months of age: 2.5 mg given once daily (maximum dose 5 mg daily)

· 12 - 24 months of age: 2.5 given once or twice daily (maximum dose 5 mg daily)

· 2 - 6 years of age: 2.5 - 5 mg given once daily (maximum dose 5 mg daily)

· Over 6 years of age: 5 - 10 mg given once daily (maximum dose 10 mg daily)

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.

Benadryl tends to be an inferior treatment. It lasts ¼ the time of Zyrtec and has more side effects.

New on the market: There are some bite pens that use a combination of heat and vibration. If used properly, these are safe and potentially helpful

Here are some bonus facts about mosquitoes:

• Both males and females make that awful whining noise, but only the females bite humans.

• That whining sound comes from their wings beating an incredible 300 to 600 times per second.

• Mosquitoes are especially attracted to people who drink beer.

• Mosquitoes love the smell of sweaty feet.

• Mosquitoes can sense CO2 from up to 75 feet away.

• Mosquitoes only fly as fast as 1-1½ miles per hour.

• Some blood types may be tastier than others. O seems to be the favorite, A the least. B lands somewhere in the middle.

• Mosquitoes love pregnant women (regardless of their blood type) possibly because they emit a little extra CO2.

• Mosquito activity can spike by up to 500% during a full moon because they rely on visual cues to navigate.

• Mosquitoes are responsible for more human deaths than any other animal due to the diseases they transmit, such as malaria and dengue.

• Mosquitoes have existed for over 100 million years and have adapted to survive in a wide range of habitats, from wetlands to urban areas.

For further reading, here is some current info on some of the more common mosquito borne illnesses

West Nile Virus

https://www.cdc.gov/west-nile-virus/index.html

Zika

https://www.cdc.gov/zika/index.html

Chikungunya

https://www.cdc.gov/chikungunya/about/index.html