Friday, February 16, 2018

The misadventure of Nurse Judy/Managing Stress

The misadventure of Nurse Judy

Last Sunday I was taking a hike along Land’s End. I tripped and fell forward. My right wrist took the brunt of the fall. The triage nurse part of my brain knew that bones were broken. What an impact one little misstep can make!

  • I didn't fall off a cliff, break a leg or sustain a head injury.
  • I was with sensible people who helped hike the mile back to the car.
  • One person had a large scarf that we were able to fashion into a sling.
  • All of the passing hikers stopped and offered to help. Humanity put on it’s best face.

  • I had no id or insurance cards with me.
  • It’s time to update the first aid kit in the car and make sure it has arnica and instant cold packs.

I spent a few hours in the Davies ER. It's OK to call ERs to see how long the wait is for non-critical care. UCSF was 3 hours. Davies was none! That is a gem of a resource for adult patients. I was able to get an early Monday appointment with an orthopedist. Both of the bones in my right forearm are broken. Yes OUCH

  • I have a wonderful support system (thank you Sandy), family, friends, good insurance, and access to good health care (way to meet the deductible early in the year!)
  • Noe Valley Pediatrics is a very supportive work environment and is trying to muddle along the best they can with the office manager mostly out of commission.

  • Ongoing trying to figure out how to manage for 6 weeks without use of right hand.
  • Trying to Learn how to say yes to the friends who have reached out with offers to help

Impact on the office
Nurses will be short staffed. Every effort will be made to return calls in a timely manner, but please understand we won’t have the luxury of time for longer conversations. The turn around for emails may be as long as a week. Please call if you need to speak to a nurse.

I have cancelled February classes. I will update this after my next ortho appointment. I may end up requiring surgery, so it is difficult to plan.

Don’t count on weekly emails, but I will try to keep them coming. 
This post is short and simple, but hopefully it can give you a new awareness or way of looking at things.

  Topic of the week: Managing Stress
My kids grew up having to deal with all of mom’s theories. One of the classics is the “stress theory”. My daughter Alana, who is now a therapist at a community mental health center in Michigan, finds herself referring to some of these with her clients.

She let me know that she used this one the other day and I realized that I had never put this one in a post. So here goes.

Is there a water bottle near by? Take a look at it, Imagine that you are that bottle. There is a thick label. You can not easily see how much liquid is inside. Elements of your life are varying amounts of fluid. Every aspect of your life adds liquid to the bottle. Some things may add a few ounces, others only a tiny drop (drops can add up!) Being a sleep deprived parent is easily a couple of ounces. A new job? An illness in the family? Moving? Ounces! Large changes or stresses are of course equated to larger amounts. Breaking your wrist - half a cup!

We generally don’t pay too much attention to how full our bottle is until it is near the top. The smallest drop of water, something that normally you could handle with no problem, may make the entire bottle overflow.

This is the proverbial straw that broke the camel's back. Are you crying because you burnt your toast? Take a moment to figure out what is going on that has your bottle so full that the littlest thing can set you off.

One of Alana’s clients found that this way of looking at things really resonated with him. He coined the term “dump the cup,” which in turn resonated with me.

What can you do to dump out your bottle a bit? Arrange a little time for yourself? Take a walk? Have the perfect cup of tea? Sometimes making a list of all the things you feel like you need to do helps quite a bit.

With your young kids, they can’t hold as much. Simply being tired or hungry will fill their little ‘bottle’ right up to the top. That’s when the temper tantrums and meltdowns happen.

Everyone who you interact with has their own stress level. It is good to keep that in mind if someone seems to be ‘overreacting’.

Are you past the sleep deprivation hell? Do you have a friend with a new baby? If you are thinking about giving a gift, consider skipping the outfit that the baby will grow out of in a minute. Give them a certificate or two that can be redeemed for a 2 hour nap while you watch the baby.

Helping your friends "dump their cup" feels pretty good.

Friday, February 9, 2018

When is your child contagious? 2018

Some of the most common questions the come to the advice nurses revolve around when kids are contagious and at what point are they ready to go back to nanny-share, daycare or school.
The answer is almost never clear cut. In a black and white world, this is my 50 shades of gray.  In order to logically best make these decisions there are many issues that we need to consider.
Of course we want to be a responsible parents and not expose others to our sick child. We also want to protect our own recovering child from going back into the 'germ pool' too quickly. If they are just getting over something, their immune system may a bit diminished and they are vulnerable to coming down with something new.

For older kids,sometimes they have an important test that they are reluctant to miss. Some are reluctant to miss school. (others not so much.....)

Another consideration is that some parents have an easy time taking time off to stay home with their little sick child and others simply can't afford to. It is naive to think that these aren't real factors.

What makes it all so tricky  is that most viral syndromes can be spread a day or two before the kids show clear signs that they are ill. Many kids may be a little fussier than usual. Perhaps they don't eat quite as much. Most savvy parents know enough to be suspicious when their 5 year old who fights naps with a vengeance announces that they are going up to have a daytime snooze. Your antenna might be up that something is brewing, but are those reasons to miss work and keep your child at home??? Of course not!

The fact is, if you child comes home from school in the afternoon and is sick that evening, most likely everyone they were with earlier that day has already been exposed and I am going to take that into consideration when we try to come up with the most sensible plan on when they can return.
It is nearly impossible to isolate siblings. Of course be scrupulous with your hand washing, avoid sharing utensils and sloppy wet kisses, but it is likely that they will catch each other’s cooties. Breastfeeding moms, sorry to say that by the time you realize you are ill, it is too late to prevent an exposure. Hopefully the magic of breast milk will protect your baby, but it is rare that we would suggest that you avoid nursing. Most of the time we will recommend that you keep on with the feedings. (Make sure that you are getting plenty of fluid. If you are given medication, check with your nurse or doctor’s office to see if it is compatible with breastfeeding.)

If you are in a small share care situation, it is essential to have a talk with the nanny and the other families involved to make sure you are all on the same page.
I would suggest that you agree that the kids will have  a "sibling" relationship. This simply means that you all accept that the kids are most likely going to get each other’s mild illnesses.

As far as common colds go, the average child under 2 years of age has EIGHT colds a year. Frankly, if you plan on keeping your child at home until your little toddler is free from a runny nose, you will be waiting a very long time before you leave the house.
Remember that some clear runny noses are not contagious. Teething as well as some allergies can be the cause. (There is debate about whether or not teething is associated with congestion. Nurse Judy votes yes.)

While I would strive to keep my youngest and most vulnerable patients free from viral syndromes and colds as long as possible, exposure to these common viruses is in fact developing the immune system. At some point they are going to have to deal with the myriad of  illnesses that make the rounds. Think of it as a rite of passage. It is actually better to get some of the childhood illnesses out of the way. Unfortunate adults that lack immunity and catch these illnesses are pretty miserable.

Typically if I have a child with a fever over 101, a  new case of diarrhea, or a brand new cold that has them spewing green mucus it is worth keeping them home for at least a day or so to see what  is coming next.

If your child has an infection that is being treated with antibiotics, we generally consider them no longer contagious after they have been on the medication for at least 24 hours.

Bacterial conjunctivitis is also usually given the all clear after 24 hours of eye drops (of course you need to finish the course.)

Hand Foot Mouth issues come up a lot. I respect that schools want to keep this yucky virus from getting spread around. Patients can shed that virus in their stool for several weeks. I would suspect that there is a reasonable chance that the infected kids likely got it from school in the first place and/or were contagious before they were identified and segregated.Since I don’t think schools are able to genuinely keep them out until they are completely clear, I suggest common sense guidelines. If they have a fever keep them home. If they are fussy and miserable, they will be much happier home with mom or dad. If they seem to be feeling okay and are fever free, for the above reasons, I don’t think it is reasonable to exclude them from daycare/school until all the blisters are gone. Kids are going to get this.

If you are questioning whether or not to go on an upcoming play date, explain your situation to the other parents. They may be perfectly fine hanging out with you and your snotty nosed child, or perhaps they have an important event or vacation coming up and want to be more cautious. Let them decide. Full disclosure ahead of time is the best practice.

We wish there were a magic light that signaled the "all clear." Alas, there isn't.
I wouldn't even completely trust the rapid tests that we do for strep, RSV or Flu. If the test says negative, but the child looks sick we have to remember that the tests aren't 100% accurate.
There is never any complete assurance that can be given that your little one is "not contagious".
Use your best common sense. When in doubt avoid contact with anyone who is vulnerable. This would include newborns, or someone with a compromised immune system.

Friday, February 2, 2018

When should your child start seeing the dentist? 2018

Topic of the Week:
When should your baby start seeing a dentist?
SF Dentist guide 2018 and Tooth Brushing tips

Scroll down for the list of dental practices

Parents often ask us when they should start taking their kids to the dentist. Believe it or not, the current official recommendation now is that your child should have his or her first dental visit by age one. In California, about one third of preschoolers have dental decay. It is much easier to prevent decay in toddlers' teeth than to fill a cavity in a young child. Tooth decay is the most common chronic childhood disease and it can be prevented.

As parents, we may think, "baby teeth fall out, so we don't need to worry about them." This sounds logical, but unfortunately is not true. Luckily, dental science has found out many new facts about how to prevent dental decay. We now know that bacteria causes tooth decay. This "bad" bacteria can find its way into your babies mouths in many ways. Eating foods high in sugar is one of the most obvious offenders. In order to prevent decay in our adult teeth, baby teeth have to be kept healthy as well.
What can you do to keep your child's teeth healthy right from the start? For the youngest babies with brand new teeth you can wipe them off with a soft piece of gauze or a wet washcloth. Not only are you cleaning off the teeth, (breast milk does have sugar) but you are getting the baby used to a routine. Training your child from the start that teeth get brushed is a good way to create good dental habits that will last a lifetime.

There are other options besides the standard hand held toothbrush. For very young babies there are little flavored towelettes specially formulated for wiping baby teeth. Spiffies was the first of these that I was familiar with. Now there are several brands available. You could also consider using a soft finger brush. These fit over your finger and if your baby will let you, this option allows you to get in there and do a nice thorough job.

If you use a regular toothbrush, make sure it has soft bristles. Replace the brush when it looks like the bristles are getting worn. It is also a good idea to run all the family toothbrushes through the dishwasher every once in awhile. One extra perk about routine dental care is that you might walk out of the dentist's office with a new toothbrush! Younger children will have an easier time handling a toothbrush with a thicker handle. Perhaps you can let your child be in charge for one brushing a day and the parent be in charge of the other; that way you know you are doing a more thorough job at least once a day. Some people use a two toothbrush approach. Toddler gets to hold one, but so do you. Both of you can be in there at the same time.
Consider putting a little tune on while you brush. This can act as a timer. Brushing is ideally supposed to last 2 minutes. Do the best you can. A full two minutes might be a goal that is a little unrealistic for many of my patients.

Daddy Adam sent me this tip: He used a kids bluetooth sonicare toothbrush, which has a corresponding app on the iPad. It gives you a little creature that you need to take care of, and you not only clean the critter's teeth when you brush yours, but you also get food and treats to feed it. His daughter Millie loved it, and it made brushing super easy. They no longer use the app very frequently anymore, but the brushing routine is ingrained. 

You can sing...but don’t dance!!
I just had a patient who got a fairly serious mouth injury from doing a little rough housing while brushing his teeth. Make sure your child isn’t running around with a toothbrush in the mouth.

The old recommendation was to use non fluoride toothpaste for kids younger than two years. The new suggestion is to actually use a tiny amount (just a little dab) of fluoride toothpaste. It is important to note that too much can be harmful so keep the amount tiny. Once kids get to be over two and can spit it out after brushing, you can use a pea sized amount. Xylitol is another recommended ingredient for dental health. It is found in some toothpastes. This natural sweetener is found to help reduce bacteria and strengthen tooth enamel.

It is important to use a toothpaste that is non abrasive. Most kids brands are specially formulated to be gentle. Some adult ones are fine. Most toothpastes will have the abrasive rating noted on the package. Ideally try to brush twice a day and floss once a day (for teeth that are touching.)

Pay attention to habits that may or may not be good for your teeth. Children who are “grazers” tend to have more cavities than the those who eat less frequently. Saliva neutralizes the acids in the mouth and actually ‘washes’ the teeth, but it needs about 2 hours in between meals to work. If someone is constantly eating, the saliva isn’t getting a chance to do its job.

Foods that are high in carbohydrates and sugar are not healthy for our teeth or general health. A daily intake of 60 grams of carbs or higher more than doubles your chance of getting caries (and all that sugar can lead to type II diabetes in kids!)


Find a dentist that treats very young children and bring your child to his or her first appointment when the first teeth erupt - no later than by age one. During the visit, the dentist will check your child for dental decay and talk to you about cleaning your baby's teeth. They might also talk to you about proper nutrition for keeping baby teeth healthy.
If you have any concerns about the manner in which the teeth are erupting, having a dentist who is familiar with your child will be very useful.

Another important thing to think about is that having a dentist can come in very handy if you happen to have any dental emergencies. Kids have accidents! It is not unusual for me to get calls about chipped or loose teeth after a fall. I usually suggest that they contact their dentist on those occasions, and the folks that already have one are way ahead of the game. If there is a dental emergency, early intervention can be the difference between saving the tooth or losing it.

Some parents avoid taking children to the dentist to save money, yet studies show that the dental costs for children who have their first dental visit before the age of one are 40 percent lower in the first five years of life than for those who do not see a dentist before their first birthday. Consider this when deciding whether or not to add your child to your dental plan (if you are lucky enough to have one.)

We are fortunate to have lots of excellent choices in our city. Below is a partial list of dentists who we send patients to. If someone is conveniently located or is on your insurance plan that is certainly worth consideration.
If you have a favorite dentist who you think should be included on my list, let me know!

David Rothman 415-333-6811 is over on Ocean avenue near Stonestown. He was my kids' dentist and they loved him. He is an excellent dentist with a wonderful sense of humor. His office is able to do procedures under general anesthesiology in the office if needed.He remains my "go to" guy if I have any tooth related questions.

Bergen James, Doris Lin-Song and Jennifer Yu 415-668-3500 They are located on Parker Street near Laurel Village. Love dogs? They have a couple in the office! Dr. Kaplan uses this office for her son and gives them two thumbs way up.

Claudia Masouredis 415-753-2777 is fairly close to our office, just up the hill on Portola. Nurse Jen brings her kids here and they adore her. Dr. Masouredis can also do procedures in her office that require sedation.

Dorothy Pang 415-681-8500 is on Taraval and 18th in the Sunset. Dr. Pang is affiliated with the UCSF dental school. If someone needs a dental procedure under anesthesiology she can do this at UCSF rather than in the office.

Raymond Katz 415-751-7900 This practice is at 5233 Geary. We have plenty of patients who have been using these folks and only have nice things to say about them. Dr. Schwanke used to take his girls over there when they were young.

Han Pediatric Dentistry 415-681-3220 Dr. James Han’s office is at 1530 Noriega Street. Dr Han is also on staff at CPMC and attends any dental emergencies at the ER there. He can perform general anesthesia cases in the OR there as well.

Dr. Charles Spitz and Dr. Tyler Davis 650-375-8300
Peninsula Pediatric Dentistry and Orthodontics. If you are looking for a practice down on the peninsula, this great practice is located in San Mateo. Dr. Davis works with Dr. Spitz, who used to have a practice in the Mission. They are located in the Mills Medical Arts building on the corner of South San Mateo Drive and 2nd Avenue in downtown San Mateo.
"We are a preventative practice first and foremost. We believe the best dental care is personalized to meet the individual needs and preferences of each child we see. We work hard to get to know our patients and their families. We're always willing to listen, to discuss options and to answer your questions."

Anne Lee DDS 650-873-5212

Dr Retailleau is the newest member of the Noe Valley Pediatrics team. This is the dental office where she takes her own kids. She has had good experience with them. They are located in South San Francisco

Kid Smiles 415-681-5437

I don’t know much about this office, but some of my patients go there and give them a thumbs up

These folks are right down the street from the office. Their pediatric dentist is not in every day, so check their schedule when you call. Patients have found them lovely and convenient for basic care, but have been referred out for dental emergencies.

There are some low cost options available as well.

If you need assistance in finding a dentist, or low-cost children's health insurance in San Francisco, please call the Women and Children's Health Referral Line @ 1-800-300-9950.

In honor of Dental health month San Francisco Give Kids a Smile Day 2018 is hosting several free dental check ups

Saturday February 10th

February 24th

RECAP: Tips for Healthy Teeth
Take your child to a dentist twice a year; starting by age one. Brush your child's teeth everyday; as soon as they come in. Make that snacks are healthy ones. Take care of your own teeth; adults can spread cavity-causing bacteria to children. Cups and/or bottles in bed are not a good idea in general, but, if you must, have them filled with water only.2018

Friday, January 26, 2018

They stuck What...Where?

They stuck What...Where?

While it might make an amusing anecdote well after the fact (and it keeps the advice nurse job from being far from boring) it can be quite the ordeal when you find out that your child has stuck some little object into an orifice.

By far and away the hole that gets the most inappropriate things passing through is the mouth; That got it’s own post several weeks ago. This week I am going to focus on all of those other interesting places that need to be explored. I refer to noses, ears, butts, if there is a hole...things get stuck in there.

One of my favorite stories is told by a friend who had a child that smelled fairly horrible. No amount of baths could mask a mysterious foul odor. The child was taken to the doctor who asked the magic question.

"Honey, do you ever stick anything in your nose?"
The child shrugged and then answered matter of factly, "just cheese..."

We get the calls on a fairly regular basis that a child has stuck something somewhere. Most of the time, it is the nose. It seems that it is just so hard to resist.

A year or so ago I had a call about a little fellow who had stuck a bright yellow lego piece in his nose. Mom was trying to figure out how big it was, it was really wedged in there. Her helpful child went over to the lego catalogue and was able to point out the exact piece that he had stuck up there.

Nurse Jen recounted the time that her daughter Isa stuck something in her nose in order to find out if the nose was connected to the throat. While a little proud of this attempt at an early science experiment, Jen recalls that a straight jacket was needed in the ER to get it removed. Isa was absolutely right - the nose is connected to the throat, but there are all sorts of sinus cavities where something could get waylaid.

Gianna Frazee, a wonderful local pediatrician, shared with me the story of a memorable five year old patient who felt the need to stick her tongue inside a Barbie doll head. The tongue swelled up and got stuck.
You may want to tell your children stories about other little children who have done these things and then had to go to the doctor and it was yucky getting it fixed. Perhaps a little teaching and mild scare tactics in advance might be preventative but the urge is strong. In my immediate family we told the tale of my niece Lena who stuck a raisin in her nose, and perhaps the power of the tale kept my own kids and the other nieces and nephews "raisin free."

If prevention hasn't done the trick and there is something stuck up the nose you have several options. If your child is old enough, have them try to gently blow it out. If that doesn't work, or your child is too young to have mastered the concept of nose blowing, you can try to suck it out. Whereas I did once have a mom who successfully sucked a pea out of her toddlers nose with her mouth, (good for her but...ugh), I would suggest trying the suction with a Nose Frida.

If that doesn't work, I have another method for you. Assuming the something is in the right nostril, push the left nostril closed with your finger and do a firm rescue breath into the mouth. If it doesn't blow the object out, reposition and try again. This works more than 50% of the time. I have seen all sorts of interesting things go into noses....peas, beads, little wads of paper, raisins, a starburst candy. Kids are creative!

It is fully possible that whatever it was was sucked up was subsequently swallowed, but never the less, if it went up in the nose and you weren't able to get it out, someone needs to look in there. As Dr. Kaplan says, "if it is an object, say for instance the #3 key from a toy telephone, it needs to be removed." If it is a small organic thing like a piece of rice, she doesn't get worried if it isn't retrieved as long as it doesn't seem to be causing any issues.

If you aren't quite sure if they stuck something in there or not, kids are often not the best historians when it comes to finding out the truth. If you ask them if they put something in their nose and they think that answering yes will either get mommy or daddy mad, or land them at the doctors the answer may well be an emphatic "Me? Something in my nose? I don't remember!"

Keep that in mind, as a constant running nose, foul odor, or signs of irritation in or around the nose could be signs that a foreign object is the source of the trouble.

The docs in our office are willing to try to get something out, but we might not be your best choice. If there is a way to get onto the schedule of an ENT that is usually the better option, They have better tools for getting the job done right the first time.

We also have our share of patients who stick things in ears. One of the more memorable for me was the little boy whose brothers had convinced him to do a wee experiment and see how many unpopped popcorn kernels could fit in his ears. Of course this was 4:30 on a Friday...right? As he came into the office I could hear him crying "I don't want them to have to cut off my ears." Those same brothers of course were behind that as well. Ah siblings. Although we may be able to remove something simple from the ear,that little fellow also ended up at the ENT.

Not all that long ago, Dr. Jessica saw a little blue bead in an ear during a routine exam which she was able to safely remove, while a little silver pellet from an ear of a different patient was referred out. 

Parents shouldn’t be sticking things in their kids' ears either. Q-tips are the biggest offender. Between 1990 and 2010 there were more than 260,000 children treated in the emergency room for ear injuries related to cotton tipped applicators.

Yes, we have had the occasional thing stuck in the butt (in fact it was a tube of mascara most recently;) those are fairly rare thank goodness.

It would be nice to think that there is a magic age when folks grow out of this. Nurse Kenlee currently works in an adult ER. She says that the stories she could tell are probably not suitable for sharing!

Friday, January 19, 2018

Old letters and Photos

Old letters and photos
I was just back in Pittsburgh, Pennsylvania with my sisters, Marjie and Amy, sorting through boxes of stuff in the house that I grew up in. Pittsburgh in January is cold and snowy, perfect weather for hunkering down and staying inside. I equate this undertaking to taking a teaspoon full of liquid out of a 50 gallon aquarium. It is hard to see progress; there is so much to do. We have opted to take our time and gather together every few months so that we can celebrate the memories and poke through things together. It is a luxury that we are able to do that. As a bonus, my younger daughter Alana flew in from Michigan to join us for the weekend.

I grew up in a house that was filled to the brim with books on every subject. (We will start dealing with the books at the next visit.) There were plenty of costumes and odd clothes with which to play dress-up. At one point there was even a hoop skirt; I have no idea where that came from. Having a mom who was a kindergarten teacher made it a given that we had plenty of odd things on hand for variety of arts and crafts activities.

The last visit was geared toward ridding the house of the obvious junk:

This visit we focused on the shoe boxes jam packed with letters, papers and pictures.

My family, going back to great grandparents, were faithful correspondents and it seems that they didn’t believe in throwing away letters. This is now truly the proverbial mixed blessing. Even though it is a daunting task, there is something magical about holding an old letter. We lose something in this digital age.

In regards to the photos, my father loved to take pictures of everything. Some are in envelopes, many are duplicates, some are in albums ( my mom’s efforts), but the majority are loose in boxes. The unflattering, out of focus photos got the same treatment as the good ones. They are all waiting to be sorted, all gazillion of them.

My grandmother’s photos and letters are there as well. Some of the photos date back to the 1800s! I took the opportunity to reach out to some cousins that might be interested in checking out old family treasures and we had a fabulous gathering of people who had driven hundreds of miles to get together and help us identify the people in some of the older photos

Here is a copy of the Facebook post that I added during the trip:

I got a gift from the universe today. We have been going through an amazing stash of family letters and photos this week. Reading the love letters from my grandfather Asher to my grandmother Flora was one of the highlights. We realized that somehow or other, none of us knew the story of how they met. How could that be? The loss of my mom last year was staggering. We couldn't just turn to her and ask her for the story. I then remembered that 30 years ago or so, my grandmother had been interviewed by the National Council of Jewish women as part of an Oral History project.

I googled, Flora Isaacs Oral History and there it is, two hours of my grandmother talking, divided into 4 parts. This is something to savor. We listened to the first side last night. This evening Amy and I listened to part 2 and sure enough we got to hear Grandma tell us the tale of how she and Grandpa met.

We had all sorts of lovely serendipity. My sister found an old pair of rhinestone folding opera glasses tucked out of the way in a small box in the attic. She brought them down for us all to see. Later that day, as I sorted through piles of letters, I happened to take the time to read one from my grandmother to my mom: “Mrs. So and So brought you a gift. They are wonderful little opera glasses that fold up; make sure you write a thank you note.”

Okay lovely readers, here is your takeaway assignment. Figure out who are the people in your photos. Even if they are digital, make sure that you manage to accurately label them. If you have old photos, get your parents, grandparents, aunts, uncles... etc. to look through them with you, and tell you who the people are. This information is lost otherwise.

Don’t save the crappy photos. Having a smaller collection of good pictures is much more valuable.

Get the stories! Do you know how YOUR grandparents met?

Friday, January 12, 2018

Building and Protecting your immune system

Topic of the Week:
Building and Protecting your immune system

This is the season to focus on boosting your immune system. I have had multiple requests to address this topic in a post.
One of the blessings of working at Noe Valley pediatrics is that although we are a western medicine, science based practice, the advice nurse team is allowed to stray off the rigid telephone triage guidelines that most advice nurses must adhere to. My patients over the years have been on the receiving end of advice from me that includes some more natural or holistic suggestions.

This post in particular strays way off the basic western medicine path and includes a combination of conventional wisdom, with some anecdotal remedies shared with me by healers from a variety of modalities. Some of the things that I suggest can be found as my husband laughingly describes it, down the “placebo aisle” of the local drugstore, but as we are in the full throes of a variety of illnesses, many of my patients are ready to try anything.

My kids grew up with my husband's grandma’s recipe fondly referred to as Muggala Guggala, (see below for recipe*) I imagine many families have their own health rituals. As long as you are not ignoring a condition that warrants medication such as asthma inhalers or antibiotics, there is little harm in exploring some natural options. Who knows, you might find something that helps.

Good Hand Washing is the cornerstone to staying well.

If you were out and about in a crowd of sniffling,coughing people make sure you scrub up and change your clothes as soon as you get home.

Getting enough sleep is essential. If kids seem tired, you might need to start the bedtime routine a bit earlier. If you are interested in really finding out more about the actual quality of your child’s sleep, Knit Health is an interesting, reasonable option.

For older kids and adults make sure you limit the screen time for at least an hour before going to bed. Most experts suggest longer than that, but I accept that it often isn’t that realistic. (For the record, binge watching Game of Thrones right before bed is NOT a good idea.)

Make sure you and your kids are getting enough Vitamin D. Many folks have vitamin D levels that are significantly below where they should be and would benefit from a daily supplement .

Make sure you are getting enough Iron. Magnesium, iron and vitamin D are all connected to sleep as well as to a healthy immune system. (Magnesium also helps with pooping.)

I don’t love to binge on most vitamins, but a multi that has A and C is especially important during the cold and cough season. Check out Ester C. This is an exclusive form of vitamin C that is designed to give round the clock immune support. Sandra Roddy Adams, my chiropractor, gives this a big thumbs up.

Zinc is an important cold fighter and some studies show that it can decrease the duration of a cold by 50%.
Zicam lozenges are what I like. I actually think that the generic orange flavor tastes the best. These work better if you catch it early! With any zinc product it might be best to take with something in your stomach to avoid nausea. Kids need to be old enough to safely take a lozenge or chews

I asked my cousin Sam, who is a retired family practice physician if he had any favorite supplements. Echinacea,
ginger,garlic,myrhh, cayenne, vitamin C, vitamin B6 and bioflavanoids all made his list. For the grown ups out there, he recommended a Source Naturals Wellness Formula that has a lot of the good stuff in one capsule.

More and more studies are finding that having a healthy gut is essential to the immune system. My friend Sari is a craniosacral therapist in Arizona. When I reached out to pick her brain about this post she concurred with me that more and more studies are finding that having a healthy gut is essential to the immune system.

Probiotics are good for any age

Oil of oregano is thought to be a great immune booster. I would recommend this for grown ups or kids over 6 who are very cooperative, It has a very strong taste and causes some oregano burps but can work pretty well

Omega 3 are mostly found from eating fish, but most people probably don’t get as much as they should. This supplement makes it to most of the lists as a worthy supplement.

Local honey has antioxidants and is thought to be helpful for the immune system. Dr. Anne was the one who added this to the list. She actually adds honey to her coffee! I tried it and it isn’t bad. Hey, working in this office gives us a lot of exposure to everything that is going around. We will try anything!
Remember that infants under one year should NOT eat honey

Chinese Medicine - Dr Schwanke started using Chinese herbs in our office many years ago, but only carry a limited line that we use for ear infections and congestion. We are fortunate to have the creator of those formulas right in the neighborhood at the Chinese Medicine Works. It is important that any Chinese medicine comes from a reputable source. I like the gentle warriors brand because it is made locally

It might be worth exploring some herbs if you or your kids keep getting sick.

My amazing friend Anita is an acupuncturist in Colorado.
She encourages warming foods for her patients. These keep the internal temperature up. Viruses prefer the cold environment. She suggests that drinks be room temperature or warm/hot. Don’t add ice to drinks. Use warming spices and herbs such as garlic, cinnamon and cloves.
Soup is always good! Here is a bonus Acupressure point good for boosting the immune system: acupressure point stomach 36

Herbs and Homeopathy
Sambuccol is at the top of my list when it comes to my personal self care. This is an elderberry base, fairly widely available that has some scientific studies backing up it’s immune boosting properties. (Even Sandy doesn’t scoff at this one.) I start taking these the moment that I feel the scratchy throat feeling that makes me worried that I am starting to come down with something.The earlier you start this, the better it works. The bottle says for children over 2. The UK version gives the dosage for over 1.

These are homeopathic sprinkles that I refer to as fairy dust.
I don’t understand homeopathy, but many folks swear by these. I take a tube every time I fly. Sandy tried to figure out what’s in them and the only ingredient he recognized was duck liver.

This herb is on many folks list of remedies. The studies have been mixed as to whether or not it works. Make sure you are a label reader when getting this supplement

My friend Oran is a wonderful healer who lives in Israel. Both of my daughters had moments during their travels there when they showed up on her doorstep with various illnesses and she nursed them right back to health. She has the ‘No White’ rule when people are sick. No white sugar, No White Flour and No Dairy. All of those can contribute to inflammation.
She also shared something that I confess I had never heard of. She suggests cutting an onion in half and leaving it on a plate right near the head of the bed.

It is very important to avoid secondhand smoke. If you are someplace where the air is dry, or in SF you have turned the heat on, consider using a humidifier at night. Make sure you keep it clean and turn it off during the day. Running it 24/7 can create a mold situation.

It is fairly common for parents to call us, incredibly frustrated when their kids seem be sick all the time. It makes sense when you think about it. If they are depleted from illness number one, when illness number two comes around they are more vulnerable. Everyone is being exposed to so much this season. I have patients who actually have more than one illness at a time. RSV and Flu together seems to be a popular combination at the moment. Unfortunately most viral syndromes simply take time. Antibiotics are NOT useful for a virus.

If you are stuck in a cycle of catching one thing after another and the above suggestions haven’t helped, explore your options and see if you can keep your child out of daycare for a week or so. Sometimes that break makes a big difference.
Don’t forget to swap out the toothbrush or put it in the dishwasher.

* Muggala Guggala - 1 cup milk, 1 Tbsp of butter, 2 Tbsp honey - heated in a saucepan.

PS Mama Jaime chimed in to share that she has found that Thrive Market is a good place to get many of these supplements at a good price.