Rashes/ When to worry

 Rashes happen frequently. You can’t imagine the scope of the emails we have gotten from people asking for us to help them figure out what is going on. Many include photos of random, not easily identifiable body parts. It keeps things interesting.

Rashes can be spotty, blotchy, hives, and/or oozy.

They can be caused by allergies, bug bites, poison oak, contact with an irritant, virus, bacteria or fungus.

They can be on only one body part or cover most of the patient.

They can be part of a chronic condition that comes and goes, or something acute.

Once in a while we can look at a photo of a rash and have a good guess of what we are looking at, but more often things aren’t completely clear cut.

Here are some of the questions that we get all of the time:

Common Rash FAQs (a window into the daily life of a pediatrician):

• Do these spots mean I need to keep my kid home from school?

• Is this diaper rash worthy of urgent care? It looks so painful. Is it from an allergy to something they ate?

• How do I know if my baby’s rash is due to a food allergy?

• How do I treat this persistent cheek rash between ages 6 and 24 months? Does this rash mean my baby has a food allergy?

• Does this diaper rash need an antifungal or regular desitin/vaseline/barrier cream? Should I change what they’re eating?

You may notice a theme in the most common questions we get from parents, but all kidding aside, the most important thing really comes down to one very important and basic question: “Do we need to be curious about this rash, or actually worried?“

If you learn nothing else:

A child with a random rash who is running around, playing, eating, and acting like themselves is very unlikely to have something serious.

Rashes that we are curious but not worried about

If the rash bothers you more than your child, it likely isn’t urgent, but let’s do some problem solving.

• Are there any new medications? Especially antibiotics; even if it is the end of a course or they just finished. This is important information.

• Was there a recent illness/fever? If they just had a mystery fever and then a rash comes out once the fever is gone, we are NOT as concerned about it. There are quite a few viral syndromes that wave goodbye with a rash

• Do they have a history of eczema or atopic dermatitis. This tends to be a common culprit.

• Are there any new foods? Yes sometimes they are the cause, it’s just not as often as you think.

• Have they been enjoying lots of citrus or berries lately? This is a mild, temporary irritation due to acid, not an allergy. The anus might also have a characteristic red ring around it.

• Are there any new soaps, detergents, bubble baths?

• Have you used a new sunscreen or lotion of any sort?

• Do you have pets? Flea bites love the ankle areas, but for a crawling toddler, anywhere is fair game.

• Has there been an exposure to a new animal? Keep in mind that allergies are more likely if kids are older than 2. It is certainly possible as early as age 1, but unlikely to show up before then.

• Have they had a MMR or chicken pox vaccination within the past 2 weeks?

• Has your child been in a hot tub 1-3 days ago?

• Is the weather very warm? (babies don’t like the heat, especially if they’re over-bundled)

• Has your child been laying in the grass or sand?

• Any recent hiking? (think poison oak)

• Has your child done a recent art project with a new substance?

• Have you checked the mattress and area around the bed to see if there are any spiders or insects hanging around? (shudder)

If your detective work has given a promising clue, make the common sense adjustments, use some of the tools below and see if you see any improvement.

Regardless of what is causing a rash, there are several basic staples that are worth keeping on hand.

• Neutral cleanser (Cerave, Cetaphil, Vanicreme, Eucerin are all great, minimal water needed, apply and wipe off with lukewarm water and no rubbing).

• Aquaphor or Cerave ointment for broad dryness or redness.

• A good moisturizer (Tubby Todd All Over Ointment is fantastic albeit expensive)

• You all know that we love adding a splash of apple cider vinegar or baking soda to the tub for all sorts of rashes.

• Oatmeal bath (don’t clog your drain with real oatmeal, there are special products used for this).

• Bleach! Believe it or not, many dermatologists will suggest a diluted bleach bath for helping clear up eczema or bacterial infections. Directions for this are below.

The following items are worth having in a well-stocked medicine cabinet.

These are targeted treatments for allergic, fungal, and bacterial skin issues, and are usually worth a brief consultation to figure out which ones are appropriate for the situation.

• Over the counter Neosporin/Bacitracin or prescription Mupiricin for anything red and painful or yellow crusty.

• Over the counter anti fungal cream/ointment for any possible yeast rashes (photos below in the diaper yeast section, but these have a characteristic look).

• Over the counter hydrocortisone cream/ointment for itchy areas.

  • One clear exception to the use of hydrocortisone: discrete red or pink dots in dark wet places, usually the crotch or diaper area, should always start with an antifungal before hydrocortisone. Fungal rashes “eat steroids for breakfast.” They’re likely to make things worse. Not dramatically, but don’t start with them.

• Zyrtec, Claritin, or Allegra are antihistamines to have on hand. Benadryl is absent from this list because it lasts ¼ the time but has all the unwanted side effects, especially drowsiness (We see you parents, saying, ‘Hey wait, who said drowsiness is unwanted!?”)

Of course feel free to call your advice nurse or doctor’s office to help you troubleshoot. If a rash is persistent and your best attempts at clearing it with a variety of OTC creams isn’t helping, you may be sent to the dermatologist.

Rashes that need to be seen/Now we are worried

Any purple rash could be an emergency. These rashes don’t lighten up when you press firmly on them. If you have a child who has a purple rash and also has a fever and looks ill, they need to get to an emergency room immediately to rule out meningitis. A stiff neck, vomiting and headache would make us even more concerned. These kids are not happily playing.

Hives are scary because most people associate them with a severe allergic reaction. If the hives come along with sudden coughing, vomiting, diarrhea, swelling of the lips or tongue, or altered mental status, they need to be seen ASAP.

Once they have a history of severe allergy to something, you should always have an epi-pen, AuviQ, or Neffy (nasal epinephrine) on hand. Treat immediately at first sign of a reaction, but then head right to the ER for some close monitoring. Luckily, hives alone, are not usually urgent. (more on that below)

Urgent, but extremely rare:

One final rash deserves special mention: the rash that comes with Kawasaki disease or MIS-C (Multisystem Inflammatory Syndrome in Children). The good news is that the rash itself is usually not the most important clue. These rashes can be blotchy, widespread, or just plain hard to describe. What matters more is the whole child. These kids have persistent fever and they look sick. They often have very red eyes without any discharge, bright red or cracked lips, a red “strawberry” tongue, swollen lymph nodes in the neck, or redness and swelling of the hands and feet. Belly pain, vomiting, diarrhea, or unusual fatigue are especially common with MIS-C.

These are conditions that need prompt medical evaluation. Fortunately, they are uncommon, and with early recognition and treatment, the vast majority of children recover completely.

It is worth repeating: if your child has a rash but is running around, playing, eating, and acting like themselves, Kawasaki disease, MIS-C, or anything else worrying are much less likely.

Not urgent but potentially worth a visit:

Confer with your provider before just showing up. Some offices may take steps to avoid having someone who is potentially contagious hanging out in the waiting room.

Measles would also present with a high fever and a rash. It is very sad that it needs to be back on this list. Click the link for a full description of symptoms but these patients look sick! It is essential to have it identified as quickly as possible to prevent spread.

Strep throat often presents with fever and a rash, usually there is no congestion. While it will often go away on its own, it is worth treating to avoid potential complications.

If the rash is oozy and crusty it might be bacterial. Impetigo is fairly common. It often presents with a sore around the nose or mouth that doesn’t seem to heal. A yellow crust makes it pretty easy to figure out. If your child has a history of impetigo, you don’t need to rush in. If you already have Mupirocin, you can try to treat a small area. However, if it isn’t clearly taking care of things, an appointment is warranted. Sometimes oral antibiotics are indicated.

If a rash seems to have lots of clear fluid filled centers, it could be chicken pox or herpes!

Any painful rash that is only on one side of the body and doesn’t cross the midline could be shingles. It is rare for children to get this, but it can happen.

Some viral syndromes that may have the rash and fever concurrently are Slapped Cheek and Hand Foot and Mouth. Neither of these are urgent, but it’s nice to be seen to differentiate from the others. We don’t have anything other than suggestions for symptomatic relief for those. You simply will need to ride them out.

Hives without signs of anaphylaxis are usually not a big deal, but may be worth a visit. They are a signal that the body is reacting to something, but often it is viral. We have had patients with mystery hives that have cycled on and off for several weeks before finally fading. This is actually pretty common 1-2 weeks after an illness in children, and sometimes kids didn’t show any signs of being sick (i.e. there weren’t any symptoms).

Even if they don’t look terribly sick, if your child has several days of fever, a rash, and that little voice in your head is saying, “Something isn’t right,” trust that instinct. Going in for a little reassurance is never the wrong answer.

If the rash seems very painful or itchy certainly try Zyrtec or Claritin, but if your child is uncomfortable let’s get them seen to see if we can help. Some itchy rashes like poison oak may need oral steroids.

Photos

Disclaimer : You may not want to be eating if you scroll down. Seriously, rash pictures can be tough. (Our editor, Sandy, says we needed a stronger warning)

Welcome to our world!

Common Baby Rashes

Diaper yeast/fungal infection:

We suspect a diaper rash is caused by yeast/fungus/candida when we find the classic “satellite lesions” red dots that are thrown off the main rash. There tend to be lots of little bumps or dots instead of broad smooth red areas.

Diaper “Dermatitis” (not caused by fungus/yeast)

Source: Uworld Medical

Severe diaper rash (note the skin breakdown, this needs a high concentration Zinc-based barrier cream like Desitin applied like icing on a cake, so you can’t see the skin). Nurse Judy likes Bag Balm for this:

Drool rash (“irritant contact dermatitis”)

Neonatal Acne

Infant Eczema (note the predominance on cheeks and trunk, not behind the elbows and knees like the older kids)

Illness rashes:

Hand Foot Mouth

“Slapped Cheek” (parvovirus B19)

Antibiotic rash (amoxicillin measles)

Poison Oak or other “contact allergy” rashes (note the streaks where the plant was brushed on the skin):

Hives/allergic rash (they are raised welts. Lots of little red dots are not hives):

Impetigo

References

Bleach Bath Recipe & Dilution

• For a full tub: ¼-½ to cup of regular, plain, unscented household bleach (around 5%-6% sodium hypochlorite).

• For a half tub: ¼ cup of bleach.

• For a baby tub (about 4 gallons): 1 tablespoon of bleach.

• Water Temperature: Lukewarm.

Instructions

1. Mix: Fill the tub with lukewarm water and thoroughly stir in the bleach before getting in.

2. Soak: Soak only the torso or affected areas for 10–15 minutes. Do not submerge the head or face.

3. Rinse: Thoroughly rinse the skin with fresh, lukewarm tap water.

4. Dry & Moisturize: Gently pat the skin dry with a towel (do not rub). Immediately apply any prescribed medications and moisturize

   Helpful for eczema or rashes caused by bacterial source (Staph)

Baking Soda Bath

Recipe

• Full bathtub: ¼-½ cup baking soda.

• Baby bathtub (about 4 gallons): 1-2 tablespoons baking soda.

• Water temperature: Lukewarm.

Instructions

1. Fill the tub with lukewarm water and dissolve the baking soda completely.

2. Soak for 10-15 minutes.

3. Gently pat the skin dry (don’t rub).

4. Immediately apply moisturizer or any prescribed creams.

Helpful for: Itchy skin, nonspecific irritant rashes, eczema flares, and viral rashes.

Apple Cider Vinegar Bath

Recipe

• Full bathtub: 1 cup apple cider vinegar.

• Half-full bathtub: ½ cup apple cider vinegar.

• Baby bathtub (about 4 gallons): 2 tablespoons apple cider vinegar.

• Water temperature: Lukewarm.

Instructions

1. Add the vinegar after filling the tub and mix well.

2. Soak for 10-15 minutes.

3. Rinse briefly with clean water if the smell bothers your child (optional).

4. Gently pat dry and immediately apply moisturizer.

Helpful for: Mild eczema, irritated skin, folliculitis, and helping restore the skin’s natural acidic barrier.

Do not use on large open wounds, severe skin breakdown, or if it causes significant stinging.

The stuck WHAT in their mouth? Coby swallows a penny

 Last week my 28 month old grandson Coby swallowed a penny.

Lauren heard something in his mouth that didn’t sound normal.

“What’s in your mouth?”

“A coin!”

“What?! Open your mouth!”

“I swallowed it.”

“Did you really!?!?”

“Yes”

“What kind of coin was it?”

“The gold one.”

As I told him over the phone the next day, when you are smart enough to inform your mommy, “I swallowed the gold one,” you should also be savvy enough NOT to put things in your mouth that don’t belong.

When it happened, Lauren knew to refer to my old blog post, but as a nod to Coby I figured this is one worth updating and refreshing.

They put WHAT in their mouth?

Kids like to explore. Many times this involves sticking things where they don’t belong. Being fairly oral critters, most of the time the object they are handling gets placed in the mouth. When this happens there are two passages where something might go down.

If it goes into the esophagus, that is the beginning of the digestive tract. It hopefully will make its way down into the stomach, through the intestines and then get pooped out.

If something was swallowed, here are some things to consider:

Is it stuck?

How does the child look? Are they able to take a sip of water? Can they swallow just fine? Is their breathing relatively normal?

If something has gotten stuck in the esophagus they will look uncomfortable. There will be frequent coughing and throat clearing going on. You will know that something is amiss. This will necessitate a visit to the ER.

(In Coby’s case, he was able to easily drink water and eat an applesauce pouch, which was very reassuring)

Is it poisonous?

If you have any doubt about that, call the poison control center

1-800-222-1222 . For more info about dealing with poison, here is my blog post.

Is it potentially germ laden?

The answer is most likely yes, but that doesn’t mean you need to freak out.

When I was still working in the pediatrician’s office, I would get calls all the time about kids eating things that are pretty disgusting. More often than not, there were no actual consequences.

Young infants are the most vulnerable to germs, but the good news is that they don’t usually have the hand/mouth coordination to actually get anything into their mouth.

Once they have mastered that milestone, they are old enough that a normal healthy gut has good bacteria that can be somewhat protective.

If whatever it is that they ingested is going to cause trouble, symptoms will usually show up with tummy aches, vomiting and loose stools within a day or so. Persistent tummy upset will usually warrant an evaluation.

Is it a battery or magnet?

Any battery can be trouble, but button batteries can be a tremendous hazard because they can be easily swallowed and they seem to be everywhere these days.

Several years ago I got a call from a mom of 15 month old twins. There they were, sitting on the floor with mom’s pedometer right in between them. It was open and the battery was gone. Because of the uncertainty involved, we did have to send them to get x-rays. Indeed there it was, that little battery, sitting in the stomach of one of the kids.

In this case it passed safely, but if a battery gets stuck anywhere on the way it can cause a dangerous amount of damage.

As an important safety measure, pay attention to where any button batteries are in all of your little gadgets and make sure that your kids have no access to them. Keep a strict inventory and perhaps stick a piece of duct tape across any battery compartments.

Other objects that you need to be wary of are magnets. I am not talking about the little letters that you may have on your fridge. The ones that cause concern are the industrial strength magnets that you may find in some “grown up” toys like buckyballs or jewelry.

If more than one of those get swallowed it can wreak havoc on the intestines and be deadly. Keep them away from your kids!

Water/Agua beads

I am glad that these weren’t around when my kids were little. Coby is such a little goat, that Lauren has wisely not let them anywhere in her house.

These are little sensory beads that can grow to almost 100 times their original size when wet. They claim to be non-toxic, but they can be very dangerous if swallowed. These beads are associated with thousands of ER visits every year. If the beads are ingested they can continue to grow inside the body. This can cause severe discomfort, vomiting, intestinal blockage and life-threatening injuries.

As an aside, they are probably helping put many plumbers’ kids through college. Your pipes will thank you for not letting these into your home.

Is it sharp?

If the something that they have swallowed has a point or sharp edge, keep an extra close eye on your child. Feel the tummy to see if it is nice and soft. Look for blood in spit up or drool. Keep an eye on the stools.

If your child seems to have a rigid painful belly or has any dark, tarry poop or bright red blood they will need to be seen right away.

You may as well laugh

Some of the stories of what kids ingest are worth a giggle once everyone gets the all clear. One episode that I remember was a 3 year old patient who managed to swallow one of her Grandma’s one carat diamond stud earrings. It did pass through and was retrieved with no harm at all to the swallower. However, Grandma didn’t want it back; it was reunited with the mate and is in a safe deposit box waiting until the little girl is 18.

Most of the time, like the earring, it is simply a matter of watching for whatever it was to pass through. I have seen all sorts of stuff get swallowed and pooped out without incident. I think I have seen enough change to put a kid through college. Most coins smaller than a quarter go through fairly easily.

Here is a fun fact. I am more concerned about a penny that is newer than 1982. Why? Because these newer pennies are more zinc than copper, and the Zinc can be more reactive with the stomach acid.

However, when a worried parent would call me to report a swallowed penny, asking them what year it was, was unlikely to be helpful.

Nurse Judy’s ‘corn in the poop’ tip

Okay, so they have swallowed something, what’s the next step?

Once it is clear that nothing is stuck, let’s encourage a quick passage! Increase the amount of fluids that your child drinks. Perhaps add prunes. If your child is old enough that they are beyond simple pureed food, consider giving some corn kernels (you won’t see that in any textbook). Have you figured it out yet? For those of you who need this spelled out, corn kernels are usually fairly recognizable after they have been pooped out. They can act as a marker. That bright yellow kernel of corn can help you track the transit time.

(Lauren gave Coby corn as directed, but then didn’t look too carefully to see if the penny passed. In all fairness, Coby was in the process of potty training himself, so some poops were in the potty, and one was messy enough that she ended up simply tossing the training underwear rather than having to deal with it.)

When do we need to start paying extra attention to this ‘oral’ behavior?

Once in a while just about every kid is going to do some exploration, but if your child is old enough to know better and seems inclined to continue to put non food items in their mouth, this might be a condition known as Pica. Pica is the persistent eating of substances such as dirt or paint that have no nutritional value. This is worth pointing out to your doctor. There might be a nutritional deficit or something else going on. Low iron levels or high lead levels could be part of the issue.

Choking

Up until now, we were discussing things that went into the esophagus.

If the object goes into the trachea it may block the airway and you have a choking situation on your hands, or it could get aspirated into the lungs. Neither is good.

Your child will clearly be having breathing difficulties if this has happened. It is important to note that if someone has a blocked airway, they can not speak or make sounds. They will likely have a color change and look pale or blue.

It is critically important that all parents and caregivers are trained to do a choking rescue. Of course with any emergency you should call 911

Prevention!

To avoid this happening on your watch, do your best to keep little items away from the young kids. Anything that can fit into a toilet paper tube is too small for an infant or young child to be handling. Food pieces should be soft or cut into long strips rather than round pieces.

Encourage safe eating: sitting instead of running around, chewing and swallowing rather than shoving in wads of food. Parents, please model good behavior!

So what about the new devices that can help if your child is choking? These are relatively new and get mixed reviews. Alas these are not geared to children less than 22 pounds, but might still be a nice piece of mind for older toddlers.

A final note on the penny.

I had seen countless patients who swallowed pennies without any complications, so I was not terribly concerned.

But then….Coby got a fairly significant rash.

There were a few Xs in the equation. He had just finished a course of Amoxicillin, which was the likeliest culprit. It also could have been viral. But just to make things interesting, there was also the remote possibility that it could have been a reaction to the zinc or copper.

Fortunately the rash resolved and we are assuming that the penny is somewhere in the plumbing system as opposed to being stuck somewhere.

And now Coby is eagerly retelling his version of this story: “mama heard something in my mouth… it was a coin…. I swallowed it!”

Me: Lauren, can I get a photo of Coby holding a penny, for my blog?

Lauren: You think I would trust him with a penny!?!?

This photo will have to do.

July 4th Safety Tips/ There may be things you haven't considered

 Here are some tips that can help you all have a safe & healthy holiday weekend.

Posting it a day early. It might be more useful for planning purposes.

Fireworks

Not surprising that these are on the top of the list.

Please be very careful of fireworks. If you are skipping the organized shows and planning on setting them off yourself, make sure your kids don’t have any access to the fireworks or matches ahead of time. Do an inventory and know exactly what you have on hand. Keep the kids at a safe distance during the actual fireworks. Have a bucket of water or a hose nearby.

The danger isn’t only personal injury. If you are living in an area where the fire danger is elevated, please don’t be a dumbass.

Fireworks are LOUD

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

How loud is too loud?

Dogs and cats hate the 4th of July

Try to keep your pets indoors with windows closed. There are items such as the Thundershirt or medications that you can give them if you know your animal has a tough time with the booms of fireworks. There are also some noise canceling headphones for pets, newly on the market.

I know this first hand, my poor grand-dog, Bowie, who is an enormous fierce looking shepherd/husky mix, is absolutely terrified of fireworks. We were in Golden Gate park a couple of years ago and some (^%$#) set off a firework just yards away. Poor Bowie, all 75 pounds of him, jumped into his daddy’s arms and needed to be carried to the car. ( Luckily Adam is a strong guy)

Also, pay attention. Stressed out animals need to be observed especially closely with any interactions with your children and babies.

Make sure that your animals are microchipped or have current tags on, in case they get out.

Going out in a crowd

Since some of the holiday festivities may involve large crowds, I have some recommendations for dealing with situations where you might find yourself in a throng of people. Dress your child in bright clothes that stand out from the pack. Take a photo of them before you set out, so if heaven forbid you get separated, you have a current picture to pass around that shows exactly what they are wearing. Another sensible and creative idea is to write your phone number on your child’s wrist and cover it with liquid band-aid to make sure it doesn’t wash off. Make sure all phones are fully charged.

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

Protect from the sun and stay hydrated

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

For those of you escaping the city…..

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

Sunscreen post

Safe Grilling/food safety

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

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

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

Outdoor woes

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

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

Tick Post

If you are doing any hiking, or have a dog who is tromping around in the bushes, then pay attention to the possibility of Poison Oak

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

Sandy's first Father's Day Post

 Ten years ago, Sandy wrote his first “Father’s Day” blog post . It ended up being one of my most popular posts. I am rerunning it this week. The words of wisdom don’t have an expiration date.

2016

In honor of Father’s Day, Nurse Judy has invited me to pen this week’s column and share some of my thoughts about why I have, and believe you can have, the absolutely greatest relationship with your kids through all stages of their lives. I believe that inherently, mothers are more nurturing, protective, overtly emotional, physical, and “maternal” in their instincts, beliefs and behaviors towards their children. But from the moment I first saw Lauren, a day that all who know me recognize as the most impactful day of my life, I knew I was going to give Nurse Judy a run for the money. I, like many of my generation, had an ok relationship with my parents. But it was not the one I wanted with my kids, and that became immediately obvious that day Lauren was born.

I have been called a lot of things over the years. I am frequently referred to as Mr. Nurse Judy. After years of taking our golden retriever to the park up the hill in the afternoon when the local elementary school let out, I became known to a few generations of kindergarteners and first graders as Java’s daddy. I was known as a business executive. But the grandest name I treasure is that of daddy (or father or papa bear or now Papa…) Why? Because after building a relationship with Lauren for 28 years, and with Alana for 25 years, I continue to have new and grand experiences with them, experiences that are direct descendants of the beliefs I had in raising them. And now I have a daughter who jumped at the opportunity to go on a daddy/daughter cross country road trip when she left for grad school, where we got to eat yellow (yes, there’s a story there) in Indiana, and simply cross a bridge into Kansas, make a U-turn, leave and say “we’re not in Kansas anymore.” And I have a daughter who is still my roller coaster buddy every August, and is accompanying me on what may be the stupidest thing I ever try – climbing Kilimanjaro (ed: which we successfully did in July 2016, followed by Everest Base Camp in 2018). So how did I get here?

First of my early parenting philosophies was simply make time. I’m not talking about the “I’ll play with you when I get home and I’ll read you a bedtime book” type of time. I’m talking about the “take a morning off to hear your 2nd grader say one line in a play; use vacation days to chaperone school outings; play Barbie for hours on end; and supervise a cabin full of 5th grade boys on the school trip” kind of time. A typical dad probably spends more time away from their child than the mom. So take advantage of the time that you can have! As soon as my kids came home from the hospital, I never missed an opportunity to be with them. Each night, when an infant would wake up and cry, I went in. It was pickup and delivery to Judy to nurse them. Judy thinks I was doing this for her but she was just a benefactor. I picked them up, sang softly or told stories to them as I cleaned them up, and then brought them to our room. And then back to their cribs. Every night. We built up quite the relationship. Bath time? That was mine too. Nightly bedtime ritual? Well we both had one. But much of my daughters’ love for the great rock and roll of my youth comes from that time we spent every night. As they became toddlers, every weekend I took them to Miz Brown’s diner in Laurel Village. So Judy could get more sleep? Hmm, ok, but not really. It was completely selfish on my part. Want more time? Be the home that welcomes the gathering of the friends. While perhaps not directly involved in your child’s life at that moment, the benefits are extraordinary in what you get to witness, the welcoming environment you’re modeling for your kids, and the lifetime of relationships with your children’s friends, who consider you an extra dad. (2023 update - as a result of this, I have officiated three times at the wedding of one of my extra daughters!)

Next on my list of dad-parenting beliefs is “don’t look for a reason to say yes; assume that’s the answer, and instead force yourself to look for a reason to say no.” It’s simple but at least for me, it was initially uncomfortable and unnatural. But once I grew comfortable with this practice, it was an epiphany! Saying yes to as much as you can say yes to, is so much easier than saying no. And it has such wonderful benefits. Questioning, exploring, learning, experiencing…and you get to be a cool dad! Talking about going on a family camping trip when you’re asked if they can try camping in the house? Say yes, and set up the tent in the living room, light the fire, roast marshmallows, and sleep in sleeping bags. We can all think of valid reasons not to do this and I’m certain my instinctual reaction was “too much time; too much effort, and then I have to clean it all up and put it away.” But saying “no” wasn’t going to lead to the magnificent shared family memory we now have 20+ years later, and I certainly don’t remember anything about setting it all up or taking it down. “Dad, can I help?” Of course there are reasons to say no; it will certainly take more time. And you may have to watch your language. Unless it’s urgent, so what? Invite your 3-year-old to crawl under the car with you. Rub some dirt on their nose to make it official! And let them help! “Can I go someplace?”; “can someone sleep over?” Yes. And yes. Unless something is a threat to their health and well-being, be quick with the yes! Might some of these yeses have less than ideal implications to you and your free time? Probably, but that’s not what you’re going to remember! Only after saying yes can you then figure out if there is a “no” reason significant enough to change your mind. The more you say yes, the more they will ask you. As school children. As teenagers. And now as adults. You will never remember saying no; you will always remember saying yes!

You will recognize my last pearl of wisdom as a modification of the Peter Pan syndrome. Let them be kids as long as possible! While it may be cliché, as we all know and live every day, once that’s gone, it’s gone forever; I know that I, and maybe you, wish you could get it back! So don’t take it away from them. Don’t be in such a hurry to “help” them see things as you see them, through adult eyes and perceptions. They are emotionally, physically, and intellectually naïve – it’s a wonderful time so don’t rush to take that away from them. In fact, for a truly wonderful relationship, force yourself to see the world as they do! That’s why I once found a pet/fish store open till midnight so I could go out and replace the fish that had died when Lauren was asleep (and yes, I brought the dead fish with me to try to get a match!) Of course she would have to learn to deal with the death of a beloved pet, and eventually beloved humans. But she didn’t have to learn about it that day, and it let her be a kid a little bit longer.

Don’t try to explain why work is so busy, that you need to do it to pay the bills that benefit them, and thus you don’t have time to play Chutes and Ladders for the 5th time in the past 2 hours. Instead, see it through their filters – why would anyone want to deal with things that are drudgery and frustrating when you can have fun playing a grand game? They didn’t ask to be your child – you decided to make them your child. I hope that decision was made with an appreciation for the fact that this responsibility instantly became the single greatest responsibility you have ever undertaken. The consequences of that decision are literally life changing for all involved. If it’s not your greatest responsibility, then something’s awry and you will miss out on immeasurable joy.

In the summer of 1988, my family of 3 (Lauren was 1) was invited to a swimming party at the home of my then senior VP. He had 4 adult daughters. While everyone was subtly vying for his attention, I spent the greater part of the day with Lauren in the pool. Late in the afternoon, the VP’s wife found me and pulled me aside to tell me that her husband had spent much of the day watching us play in the pool. Why? As she explained, he had been the wonderful corporate soldier. Moved all around the country when he was asked to. Frequently traveling. Successfully moved up to senior VP of one of the world’s largest companies. And she told me that if he had to do it all again, he would rather have spent the time in the pool with his daughters, because now he was here, envying me and the relationship I was already building with my child. Over the course of my career, I was often asked to make those same sacrifices, but by then I had already learned my golden rule – I worked to live; not lived to work. And while I had a satisfying and rewarding career, I never reached for those corporate stars that were dangled in front of me. Because one day I was hoping that I would have the type of relationship with my children that allows me to eat yellow with one of them and climb a mountain with the other.

Sandy went on to write a sequel which is linked here

Happy Father’s Day to all who celebrate

XO