Warts and Molluscum/ Two viral kinds of bumps

 Doctors get calls about warts on a fairly regular basis. Another common reason for those calls is molluscum. Both are viral skin infections that can spread and usually clear eventually, but they come from different viruses and look a little different.

Imagine that the body is a castle that has guards, but somehow these tricky little viruses snuck through the defense system and are already at the castle walls.

Both viruses have figured out ways of staying under the immune system’s radar while they reproduce in the skin. Eventually, however, the immune system usually catches on. The guards are still on duty; these particular intruders just take a while to get their attention. Time will ultimately take care of them, even if you do nothing.

What are warts?

Warts are caused by human papillomavirus (HPV). HPV has tons of strains. In this post, we are talking about the strains of virus that cause benign warts (NOT the HPV types associated with cancer that are targeted by the HPV vaccine).

The virus gets into the deeper layers of the skin through tiny breaks, sometimes so small you can’t see them, and infects the cells that make new skin. HPV then essentially hijacks those cells and encourages them to keep growing, producing the thickened, rough mound of skin we recognize as a wart. The virus is particularly clever at staying under the immune system’s radar, which is one reason a wart can sit there happily for months or years before the body finally recognizes it and clears it.

Warts have an easier time getting into skin that is not intact. If your child has eczema or is a nail biter, they are more prone to warts. Common warts often show up on hands, fingers, or knees; those around the nails are called periungual warts.

Warts on the soles of the feet are called plantar warts. Pressure from walking can flatten them and make them sore. Being on the bottom of the foot doesn’t automatically mean a wart needs a specialist, but pain or trouble walking is a good reason to get help from a pediatrician, podiatrist, or dermatologist.

Treating warts at home

You don’t necessarily have to treat a wart that isn’t bothering your child. Remember, many go away on their own. If you would like to move things along, over-the-counter salicylic acid is a reasonable place to start.

Salicylic acid works by gradually removing the layers of skin containing the wart. Soaking the wart first and gently filing away softened dead skin with a disposable emery board every few days can help the medicine penetrate. The point is to remove dead skin, not to make the wart sore or bleed. Use the board only on the wart and discard it afterward so you don’t spread the virus elsewhere.

17% or 40%? Liquid or patch?

The wart-remover aisle can make this feel more complicated than it needs to be. There are two things to consider: how strong the medicine is, and how you’ll keep it on the wart.

For a small common wart without much thick skin over it, 17% salicylic acid liquid is a reasonable starting point. You dab small amount directly onto the wart and let it dry. This can be handy when a patch won’t fit well or keeps falling off.

For a thick, callused wart, especially on the bottom of the foot, a 40% patch may be useful. The medicated part needs to fit the wart without covering the healthy skin around it. A patch is convenient only if it stays put; liquid may be easier for a small or awkwardly placed wart.

A higher number doesn’t guarantee a faster cure. Choose something appropriate for your child’s age that you can apply consistently, and follow that product’s directions for how often to use or replace it.

Dry the area after soaking and before applying the medicine. Some softened skin peeling off is normal. Be patient: treatment usually takes weeks to months.

Don’t use wart-removal acid on the face, genitals, or broken skin, or on a bump you aren’t sure is a wart. Children with diabetes, poor circulation, or a weakened immune system should have pediatrician guidance before home treatment. If the wart is near a nail, the surrounding skin is sensitive or affected by eczema, or you’re treating a young child, ask your doctor which product to use. Pain, bleeding, or raw skin means it’s time to stop and check in…not move up to something stronger.

There are loads of other suggestions out there. Natural remedies such as tea tree oil have limited evidence and can irritate the skin. We will equate them to using a watering can to fight a fire. The OTC wart patches are your fire extinguishers. The dermatologists and podiatrists have fully equipped fire trucks! Fortunately, a quiet little wart doesn’t always need the fire department.

Treating warts in the office

If home treatment isn’t helping, or a wart is painful or bothersome, go ahead and make an appointment to evaluate treatment options with your pediatrician. It is fully possible that the home treatment will take care of it while you wait, and then you can just cancel the appointment (of course, give the office plenty of warning).

If you do end up at the doctor, they will base the treatment on your child’s age, the wart’s location, and what your child can tolerate. Freezing with liquid nitrogen, called cryotherapy, is one option, especially for older kids. It feels very cold, which can be uncomfortable, but it’s quick. It often requires several visits.

For stubborn warts, doctors sometimes use cantharidin (“beetle juice”… fun fact, this is a substance secreted by blister beetles), which causes a controlled blister beneath the wart. Application is often painless, but the blister can be very itchy and then sore later, and repeat treatments may be needed.

Some treatments injure the infected skin or create local inflammation, which may also help the immune system recognize HPV. Think of that part as an “Intruder Alert” signal to the body. But the treatments don’t all work the same way: salicylic acid primarily removes infected skin, while freezing directly damages it.

What is molluscum?

Now that you have learned more than you ever wanted to about warts, it is time to alert you that sometimes you are dealing with something different. If you are seeing clusters of little bumps, another possibility is molluscum (muh-luhs-kum) contagiosum. It can look like a collection of tiny warts, but it is a separate infection.

Molluscum is caused by a completely different virus called molluscum contagiosum virus, a member of the poxvirus family. Rather than stimulating the skin to build a thick, rough wart, molluscum virus turns infected skin cells into little virus-producing factories. As those cells grow and fill with viral material, they form a characteristic smooth, pearly bump with a tiny dimple in the middle. That waxy white material you sometimes see inside a molluscum bump contains infected cells and lots of virus, which is why scratching, popping, or picking at one bump can spread new bumps nearby.

Often the only sign is pink or flesh-colored bumps on the skin. These can appear almost anywhere, though usually not on the palms of the hands or the soles of the feet. Many people get about 10 to 20 bumps; a person with a weakened immune system may have many more. Bumps can take weeks or months to appear after exposure.

When the bumps appear on the skin, they often:

• Begin as small, firm, dome-shaped growths.

• Have a surface that feels smooth, waxy, or pearly.

• Are flesh-colored or pink.

• Often have a dimple in the center. The dimple may be filled with a thick, white substance that is cheesy or waxy.

• Are painless, but some bumps itch a little

• Many parents think they’re bug bites at first, but once they stay for weeks unchanging they realize that’s not the case

Molluscum bumps may become red, swollen, or crusty shortly before they disappear. That can look alarming, but it is often a sign that the immune system has finally noticed the intruder. Increasing pain, spreading redness, or pus deserves a call, though, because infection can look similar.

Managing molluscum

Like warts, this condition usually goes away by itself, often within a year, though it can take longer. If the bumps aren’t bothering your child, watching and waiting is a reasonable option. Having bumps after a month or two doesn’t, by itself, mean your child needs a specialist, unless the bumps are itchy, spreading, or causing trouble with eczema, or your child is bothered by them. At that point it is worth seeing what treatment options are available.

Don’t squeeze, pick, or file these bumps with an emery board; that can spread the virus. We know they look irresistible to pop…because hey, there’s white stuff inside. Resist!

Treatment

Treating surrounding eczema and itch can help cut down on scratching/spreading.

Cantharidin is one office treatment for molluscum, too. YCANTH is FDA-approved for adults and children age 2 and older and is applied by a health care professional. Follow the doctor’s instructions about washing it off and caring for the treated skin. It can’t go on the face or genitals without dermatologist oversight.

There are lots of internet “cures” for this, including coating the body with silver… but they may waste time and money and can harm the skin.

Are there benefits to treating early once you have a diagnosis?

Sometimes. Neither warts nor molluscum has to be treated…your immune system will eventually clear most of them on its own. But there can be advantages to treating when there are only a few spots.

For molluscum, early treatment may reduce the opportunity for a child to scratch the bumps and spread the virus to other parts of their own skin. This can be especially helpful for children with eczema, who sometimes get dozens of lesions once molluscum takes hold.

For warts, smaller and newer warts may be easier to treat than large, thick, longstanding ones, although treatment still takes patience and there is no guarantee that starting early will make them disappear quickly.

So there is no emergency to treat either condition. But if lesions are multiplying, being picked at, causing discomfort, worsening eczema, or simply bothering your child, there is also no particular advantage to waiting.

How they spread

Both infections can spread through skin contact with obvious lesions, and scratching or picking can move the virus to other areas of the body. People can get molluscum by sharing towels or clothing; shared sports equipment and mats can also be a route of spread.

Unfortunately, folks can get molluscum more than once; having a prior case doesn’t guarantee immunity.

Keep hands off the bumps as much as possible (bandages help keep hands off the bumps and seem to stop the spread), wash hands after touching or treating them, and don’t share towels, washcloths, razors, or wart-filing tools. Cover exposed bumps with clothing when practical. Wearing sandals in communal showers and locker rooms can help reduce exposure to wart viruses.

You don’t need to spray every shoe, sock, and surface with Lysol. Focus on those practical precautions and routine cleaning. For shared baths, the concern is contact with bumps and shared washcloths or bath items; separate bathing can make those contacts easier to avoid, but a total ban isn’t the central prevention strategy.

Kids with molluscum can generally still swim. Cover visible bumps with a waterproof bandage when practical, and avoid sharing towels. Molluscum appears to spread more readily through direct skin contact and shared items than through the pool water itself.

Will siblings likely get it?

Maybe, but it’s not inevitable. Both warts and molluscum can spread between siblings through direct skin-to-skin contact or shared items, but plenty of siblings never develop them.

Molluscum tends to spread more readily between young kids, especially when they share baths or towels, wrestle or cuddle, or when a child scratches or picks at the bumps (have you ever met a child that didn’t scratch or pick?) Children with eczema may be particularly susceptible because the virus has an easier time getting through an irritated skin barrier.

Common warts can also spread between siblings, but usually not from casual household contact alone. HPV generally needs an opportunity to enter through a small break in the skin. Nail biting, picking at a wart, eczema, and sharing items that rub directly against a wart can all make transmission more likely.

You don’t need to quarantine siblings or disinfect the entire house. Focus on the easy things: discourage picking and scratching, don’t share towels or items like nail clippers, keep irritated or easily contacted bumps covered when practical, and keep eczema under good control.

Conclusion

If you aren’t sure what a bump is, start with your child’s usual clinician. Check in if it is changing quickly, bleeding without being picked, painful, interfering with walking, or showing signs of infection. Bumps near the eye or on the genitals, and bumps in a child with a weakened immune system, also deserve medical guidance.

For a stubborn wart that isn’t improving with consistent home treatment, or molluscum that is spreading or bothering your child, a non-urgent appointment makes sense. Ordinary childhood warts are benign; the reason to evaluate an unusual growth is to be sure it really is a wart. A familiar, comfortable bump doesn’t become an emergency simply because it has been there for a month or two.

Forgiveness and Atonement

 “Forgiveness is a strange thing. It can sometimes be easier to forgive our enemies than our friends. It can be hardest of all to forgive people we love. Like all of life’s important coping skills, the ability to forgive and the capacity to let go of resentments most likely take root very early in our lives.”

Fred Rogers

“Being angry is like swallowing a spiky and potentially poisonous stone. It can do no good inside of you...poop it out and flush it away”

Nurse Judy

I am not a classically religious person. My friends and family have heard me say that my belief system is simple:

1. There is ‘more to it than this’, we just don’t get to know exactly what that is

2. Be kind

So while I am skeptical about an all powerful being with a white beard judging my every action, there is something about the upcoming holidays that has me treat them with a bit of reverence.

Jewish holidays run on a lunar calendar. Some years they feel very early and sometimes quite late. This year, somehow it feels right on time.

This evening, September 11th is the start of the Jewish New Year, Rosh Hashanah. Happy 5787

The message of Rosh Hashanah is one of renewal. Out with the old year (don’t let the door hit you on the way out) and in with the new. We eat apples and honey to usher in a sweet one.

Ten days later Yom Kippur will come along.

The message around Yom Kippur is twofold: forgiveness and atonement

I will start with forgiveness.

I am not saying that you shouldn’t get angry at someone who has done something wrong. By all means, feel those feelings as much as you need to. But then take a moment to do some thinking. When we feel a strong emotion we can ask ourselves what this particular feeling is trying to communicate to us. Perhaps something has been threatened or a boundary has been crossed.

Once you have identified the purpose of the emotion it has done its job. Now it is time to let your head take over.

It might seem like I am going off topic, but bear with me for a moment:

When I was working at Noe Valley Pediatrics, it was not unusual for kids to vomit, snot, poop or bleed on a surface or the floor. People who work with kids know that this is simply part of the job. Bodily secretions are considered biohazards. We had to have a system for dealing with these messes.

Fortunately we had nifty little kits designed for exactly this purpose. The amazing medical assistants who I was lucky enough to work with would spring into action. They would put on some protective equipment and proceed to sprinkle a special substance on the mess. This chemical turned whatever yucky stuff we were dealing with into a gel form that created a blob that was easily cleaned up and disposed of. These clean up kits were a valuable tool.

Anger and grudges directed towards someone are like a biohazard. Those negative feelings can actually impact your health. You need tools for learning how to change something potentially toxic into something more benign and easily dealt with.

One technique that I like is to turn mad into sad. Turn anger into disappointment. Those are potentially heavy feelings, but they are less toxic to you.

What can you add to your own little ‘bio hazard’ kit?

Perhaps talk to a therapist. Meditate. Go to a rage room. See what you can come up with that helps you let go of stuff.

And, there are indeed some things actually feel unforgivable. But what you do with that is up to you. Can you find a way to still love somebody?

Don’t forget to forgive yourself! None of us are perfect and we all have lessons to be learned. You will be amazed how much lighter you can feel when you let go of even some of that negative energy.

Atonement is perhaps more complicated. What constitutes actual atonement? My sister-in-law Barbara and I discussed that in depth while we wandered around Flower Piano this afternoon. Saying a prayer? Giving an apology? Words without inherently recognizing what you have done was wrong, feel pretty empty. Performative action also might not qualify as true atonement.

After a fascinating discussion, we came up with no real resolution and ended up participating in a Neil Young sing along instead.

With the theme of atonement at the heart of it, traditionally between Rosh Hashana and Yom Kippur, there is a lovely ritual called tashlich, where you toss breadcrumbs into a body of water as a symbol of casting off your sins.

I remember one year so long ago (Lauren was probably exactly the same age of my grandson Elliot) I took my young daughters out in a boat on Blue Heron Lake to do our own version and toss bread to the ducks (ducks actually shouldn’t eat bread, but I didn’t know that at the time. I have forgiven myself.)

We did our own little ritual.

“Is there anything you have done that you feel sorry about?”

Lauren went first and did it with a gusto as she tossed piece after piece to the eager ducks. She had an absolute laundry list of confessions.

“This is for the time that I …….

And this is for the time that I……”

She went on for several minutes confessing to all sorts of little misdemeanors that I had been clueless about. Yikes!

Finally she was done. Her conscience was clear.

“Alana, it’s your turn, Is there anything you feel regret about?

“Nope”

“Nothing at all?”

“Nope.”

Okay, well then…..

Alana’s friends might be nodding their heads right now. It is quite possibly accurate.

How you say you are sorry makes a difference.

If you accidentally knocked over a glass of milk, pointing out that it was awfully close to the edge of the table is not an appropriate part of the apology.

“If someone hadn’t left that glass there, this would not have happened” (try again)

“Oops, I should have been more aware of my surroundings, let me help get that cleaned up” (better)

In the same vein, it is important to point out the difference between intent and impact. While good intentions gone awry happen frequently, it is the impact that is what matters. If you said something hurtful, it doesn’t matter all that much if you meant it or not. If it caused pain, make the apology a clean one, don’t muck it up with the defense or reason. Simply be sorry, learn the lesson and try not to repeat.

Parents, caregivers and people who are role models to children - Your kids are watching you! If you can learn to forgive, they will notice. If you learn to admit mistakes and try to do better in the future, they will notice.

As the amazing Mister Rogers noted in the quote at the beginning, these behaviors take root early on.

There is nothing easy about this. Especially these days when it is so easy to be angry at people who are making horrible choices.

I wish that genuinely atoning for something was actually as easy as tossing crumbs into the lake.

Have I completely forgiven the people who stole the catalytic converter out of my 14 year old Honda a few years ago? Perhaps. Knowing that I cursed them with never ending pinworms, bedbugs and head lice took a little of the sting out of it.

Regardless of your faith or religion, I am wishing absolutely everyone a sweet New Year.

Thank you to Taco Cat for being my model this week.

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!