Keep a journal & document your milestones!

Keep a journal &

document your milestones!

It’s almost the New Year. This is often the time when people find themselves making all sorts of plans for how to generally improve aspects of daily life. I have a suggestion for one resolution that is fairly easy to keep. This will be useful and has the potential to bring plenty of smiles in the years ahead. Start keeping a journal! Sure, we all take a lot of photos and movies these days, but there is nothing like the written word. If you haven’t done it from the first, it is never too late to begin. Start keeping track of milestones and illnesses. Having things written down can be a valuable resource. I am not advocating keeping a list of every bowel movement (yes there are parents who do that; you know who you are) but knowing how often your child has had strep throat, an ear infection or any significant illness can be quite handy. Especially if you have more than one child, it is often easy to get things mixed up. I have more that one parent who has said, “I know one of my kids gets a rash on Amoxicillin, I am just not sure which one.” Keeping record of milestones and illnesses alone makes keeping a journal worth the effort, but immortalizing memories and anecdotes is what makes it fun and even more valuable. We have tracked all kinds of odd statistics. My 28 year old Alana has been on 262 flights. 31 year old Lauren will be completing #379 later this week when she returns from her honeymoon. Two of Lauren’s flights were skydiving expeditions and both of my girls have managed to be at the controls flying a private plane. (This mom knows how to feel somewhat proud and somewhat horrified at the same moment.) If you give me a moment I can also retrieve all sorts of random facts, like the first movie they ever saw in a movie theater and when they lost their first tooth. I actually started keeping track of things when I found out that I was pregnant for the first time. Clearly you don’t need to write things daily, but keeping track of milestones and fun things that kids come up with can create a wonderful database of stuff that you are sure to refer to and enjoy as your children grow. My journal unfortunately does have some huge gaps, when I never got to it; just do the best you can. What started out as my personal musings written in a notebook, morphed into a family journal when I transferred it to a word document. If you like you can create a shared document that both parents can add to. Google drive would be perfect. (Make sure you backup any important documents!) In our journal (both kids share the same one) daddy’s voice was written in italics. My husband had the wonderful habit of documenting conversations. The following was from when Alana was seven and daddy was picking her up from school: Alana:  I'm doing a picture in reds and pinks. Sandy:  Why? Alana:  Because Van Gogh had a red period. Sandy:  You're learning about Van Gogh? Alana:  Yeah. And then I'm going to do a painting in different shades of blue. Sandy:  Why Alana:  Because Van Gogh also had a blue period. Sandy:  Well that's terrific. Alana:  And Miss Price is going to bring a real artist to class so he can teach us. Sandy:  Well that will be very exciting. Alana:   But it won't be Van Gogh because he's dead! In our case I am delighted that we were able to track early milestones like first words and motor skills. Over the years random facts like teachers names, the revolving door of boyfriends and life events have all been documented. One of my favorite posts recounts about the time that 5 year old Lauren and I took a family ceramics class at the local Randall museum. At the start of the first class, the instructor had everyone get a feel for the clay. We stretched and pulled in into all sorts of shapes. As we played, the teacher asked ”Who knows where clay comes from?” Lauren was never shy. Without missing a beat, she called out the answer in a loud, authoritative voice. “Cows! Clay comes from cows!” There was a moment of stunned silence as all the grown ups at the table did our very best not to break out in laughter. “Hmmm”, said the teacher, handling it very nicely. “Great guess, but it actually comes from the earth.” Cows?? I remember that being one of the hardest giggles I ever had to stifle. Laughing in the face of my five year old was not something I wanted to do. Kids do come up with some wonderful stuff. Another one that became part of family lore was the time that 3 year old Alana bit her sister: Mommy: “Alana, why did you bite your sister?! You know you shouldn’t bite!” Alana: “I forgot not to.”  That “I forgot not to” line still comes up every once in awhile. When does it stop?? My kids say never. They especially insist that I keep up with their flight tallies! (We still count every take off.) You might be dealing with any of the more challenging aspects of parenting like sleep deprivation, the “terrible twos” or teens that are giving you a run for your money. Warning, time zips by. Blink and they are out of the nest. Carpe Diem! The online journal is a great way to capture moments forever. Grandparents might want to start their own version. A new friend that I met on my recent trip recounted an experience. Her twin grandsons were visiting. Clearly she wasn't in the habit of locking the bathroom door. One of her 5 year old grandsons showed up in her bathroom while she was in the shower. He was wearing a hat and carrying a fishing pole: “Grandma, You need to stay where you are for a bit. There is a triceratops in your bedroom, but don’t worry about it, I’ve got this.” Capture your moments!!

Assessing the impact of the recent smoke exposure

Assessing the impact of the recent smoke exposure

Everyone living in the Bay Area or anyplace within 100 miles of the recent fires has been exposed to unprecedented poor air these past couple of weeks. Aside from dealing with the tight lungs, burning eyes, sore throats and stir crazy kids and pets, families are worried about potential lasting impact that this might have on their children’s health. Chronic exposure to pollution can lead to issues with our hearts, our bones, and our lungs among other things. There are some anxiety provoking studies out there suggest that a fetus is not immune even though they are not directly breathing the air. I tend not to let different studies cause too much of a stir. Studies on things that we have no control over can get people spinning. One headline this week claimed that exposure to this unhealthy air was the equivalent of smoking 10 cigarettes. Gee, thanks for that extra dose of terror. Of course we would have had to have been outside, without a mask for an extended period of time to be affected like that. Please keep in mind: Millions of people live in large cities where this terrible air is the norm. Here in Northern California, we only had to deal with it for just a few weeks. I imagine that we all breathed some nasty air, but hopefully most of us were able to limit our outdoor exposure. Assuming that the air quality index is no longer in the red zone, take a deep breath and prepare to review an important life lesson; my mom had a saying that she would repeat frequently “It is what it is. You do the best you can.” There are some things that are within our control and some things that are not. We need to be able to identify which is which Lets focus on things that are in our control. Being kind Being honest Friends we choose Taking care of ourselves Working hard Apologizing Asking for help How we respond to others What we do in our free time Things Out of our control Others being kind Others being honest Others forgiving us Who likes us The family we were born into The color of our skin Past mistakes Natural disasters Death Taxes Are you beating yourself up because you stayed in town? Really? Assuming you had the time, the money, the ability and the fortune telling magic to know how long this bad air was lingering, was hightailing it out of here the right solution? Are you feeling like a terrible parent because you couldn’t stand being cooped up and you let your kids run around outside for a bit and now you are worried? It’s easy enough to be the Monday morning quarterback. ‘Woulda Coulda Shoulda’ are simply not worth much. My husband was an executive for many years and his employees knew that after bitching about something or another that had happened, they would inevitably hear him say: “you can’t manage the past” My daughter Alana who is now a therapist here in SF taught me that Dialectical Behavior Therapy (DBT) refers to my mom’s “it is what it is” as radical acceptance. There are an infinite number of things that cause pain, suffering and anxiety, but only 4 different actions that we can take: Problem solve: Is there something within your control that you can do? Find the silver lining or lesson :There is always a lesson but sometimes the silver lining doesn’t become apparent until sometime in the future, if at all. If you look hard enough there is usually at least a sliver. Practice radical acceptance: It is what it is and you do the best you can (Just like mom...repeat this frequently) , or Stay stuck While we can’t problem solve past exposure to poor air quality away, what we can do is learn any lessons that may come in handy in the future. It is safe to say that this could happen again. We need to make sure that we are prepared. Order masks in advance so that you have them on hand if the need arises. Have a HEPA air cleaner (change the filter periodically. We just changed ours and it was beyond gross). My sister-in-law and brother-in-law just purchased one of the newer ones that gives you a reading of the air quality in the area of the machine. Before they even plugged in it, the air in their house rated just fine. Being inside does make a huge difference. Have an evacuation plan for your family. Earthquakes are just as much an issue as fire. Now is the time to check your earthquake kit and update it as needed. Get familiar with local resources that can help you out in an emergency. For those of you in the Bay Area, this is an important site for guidance in case of all sorts of emergency situation: https://www.sf72.org/ If you are looking for some more benign and possibly helpful actions? Personal Lets tend to our bodies. Stay hydrated Decrease mucus producing foods (Dairy products are often the biggest offenders) There are multiple sources that claim different foods can help keep lungs healthy. That list includes pineapple, garlic, ginger, turmeric, dried figs, tomatoes, apples, green tea A steamy shower with essential oil (like eucalyptus) Get or give a massage with warm oil. This will relax and open the airways Do some good deep belly breathing Global Be a voice for to help protect our ailing planet from climate changes. This should not be a partisan issue. If there are tangible, sensible things that we can do to minimize pollution everyone should be on the same page. I reached out to my dear friend Brenda Ekwurzel who is a senior climate scientist and the director of climate science at the Union of Concerned Scientists and asked her for advice on a good fund to donate to. She suggested theNature Conservancy Climate Changes Everything is another good site to check out. This is a friend of a friend who has taken on climate change as his personal mission. Check it out. Or you might give money to folks impacted. Charity Navigator can help you research effective organizations to make donations to. In any event, taking some sort of positive action can help us not 'stay stuck.' Don’t be afraid to have conversations with your kids. Here is the situation. These are the things we can do. The review of things in and out of our control is an important one. It is the rare child under 5 who will get it, but you are the model. They will learn by example.

Air Quality update November 2018

Air Quality Update

Wishing all of you a happy and healthy Thanksgiving.

I was all set with my Thanksgiving topic on how to deal with turkey leftovers and general food safety, but all the calls I have gotten in the office today prompted me to add a bit of focus on the air.

What would make us all jump for joy is a bit of rain. For those of you not in the Bay Area, go outside and take a deep breath of air for all of us. Today our air quality moved into the purple range. Very unhealthy for everyone. If you are traveling, I would think hard before returning home until things start to clear.

Air Quality index

It is Horrid. It is eerie. It is scary. It is claustrophobic. As bad as it is for us with our scratchy throats, tight lungs and irritated eyes, my heart goes out to all those thousands of people who have lost loved ones, homes and are even closer to the fire. This feels even worse than last October, and those fires were weren't even as far away.

What can we do to deal with this smoke?

• Stay indoors as much as possible!

• If kids are stir crazy, consider a mall like Stonestown (especially if you can park underneath and avoid walking outdoors) Consider creating an indoor activity there like a scavenger hunt or bring a pad of paper and colored pencils; practice drawing

• Sometimes we just need to turn on the tv or watch some videos on our ipads. Do what you need to do to get through this smokey period. As long as you control it and use tech time as a tool it's okay to make some exceptions and allow a little more than you might in normal circumstances. Your sanity counts for something.

• If you are outside wear an N95 or N100 mask. There are cute children's ones available on Amazon.

• After two years in a row, I fear that this seems like the new normal. I suggest ordering some extra N95 masks to keep on hand so that you are always prepared.

• Avoid ANY strenuous activity.

• If you have a HEPA filter keep it running.

• If you are in your car, keep the air on recirculate.

• Avoid adding to indoor pollution. Don't light candles or vacuum. No Smoking!!! DUH

• Pets shouldn't be exposed to the smoke any more than we should. ( I know, try explaining that to them!)Toss the ball a little bit more indoors, but limit their outdoor time as much as possible.

• Be aware that food delivery services are being impacted. Today, many of the couriers were not delivering due to safety concerns. Plan ahead with your meals.

Smoke is bad enough, but if we are ever in the situation that we need to be dealing with actual fire, I am sharing this essential information from a friend of mine who lives in Santa Barbara and has been through this a number of times.

Home Evacuation Checklist – How to Prepare for Evacuation:

Inside the House

• Shut all windows and doors, leaving them unlocked.
• unlatch the garage door
• Remove flammable window shades, curtains and close metal shutters.
• Remove lightweight curtains.
• Move flammable furniture to the center of the room, away from windows and doors.
• Shut off gas at the meter; turn off pilot lights.
• Leave your lights on so firefighters can see your house under smoky conditions.
• Shut off the air conditioning

Outside

• Gather up flammable items from the exterior of the house and bring them inside (patio furniture, children’s toys, door mats, trash cans, etc.) or place them in your pool.
• Turn off propane tanks.
• Move propane BBQ appliances away from structures.
• Connect garden hoses to outside water valves or spigots for use by firefighters. Fill water buckets and place them around the house.
• Don’t leave sprinklers on or water running, they can affect critical water pressure.
• Leave exterior lights on so your home is visible to firefighters in the smoke or darkness of night.
• Put your Emergency Supply Kit in your vehicle.
• Back your car into the driveway with vehicle loaded and all doors and windows closed. Carry your car keys with you.
• Have a ladder available and place it at the corner of the house for firefighters to quickly access your roof.
• Seal attic and ground vents with pre-cut plywood or commercial seals.
• Patrol your property and monitor the fire situation. Don’t wait for an evacuation order if you feel threatened.
• Check on neighbors and make sure they are preparing to leave.

The Pie Theory of life 2018/ Nurse Judy's Pie shifts

Somehow or other I currently have 2,400 subscribers who now get my weekly posts. The blog has had 270,000 visits which astonishes me. Thanks to all of you who read them and share them. Writing these has been a pleasure. I am always learning. Your feedback has been something that I cherish. In honor of this being my 100th post since starting the weekly emails on Constant Contact I am running one of my all time favorite posts. My kids and I live by the “pie theory.” My personal pie is going through some shifting pieces. Detail are at the bottom of the post.

This week's Topic Finding Balance/ The pie theory of life

Here is an update of one of my top ten favorite posts. Scroll to the end of the post for an update in the shift in my personal PIE The "pie theory" got its inception many years ago. For a number of years (many years ago) I was the Parent Association president at my daughters' elementary school. It took an inordinate amount of my spare time, including meetings several times a week. On many levels it was rewarding being so involved but I assure you, I was delighted to pass the reins when my stint was over. Though I was really genuinely relieved to have my time back, I felt off balance by all the sudden free time in my schedule, and at first I couldn't figure out why I was so unsettled. I finally realized that although the new empty hours were welcome, they had created a bit of a vacuum. I filled it quickly (started taking up karate a few evenings a week), but it was right around that transition period that the "pie theory" helped me make sense of things. Imagine that your identity is a circle (or whole pie). Who you are is divided into many pieces; some pieces are large, some small, some temporary. Some are constants that are with you life long, some are optional, some are good for your soul, while still others are energy sappers that give you little in return. Are you: Daughter? Son? Sibling? Friend? Spouse? Ex spouse? Grandparent? Student? Volunteer? Pet owner? In a job/occupation or seeking one? Doing a hobby that takes time and energy? Member of a book club or any club for that matter? Churchgoer? Exerciser? House cleaner? Carpool driver? Event planner? Adventure seeker? and of course last but not least....Parent? The list goes on and on. What activities make up your day, your week, your month, your year? What pieces make up your pie? Take a few moments to figure it out. Get a piece of paper and a working pen (if you can find one) and create your pie. It's interesting to think how you can be identified in different ways by the various pieces of pie. Many folks recognize me as Nurse Judy. More than once I have actually looked at a rash, or given advice from a restaurant table (as my patient husband rolls his eyes.) There was a time years ago when I came to work one day and saw a construction worker on the roof of a neighboring building. He looked awfully familiar and I was struggling to place him; was he a parent from the practice? Someone from school? I could see that he recognized me as well; we kept looking at each other and a moment passed. I could see that he had figured it out first. He gave a big grin and called out "Ahoy there Java's mom!" Of course! I ran into him several times a week with his pack of dogs when I walked my dog Java. Not only did being a dog owner dictate my daily schedule and get me out walking rain or shine, it also included me as a member of a distinct social network in the neighborhood for many years. All the dog owners knew each other by sight and all the dogs by name. Being "Java's mom" was a wonderful piece of my "pie" for 12 years. If you are a pet owner, that piece has a very special place allotted to it. I am now proud to be grandma to my daughter's giant puppy Bowie. Your pie is finite. You can only do and be so much, as there are only so many hours in the day. Some folks have too many things competing for time and attention, and figuring out which pieces can be compressed can be quite stressful. Sometimes we make poor choices. For busy working parents this might be a foreign concept, but some folks don't actually have enough pieces to begin to fill the shell. A big empty pie can be just as unsettling as a full one. Have you ever noticed that when you are super busy you can manage to get through an entire to-do list very efficiently? On the other hand, on a quiet day you may have only one or two things on the list but somehow nothing gets done. A healthy pie has plenty of interesting pieces that can grow and shrink according to your needs. The more forgiving and elastic the pieces, the easier time you will have finding a good balance. Your pie will naturally change from year to year, but some changes are enormous. Some people are comfortable having a very crowded pie, while others are quite fine and happy doing nothing at all. Part of this is figuring out what your ideal is, and work towards that. Any large sudden changes to your pie will make you feel unsettled, way less so if you have a glimmer of what is going on; hence this theory. Both of my daughters have taken this to heart. In fact Alana has permitted me to share her own blog post on the Pie Theory that she wrote several years ago: Alana's blog about the Pie Theory (Blogging runs in the family I guess) When there is a large shift in your pieces my girls and I refer to this as "pie disequilibrium." Common culprits might include: Event planner: Folks planning a wedding or large event can spend months dealing with all the fun details. When the event is over, that planner piece is gone, your pie has a gap. Sports Fan: My daughter Alana has a twinge of "Pie Disequilibrium" every October when baseball season is over. Actor: My daughter Lauren had to learn how to deal with the extra time that appears after a show run is over. . Caregiver: Folks that spend much of their time and energy tending to someone else’s needs might find themselves suddenly with a large vacuum when that person is gone or no longer needs them. Parent: As your children grow up it can be a tough adjustment (don't worry, they still love you.) Luckily this happens in stages. Kindergarten...a full day of school...college. Parents who have the "parent piece" taking up the entire pie may feel a twinge when their kids don't need them in quite the same capacity. Huge life changes will create seismic shifts. Nothing will ever match the huge transitions that take place when you add the parent piece to your pie. My best advice to you as you shuffle all your pie pieces and see how things fit comfortably is to identify pieces that need to be protected so that they don't get too small. DO NOT IGNORE YOUR PARTNER! Protect that piece. Get creative and make sure that you have time for the two of you; have some moments being a couple. DO NOT IGNORE YOUR OWN NEEDS! Being the best parent that you can be includes living by example. Let your kids have parents that are multifaceted and not consumed by any one thing (be that parenting or a job.) Best of luck finding a balanced, interesting, and fulfilling pie! Nurse Judy's shifting pie: As many of you know, I have been working at Noe Valley Pediatrics for over 30 years. In July of this year I opted to remove the office manager slice of my pie. I am continuing with the parts of the job that I love, which are teaching parents, giving advice and writing. I am now in the office Mondays and Thursdays. I am fortunate to be enlarging my mom piece, as both of my daughters and now my son-in-law, live several minutes away from me. My travel piece gets to stretch a bit in December. My husband and I will be doing an exciting trip to Southeast Asia. I don’t do the mountain climbing with him; this is his turn to do some tamer traveling with the wife. But the big news is that I am planning to expand the “piece of pie” that involves my writing. I have been encouraged by many, (gently nagged by a few) to go beyond the blog and write a book. I am at the very beginning of the process. I would love to hear from folks who are writers, or are in the business. I am currently gathering info and advice and would appreciate any wisdom or tips that you are willing to share.

Honesty

Honesty

It is all well and good to want your children to tell the truth, but until they have reached a certain age, don’t let yourself get too disappointed when you realize they have been less than honest. Many young kids can actually convince themselves that what they are telling you is the absolutely as real as can be. When they get a bit older they are simply calculating which outcome will get them in less trouble. I had to learn this the hard way with my older daughter Lauren. Even back in her earliest years, she was an actress. The earliest whopper that I found out about happened a day after the Northridge earthquake in LA. Lauren was in 1st grade. When I went to school to pick her up, I was surprised when multiple people came up to give me consolation hugs. “Judy, we are so sorry” “What a tragedy” “How old was the baby cousin that died in the earthquake?” HUH? I was more than confused. I assured them that as far as I knew, everything was fine. We didn’t have family in LA. “Hmm, but Lauren said…” More confusion ensued. I picked Lauren up and asked her why on earth people were coming up to me and offering sympathy. She looked genuinely puzzled. Actress, remember...she was going for her first academy award. “Oh, I think I know” she said, “At recess we were playing some pretend games and someone must have overheard and thought it was real.” I accepted that without a second thought. The next morning at school I bumped into her teacher. “Oh Judy, that is so sad about the baby” “Oh dear” I responded, “That is all a misunderstanding. People must have overheard kids playing and thought it was real.” Mrs Calhoun paused, and then gently informed me that in fact, in ‘sharing’ yesterday when everyone was going around the circle telling their news, Lauren stole the thunder by announcing that her baby cousin had died in the Northridge earthquake. There was no misunderstanding or overhearing recess pretend games. My daughter had given me a ‘look you in the eyes bald faced lie’ and I was mad. We had a talk that evening about the importance of honesty (which likely went right over her head.) She continued to be caught in little lies, and promises meant little. That week Goldie the fish was found floating. You might be disappointed to know that sweet Nurse Judy’s initial response was “Maybe if she thinks that breaking promises has consequences that isn’t such a bad thing” Fortunately, her daddy took it upon himself to make sure that she wouldn’t have to feel the guilt of having killed her fish with a lie. In fact there would be no mourning needed this time around. He took the dead fish to a pet store that kept late hours, found a fish that matched the general look and size, and Goldie II started her reign in the tank. Lauren was none the wiser. The irony that this fish tale in included on a post about honesty is not lost on me. It is complicated. While my opinion might be tossed out in a court of law, I maintain that shielding someone from a difficult truth is sometimes the action that feels like the right thing to do. If Lauren had asked me directly about Goldie, I would have insisted on telling her the truth.  Scroll on down for a bonus tale of Lauren and her lying phase. Children and adults might lie for a variety of reasons. These include trying to get out of trouble, attempting to impress someone or even to be polite. At the age of five, trying to avoid a punishment is often going to take precedence over the concept of honesty. It is so important to let them know that you put more emphasis on their telling the truth than on the consequence for their dishonest behavior. What can you do? Model honesty. “Tell them I’m not home” is a good example of an easy lie that we call can get trapped in. Be thoughtful enough to tweak it to “I’m not available.” If your kids catch you lying, there is no reason to expect them to act differently from the adults in their lives. Talk about how being truthful often takes a lot of courage. Read some of the great books out there that are all about telling the truth. Books are a good launching point for further discussion. Amazon books about Honesty  Help them avoid the lie by not asking questions that will get them into a defensive situation; instead state what you see: Rather than “ Did you eat a cookie after I told you not to?” try “A cookie is missing. I see crumbs on your face. I will be more disappointed in you not telling the truth, than I would be about the missing cookie” Help them avoid the lie by not asking questions that will get them into a defensive situation: Rather than “did you break that vase?” try “I see that the vase is broken. Do you want to tell me what happened? Remember that telling the truth is more important to me than the broken vase.” If you get through the years without a lying phase, wow! Most likely there will be a time when your children are not going to tell you the truth. Take a moment to figure out if there is an obvious cause for the lie and form your response based on that. Please don’t ever label your child a liar, even if they have some lapses. Let’s be real. The true value of honest communication and trust between you and your child goes way beyond the missing cookies. It is essential to be able to be truthful with each other when your child becomes a teenager. They need to know that they can call you for a pick up, no questions asked, when they find themselves in a tricky situation. Hopefully they can feel free to talk to you about important issues and ask you difficult questions.This won’t happen without a trust that goes both ways. Consistent message about how you value honesty will hopefully help foster the trusting relationship that we are striving for, now and in the future. ----------------------------------------------------------------------------------------- Here is the bonus Lauren story that went down in family lore. This was soon after my 'family tragedy' in the earthquake. Lauren got a new teaching assistant who she adored. He had very long hair that he wore in a ponytail. His first name was Sotweed. His last name was also odd enough that when she first told me his entire name, I thought she was making it up. I giggled and she admonished me “It isn’t nice to laugh at someone’s name” “You are right, I shouldn’t laugh” Shame on me though, when she would say his name over the next few weeks, I confess to an occasional giggle. Okay, so there we were in the car on our way to a school event where I was going to meet the famous Mr. S for the first time. “I told Mr S that you laugh every time I say his name.” Let’s describe me as annoyed. ” Lauren, you are right that I shouldn’t have laughed at his name, but if it only happened in private, nobody’s feelings were hurt. Now I am embarrassed and perhaps Mr S feels badly about it. I am upset that you told him this” Lauren mulled this over, you could see the wheels turning. She was clearly trying to figure out which path was going to get her in less trouble. “I am just kidding, Of course I didn’t tell him” I looked at her for a bit. “I don’t know if you are telling me the truth. I am going to have to ask Mr. S if you said something to him or not. This is your opportunity to tell me what is true” (I was sorely tempted to threaten her new fish, but that was still a secret.) Pause, more thinking... “I did tell him that you laugh” “Thank you for telling me the truth” Argh... “Hello Mr. S, I am afraid I owe you an apology. Mr S immediately let me off the hook. “I have the kookiest name in the world, of course it makes people laugh.” Mr. S, if you are reading this post, thank you for being such a great guy!

Acute Flaccid Myelitis

Acute Flaccid Myelitis

There are three categories of urgency levels when we get notices from the public health department: Health Alert conveys the highest level of importance and warrants immediate action or attention. Health Advisory provides important information for a specific incident or situation, this may not require immediate action Health update provides updated information regarding an incident or situation. This is unlikely to require immediate action This week we got a Health Advisory from the California Department of Public Health regarding the national increase in reports of suspected Acute Flaccid Myelitis cases. The Media has been all over this and it is scary indeed. It is hard not to get nervous. Of course I have had some calls about it. It is NOT my intent to fan the flames and make folks panic, I just want to give you some basic knowledge and share what is currently known about it.   Acute Flaccid Myelitis (AFM) is a very rare neurological condition that is characterized by sudden onset of weakness in one or more limbs. An MRI will show distinct abnormalities of the spinal cord gray matter.   Nationally, from January 1 through October 16, 2018 the Center for Disease Control and Prevention (CDC) has reported 62 confirmed cases in patients from 22 US states. They are investigating other possible cases at this time, so the numbers will likely change. More than 90% of the cases occur in patients who are under the age of 18 years old. Some lucky folks have recovered quickly and completely while others continue to experience paralysis and weakness.   There were similar episodes making the rounds a few years ago that were associated with Enterovirus D68 . This time around patients have been tested for that strain of enterovirus. It has not been consistently detected in every patient with AFM, so there isn't a clear connection, but many experts still think that D68 is the most likely cause and that the virus has mutated to make it harder to detect. Other thoughts are that it could be connected with a mosquito borne illness. The investigations continue. AFM is NOT thought to be contagious from person to person.   While I don’t want folks losing sleep over this, (our odds of winning the current giant lottery are on par with having to deal with this) seek immediate medical attention if you see any of these symptoms: Difficulty moving the eye or drooping eyelid Facial droop or weakness Difficulty swallowing or slurred speech Sudden arm or leg weakness   https://www.cdc.gov/acute-flaccid-myelitis/infographic.html   If we are suspicious of AFM, further testing and likely an ER visit would be the next steps.

Time out variations/behaviors that 'cross the line'

To recap last week’s post: behaviors can be sorted into three categories: Good stuff that we want to encourage Annoying stuff that we want to discourage Actions (usually bad stuff) that require immediate attention or intervention Last week I wrote about catching kids being good and ignoring the irritating behaviors. (Attention/Parenting Pearls) Several parents sent me requests to address category 3 sooner than later. Parents and caregivers need to be prepared to deal swiftly with the more challenging behaviors. I am referring to the actions that cross the line. This would include anything that is safety related. It is beneficial for parents to think about these types of things before they happen. Maybe you will be lucky and won’t ever need to be the parent of the biter, but it never hurts to be prepared. This is a good “what would I do if?” activity for parents. Let us begin by replacing the concept of punishment with consequence: If you act a certain way________________the consequence will be__________ Load your arsenal with your sensible consequences ahead of time. Being consistent is essential. All the folks who parent your child need to be on the same page I like to use sports analogies and in this case let's consider hockey. When a player gets out of line, they are moved to the penalty box for a designated amount of time. When the time is up, they are allowed to return to the ice and all is forgiven. The player essentially just had a time out. The goal of a time out should be removing the person from a situation that got out of hand. A timeout is not a time for discussion; that comes later. Here is what makes the time out that I recommend a little different. This ‘chill out session’ can actually happen right on your lap. Find a name for this ‘time out’ period that works for you. Maybe ‘breathing space’. Maybe ‘reset time’. You are a safe place, but stop short of making your cozy lap the goal. This isn’t the time to sing and give a back massage. Some quiet counting and some nice deep breaths are all they should get. This could happen anywhere where you can sit down and hold your child close. You actually likely have a timer in your pocket. Most cell phones have an hourglass app that you can download for free. This period doesn’t need to be long. Some experts suggest that it be a minute per age, but I have a suggestion. Ask your child how long the session should be (this is very effective for some kids and absolutely ludicrous for others.) “You hit your sister. How long do you think we need to reset, 1 minute 2 minutes or 3 minutes?" We can’t anticipate everything of course, but here are some common behaviors that merit a reaction. Being physically rough This gets an immediate version of the ‘time out’ that you have chosen. (We get calls about biting quite a lot. I frankly don’t know which is worse, being the parent of the biter or the child that got bitten. Both are difficult. Separate the kids immediately. If you have the luxury of 2 adults, one can tend to the victim and the other can sit with the offender. Human bites can get easily infected, so if there is broken skin, they should get checked by a doctor.) We had a situation once in which Lauren came running and crying. "Alana bit me". "Alana, Why did you bite your sister?" "I forgot not to" was the response. Sometimes we laugh even though it is probably not the correct thing to do. Once they have been ‘reset’ they need to earn the privilege of close contact with the other person. They can go back to playing nearby but not in touching distance. “When I trust that no one will get hurt, you can play closer” If they act out physically to you and you are in a circumstance that allows for it, walk away. Don’t let your child abuse you. Use your own ‘walking away power’. Go out of the room and close the door for a moment. Make sure you are out of their line of sight.That is generally not the response they are looking for. Later, find a moment when everyone is calm and talk about what happened. Talking points: You weren’t gentle. What feelings were happening? Mad/ sad/ bored? It is fine if they don’t choose to pick one. What are some other choices that might have been better? Using words/using walking away power/ asking a grown up for help... Running off This is a safety issue. I don’t like to see kids on leashes, but we all understand the frustration that must have lead to that decision. Know the rules ahead of time. For instance, we hold hands when we cross the street. A child who is at risk of running off without listening, has lost the privilege of walking without being held on to. Perhaps they need to be strapped into a stroller until you are in a safe area. This is a behavior that you need to work on in more controlled situations. Find some parks with gates, so it isn’t actually dangerous if they don’t listen. When you are practicing this, it is probably useful if you have an extra adult on hand, especially if you have more than one child with you. Find an opportunity to play a freeze game, or red light, green light, so that they can learn to stop at your command. Give lots of positive attention when it is merited. Going to an off limit area. (Think wires, hot stove, climbing inappropriately..) Do some reasonable child proofing in advance to make sure your home is as safe as possible. Blocking access to every wire isn’t usually possible so training a child that there are some places that are off limits is important. Be consistent and move the child away immediately. It might take a dozen times. If they are willfully defiant, I don’t believe in 3 strikes. That implies that they have 2 chances to ignore you. Be clear; “The next time you touch the wire we will need to ‘reset’. Throwing things That’s an easy one. Take it away. If they throw something that isn’t sanctioned, they lose it. When everyone is calm, you can decide when they have another chance. Perhaps have something soft and safe that you can offer in its place. “I see a little boy who wants to throw something. Someone could get hurt or something might get damaged. Lets see if you can play with this instead.” Here is a real life example of a child crossing a line and how it was dealt with: In my parenting class I tell the story of one of my daughter's friend Anya. She is one of my extra kids. For several years, Anya was working as a nanny. Any family would have felt like they won the lottery to have her helping them raise their kids. Anya took “firm but loving” to heart. One day, she was at a class with her little 2 year old charge. This was a little dance class at a multi purpose community room. In a corner by the stage there was a pile of martial art equipment. Anya was clear. “Don’t go near that pile”. Her little toddler was feeling a bit defiant that day and went right over like a dare and tried to touch one of the off limit objects. Anya calmly picked her up, removed her from the danger zone and back to the dancing group. The little toddler went right back over. This repeated several more times. Finally Anya picked her up and this time they left the room completely. Little B was at this point kicking and screaming. “When you are calm we can go back to the dance class, but if you go near that pile we will leave again.” This process took up most of the class time, but I think that for the last several minutes they were able to rejoin the class and finished up happily dancing. B had learned a lesson. (When Anya told me about this, she also mentioned that some of the parents observing all of this commented that it seemed a bit hard on B that she carried her out of the room. Really? I would give her an A+) Have you ever gotten towed? It’s horrible, but what is worst is that once you have paid the $$$ to collect your car, you find a ticket on the windshield. You are going to be careful in the future that it never happens again. The Timeouts are the initial tow. Some behaviors now have also earned the ‘ticket.' Try to find a consequence that makes sense. For kids over 3, using tech time as a commodity works well. They start with a daily allotment with opportunities to increase it within reason. Poor behavior docks some of the time away. Maybe a special outing gets cancelled. “You are not listening when I tell you to stop running. I don’t feel safe going to the park.” DO NOT make the consequence so big that you are not going to stick to it. No TV or play-dates for a month is just silly. I can't help hearing, "No soup for you!" (That is a Seinfeld reference for any of you too young to know what I am referring to) Do not let one parent undermine the other. Talk in advance as a team, or wait to pass judgement and come down with the sentence as soon as you are able to come to an agreement. Here are some parenting tools to use before or after an incident: Look for the triggers. Prevention is preferable to having to deal with something. If you see something about to happen, take some prophylactic step. Are kids starting to bicker? Perhaps it is time to give a snack, distract and/or separate. Tell stories about another child who crossed a line with their behavior.What were some of the consequences? Get out the stuffed animals and do a little playing. Your child is the parent and you are the misbehaving critter. Walking away power is a great choice if anyone is in a situation that is making them feel unsafe. If they are with a friend who gets mad and hits, getting up and leaving is a better choice than hitting back. Taking deep breaths is often a good way to slow down. Share the wisdom with your child that everybody makes mistakes and we can all learn from them. This post has the most relevance for parents with younger kids. For my patient readers who have older kids and still took the time to read this through, I haven’t forgotten about you. I will do a post dealing with teen consequences sometime soon.