The christmas cactus

 

The Christmas Cactus

My grandmother had an enormous plant known as a Christmas cactus. They are known to bloom once a year. December is a common time for the flowers to come out, hence the name. Grandma gave a cutting to my mom. The cutting that my mom had thrived. It didn’t know that it was supposed to bloom just annually and would occasionally burst into bloom throughout the year. My older sister inherited Grandma's plant which also seems to have a mind of its own. Regardless of what was going on in the world or her personal life, mom would be joyful every time the plant bloomed. For her it was a signal of hope and positive energy. It was infectious and the entire family would somehow feel a lift. Prior to Covid, and when my parents were still alive, I made sure to go home to Pittsburgh every four months or so; these visits were even more frequent as both my parents got older. Scoff if you like, but more often than not, the plant would flower right before my visits and stay that way for several weeks. When mom died, my sister gave me a cutting of the plant. To say that I have not been very good at keeping plants alive is an understatement. Fortunately, Sandy has taken on the role of the plant tender. Historically he was no better at gardening than me, but after years of killing anything even remotely green, we now have an array of indoor plants that are flourishing under his care. The centerpiece is the offspring of the family plant. It has quadrupled in size since we have had it. I have given cuttings to my daughters. This week it burst into flower. It magically fills me with a sense of optimism. I feel my mom’s presence. Goodness, we all need hope and optimism more than ever after this year. Between the pandemic, the economy, the divisive politics, the climate woes, 2020 will be a year that most of us will be happy to see the last of. We all have pandemic fatigue. Please hang in there. The cactus is blooming. We are almost in a new year. Things will be better.

Santa and Covid

Let me preface this post by saying that I think it is essential to be honest with people in your lives. 

You don’t need to knock them over the head with the truth, but if they ask a direct question and press for an answer, please don’t lie. 

 Over the years several parents have asked me to weigh in on the ‘Santa discussion.’ 

What is the best way to keep the magic alive while not endangering the trust that is so important in any relationship? 

 For this general discussion about Santa, we can put him into the fine company of the Tooth Fairy and the Easter Bunny, but it is safe to say that Santa is usually the member of this trio that has the most emotional connection. 

 The Covid pandemic has added an extra layer to the conversation. This year some kids are worried that Santa will either have issues with social distancing or have trouble taking the time to wash his hands in between the houses that he visits. 

Talk about a potential 'Super Spreader'! 

 In my Jewish family, the girls never gave too much thought to the man in the red hat or the giant bunny, but we did get routine visits from the tooth fairy every time the girls lost a tooth. 

When I wrote this post a few years ago, I checked in with my grown girls to see if they remembered any feeling of betrayal when they realized that it was daddy sneaking the money under the pillow.

 Lauren tried hard to remember. She vaguely recalls that she figured it out reasonably early, but played along for several years. She wanted to make sure that the gravy train didn’t dry up. 

Alana says that she was too busy trying to figure out if monsters were real or not (thanks to having a big sister who teased her by making strange noises in the middle of the night) to worry too much about the Tooth Fairy. 

 For the young kids who ask if the mythical creature is real, if you want to extend the magic for another year, you might deflect the questions fairly easily without telling a falsehood. A simple, “What do you think?” works pretty well. 

Or, “It is fun to believe in magic sometimes and Santa is part of the holiday magic” 

 Keep in mind that once your child gets to kindergarten believing that Santa is actually going to try to fit down your chimney, rather than the ‘spirit of the holiday magic,' they might be in for a shocking disappointment when they learn the truth. 

There are lots of kids at school, even virtually, who are eager to share the cold hard facts with your innocent child. 

It is much better if this discussion comes from you before your kids find out a harder way. 

 I spoke to several people who recounted that they believed in Santa with all of their hearts and were completely devastated when they learned the truth. 

They felt deceived. 

One person told me that finding the truth was the moment they stopped believing in all magic.

 How sad!

 Letting them know the truth gently doesn’t have to be a negative experience. 

 For older kids, I love a good story. 

Many stories start with an element of historical truth: “Once upon a time in a far off country there was a man named Nicholas. He loved to do good things for other people. What was special about him is that when he gave people presents or did nice things, he didn’t do it because he wanted something in return. He simply wanted to do good things. 

Lots of times he did it in secret and no one even knew who did something nice for them. 

Maybe this Nicholas was big and jolly and had a white beard. 

He became known as Santa Claus. Santa is a symbol of love and magic and hope and happiness. 

He teaches children how to believe in something that they can’t see or touch. 

I am on his holiday kindness team and now you can be too. 

Really little children might believe that there is one Santa who manages to be everywhere at once. Big kids like you get to know the secret. 

Team Santa is all the big kids and grown ups who want to help make other people happy. “ 

 Perhaps take the opportunity to help your child be an active member of this awesome team; an initiation of sorts. Is there someone in your life that seems like they need a little kindness? 

What could you do for them? Is there a little gift that might make a difference? 

Plotting a secret kindness is the thing that wonderful lasting holiday memories are made of. 

 PS: Even when Covid is no longer an issue, the photo on Santa's Lap should be voluntary. If your child isn't eager to go sit on a strange guy's lap, please don't force them. 

If the kids are up for it, there are places that are making socially distanced Santa Visits possible this year. https://datebook.sfchronicle.com/entertainment/where-and-how-to-get-your-2020-photos-with-santa-in-the-bay-area

Talking Barbie takes a bath

This week's topic Talking Barbie takes a Bath

This post is not going to educate or problem solve, but it might make you giggle, which is actually what we all need these days. Sandy’s uncle Bernie was a very senior executive at Mattel, and a friend of Ruth Handler, the inventor of Barbie. What this boiled down to was that every December, an enormous box would be shipped to our house filled with the latest toys, and dolls. My girls ended up with an absurd amount of Barbies. And we even had boxes labeled with extra Barbie parts - arms, legs, heads... My kids could entertain themselves endlessly with these. My sister-in-law Barbara was just recounting a memory of watching her nieces play with the dolls. At one point Lauren declared “This is boring. Let’s play Barbie in Russian”. They proceeded to continue the activity that looked to be completely unchanged, but now the various Barbies spoke to each other with Russian accents. Somehow this added just the element of excitement that was lacking, and the play happily continued. One year, a very special Barbie made an appearance. This one talked. When you pushed the button on her back she would come out with a multipart statement such as “ Want to go to the Beach? With Ken? Tomorrow?” When you mixed and matched, it turned out to be a pretty wide range of Barbie appropriate statements (no Russian accent). This was a long time ago. My 4 and 7 year old daughters shared a bedroom and the third bedroom in the house was an office/toy room. One evening the girls were in the tub. They had brought some dolls in there with them. They were past the age of needing eagle eye supervision, but I was in my room keeping an ear out when I heard the new Barbie chatting. I went into the bathroom and said, “this Barbie should probably not be in the tub. I don’t think she should get wet.” No problem; they handed her over and I put her away. A short time later I heard her talking. “ Want to get some pizza/ with Skipper? On Monday?” “Hey girls...I told you Barbie can’t be in the tub” “She isn’t in here!” This is when I heard Sandy pipe up from the office…”uh, she is in here.” So, there she was, right where I had left her, just occasionally coming out with something to say. We figured at some point it would just stop. Bedtime routine continued and the girls were tucked in. Sandy and I were down in the kitchen when some time later the girls appeared; they were laughing and holding the Barbie. “We can’t fall asleep. She is keeping us up.”  Sure enough, Barbie was now ranting and it was LOUD. “Pizza, shopping, beach, Ken, Ken….” Sandy, who was always the bedtime enforcer, took the doll and said, “okay...back up to bed, we will take care of her”. He wrapped her up in a towel and you could still hear her yacking away. So we did the next obvious thing, we opened the oven door (it wasn’t on of course) and put the towel wrapped rambling Barbie in it. You could still hear her. It was a little Twilight zone-ish. We looked at each other at the same time and said “batteries, Duh!” Laughing at ourselves that our ‘obvious’ solution had been to wrap her up and try to muffle her, we retrieved Barbie from the oven and with the help of a small screwdriver, removed the battery. We left her on the kitchen counter. The next morning, I was down in the kitchen making lunches for the kids to take to school (Alana in general refused sandwiches so I always had to be a little more creative.) I was still a little sleepy, so when the Barbie, sitting on the counter suddenly said “Do you want to go shopping?” I confess that I let out a scream and dropped whatever I had been holding. Unbeknownst to me, Sandy had replaced the battery before he left for work Since she was no longer yelling, we let her talk herself out until the battery finally died, at which point she was relegated to the status of just another Barbie. Wishing you all a season filled with plenty of things that make you smile!

Holiday Safety Checklist 2020

The day after Thanksgiving is typically when people start thinking about the upcoming Holiday season. Flip through some radio stations and you are sure to find seasonal songs playing already. According to a news story that I was watching this week, people are actually starting to decorate for the holidays even earlier than usual because, well…..we need to be cheered up after this horrible year. Early tree sales are soaring. Over the years I have continued to update my holiday safety post. Whenever I think I have seen it all, strange accidents and events come to my attention and get added to the list. This year aside from warnings about candles, trees and lights the biggest safety issue is a sad one.....Stay away from people who are not in your quarantine bubble. I know that there are probably a number of you who are relieved that you have an excuse to avoid the large family gathering, but for others it is heartbreaking to be away from larger, traditional gatherings. The COVID numbers are frightening. Just a few weeks ago, things looked like they were improving. Alana and I gleefully got our first pedicures in more than 8 months. Now? Looking at the uptick in cases, I wouldn’t have taken the chance. Back in June I did a post that addressed the risk/benefit for easing out of the restrictions. Your health and the health of your family are simply more important than a holiday gathering. I fear that many people ignored all the warnings and gathered for Thanksgiving this week. I hope I am wrong, but if I am not, we can expect even a bigger increase in cases as well as a strain on the hospital systems in the coming weeks. If that is the case, I would be really nervous about going anywhere! Go ahead and decorate your house (safely) Make your wonderful meals and create a magical atmosphere in your home, but please please make smart choices when it comes to leaving the safety of your bubble. Holiday Safety Checklist Have you thought of everything? The lights are twinkling and the radios are playing the holiday tunes. People are putting up the holiday decorations. It is time for the holiday safety post. Take a moment to give this a careful read. There may be some things that hadn't occurred to you. For most people, the holidays are a time for celebration. That means more cooking, home decorating, entertaining, and an increased risk of fire and accidents. For every aspect of holiday celebrations, I can tell you the story of a patient who called with a related accident. It is not my intent to scare folks with my tales. As I tell parents who attend my safety class, if you know ahead of time what accidents can happen, you have a way better chance of avoiding them. I have seen some wild and improbable things over the years. Baking cookies is just one example. A patient's mom called to tell me that her 10 month old had sustained a burn on his hand. She was holding him in the crook of one arm as she removed the cookie sheets from the oven. As she recounted, he turned into a cartoon character with a telescoping reach and he was able to stretch across her body and grab a hold of the piping hot tray. Simple solution: don't hold your child when you are working with hot stuff in the kitchen. Their arms are longer than you think. If even one accident has been prevented, this post was worth it. Candles are another hazard. It was a winter evening many years ago in a cabin at Lake Tahoe. Dr. Jessica and family lit some holiday candles and went to sleep. Somehow one of the candles ended up burning a hole through a plastic mat that was on the table. Luckily the smell of burning plastic woke them up before any real damage was done, but it was a frightening lesson. This was a vacation rental. In this instance, there seemed to be no working smoke detector. She had no idea if and where there was a fire extinguisher. There are several obvious lessons here. Never go to sleep with candles or a fireplace still burning. Get acquainted with the safety features of any place your family is staying. Below are some safety considerations for dealing with the holiday season ahead. Some of these may seem like common sense but there might be a few tidbits in here that I am betting you haven't thought about. Beware of button batteries. They are everywhere nowadays in all sorts of small electronics (and musical cards) and can be quite hazardous if swallowed. Take time in advance to do a mental inventory of items that you have around that may be powered by these. Put a piece of duct tape over the battery compartments to make sure they can't fall out. Certain holiday plants like poinsettias can be mildly toxic (especially to someone with a latex allergy). You may not have them in your own house, but if you are visiting a friend or even a supermarket make sure little hands don't grab the pretty red leaves and put them in their mouths. Be very careful transporting hot food to a holiday potluck. I have patients who have been burned from hot food spilling on them in a car. WARNING TO PET OWNERS! One of my patients had a tragedy several years ago. An eight year old healthy dog got into a wrapped package that was filled with chocolate. The amount ingested proved to be too toxic for this little dog to handle and they didn't make it. Please don't let this happen to you. Make sure that any mystery packages are nowhere near where a pet can get to them. Christmas tree checklist: When purchasing a live tree, check for freshness. A fresh tree is less of a fire hazard Cut 1-2 inches from the base of the trunk immediately before placing the tree in the stand and filling with water to ensure absorption. Don’t add chemicals that might be toxic to kids or pets. A dash of plain 7 up can help keep the tree healthy. check the water level daily to avoid the tree drying out When purchasing an artificial tree, look for the label "Fire Resistant" Never use electric lights on a metallic tree. The tree can become charged with electricity from faulty lights and a person touching a branch could be electrocuted. Place your tree at least 3 feet away from all heat sources, including fireplaces, radiators and space heaters Make sure the tree is steady enough that it can't be pulled over by a toddler. You may need to attach it to something solid. Trust me, trees get knocked or pulled over. Older kids running around can cause this issue, it isn’t just toddlers. Trim your tree with non-combustible or flame resistant materials. Before using lights outdoors, check labels to make sure they have been certified for outdoor use. Make sure all the bulbs work and that there are no frayed wires, broken sockets or loose connections. Plug all outdoor electric decorations into circuits with ground-fault circuit interrupters to avoid potential shocks. Strings of lights and garlands are a staple of holiday decorating, but they can also pose a strangulation hazard. Avoid trimming the tree with things that look like candy which may pose a temptation to the kids. Keep sharp, glass or breakable ornaments out of reach of small children. Holly berries and other small decorations can be choking hazards. Don't overload extension cords; make sure that your extension cords are high quality. If you are going to use your fireplace, make sure that you have the chimney checked and cleaned if it has been awhile since you built your last fire. (make sure that it isn’t a spare the air day) http://www.sparetheair.org/stay-informed/todays-air-quality This is not a safety issue, but it is worth mentioning. Is your child exhibiting any new allergy symptoms? Take a minute to consider whether or not they started during the holiday season. Trees, scented candles and other seasonal extras can trigger some allergies. Hanukkah doesn’t fall on the same date every year since it is based on a lunar calendar. Many folks laughingly refer to it as coming either “early or late”. It also has more spelling variations than any other holiday. This season the first candle will be lit on the evening of Thursday December 10th. Make sure that all candles are safely out of harm's way. The menorah should be on a glass tray or aluminum foil. Make sure candles are not close to wrapping paper. Don't go to sleep with candles still burning. Don't leave the matches or lighters hanging around. If you are frying latkes (fried potato pancakes that are a holiday tradition, yum) make sure that no one gets splattered by oil and of course, never leave the hot oil unattended  Remember that adding water to a grease fire will make it worse! Baking soda is okay, but a fire extinguisher is best. Make sure you know where it is and how to use it. Kwanzaa may be the safest of the holidays, (no hot oil or stressing the electrical outlets) but there are still candles involved, so make sure they are placed in a safe place and toddlers don't have access. If I missed any holidays, let me know! I will add them to this post in the future. This is also a great time to test your smoke alarms and carbon monoxide detectors!!! Stay safe and have a wonderful holiday season.

Thanksgiving 2020/Food safety guidelines

I have always loved Thanksgiving.  For more than 25 years, several close families have joined with ours to create wonderful holiday traditions. Our typical celebration includes deep fried turkey, boozy cranberry sauce, my grandmothers award winning apple chocolate chip cake (recipes below), games after dinner and Sandy wearing his special "uglier than you can imagine" Thanksgiving pants. Mostly it was about friends and family gathering with our numbers growing every year as we would figure out how to creatively fit more people around the table. One fond memory from many years ago comes to mind. My daughters were probably 6 and 3 years old. We were taking turns sharing our thoughts about what we were thankful for. This was long before an activity like this would simply bring on heavy eye rolling from Lauren, but at the age of six, she embraced this activity with a gusto. She was thankful for rainbows and sparkles, family and love...she went on for several minutes with a fairly classic list of things that made a 6 year old girl feel happy. The other kids at the table followed her lead and the lists of things to be grateful for were getting longer and longer. Then it was 3 year old Alana’s turn.  “Lani, what are you thankful for?” There was a moment's pause and the one word answer. “Soda” This year of course we will be putting our more than 25 year tradition on pause. My usual 30 people will be limited to 6 (this will ensure that there is plenty boozy cranberry sauce to go around.)  I understand how hard it is to be away from friends and family during the holiday season. I also know how lucky I am to be in a quarantine bubble with my local immediate family. That beats soda any day. For everyone who is impatient and tempted to go to a larger gathering, please be smart. Hang in there for a bit longer. There is a light ahead. I know it is still dim, but it is there. In honor of Thanksgiving, I am reposting my food safety guidelines. There are some terrific links in here that you might want to bookmark for later. Food Safety Guidelines

Thanksgiving is a holiday associated with lots of yummy leftovers so it's usually a good time to update my food safety post. If you watch the news you know that food contamination issues can happen all year round. This post will give you some safe guidelines for foods that you buy and cook. If you do a lot of eating out, restaurants are supposed to have their cleanliness rating publicly displayed. Check the bottom of the article for some great links on food storage guidelines; everything from egg safety and turkey leftovers to breastmilk storage. It is certainly not a sterile world. As soon as they are able, your baby will start putting anything that they can reach into their mouths. You can't even begin to imagine the phone calls I have gotten about icky things that some of my little patients have managed to get their hands and mouths on. Chap-stick, particles from an exploded hot pack, kitty litter, the little packet in shoe boxes that says do not eat. You name it, they lick it. So yes, the world is full of germs, and while I don't generally get too concerned about a little dirt here or a big sloppy dog kiss there, foodborne bacteria can be nasty, and we need to minimize any exposure. There were more than 300,000 reports of children under the age of five being impacted by tainted food last year alone. Infants and young children are particularly vulnerable to foodborne illness because their immune systems are not developed enough to fight off infections. This is especially important for infants under 6 months of age. Extra care should be taken when handling and preparing their food and formula. Here are some basic food safety guidelines. Wash hands for at least 20 seconds before food preparation. Soap is best. Hand sanitizer will do. Re-wash as needed after handling food that might carry germs. The most common offenders are poultry, meat, raw eggs. Make sure kitchen towels and sponges are changed and cleaned frequently. Sponges can go through the dishwasher. Cloth can get easily contaminated and then spread germs. Watch out for potholders or other cloth items that come into contact with raw food. Keep your refrigerator temperature at 40 degrees or colder. It is worth investing in an appliance thermometer so that you can keep track. All the science says that the 40 degree number is essential for keeping the bacteria from multiplying. Your freezer should be below 0 degrees. To ensure the safety of your frozen food, you need to be sure that it has been actually kept constantly frozen. One clever trick to make sure of this is to keep a baggie filled with ice cubes in the freezer. If they remain cubes, you are in good shape; if they melt and refreeze as a block of ice that means that at some point your freezer was not cold enough. This can happen in a power outage or even if the door wasn't kept tightly closed. I am sad to say that if there was stored breast milk in there that has thawed and refrozen, I would no longer consider it safe. Label things in your freezer and rotate so that you are using up older stuff first. Check the dates of baby food jars and make sure the lid pops when you open them. Don't put baby food back in the refrigerator if your child doesn't finish it and you used the "used" spoon to take the food directly from the jar. Your best bet - simply don't feed your baby directly from the jar. Instead, put a small serving of food on a clean dish. Add more as needed with a clean spoon. Remember that once saliva has come into contact with the food it is no longer sterile and some bacteria can grow quickly. Powdered formula is NOT sterile. Don't mix up more than you need in advance. If the infant is less than 4 months, I would mix it with boiling water and let it cool. Don't leave open containers of liquid or pureed baby food out at room temperature for more than two hours. Bacteria thrive in temperatures between 40-140 degrees Don't store opened baby food in the refrigerator for more than three days. If you are not sure that the food is still safe, remember this saying: "If in doubt, throw it out." See links below for guidelines on how long food stays safe. Make sure that foods are properly cooked. A food thermometer is the best tool for this.  Beef...160  Chicken ( white meat/ dark meat)...170/180  Fish......160  Eggs....not runny For all of you "older kids" who will be baking this holiday season, watch out for the batter (I am a notorious offender.), Even one lick from raw food containing a contaminated egg can get you ill. ____________________________________________ Myth: Freezing food kills harmful bacteria that can cause food poisoning. Fact: bacteria can survive freezing temperatures. When food is thawed, bacteria can still be present and can begin to multiply. Cooking food to the proper internal temperature is the best way to make sure any bacteria is killed. Myth: vegetarians don't need to worry about food poisoning. Fact: Fruits and vegetables are an important part of a healthy diet, but like other foods they may carry a risk of foodborne illness. Always rinse produce well under running tap water. Never eat the pre-washed 'ready to eat' greens if they are past their freshness date or if they appear slimy. Myth: Plastic or glass cutting boards don't hold harmful bacteria on their surfaces like wooden cutting boards do . Fact: Any type of cutting board can hold harmful bacteria on its surface. Regardless of the type of cutting board you use, it should be washed and sanitized after each use. Solid plastic, tempered glass, sealed granite, and hardwood cutting boards are dishwasher safe. However, wood laminates don't hold up well in the dishwasher. Once cutting boards of any type become excessively worn or develop hard-to-clean grooves, they should be discarded. Myth: Locally-grown, organic foods will never give you food poisoning. Fact: Any food, whether organic or conventional, could become unsafe with illness-causing foodborne bacteria at any point during the chain from the farm to the table. Consumers in their homes can take action to keep their families safe. That is why it is important to reduce your risk of foodborne illness by practicing the four steps: Clean, Separate, Cook, and Chill. Some excellent resources for food safety tips can be found at: www.foodsafety.gov  This site keeps track of any food recalls www.Stilltasty.com This is as great site for seeing how long food will last. I used it just this week to figure out if an open can of chickpeas was still good. (After a week, the answer was no) www.fightbac.org   This site has loads of kid friendly activities Breastmilk storage guide http://www.eggsafety.org Enjoy your Thanksgiving!

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Grandma Fuffy’s apple chocolate chip cake Beat together 3 eggs 1 3/4 cups sugar 1 cup oil (can make some of it apple sauce) sift together 2 ¼ cups flour (can substitute cup for cup Gluten free flour) ½ teaspoon salt 1 teaspoon baking soda                             ¼ teaspoon baking powder Mix together wet and dry ingredients Add ½ cup of chopped nuts ( optional) ½ cup chocolate chips ( sometimes more seem to find their way into the bowl) 4 cups peeled and diced apples ( about 4 apples) this is the only pain in the butt part of this recipe, otherwise it is so easy cook in ungreased 9X13 pan in 350 oven if you use only oil it is about an hour, if you use some applesauce it is done more quickly, use a toothpick to check the center ******************************************************************* Cranberry Puree (8 servings) 1 pound of fresh cranberries 2 cups of sugar 3/8 cup of Marsala wine ½ cup of Grand Marnier 1/8 cup of Angostura Bitters Cook cranberries and sugar in heavy medium saucepan over medium heat until cranberries are very soft, stirring frequently, about 20 minutes. Puree mixture in blender with half of Marsala wine. (The original recipe says that you should strain this mixture into a medium bowl, pressing to extract as much fruit as possible, although I don’t bother with this step as I think the texture with the seed and fruit bits is more interesting.) Whisk in remaining Marsala wine, Grand Marnier, & bitters. Cover and refrigerate overnight. (Can be prepared up to 5 days ahead.) Serve well chilled. (The amounts of alcohol can be decreased but not by more than ½ of what is called for; the less liquids added, the more jelly-like the puree.)   Don't eat this cranberry sauce and drive!!

Teaching your child how to be a good winner or loser

Teaching your child to be a good winner or loser

It is our job as parents and educators to teach our kids the all important lesson of how to lose and how to win without being an ungracious %%$%. I started writing this post several months ago, but put it on the back burner. The topic was on my mind from watching the news a little too often. The ability to remain civil and be a good sport seems to be a waning skill. Some adults don’t seem to have the capacity to say, “Congratulations, you won, good job.” When I see an adult acting badly, It gets me thinking, what was their childhood like? Was love and approval conditioned on success? Is success measured solely by winning or losing? Now, after watching this historic election for the past several days, I decided to dust off this piece and finish it. My post about RSV can wait until next week. There will be times in life where we don’t succeed or come out on top. Tools for dealing with those situations gracefully are gifts that you can give to your kids from a fairly young age. This should be an essential lesson for people of all ages Sports and games of all sorts should be a normal part of growing up. Children who are blessed with siblings haven't had to take a break from social interactions. For all the others the quarantine has made that very challenging. After the quarantine, at some point, life will go back to normal. We will return to our normal social interactions. Kids will be put in situations where they are playing and competing. Find time to have real conversations about winning and losing. When your child is having a temper tantrum because they just lost a card game with their sibling is probably NOT the ideal time. When you find that magic moment, here are some talking points. Was playing the game fun?  Was the actual activity less fun because you didn’t win? Is there luck involved? Is there skill involved? If you practice, do you think you could improve? Is there knowledge involved? Could you study and learn? Tell stories about people who win and lose and how they act nicely or like spoiled brats.  Get out the stuffed animals or dolls and play it through. Exaggerate how sweet and gracious the good winners and losers act. Go over the top acting out the obnoxious poor losers or boasting winners. Who would they rather spend time with? Consider doing the following: We are going to try something. It involves playing a game. For the game, only one person can win. But in the big experiment you will all be awarded points One point for winning the game but three points for: Compassion. Being happy for the person who won Being kind and gracious to the people who didn’t win. By all means, it is perfectly fine to try hard and be proud of yourself for winning. On the other hand, losing shouldn’t be shameful or something we can't handle. We need to teach our kids about what is really important and to recognize when things are less consequential, so that they don’t get consumed with the importance of getting the gold medal. Admittedly some contests are much more important than others, but regardless, character matters! My daughter Lauren ( Inclusive Arts ) teaches improv and theatre classes, and told me about several of the ways she teaches her students to cope if an activity doesn’t go their way. If it is a game in which a group is working as a team to accomplish a shared goal, and one or more group members seems to be struggling with the challenge, at any point in the activity, any member of the group can call out ‘AGAIN!’ which everyone then echoes all together with a big celebratory gesture (changing the narrative from “we have to try again” to “we get to try again”). She also uses what is called “the failure bow”; if there is a competition or an activity in which the possibility of being eliminated or losing exists, they get the opportunity to do an epic bow while everyone else applauds. The goal (and usually the result) is to maintain the feeling of celebration regardless of the outcome.  Model good behavior. Show your kids the proper way to lose and win. Don’t whine and throw the game board across the room if you lose, or accuse your opponents of cheating. Don’t taunt people when you win. Pay attention to when your kids take the high road and let them know that you noticed!  Since Lauren weighed in on this post, she couldn’t help but point out that when her father Sandy would win a game, he would ‘Assume the Position’ which translated to doing a royal sprawl of celebration with a loud and satisfying sounding “Aaaaaaaaaah.”  It is okay to be a little bit of a brat...just keep it fun! If children are reassured that trying hard, having fun, and being kind and gracious are the things that make parents proud, and encourages other people want to engage with them, than a very important lesson will be learned.

Adjusting to the time shift

Adjusting to the time shift

I am quite certain that it will happen. Forty eight hours or so before the official directive to set our clocks back, I will glance at a clock somewhere in my house and do a double take, “What? It is only 9 o'clock? It feels so much later!” Sandy will laugh and we will know that he ‘got me yet again’. There are so many clocks to adjust in our houses these days between the clocks in the cars, microwaves, coffee makers, etc. Some adjust automatically, but for the others, in our family it is Sandy’s job to make the changes, and for all of the years that we have been together, it has been his habit to start the process several days ahead of time. Even though I should know better, invariably there will be the moment I look at a clock and get confused and caught off guard. Indeed, twice a year the powers that be have decided that we need to adjust our times either one hour backwards or forwards. Some people love it and others hate it, but unless the law changes, or you live in Hawaii or Arizona, it is something most of us need to deal with. In general, for most adults, other than a tiny bit of lag, a one hour time shift is a no big deal. However it is quite the thing when you have a baby who is already waking up at 6 am. If you don’t make a bit of effort in advance, the ‘Fall Back’ means the babies are now awake at 5am (shudder!) With a little bit of planning, the following tips should make it a bit easier for you. Before we tackle the time shift, let's review some sleep basics. There are many different approaches to helping your kids sleep well, but here are the cornerstones. Getting enough sleep is essential, not only for the health of your child, but for the sake of your own sanity. If your child has the ability to do some self soothing, everything will be easier on you. It is never too early to start paying attention to this. Even if they are only able to doze off without having a nipple in their mouth or by having you actively rocking them once a day, consider that a win. Create a routine and strong sleep association, such as a special song, massage or snuggle. Make the environment conducive to good sleep. People tend to sleep better in cool dark rooms. Babies are no exception. A perfect temp is somewhere around the 68 degree range. See what you can do to keep the room dark. Consider the use of a Hepa filter or white noise machine. Hopefully once your little one weighs more than 14 pounds, they are giving you a good stretch at night and are on somewhat of a regular schedule. This is not something I count on for babies who are younger than 4 or 5 months. For you newer parents, take a deep breath, you need to be patient for just a bit longer. Babies still need to be feeding at night for the first several months. This phase will pass. Even though the young ones don’t usually have a real schedule in place yet, and it is normal for them to be feeding during the night, self soothing, sleep associations and a good environment are still very important, trust me! If you start good habits early, you will tilt the odds in your favor for getting a good nights sleep sooner than later. Once your baby is routinely sleeping through the night, the sleep goal should be that they stay in bed roughly 11 hours after bedtime. If bedtime is 7:30pm, the ideal wake up time would be 6:30 am (I see some of you rolling your eyes at the concept of 6:30 am being considered ideal. Someday you will be able to sleep in again, just not right now.) The simplest way to adjust to the new time zone is to do it gradually. I would suggest starting a week or so earlier and every night, move the bedtime 10 minutes earlier. This fall, the official time to change the clocks is 2am, Sunday, November 1st, but most people (except Sandy) change the clocks on Saturday night. For toddlers and preschool kids, many parents end up purchasing a toddler clock or someway that the kids can see so they know when they are allowed out of bed in the morning. If they get up earlier, for the big kids, calmly walk them back to their room, but with the infants, you can do the check in and pat them. Pam from Sweet Dreams suggests not switching your clocks until you actually wake up on Sunday morning. I tend to agree with her, but I would add that being conscious of the “extra hour” can be a fun thing to do with your kids. For the grown ups, make sure you each get an hour of being off duty. Spend it doing something just for yourself, maybe a bubble bath, or some meditation or go for a run. It is your hour. Your partner gets one as well. For the kids, ask them how they would like to spend their hour. I want to make one more point about the early waking. When my sisters and I were young, my mom was the first one up. She loved the dawn. Sometimes it was because it was the only time she could claim quiet time before the rest of us woke up, but there was something about it that called to her. The reason that this lifestyle worked for her was because whenever she could, she also went to sleep early. Many of us get a second wind in the evenings and enjoy some adult time once the kids are in bed, but if you are routinely exhausted in the morning, it might be worth the effort to put your kids schedule on the back burner for the moment and take a look at your own. Sleep needs vary. How much do you tend to get? How much do you think you need? If you are running at a steady deficit, this is going to start taking a toll on every aspect of your life. Much of the time it is simply about making better choices. Yes, I am saying that perhaps you should stop binge watching whatever series you are following, or put down candy crush and get into bed! If you have trouble falling asleep, make sure your iron and vitamin D levels are within normal limits. When your kids have grown and you are retired, you can sleep in as late as you wish. The years with young kids in the house are fleeting. Most kids are early birds. See if you can train yourself to embrace this, or at least not look at it as torture. If life offered the option of going back in time, I wouldn’t rule out a 6 am encounter with my babies Enjoy your extra hour! I hope your kids behave. You are on your own with your pets......

Happy Birthday to Frida the Lamp

Happy Birthday to Frida the Lamp

As many of you know, Sandy and I spent 2 months last year wandering around Europe by train and by foot. Knowing what we now know, I am so grateful that we traveled while we could. We packed extremely sparingly. We each had one small rolling suitcase and shared one smalI backpack that we took turns wearing (meaning I had it 5% of the time and Sandy had it the other 95%) I found that packing cubes were essential (Sandy found them useless). My suitcase was like an intricate puzzle. Things just fit exactly. There wasn’t a spare micro inch for anything else. We didn’t do much shopping, because we simply couldn’t fit anything extra. I joked that every time I used a Q-Tip there was a tiny bit more room in my suitcase. Because we were doing so much walking, we were grateful that we were able to manage traveling so lightly. Typically we would simply have to manage our stuff from the train station to whatever lodging we had chosen. Finding lodging that was walking distance to the train station location was always a consideration when selecting our hotel, or AirBnB. It was amazing how much walking we did. We ended up taking a total of 3 cabs/ubers the entire 2 months! A bit over the midway point in our trip we were in the lovely city of Florence. Our daughter Lauren and her husband Adam had been in Italy several months earlier. She had a favor to ask. While they were there she had fallen in love with a lamp that she saw in a cute little store. It wasn’t cheap. She wavered for several days and couldn’t stop thinking about it. Adam strongly encouraged her to just buy it, and finally Lauren agreed. On their last day, they returned to the store and to their great dismay found that it was closed. How many of you have had the item that “got away”, you were in a store eyeing something, but decided for whatever reason not to buy it and the moment was lost? For Sandy and me, it was a clock. If you live in the Bay Area, you might have seen it. Many years ago, a quirky store in Sausalito had several amazing clocks in their window. These were large clocks with gold wire mechanical figures climbing and moving about throughout. We were both enthralled. It wasn’t so much that they were expensive, but they were also big, and we weren’t even sure where we could put it. One day we were over in Sausalito and saw that the store was going out of business. The one clock left was on sale; should we finally get it? We gave ourselves a night to think about it. When we went back the next day it was gone. The store was shuttered. Of course now that we had lost our chance, we really wanted it even more. We did an internet search putting in all the keywords that might help us, but we never saw anything quite like it. We were out of luck. We still look for it! Whenever we pass an antique shop we pop in to see if ‘Our Clock” is there. So, when Lauren told us about the lamp, we understood. She insisted that she would want to reimburse us, but could we go by and purchase one of the lamps for her? She remembered exactly where the store was.  We went to the store and immediately understood why she was charmed. It turns out that there were dozens of these wonderful lamps. They were figures holding umbrella lamp shades. Each one was wearing something different and was holding a different colored umbrella. They all had names. They were all unique. We connected with Lauren over WhatsApp, explained to the puzzled shop owners what we were doing, and wandered through the store showing her all of the options. It is easy to take for granted how easy it is to communicate these days. When I traveled as a teenager my poor mom had to wait weeks for the airmail letters to get through. Lauren ended up choosing the lamp named Frida. We started the process of buying it but when we got to the shipping option we were shocked to find that the shipping cost was almost as high as the cost of the lamp. We did some searching around to see what all the options were. The lamps were NOT available for purchase in the US and there was no way to ship it without paying exorbitant costs. We updated Lauren and she sighed and told us to never mind. Sandy and I thought about it overnight and both of us came to the same conclusion. We would get it and just carry it with us. The store did a magnificent job creating a little handle on the large box and we were on our way. Did I mention “large box’? The lamp was taller than my suitcase.  So, as mommies and daddies will do for their kids, we schlepped this large lamp with us for the rest of our travels. If this lamp had her own passport, it would be an impressive one, When we were lucky, Frida got her own seat on the train. During our last night in Amsterdam, for some reason we were upgraded to a 4 bedroom suite (the benefit of traveling off season); Frida the lamp got her own room! On our flight home, she was too large to take on as a carryon, but we were amused that she was literally the first thing to appear on the baggage carousel. Friday now lives happily shedding some light on Lauren’s piano. It is hard to fathom that it was almost exactly a year ago that we got her. It feels like just moments have past, while at the same time it could be a century ago. Many of my posts and stories have a lesson to be gleaned. Hmmmm, not sure what the lesson from this one is. Maybe.. When you see something super special, if you can afford it, don’t let it get away. There are usually more regrets from passing it by, then buying it. OR A bit of short term schlepping is absolutely worth the long term pleasure. OR When we are all are able to travel once again, packing cubes are great! (except for Sandy, but I think more people agree with me!)

Teething 2020

Teething symptoms and remedies: Dos and Don'ts Normal infants have 20 primary (baby) teeth which have started to develop in the womb. The teeth start to erupt through the gums around 6 months of age. The baby teeth are then shed at various times throughout childhood. At the end of this post, you will find a chart with the normal range of ages when most teeth start to come and go. Occasionally, I have a patient that doesn’t seem to like to follow rules, ignores the charts and does things their own way. I know of one baby who was born with teeth! Another started out with the upper canines and looked like a little vampire. As you can imagine, those parents were so happy when the rest of the teeth popped through. There is some heredity involved. If one of the parents was very early or late it is possible for the baby to follow suit. If you are lucky enough to have the option, check with grandma to see if she remembers anything special about your teething pattern! It is rare for teeth to actually make an appearance before 4 months. Once in a while parents will notice a smooth round white bud on a baby’s gum. This is a little benign cyst called an Epstein Pearl. It is not a tooth and it usually goes away without causing any bother. Many parents think of teething as something they are only dealing with for their young infants. Think again. If your 6 year old is going through an extremely grumpy phase, or has a mysterious bout of mild, clear congestion that has been hanging on for a few weeks, take a feel in the back of the mouth and see if those first permanent molars are starting to pop through. Once your child reached the age of 21, all 32 of the permanent teeth have usually erupted and they can no longer blame their grumpiness on teething. Just like the timing varies, the symptoms may also vary greatly from child to child and even from tooth to tooth. By far, the most common first teeth are the ones in the bottom middle (and they are so cute once they come through). Take your clean finger and run it along your baby’s gum. If the tooth is imminent you may feel that the area of the affected gum feels soft and boggy. Let's talk about the symptoms. Many healthcare providers and dentists dispute that there is any real relationship between teething and any of the symptoms below, but I have been an advice nurse for a long, long (long) time. I speak to parents of teething babies all of the time, and I maintain that I see a connection. Fussiness: Teething is uncomfortable. Most parents report that the babies seem fussier than usual right before a tooth pops through. Do what you can to relieve symptoms, but if your baby is inconsolable (screaming with NO break) for more than 30 minutes and there is nothing you can do to calm them down, please call to have them checked. That would be an extreme reaction and we want to see if there is something else going on. Drooling: Drooling starts weeks and weeks before you actually see a tooth pop through. Many kids will get a drool rash on their chins and cheeks. There are several products that I find quite useful for this. Clean off the area with Cetaphil cleanser (no water needed, apply with a cotton ball and wipe off). Follow it up with aquaphor or cerave ointment (which you can use multiple times throughout the day). Gnawing/biting: Biting on things will feel great to the baby; not so good to your nipples if you are nursing. If your baby starts biting you during feedings I recommend a loud “ouch!!” and immediately remove them from the breast. Most babies can be trained to stop this. Remember that you want to make the association mildly unpleasant so that they will stop the habit quickly. Biting = loud yell and loss of breast! If you are too gentle some babies will think it is quite amusing and will continue to bite at will. Poor Sleeping: If your little one is miserable, this is not the time for sleep training. I would go in quietly and try one of the teething remedies listed below. If you are going through a rough patch remember that parents should take shifts. Give yourselves each a few hours where you are off duty. There is no reason for both of you to be up all night. If you have the option, it is often best for the NON-breastfeeding parent to go in, unless it is time for a feeding. This is a slippery slope; I would try not to feed for comfort throughout the night. Bleeding/bruised gums: It is not unusual to have a little bit of bleeding on the gums. Once in a while you may also see a purple/bluish bruise on the gums right before a tooth breaks through. This will usually resolve without any intervention although something cold will feel soothing. Mildly elevated body temperature: Most dentists will remind you that teething does not cause an actual fever, but I commonly see it associated with an elevated temperature. If a fever goes higher than 100.5 I am not likely to blame it on teething. Any fever that is lasting more than three days is worth a call to the doctor's office to check in. Loose stools: You will likely get differing opinions on whether or not teething can be the cause of loose stools and again; I will state here that I see it all the time. Some folks speculate that swallowing all that saliva and drool might be the reason. Regardless, I do think there is a link. If you have a baby with loose stools, you want to go with the bland, starchy diet and make sure they are on probiotics. Breast milk is safe, but other milk-based products may aggravate the situation. Rashes: If your child has sensitive skin and/or eczema sometimes, you might notice that the general rashiness flares up during active teething. Congestion: Many young teething kids seem to have a clear runny nose and congestion. This can last for weeks and weeks. Sometimes it causes a post nasal drip that in turn causes a little hacking cough.  Ear tugging: When kids are working on some of the upper teeth they tend to poke and play with their ears. Uh oh, many of these symptoms are the same thing we look out for if we suspect an ear infection. Even though teething may well be the cause, if I have a patient who is very fussy, feverish, and is having trouble sleeping, I am likely going to want to have someone take a peek in those ears. It is worth having an arsenal of tools at the ready for dealing with the months of teething that you have ahead of you. Chinese herbs: These are a great place to start. A very safe pediatric herbal tincture called Tender Teeth can be obtained at The Acupuncture Den, a family practice located in Noe Valley. Please contact Dr. Den to arrange a pick-up or mail delivery if you’re not in San Francisco. Beyond just the herbs, our local acupuncturist can offer relief with acupuncture and/or non-needle techniques. Many parents report babies taking a long and deep nap after a treatment! Cool teething rings: make sure they are made out of a safe material. Do not tie any teething rings around your baby's neck. Strangulation is a real risk! Frozen washcloth: Wet half of a washcloth and put it in the fridge or freezer. The baby will be able to hold the dry half and chomp happily on the frozen side. For an interesting twist, consider soaking the washcloth in chamomile tea before chilling it. Distraction: There is nothing as nice as a body massage and a warm bath by a calm singing parent. Homeopathic drops: The ones I am most familiar with are Camilia by the Boiron company. Click the Boiron link for a coupon. Orajel’s new formula is also safe. https://www.orajel.com/en/products/child-oral-care/orajel-non-medicated-cooling-gels-for-teething. The older formula which actually numbed the gums was recalled years ago due to safety issues. Make sure you read the labels carefully to make sure that it is Benzocaine free Feeding bags (baby safe feeder, or sassy teething feeder): If your baby has had some solid foods introduced, these feeding bags are great for teething relief. Add a cold hunk of fruit or veggie (pick a food that they have been introduced to already so that you don’t need to worry about any odd reactions) and let them gnaw away happily. With the mesh bag you don’t need to worry about them breaking off a piece that could be a choking hazard. You can find these bags online pretty easily. You can also fill one of the bags with a frozen ‘Milksicle'.Take 3 or 4 ounces of breastmilk, or formula, and combine it with some fruit, like banana, pear or mango. Puree until very smooth and stick it into an ice cube container. Pop out a frozen cube and add to the mesh feeding bag. Spa in your mouth - cool cucumbers of course! This is for kids who have proven themselves to be able to handle actual pieces of food, but for your toddlers who are cutting teeth, these might be a hit. Peel the cucumber, slice into circles, get rid of the seeds. Put the cucumber circles in a bowl in the fridge to keep cool. Teething Tube I actually just learned about these little gizmos from Pam of Sweetdreams infant care. She tells me that her grandson loves this, and it was very helpful getting him through the teething process Here is a great teether from one of my Oath mom's etsy shop Chew beads: I have had multiple parents tell me that these beads seemed to help but there is valid concern about these being a potential choking hazard. If Grandma feels strongly about using these, I have no objection as long as you have checked carefully for safety (nothing that can get loose) and are actively watching the baby while they chew on them. These should never be in a crib. I worry about strangulation with any necklace. Brandy/alcohol: Ask great grandma what she used to do for teething and she may tell you that she used to put whiskey or brandy on the baby’s gums. Obviously giving our babies alcohol is not something that most doctors would suggest today, but I actually wouldn’t worry if you caught grandma rubbing some directly on the gums. It probably does help. Some folks also say that rubbing pure vanilla extract on the gums is an effective home remedy. That may be from the alcohol content (I am referring to a tiny amount applied topically, no swigging booze!) Acetaminophen (Tylenol) and Advil (Ibuprofen) are useful but I prefer not to overuse them. Make sure you are using the proper dose. Start with the other approaches first. If possible, I would prefer to keep these as remedies for night time use only. Tylenol and Advil are quite safe but if they are used for a long period of time they can be stressful to the liver and kidneys. If you find that you have gone more than 5 nights where you are depending on these meds to keep your child comfortable, give your doctor's office a call to see if you need to make sure that nothing else is going on. DO NOT USE Any product that contains Benzocaine or Belladonna!! Once your child has teeth, it is especially important to keep bottles out of the crib. Milk has sugar and can cause tooth decay if a baby sleeps with a bottle in their mouth. It is never too early to start brushing the teeth. Let's get your baby in good dental habits. It is important to use a soft toothbrush and non abrasive toothpaste. The current recommendation is to use fluoride toothpaste; just a teeny bit the size of a grain of rice. Once they have a mouthful of teeth it makes sense to start shopping for a pediatric dentist that you can establish a relationship with. This will come in handy if you have any tooth questions or mouth injuries. Your next task is to figure out what the going rate for the tooth fairy is! I can’t help you there. Wishing you easy teething! *Thank you Marilia for letting me use Anna's teeth as my model!