Talking to your kids about differences

 

Talking to your kids about differences

You are in line at the supermarket. “Daddy, why does that person have only one arm?" "Why does that person talk funny?" "What happened to that person's hair?" The questions or statements are usually quite loud. You and your child are suddenly much more entertaining than the National Enquirer. It may make an amusing anecdote some day, but in the moment it feels awkward and embarrassing. Having some discussions ahead of time can be useful. These chats can start with conversations about how everyone is the same and different. How are people different? They might have different hair, different colored skin, different language, different sizes, different families, different beliefs and different abilities.  How are people the same? Everyone needs to eat, sleep, breathe and poop. Most people want to have a friend. It is a great exercise after noticing that someone is different to follow up with finding things in common. There are some awesome children's books out there that can be an excellent resource.  One that Lauren reads to Elliot is aptly called Same but Different. There are many with the similar theme.  Also make sure to talk about what things actually matter! Having someone who is kind is much more important than how tall they are. Society places way too much value on appearance. Wouldn’t it be nice if we could change that? Talk about how everyone has things that they are good at. Someone who can’t see might have exceptional hearing. Expose your kids to people who don’t look like you. Make sure that the books you read have many colors and ethnicities represented. When you draw, make sure you have crayons in all the lovely shades of skin that make up the human race. While there is certainly a time and place for everything, where kids are concerned, it is more often when we refuse to talk about something that it becomes dangerous or scary. One anecdote that I have shared in the past stems from a walk down Haight street many years ago. It was mid October and my family was shopping for Halloween costumes. A man walked past us. He was painted shiny gold from head to toe. Other than that, he was completely naked. Sandy, Lauren and I did a little double take. Alana walked right by and didn’t even pay any attention. That right there is the definition of someone who was born and brought up in San Francisco! The world would be so much duller if everything was the same. Variety makes things so much nicer and more interesting This conversation doesn’t even need to start talking about people. When you take a walk, point out all the different kinds of flowers that you see. Some are big, some are tiny. The different colors are fabulous. They all have different smells. Some have thorns. The message here is simple. It would be a shame if everything were the same. So many things in the news today are a stark reminder that human beings become tribal very easily. ‘Us versus Them’ is all too common of a theme. I would like to think that kids aren’t born that way. Hatred and intolerance are taught. Young children are drawn to people who look like themselves. Dr. Ted has some interesting data on this at the end of the post. It is the adults in their lives who need to give the message that it is safe to connect with others. Teach your kids to have curiosity and respect for the cultures of others. Don’t forget to enrich them with your own culture and traditions. Tolerant, curious, and open minded kids are the hope for our future. Alas there is nothing simple when it comes to the discussion about race. Obviously the deeper and difficult topic of racism needs to be age appropriate.   If we ever want real change, it is essential that parents start from the very beginning to teach our kids to accept and celebrate others, rather than fear and vilify someone who is not exactly like them. February is both Black History Month and the month when Chinese New Years celebrations take place, so it feels like a great time to pay attention to this issue. Oh, and the supermarket situation? Maybe your child will be like Alana and not notice! But the conversation ahead of time could be: “Some people are happy to talk about what makes them different. Some people are not. It is important to make sure that we don’t make someone feel awkward. If you see something that you have a question about, let me know and when we get home we can see if we can find answers together.” This topic can feel triggering for many people, here are some extra important words from Oath's Therapist Brittany Williams.  Brittany’s Tidbits:  When we become parents we do not stop being human. That means our ability to subconsciously react does not magically disappear. If given the choice, most people would always prefer to respond with consciousness than to subconsciously react. One way to decrease the gap between the two experiences is by increasing mindfulness.   Take a moment to check-in with yourself and mindfully listen to how you organically responded as you read this article. If you aren’t sure I encourage you to re-read the blog and this time, tune in and listen to what surfaces from within. What thoughts did you see cross your mind? Did you move close to a stress response (hold your breath, tighten your fists, clench your jaw, etc.) at any particular part? Perhaps you disagreed or were perfectly aligned? Maybe even a past experience came to mind. How did you interact with this material? Did you skim verses slowly digest?  Whatever comes up for you, use this intel to deepen or adjust your own level of comfort with differences. Perhaps engage with a trusted confidant, mentor, or mental health provider if you feel that would be helpful. Taking the time to do this can decrease your odds of reacting and increase your odds for responding during those supermarket moments. Lastly, a gentle reminder for all parents when you find yourself parenting from a triggered or reactive state: Your reaction is not because your child is behaving a certain way or has said something socially or otherwise inappropriate. Your reaction is always because of what that behavior means to you, and that is triggered from your own past experiences.         Dr. Ted’s Research Soon after young infants develop the ability to recognize faces, research shows that they can distinguish between faces of different colored skin. This can be as early as 3 months, but is usually most apparent between 6-9 months. You can imagine why this skill is advantageous from an evolutionary psychology perspective: we want to be able to determine who’s in our “tribe.” However, it’s not till much later (around ages 3-5) that children gain the ability to describe differences between themselves and others, such as gender qualities, the construct of race, and so on. This is the prime age to teach acceptance of variability, and kids tend to be very receptive to it!

Head Injuries/Traumatic Brain Injuries

 

Head Injuries/Traumatic Brain Injuries

‌

Kids fall. When I was working as the advice nurse at Noe Valley Pediatrics, not a week went by when I didn't get the ‘call’. The mom or dad would be in tears as they recounted in horror that their baby fell. With young babies, this can happen if you leave them on an unprotected surface for even a moment. More often than not, the caregiver was close by, watching it happen, but couldn't move fast enough. That thud is an awful sound.   Of course it isn't only babies who fall. Children and adults have accidents and sports injuries all the time.   If your baby falls or you are the first responder at any kind of accident, take a deep breath. You need to remain calm. You can give yourself some great self care, like a big glass of wine, later.   Medical personnel will want to know:   How far do you think they fell?(rule of thumb, if it's a height taller than the child, they need to be evaluated) What kind of surface did they fall onto? What was the immediate reaction? How long did it take until they stopped crying?   Of course, if there is a loss of consciousness, or any possible neck injury, don’t move them, CALL 911! A moment of stunned silence is common. If the fall is soon followed by crying it is unlikely that there was any loss of consciousness.    Do a quick head to toe assessment. Is there any obvious bleeding, bruising, sprains or fractures? Put immediate pressure on any bleeding wounds. Check the mouth and make sure there are no loose teeth. I suggest that you have an established relationship with a  pediatric dentist.  In the case of a mouth injury this will be very useful.   If your child will cooperate, get a cold pack on any bruises. If you are out of the house, a cold can from a vending machine is a good option. If you are near a freezer, a bag of frozen peas makes a nice ice pack. For toddlers and preschoolers, playing doctor before anything happens can be very useful. “Uh oh, we have a boo boo, quick, let’s put the cold pack on there to help make it feel better.”  Kids might cooperate better with one of the cute pediatric friendly cold packs. There are many options available.   I also recommend Arnica. I imagine that some of you are asking, “what on earth is that?” Arnica is a homeopathic treatment. It comes as a topical ointment or little oral pellets. Many parents swear that it significantly decreases bruises. Roll your eyes if you must, but I have seen it work. It is worth having some around. I would keep it handy in your diaper bag or backpack. Kids often like to have ‘cream’ applied to a little ‘owie’. Arnica is perfect for that.   Head wounds can create a huge amount of blood if there is even a tiny little break in the skin. If the skin remains intact, all that blood can collect into an enormous goose egg. These can look alarming. They also can turn all sorts of lovely colors, but they do resolve. A big goose egg should be checked out to make sure there is no fracture. Mild bruises and bumps by themselves are not a concern if the child is acting fine otherwise.   As long as you can get it to stop, simple bleeding doesn’t worry me. Hold pressure for at least 10 minutes. At that point if it is still oozing, you might need to go in to get the wound sutured or glued.   Bleeding that is taking place underneath the skull is a different story. Any accumulation of fluid or swelling can cause potential pressure on the brain. If this is happening, your child's behavior will probably not be normal.   I remind you that most of the time kids are fine after a mild fall, but we always need to be on the lookout to make sure there isn’t a concussion. A concussion is a type of traumatic brain injury that stems from an impact that causes the head and the brain to move quickly back and forth. The brain may bounce or twist in the skull from this sudden movement. This in turn can cause stretching and damage to the brain cells as well as chemical changes in the brain.   If your child is acting fine after a fall, that is very reassuring. If you are worried, it is appropriate to call the doctor's office to let them know what happened. Most of the time they will tell you to keep a close eye on them at home and don’t need to come in.   Keeping someone awake after a head injury is not necessary: https://www.healthline.com/health/concussion-and-sleep It is just essential to do frequent assessments so that you can see if there is a status change. Experts agree that once your child has calmed down it is fine to let them take their normal nap.   An overtired baby will be cranky and may be near impossible to assess. If they are nodding off, it is likely because they are tired, and not from the head injury. Do not let them take a nap that is longer than the typical nap time.   Nights are a bit different. Depending on how far and hard they fell, I would also check on your child every couple of hours. You can set your clock to make sure you get up to do this.   You are establishing consciousness; you often don't need to wake them completely up. With an infant you can do that by offering them a dream feed. They don't need to be fully roused. With an older child, let them know you will be checking on them during the night. You can offer them a sip of water or have them mumble “I love you”. Keep in mind that if your child is in a deep sleep stage, a gentle whisper might not be enough to wake them up. For older kids, if they know ahead of time that you will be coming in, they are easier to wake up. If your child is in a deep phase of sleep you might need to be a little more aggressive making them stir. I know it seems like sacrilege to wake a sleeping child, but after a head injury it is important.   If there is a TBI ( traumatic brain injury) you are going to have clues that something is not right. Physical symptoms would include dizziness balance problems, headaches, vision problems light sensitivity sleepiness nausea and vomiting I actually give the kids "one free vomit". Often they have cried hard enough that they might spit up a little. Let's not worry about that first emesis. If they vomit a second time, it’s time to call your doctor. Murphy's Law comes into play here. With children, Vomiting could simply be a sign that they are coming down with a tummy bug. Nonetheless, if they whacked their heads and are now vomiting, they need to be checked out.   Traumatic Brain Injury symptoms are not only physical. We need to keep an eye out for social or emotional changes as well. If the head injury patient is having any of the following issues, bring that up with your medical team. issues with anxiety nervousness irritability trouble with memory   There is no downside to getting your child evaluated if you are even the least bit concerned. Most pediatric emergency rooms will do a thorough assessment. They may order a Cat scan if there is:   loss of consciousness there is suspicion for a skull fracture the patient is under the age of two and is showing suspicious signs Doctors will use their clinical judgement and make a case by case decision. A basic neurological exam might include the following   Can they answer simple questions? Is there any complaint of blurry vision? Do the pupils react to light at the same speed? Can they touch their finger to their nose? Do this with each hand. Is there any clear drainage from the nose or ears? (Of course, what toddler doesn't have a runny nose?) Of course these little tests are age dependent.   Newer protocols for concussion care are not as restrictive as they used to be.   Rest right after the injury Take it easy the first few days when symptoms are more severe. Avoid any activities that seem to be making symptoms worsen. Screen time, reading or anything that can cause eye strain is not a good idea. Find activities that are quiet and relaxing and don’t need a lot of mental stimulation. It is okay for you to read to them. Screen time has a big impact. Patients who abstained from it for the first 48 hours had a quicker recovery   Your child can return to non strenuous activities as soon as they start to feel better.   Return to school gradually.  If symptoms do not worsen during an activity, then this activity is OK for your child.  If symptoms worsen, cut back on that activity until it is tolerated.  Encourage outside time, such as taking short walks if the weather cooperates.  Make sure they are getting a good night's sleep. It is especially important to avoid screen time and loud music before bed.   After a solid knock to the head you are not out of the woods right away. Pay attention to any dizziness or headaches. This is especially important within the first couple of weeks. Get immediate attention for any vomiting or confusion. Discuss return to sports with your medical team.   The large majority (70-80%) of people with Traumatic Brain Injuries recover within 3 months. Every child’s recovery period is unique. There have been some new findings that females across all the age spans recover more slowly from a TBI than males. Studies are being done to look more closely into that. I was discussing this post with my chiropractor Sandra Roddy Adams ( https://www.yelp.com/biz/sandra-roddy-adams-dc-san-francisco ) . She agreed with me that once the head injury patient has been cleared, having a trusted chiropractor check the alignment of everything might be beneficial. "Once the scaries are ruled out, it's a good idea to have your baby/child checked by a Chiropractor for spinal misalignments. Chiropractors are trained to deliver gentle, specific adjustments to the spine, and provide cranial-sacral care if needed. While people of all ages can benefit from chiropractic care, there are tremendous benefits of pediatric chiropractic as the skull is malleable until around 18 months. The cranium and spine house your nervous system, and even the smallest misalignment can impair its function. These misalignments don’t always cause pain; therefore the absence of pain is not a good indicator of optimal function. Correcting misalignments can not only help speed up your child’s recovery from an injury, it will also help your child feel better and function better."   Prevention Accidents happen on the watch of even the most vigilant care giver.   Sometimes a parent falls when holding the baby and they both get injured. Beware of trying to manage a baby along with armloads of groceries.   I have seen “selfie” accidents. No photo op is worth it if your baby's head gets whacked in the process.   Never leave your baby on a surface that they can fall from; they will!   Watch out for wet squirmy babies right out of the tub. Using a towel or terry cloth robe can help give you traction. Skin to skin is especially slippery.   Make sure your kids wear helmets when using bikes, scooters or skates. Model good behavior!   Make sure your child is in the appropriate car seat.   Make sure your house is child-proofed with appropriate safety gates.   Make sure that stairs are free from clutter.   If your child is sitting in a shopping cart, make sure to keep a hand on it. I had a little patient reach over to grab a box of cereal and she toppled the entire cart over!   Choose playgrounds that have a safer ground to fall onto. Sand beats concrete anytime!   Sometimes it feels more traumatic for the parent than the patient!     Stay safe!

How to make fish a safe part of your child's diet

 

‌

Trying to navigate good nutrition can feel so challenging. It feels even more essential to have solid information if you are pregnant or feeding your children. The messages seem to shift frequently enough to make your head spin. Soy, gluten, sugar, rice, eggs, coconut oil.. Are there really magically healthy foods out there? Even more importantly, can certain foods really impact our health negatively? Fish is one of the more confusing ones. Most people agree that eating fish is a really good source of protein, vitamin D as well as two omega- 3 fatty acids, DHA and EPA, that aren’t abundant in other foods. In fact the 2020 dietary guidelines from the USDA and HHS specifically call for making sure that fish and seafood are included in a healthy diet. According to the American Heart Association,  while there are plenty of supplements on the market, they are not quite as good as the real thing. Unfortunately, these days many types of fish are contaminated with mercury. Mercury is a problem for people of any age but it can have a greater impact on unborn and young children. This is because it can act as a toxin that inhibits natural growth of the brain and nervous system. Elevated levels can lead to neurological and developmental delays according to the Environmental Protection Agency (EPA). Of course fish are by no means the only source of potential mercury contamination. Old Thermometers, fluorescent light bulbs, cosmetics, older dental fillings and some water can all be unwitting sources. Most of those can be avoided if you are paying attention. Fortunately water can be effectively filtered, (boiling will not do the trick). Alas we have no way of removing mercury from our fish, so we have to choose the safe ones to eat. Some fish have a much higher concentration of mercury than others. Some of the biggest culprits are farmed saltwater fish such as the yellowfin, Albacore and Ahi Tuna.  If you want to go deeper and get solid information about where all that mercury is coming from, click this link https://anglers.com/news/mercury-in-fish/ The fish that you choose makes all the difference. There are new guidelines available to help you navigate this. https://www.fda.gov/food/consumers/questions-answers-fdaepa-advice-about-eating-fish-those-who-might-become-or-are-pregnant-or There are several excellent guides to take with you to the market https://www.nrdc.org/stories/smart-seafood-buying-guide https://www.seafoodwatch.org/ Based on their mercury levels, fish are grouped into: Best choices oysters, salmon (wild and Alaska, canned or fresh), sardines, scallops, shrimp, squid, and tilapia. Good choices Atlantic croaker, Atlantic mackerel, catfish, crab, crawfish, flatfish (flounder and sole), haddock, mullet, pollack, and trout. Fish to avoid bigeye tuna (often used in sushi. This is not the stuff in the can!), Gulf tilefish, king mackerel, marlin, orange roughy, shark, and swordfish. Women who are planning on getting pregnant, those who are pregnant or breastfeeding and young children should NOT eat anything from the last category. Canned tuna is tough to figure out and it depends a bit on who you ask. I wasn’t able to get consistent recommendations. In 2014 Consumer reports went as far as suggesting that pregnant women avoid it all together, but for young kids, it likely falls in the middle category and is fine to have on a limited basis. The albacore (sadly this is my preference) has 3 times more mercury than the chunk light. The advice is to give 2-3 servings per week of the best fish or 1 serving a week of the good fish. A serving is considered 4 ounces for anyone over the age of 7. For kids 4-7 the serving size is 2 ounces. No parental guilt if you give fish from the middle category! Since most of us don’t have a food scale in the kitchen, a good trick is just use your palm. An adult size palm is roughly 4 ounces. Don’t make yourself too nuts trying to weigh and measure the portions. Any parent knows that kids will eat what they will eat, and some of it is going to be tossed on the floor and fed to the happy pets. Be aware that fish makes it to my list of high allergy foods. When you give it for the first time, make sure you keep an eye on your child. Severe reactions will generally show up within an hour.  Thanks so much to COTY the bass guy for motivating me to do this post! Ironically, bass didn’t show up on the list. I asked him about that! He told me that since bass is typically found in murky conditions, it gives them a muddy taste based on what they consume. While taste might not be the best, health-wise, it is perfectly safe to eat.