What is in your medicine cabinet? 2023

 

My grandson Sawyer is starting daycare next week. His mommy is getting prepared and asked me about what things she should have in the medicine cabinet.This was a good incentive to update this old post.

Take stock of what’s in your medicine cabinet.

What medications should you have on hand?

If you or your child becomes ill in the middle of the night, that 3 am visit to the local pharmacy may furnish you with some interesting anecdotes about the odd folks lurking in the aisles, but generally it is something you want to avoid. Try to have some basic medications on hand ahead of time. A little preparation goes a long way.

Fever reducers/Pain relief

Acetaminophen and Ibuprofen are the most common medications used for this.

Remember that you never want to give actual aspirin to a child.

Acetaminophen/Tylenol Infant and Children's Liquid are the same

concentration so they are actually interchangeable, but the infant bottle comes with a nifty little measuring system and a spill proof bottle which is safer.  

Acetaminophen also comes as a suppository, which is great for a child who is vomiting or resisting medication by mouth. Suppositories are best kept in the fridge or someplace cool. If they get warm and mushy they are much harder to insert.

Ibuprofen is also known as Advil or Motrin. This medicine also comes in a more concentrated infant form. The infant and child dose are not the same. Make sure you understand your child's proper dose. The above link has a dosage chart

Antihistamines

Benadryl, Zyrtec and Claritin tend to be the most commonly used for pediatrics. These antihistamines would be given for general allergic reactions, itchy skin rashes or insect bites.

The generic name for Benadryl is Diphenhydramine HCL. There is no formulation specifically for infants. The directions on the bottle usually have a caution not to use it for children under 4. Most pediatric offices ignore that and are fine giving to younger patients if indicated. It is always a good idea to check with your doctor to see if they are comfortable with it.

While Benadryl will make most kids (and adults) very sleepy. Sometimes that sleepiness is a good thing!!! But be warned, it also can cause a few patients to be jittery.

Zyrtec (Cetirizine) typically has a more level response, with less likelihood of either sedation or the jitters. There is a dosage chart in the insect bite link above.

Claritin is fine for sneezy allergies, but perhaps not quite as effective for itchy rashes.

All of these come with the option for liquid or chewables.

Tummy issues

If your child is vomiting, you will be glad to have an oral rehydration solution in the house. Poplular options include:

Pedialyte and/or Drip Drop . Breast milk is also great for that, but not everyone is lucky enough to always have it on hand. Pedialyte also comes in popsicle form, which is great for older kids. 

These both come in little packets of powder that you can mix with water. As well as keeping these in your medicine cabinet, they are worth taking along with you on any trips.

Pedialax or glycerin suppositories are worth having on hand If your child is prone to constipation. If days have gone by without a poop, and diet enough hasn't helped to get things moving, these are often the next step. If it is the wee hours of the morning and you have a miserable, grunting and straining kid, getting the poop out is a good strategy.

Eye issues

For young babies, breastmilk in the eye can cure a variety of issues. For older kids and adults, it is worth having Zaditor. It is an over-the-counter treatment for allergic conjunctivitis. It works quickly if allergies are the culprit. I also find that the homeopathic brand Similason is very soothing.

If eye irritation or discharge continues, it might be viral or bacterial. It is time to check-in with your doctor. Most offices will want you seen. Gooey eyes can be a signal of an ear infection, so a visit is the best way to make sure you are getting the care you need.

Stuffy nose

XLEAR nose spray!!!

Mouth sores

If you child is prone to mouth sores or irritations, I find Glyoxide very helpful and seems to help things heal up pretty quickly

You can also do a combo/1 teaspoon Maalox/1 teaspoon of Benadry...apply topically

Respiratory

If your child has a history of wheezing, now is the time to make sure you have asthma medications available. Many of those are light sensitive so you should always mark the package when you open them. If your child uses a nebulizer, the tubing should be replaced every 6 months. If you or your child use an inhaler, the mouthpiece should be rinsed out at least once a week.

Check the directions on your specific medication to see if it needs to be primed. Some need an extra spritz into the air if they haven’t been used in more than a week.

Topical creams/ointments

• Triple antibiotic ointment for cuts or scratches
• Antifungal cream for yeasty rashes or fungal infections
• Arnica for bruises
• hydrocortisone cream for mild itchy irritations

HC cream comes in a variety of strengths. You can get the weakest ones over the counter.

Please pay attention to this rather disgusting factoid:

It is easy for tubes of ointments to get contaminated. If the tip comes in contact with bacteria from a finger or directly from the body...there you go. Yuck! One study that I read suggested that more than half of the tubes of creams and ointments that people have laying around are contaminated with Staph. The best way to avoid this is to make sure that you don't directly touch the tip to anything. Try to keep it sterile. Squeeze the desired amount onto a spoon and then use whatever applicator you want (clean fingers are usually fine.)

BASIC FIRST AID products

Consider getting some self adhesive bandage like Coban/Co-flex. They come in lots of colors and are fairly inexpensive. The advantage of these is that not only do they not hurt when you take them off and your child can’t pull them off without help. Also, your little one can’t eat the band-aid!

Deep cuts should be evaluated, but consider getting some butterfly adhesive strips for clean gashes. Those might save you a trip to urgent care. 

Ice packs/warm packs

I suggest that you invest in a child friendly ice pack that you can keep in your freezer. There are loads of adorable ones on Amazon. Holding a soft little penguin or bunny against the booboo might elicit a bit more cooperation.

Having a microwavable hot pack can also be useful. If you don’t want to buy one, you can fill an athletic sock with rice, and that warms up nicely. Another option for a warm pack is to pour some water in a disposable diaper and heat it in the microwave for a few seconds at a time until it is a good temperature.

Keep a bag of Epsom salts on hand. They come in handy for all sorts of things.

Useful Equipment

• Have a working thermometer that you have tested for accuracy before someone actually has a fever. As long as your baby is over 2 months, I am not one who is going to focus too much on the exact degree of the fever, but we do want to get a sense of how high it is.
• Have a syringe or dropper on hand for much more accurate measuring.
• Pulse oximeters have gotten very inexpensive. If you or your child is congested, you can easily check the oxygen level.
• Have a good set of tweezers for removing splinters.
• If you are a hiker, I also suggest having a special tick removal tool.

• Nebulizer if you have asthma in the family
• Humidifier

Storage

Make sure that all your medications are stored in a safe, dry, childproof location (a steamy bathroom is not the best place.) Don't underestimate the ability of a climbing child who knows where the gummy vitamins or yummy medicine is stashed.

Pro Tip: With any of your medications, put a strip of masking tape on the side of the open bottle and sign and date your doses. This will avoid the common incident of parents double dosing their babies. This also will help you keep track of doses when you are sleep deprived. I get plenty of frantic calls from parents who have inadvertently overdosed their kids by giving the medications too often. If there is a concern your first call should be to Poison Control: 1-888-222-1222 

Here is my blog post on poison action and prevention

Boost your Immune system

With the cold and flu season in full throttle I would have the following on hand for the first sign of congestion or a throat tickle

Sambuccol/elderberry

Zinc

Manuka Honey (Not for babies under 1 year)

Make sure you are already getting routine Vitamin D (all year round)

Equipment

Humidifier

Nebulizer if you have asthma in the family

Do a routine check for expired medications. 

Even though I try to stay on top of this I can be occasionally stunned by the old stuff that I find lurking in the back of my own medicine cabinet (it runs in my family.) We sometimes do a contest to see who can find the oldest thing in there. (Without knowing what the topic for this weeks post was, Sandy told me earlier that he cleaned out our medicine chest today and found medicines that had expired in 2018. BTW, 5 years is not even close to things we have found in the past!)

How to get rid of expired medications that you find?

Please don't randomly toss expired medication down the drain or flush it in the toilet. Medicine can pollute the bay and ocean, or be accidentally misused or abused. Wastewater treatment plants are not designed to remove medications or other chemicals in waste-water, so after traveling down your drain, medicine may affect our environment. If you go online, you can easily find a list of places where you can drop off expired meds. If you live in SF, I did it for you.

http://sfenvironment.org/article/safe-medicine-disposal-for-residents

What does that expiration date mean anyway?

In 1979, the FDA required that manufacturers include an expiration date on prescription as well as OTC products. This is the date at which full potency and safety is guaranteed, Usually, that date is roughly 1 to 5 years from the time of manufacture. 

The US military, which maintains large stockpiles of medications for both military and civilian populations for use during an emergency, became very interested in this issue following the 2001 anthrax scare. The cost implications were obvious. Throwing out large numbers of expensive drugs simply because they were past their expiration date was an enormous expense that could potentially be avoided if it was determined that the drugs were effective beyond that date.

To explore this, the FDA analyzed the potency of 122 common medications. The was called the The Shelf-Life Extension Program (SLEP). After vigorous testing of more than 3000 different lots of these drugs, almost 9 out of 10 lots were determined to have more than 90% potency at 1 year past the expiration date. The average extension of this degree of potency was 5 years.

So, while obviously if your child is ill, we don't want to take chances with medications that may be out of date, the bottom line is that in an emergency, expired medications are likely not dangerous (always double check); they may simply have lost a bit of their potency.

Personal Musings/ The end of a startup/What's next!

 Personal Musings/ The end of a startup/What's next!

I look back at my career path to see the stepping stones that led me to where I am today. I had seven years of critical care nursing experience before I had my first child.

Everything shifted when I became a mom. I was working in the pediatric unit of UCSF. With hormones raging, I remember weeping along with the mothers of my patients when their little ones needed to get a new IV or endure a painful procedure. I couldn’t stop thinking about how lucky I was to have my healthy baby. I felt so deeply with the parents who weren’t so fortunate. It was draining. I realized that I was ready to move on from working with severely ill children in the hospital.

I have little doubt that I could have learned to find a balance if I had remained, but I answered a small ad in the paper for a position as an advice nurse at Noe Valley Pediatrics in San Francisco. I ended up staying in that job for 31 years.

As with most new jobs, there is a learning curve. I was so used to working with the rarer and more serious conditions, that it was a huge relief to realize that more often than not, most things are normal and are easily treated. No, that healthy infant with jaundice did not in fact need a liver transplant.

During my time at NVP, I expanded my role beyond being the office advice nurse. I recognized that parents needed something extra. My patients embraced my philosophy that there is no such thing as a silly question. They needed some basic guidance about when they should be worried about something and when they could relax and let time take care of it. People needed a sounding board about so much more than just poop and runny noses. They had questions about behavior, sleep, relationships, and solid foods. They needed a safe place to vent without being judged.

I cultivated deep relationships with many of my patients and families, but I had the desire to reach more people. With this in mind, I started offering a variety of parenting classes. 

I also started writing. It was clear that there were many issues that were very common. The genesis of my blog was frankly a way to avoid repeating myself over and over again.

I must confess that I had some mixed feelings that my posts on head lice and pinworms went viral. It wasn’t exactly the claim to fame that I had been seeking! 

I called the blog Nurse Judy’s approach because while I try to lead with data, I also tend to focus on more natural remedies when possible. Many of my readers tease me that I suggest putting breast milk on everything.

The blog became a hobby with an eclectic mix of topics. It ranged from talking about poop, to stories about my own life and family.

I am blessed to have a very close relationship with my husband and my two daughters. Fortunately they gave me permission to write about them. They got used to being out in the neighborhood with me and having me be recognized, “Oh my goodness, it’s Nurse Judy, are these your daughters? Which one is the one who climbs mountains and which is the social worker?”  At a restaurant once, my husband was actually referred to as Mr. Nurse Judy. Now my delicious grandsons are the next generation of having blogs written about them. 

I retired from NVP in 2019. Sandy and I proceeded to do several months of traveling. Who knew at the time that there was a pandemic looming? We were so fortunate to be able to take that trip when we did.

Within days after I returned home, I received an email from Oath co-founders Michelle and Camilla inviting me to meet with them. Their vision to create something that was going to change healthcare as we know it, energized me and pulled me right out of retirement.

Unfortunately, startups fail more often than succeed and that was the case with this one. It shut down just a week ago. Yes there were tears.

However, ultimately the time I had working with the Oath team was an absolute gift. 

We built a platform that offered support and community to new parents. It was a wonderful several years, filled with deep connections, learning and love. 

I will confess that I never loved the name. It was meant to be based on the Hippocratic Oath, but I spent way too much time clarifying that we were not the right wing ‘Oathkeepers’. We were as far from that as could be. If it ever manages to rise from the ashes, it will certainly be called something else.

It turns out that there is such a thing as a non-toxic work environment and that was Oath. Things that went wrong along the way were celebrated as learning experiences.That frame of mind made sure that nobody was afraid to try something new. Indeed, we had many successes. One thing that is certain is that we helped countless parents feel less alone during the pandemic.

So what’s next for me? 

For now, I intend to continue with these posts. I will still be doing some of my classes on an ‘on demand’ basis. I have some potential opportunities and collaborations that I am exploring. Mostly I plan on being grandma and traveling more with Sandy.

I also am intrigued by the thought of writing a book. Some of you might recall that I was toying with this several years ago. That one was going to be all about poop, rashes, head-lice etc.  While I expect that I will keep those topics going in these posts, that isn’t the one I want to write.

The BOOK that is pulling at me will have a very different flavor. It’s not exactly ghost stories, but it will be telling a collection of random, true unexplainable coincidences. (With maybe some friendly spirits?)

I have shared some of the nutty stories in the past:

https://nursejudynvp.blogspot.com/2021/06/ghosts-and-radioshappy-fathers-day.html

https://nursejudynvp.blogspot.com/2020/09/a-mysterious-story-about-pair-of-socks.html

Do you have your own experiences to share? I would love to hear them.

As I mentioned in a recent post about gratitude, I am thankful for those of you who have stuck with me for all of these years.

Wishing all of you a healthy and happy holiday.

XO

Nurse Judy

Gratitude 2023

 

There were a lot of posts making the rounds all about gratitude last week. My inbox was absolutely full of them. It is that time of year after all. Some resonated more than others. I was all set to add my contribution to the collection, but I ended up skipping last week’s post. Maybe I delayed it to make the point that gratitude shouldn’t be something that we only pay attention to on one day a year, but the truth is that I just was busy. Talking about being grateful, I was surrounded by people I love. My daughter Lauren and family were visiting from LA. I saw a meme making the rounds that had me laughing out loud. On Thanksgiving, when that adorable toddler offers you a cookie, they are actually giving you the flu. This was sadly accurate. My grandson Elliot and his daddy Adam arrived in San Francisco already sick with influenza. The good news is that the flu shot protected the rest of us and we didn’t catch it. That is fortunate for me, because no germs were going to stop me from snuggling. To add to my joy, back in 2021, my daughter Alana donated her eggs to one of her closest friends and gorgeous baby Sawyer is now seven months old. Sawyer’s amazing mom and dad were reasonably close by for the holiday so we got to spend some time together. Even though events in the macro world are so difficult to watch without weeping, in my micro world, I am feeling very blessed. Here is my gratitude post:

Gratitude “It is not joy that makes us grateful, it is gratitude that makes us joyful” - David Steindl Rast When something is wrong it tends to make a lot of noise and gets our attention. That seems to be basic human nature. We invariably pay very little mind to things that are working smoothly. If you have ever sustained an injury this might resonate. Years ago my right pinky got broken. I was walking my large rambunctious golden. I was holding the leash in a way in which it was wrapped around my finger (don’t do that). Java might have seen a squirrel or something equally exciting. She gave chase and I felt my finger snap. Yup, it felt as good as it sounds. The point is that this impacted the use of my right hand for weeks. This meant I couldn’t hold a pencil or give an injection. Go ahead and play with your hand. Make a fist. A pinky that won’t bend affects more than you might think. We take so much for granted. The minute I had full use of my hand I gave it no further thought. Thanksgiving is the perfect time to remind ourselves to practice a little gratitude for the daily things that are working, but as I mentioned, we should be paying attention to the 'glimmers' of things that we are grateful for, everyday. It isn’t only working body parts that we ignore. We can tend to take family members and friends equally for granted. I asked Oath’s Brittany to share some of her thoughts about gratitude with me. Here is some of her wisdom: The benefits of gratitude are so real:  It can lower blood pressure It can decrease negative mental health outcomes such as depression and anxiety across all life stages & ages.  It enhances relationship satisfaction  It can Increase emotional well-being  It can generate upstream reciprocity (a stranger unknowingly buys your coffee, you are more likely to buy someone else’s coffee) It can result in a greater sense of belonging in the world   Where many of the other emotions we face daily are more messy and complex. Gratitude on the other hand, is a clean and simple emotion.   During daylight hours we may not be able to see the stars. However, we trust that they are still there. Similarly, when life circumstances (tantrums, loss, war, diagnoses, etc) make it difficult to find, it’s still possible to access gratitude.  In every moment, there is an opportunity to learn and be born into something greater than what is in the present. An opportunity for us to emerge as a different person than the one we entered into that experience being.  The best way to teach gratitude to our children is by allowing them to see us practice it. There’s an old saying when it comes to parenting that, “more is caught than taught.”  Facilitating gratitude practices that your children can participate with you is a great tool too.  Some tools to help us access gratitude include:  Nature. Get outside and notice the trees swaying in the wind. Pay attention to glorious flowers.If you are lucky to live near water, watch the ocean roll onto the beach and out again. (don't turn your back on the water!) Observe the clouds passing by in the sky.  The arts. Listen to or play a beautiful piece of music. Go to a museum and spend time in front of a piece that speaks to you Tap into your creative genius. We ALL have some. This could include painting, baking, writing, building, etc.  Appreciate your body's ability to move, such as walking, running, yoga, breath-work, dancing...making a fist etc.  Savor your ability to be kind. Compliment someone’s smile, buy that cup of coffee for a stranger, call your loved one just to say “hi!”. Maybe make soup for someone who isn't feeling well. Let the kids help put things in the pot. When you find gratitude, give yourself permission to linger or savor it.  I am grateful to Brittany for being such a wonderful resource I am also grateful to all of my readers who bother to open and read these emails/blog posts!

When is someone contagious?

 

When is someone contagious? Some of the most common questions that I get as an advice nurse revolve around when kids are contagious and at what point are they ready to go back to school, daycare or nanny-share. Wouldn’t it be nice if there was a little human equivalent of the butterball turkey pop up timer that could easily signal if someone is contagious or not? Alas that doesn’t exist, so we have to do the best we can. Covid adds a whole extra layer of stress into this discussion. I need to remind everyone that MOST of the illnesses that we are seeing are the same ones that we have been dealing with for generations. Kids who are around other kids get sick. That’s simply the way it is. Of course, we want to be responsible parents and not expose others to our sick child. We also want to protect our own recovering child from going back into the 'germ pool' too quickly. If they are just getting over something, their immune system may be a bit diminished and they are vulnerable to coming down with something new. What makes it even more challenging is that kids aren’t always accurate reporters about how they are feeling. For older kids, some are reluctant to miss school and will put on a brave face. Maybe they have a test that they don’t want to miss, or really want to be with their friends. These kids will push themselves to return as quickly as possible. Others will earn an academy award convincing you that they really need to stay home in bed. Another consideration is that some parents can take time off to stay home with their little sick child and others simply can't afford to. It is naive to think that these aren't real factors.  Early warning signs Many kids may be a little fussier than usual. Perhaps they don't eat quite as much. Most savvy parents know enough to be suspicious when their 5 year old who fights naps with a vengeance announces that they are going up to have a daytime snooze. Your antenna might be up that something is brewing, but are those reasons to miss work and keep your child at home??? It isn’t always an easy answer. Figuring out if someone is contagious or not is almost never clear cut. What makes it all so tricky is that most viral syndromes can be spread a day or two before the kids show clear signs that they are ill. Also, as discussed below, tests for illnesses like covid are not always accurate at the beginning of an illness. The fact is, if your child comes home from school in the afternoon and is sick that evening, most likely everyone they were with earlier that day has already been exposed and I am going to take that into consideration when we try to come up with the most sensible plan on when they can return. Lets address Covid first According to the CDC, the incubation period for Covid-19 is thought to extend up to 14 days, although the average is 5-6 days. This means that if 2 weeks go by after an exposure, you are most likely in the clear. Some young children may catch covid and become infectious without ever exhibiting any symptoms. For those that do develop symptoms, they usually show signs of illness long before that 14 day mark. Testing for Covid There are 2 kinds of tests for Covid. The PCR/NAAT is a very sensitive test that looks for any genetic material on a surface (such as a nostril). You would likely get this test from a doctor's office or lab. These are great to find out if you have COVID or not, but because the DNA fragments can remain in the nostrils for days to weeks, they will still show up as positive even after someone is no longer contagious. This makes them somewhat useless if you are trying to figure out if you can stop your isolation.  The rapid antigen tests are the ones many folks have at home. These tests look for large chunks of virus pieces that are signatures of Covid (the “spike” protein). A negative antigen test in the first day or two is not necessarily accurate because the virus can replicate in other parts of the body (i.e. the throat or bloodstream) without leaving accessible spike proteins in the nose. So if you have been exposed and have symptoms, retest in a couple of days or check with the PCR options before you take that negative test to heart. On the other hand, after the infection if you test negative with the home tests it means you are likely no longer contagious Quarantine versus isolation. Quarantine means staying home after an exposure but before symptoms start. It was common practice at the beginning of the pandemic but is no longer recommended as a strategy for controlling COVID-19. Isolation means staying home and away from others in your household if you have symptoms or you test positive. If you test positive, contact your doctor to see if you should receive treatment. There is no need to isolate from family members who are also testing positive. Here are the 2023 CDC exposure and isolation guidelines If you were exposed but have no symptoms Regardless of your vaccination status: Get tested immediately and 3-5 days after last exposure* Wear a good mask when around others for 10 days after exposure, even at home if other people are present If you test positive, isolate *If you had COVID-19 within the last 30 days: You don’t need to test after exposure unless symptoms start If symptoms start, isolate and get tested If you test positive, whether you have symptoms or not Regardless of your vaccination status or infection history: Isolate for at least 5 days Sleep and stay in a separate room from those not infected Use a separate bathroom if you can Wear a mask around others, even at home You can end isolation early, after Day 5, if: You have no fever for 24 hours without taking fever-reducing medication, AND Your other symptoms are gone or improving If you still have a fever, continue to isolate until the fever is gone for at least 24 hours If other symptoms are not improving, continue to isolate through Day 10 If after Day 10 you still have mild symptoms (runny nose, cough, fatigue) that are improving and no fever, you can end isolation no matter what. After you end isolation: Wear a mask around others for 10 full days after the start of symptoms. If you have no symptoms, wear a mask for 10 full days after your positive test. You may remove your mask sooner than Day 10 if you have two negative tests in a row, at least one day apart.(remember the PCR test will probably still be positive, so use the at home antigen tests) For children who test positive: Children under 2 years can end isolation after Day 5 Children 2 years and older should follow the steps above for ending isolation Okay…Thank you to the CDC for their guidance, but how realistic is it to actually successfully avoid contact with family members? It is very difficult to isolate siblings. Of course be scrupulous with your hand washing, avoid sharing utensils and sloppy wet kisses, but in many cases it is hard to avoid catching each other’s cooties. They were also likely to have been exposed to each other before you knew anyone was sick. If you have a newborn, keeping the sick toddler away from the baby is a worthy goal, but don’t beat yourself up if it is simply not possible. Breastfeeding moms, sorry to say that by the time you realize you are ill, it is too late to prevent an exposure. Hopefully the magic of breast milk will protect your baby, but we would generally suggest that you continue nursing while masked. As an aside, breastfeeding moms, if you are sick, it is especially important to make sure that you are getting plenty of fluids. Also, if you are given medication, check with your nurse or doctor’s office to see if it is compatible with breastfeeding. (spoiler alert: Paxlovid has not been cleared for nursing moms. Tamiflu is probably fine) So how important is it to get an actual diagnosis in the first place/ In other words, is it worth sticking a swab up your toddler’s nose? These days, some doctors rely on symptoms and don’t always bother to test. If you are a candidate for taking Paxlovid then it is worthwhile finding out if you have Covid or not, but some folks don’t bother. If you have an infant or vulnerable family member it is nice to know what you are dealing with. However if you aren’t inclined to test and treat make sure you monitor and if symptoms warrant, make sure you go and get checked.  Coughs, colds and other viruses Most of the illnesses are NOT covid. As far as common colds go, the average child under 2 years of age has EIGHT symptomatic colds a year. Frankly, if you plan on keeping your child at home until your little toddler is free from a runny nose, you will be waiting a very long time before you leave the house. Remember that some clear runny noses are not contagious. Teething as well as some allergies can be the cause. (There is debate about whether or not teething is associated with congestion. Nurse Judy votes yes.) While I would strive to keep my youngest and most vulnerable patients free from viral syndromes and colds as long as possible, exposure to these common viruses is in fact developing the immune system. At some point they are going to have to deal with the myriad of illnesses that make the rounds. During the first couple of years of the pandemic, kids were kept in a bit of a bubble and did not get the normal amount of coughs and colds. Guess what, the minute we got back to being with others and loosened the mask wearing, most families got overwhelmed with all of the respiratory infections. Hand Foot Mouth questions come up a lot.  I respect that schools want to keep this yucky virus from getting spread around. Unless you have been on a break, there is a reasonable chance that the infected kids likely got it from school in the first place and/or were contagious before they were identified and segregated. Patients can actually shed that virus in their stool for several weeks. Since I don’t think schools are able to genuinely keep children out until they are completely clear, I suggest common sense guidelines.  If they have a fever, keep them home. If they are fussy and miserable, they will be much happier at home with mom or dad. If they seem to be feeling okay and are fever free, for the above reasons, I don’t think it is reasonable to exclude them from daycare/school until all the blisters are completely cleared.   I know that the name alone makes parents shudder, but this is one of those illnesses that most kids end up getting. Think of it as a rite of passage. It is actually better to get some of the childhood illnesses out of the way. Unfortunate adults that lack immunity and catch these illnesses are pretty miserable. The American Academy of Pediatrics says that kids can go back when they’re fever free, feel up to participating, and don’t have many open weepy blisters (dry ones are okay). With most viral syndromes time is the ultimate healer. However, If you suspect the flu, it might be worth getting seen and tested. As opposed to most viruses, influenza hits quickly and hard with a ‘hit by a truck’ feeling. Once you get a positive flu test there are treatment options that can be useful if started within the first few days of symptoms. Bacterial infections  If your child has an infection that is being treated with antibiotics, we generally consider them no longer contagious after they have been on the medication for at least 24 hours. Bacterial conjunctivitis is also usually given the all clear after 24 hours of eye drops (of course you need to finish the course.)   So can you go on that play date? Regardless of the illness you are dealing with, if you are questioning whether or not to go on an upcoming play date, explain your situation to the other parents. They may be perfectly fine hanging out with you and your snotty nosed child, or perhaps they have an important event or vacation coming up and want to be more cautious. Maybe someone is pregnant and hasn’t told people. We never know exactly what other families are dealing with. Let them decide. Full disclosure ahead of time is the best practice. If you are in a small share-care situation It is essential to have a talk with the nanny and the other families involved to make sure you are all on the same page. I would suggest that you agree that the kids will have a "sibling" relationship. This simply means that you all accept that the kids are most likely going to get each other’s mild illnesses. Typically if I have a child with a fever over 101, a new case of diarrhea, or a brand new cold that has them spewing green mucus it is worth keeping them home for at least a day or so to see what is coming next. Just this week one of Dr. Ted’s patients asked him, “I was dropping my kid off at daycare and saw all these kids with crazy snotty noses. How can you tell me they aren’t contagious?” He reminds parents of two things: First, what are you going to do about it? Kids under five essentially live their entire winters with runny noses, and kids who are kept in a bubble without exposure to the community germ pool will do the whole process when they start kindergarten. After a virus, the body’s mucous membranes have been damaged, and the virus has left behind plenty of inflammation. As the immune system clears the debris, there is a lot of swelling and leaky fluid membranes. This is where that persistent runny nose and lingering cough come from. It is not necessarily an active infectious virus that causes these symptoms.  We wish there was a magic light that signaled the "all clear." Alas, there isn't. Use your best common sense. When in doubt avoid contact with anyone who is vulnerable. This would include newborns, or someone with a compromised immune system.  Thanks to Dr. Ted for his valuable wisdom and input! Thanks to Sylvie’s mom Leah (just getting over covid) for helping me identify some of the questions that needed to be addressed