Friday, June 21, 2019

Travel safety check list

This week's topic
Travel Safety checklist

Now that summer is here and families are traveling, I am going to do a post that my dad would have loved.

My father’s birthday was June 21. He would have been 92 today. He was a physicist who looked at the world from a unique perspective. How do things work? What is broken, what can I fix, but even more importantly what might go wrong and how can I prevent it?

When he was teaching me to drive I remember him pointing to a boy with a ball on the sidewalk.

“What could happen”?

The ball could drop, fall into the street and the boy might rush into the street to follow it. Anticipating what could go wrong was the first step to prevention.

My regular readers have heard me say that we can’t keep our children wrapped in bubble wrap. I really do encourage folks to go off and have grand adventures.

On the other hand, it is important to be aware of potential hazards. Knowledge is power and some accidents can be prevented. Others can be handled with less stress if you are properly forewarned.

I have done several previous posts on traveling with your kids that have more of a “managing the voyage." Here is the link to the most recent one:


This one has some overlap but a different focus.

The travel safety checklist

Health
Do you or your family need any travel vaccinations where you are going? Make sure you get these done at least a month before the trip if possible. It generally takes a few weeks for things to take effect. The only exception would be the early MMR, which can’t be given earlier than 6 months of age. It isn’t a bad idea to have a copy of your immunization records with you on your travels. Make sure tetanus is up to date. The CDC's Travel website is a great resource

If your child gets ill during the trip, it is important to know where to get care.

What local urgent care options are available? Are you visiting family that has a doctor who will see travelers? Do your homework, check with your insurance if that is applicable to see what will be the most cost effective choices.

If your child has a history of wheezing, even if they have been fine for years, take your inhaler with you. If they have ever had an anaphylactic reaction, make sure you have your epipen.
Also have fever reducer and an antihistamine with you.


We can NOT call in prescriptions to another country! (Including Canada!)

Are you visiting friends or family?
It might be awkward, but do it anyway - Ask your hosts if they own a gun. It is essential to make sure that any guns are locked away, separate from ammunition. (This has nothing to do with the second amendment.)

Ask about poisonous plants

Make sure that medications are child proofed. Grandma and Grandpa might have medications in areas that are easily accessible if they aren’t used to having young kids visiting. I had one little patient who got a dose of oxycontin right out of a nightstand drawer. Thank goodness she was okay.

Is there a pet? Is the animal comfortable with kids? If animals are even the least bit growly, make sure they are kept in a different room. Some pets get stressed from having little ones around. I have dealt with more dog bite cases than I can count
https://nursejudynvp.blogspot.com/2019/08/kids-and-pets.html

Staying in a cabin/ Air B&B
Make sure there is a carbon monoxide detector or bring your own. This is more important in the winter if there are wood burning stoves or space heaters


Most places have a smoke detector. Do a little test to make sure it has working batteries. Fire extinguishers are useless if you don’t know where it is and how to use it.

Check the mattress before you unpack to make certain there are no bedbugs. The best way to do this is lift the sheets and make sure you don't see any red spots. Bed bugs are large enough to spot.


In some cities like NY they are rampant. This is not a souvenir that you want to bring home.

If you are traveling internationally, be aware that cribs may not have the same safety standards that we have here in the US

Food safety
We have had quite a lot of calls regarding international travel and loose stools. If there is vomiting, diarrhea and fever, this is likely bacterial and you should be seen.

Making sure that you have clean water is essential. Make sure to avoid ice unless you are in a resort area that assures the safety of the water. It is worth asking the place where you are staying if the water is filtered.

Street food, raw fruits and veggies, raw or under-cooked meats and fish, can all lead to trouble.

Swimming and Water safety
If you are going anyplace with water nearby, appoint a water guardian.


Make sure there are alarms and fences around any pools, but there is no substitute for watching the kids like a hawk.


Crowds
Will you be out in large crowds? Take a photo of your child before the outing so you know exactly what they were wearing in case you get separated. Consider bright, recognizable colors. Write your cell number on their arm and cover it with liquid bandaid so that it doesn’t wash off. Make certain that your child knows the safety plan and where you should meet up if you get separated.

Hiking?
Do a head to toe Tick check every day.
Make sure you have plenty of bug spray and sunscreen.
Use appropriate insect repellent. Dr Anne especially likes Sawyer lotion .

Watch out for poison oak or ivy





Altitude
If you are above a certain elevation, it takes some folks a bit of time to adjust.

You have to pay extra attention to sun and hydration.

Weather
My San Francisco kids aren’t used to hot humid weather. Make sure everyone is getting plenty of fluid. Pedialyte has little packets that can get mixed with water to create a perfect electrolyte solution.



Protect the Lovey, blanket or stuffed animals that come on the trip

Deciding which security items come along on your travels is a big decision. If your child has a favorite blanket that they snuggle with, losing something in the hotel sheets can be a nightmare.
We learned this the hard way with Alana's stuffed Bambi that she had chosen to accompany us on a family trip to New England.
When we returned to the hotel room after a day out, Bambi was no where to be found. We had the hotel check the laundry multiple times, to no avail. Alana was heart broken. Several weeks later, Sandy and I were passing a Disney store and found a similar Bambi.

"This isn't my Bambi!" Alana knew. There is no replacing a lost and well loved stuffy.

"I will call him Benjamin."

Benjamin has survived and is still in Alana's childhood room.

Dr. Anne's daughter also lost a stuffed animal in an airport. I think this happens a lot.

Friday, June 14, 2019

Father's Day/Mr Nurse Judy posts

This week's topic
Father's Day Post
from Mr. Nurse Judy
In honor of Father’s Day, I am running two of my most popular posts from the past few years. They are Mr. Nurse Judy’s (aka Sandy) thoughts on his relationships with our daughters. Warning, they had more than one of my readers crying...

Happy Father’s Day!
_______________________________________________
2016

In honor of Father’s Day, Nurse Judy has invited me pen this week’s column and share some of my thoughts about why I have, and you the dad can have, the absolutely greatest relationship with your kids through all stages of their lives. I believe that inherently, mothers are more nurturing, protective, overtly emotional, physical, and “maternal” in their instincts, beliefs and behaviors towards their children. But from the moment I first saw Lauren, a day that all who know me recognize as the most impactful day of my life, I knew I was going to give Nurse Judy a run for the money. I, like many of my generation, had an ok relationship with my parents. But it was not the one I wanted with my kids, and that became immediately obvious that day Lauren was born.

I have been called a lot of things over the years. I am frequently referred to as Mr. Nurse Judy. After years of taking our golden retriever to the park up the hill in the afternoon when the local elementary school let out, I became known to a few generations of kindergarteners and first graders as Java’s daddy. I was known as a business executive. But the grandest name I treasure is that of daddy (or father or papa bear or…) Why? Because after building a relationship with Lauren for 28 years, and with Alana for 25 years, I continue to have new and grand experiences with them, experiences that are direct descendants of the beliefs I had in raising them. And now I have a daughter who jumped at the opportunity to go on a daddy/daughter cross country road trip when she left for grad school, where we got to eat yellow (yes, there’s a story there) in Indiana, and simply cross a bridge into Kansas, make a U-turn, leave and say “we’re not in Kansas anymore.” And I have a daughter who is still my roller coaster buddy every August, and is accompanying me on what may be the stupidest thing I ever try – climbing Kilimanjaro. So how did I get here?

First of my early parenting philosophies was simply make time. I’m not talking about the “I’ll play with you when I get home and I’ll read you a bedtime book” type of time. I’m talking about the “take a morning off to hear your 2nd grader say one line in a play; use vacation days to chaperone school outings; play Barbie for hours on end; and supervise a cabin full of 5th grade boys on the school trip” kind of time. A typical dad probably spends more time away from their child than the mom. So take advantage of the time that you can have! As soon as my kids came home from the hospital, I never missed an opportunity to be with them. Each night, when an infant would wake up and cry, I went in. It was pickup and delivery to Judy to nurse them. Judy thinks I was doing this for her but she was just a benefactor. I picked them up, sang softly or told stories to them as I cleaned them up, and then brought them to our room. And then back to their cribs. Every night. We built up quite the relationship. Bath time? That was mine too. Nightly bedtime ritual? Well we both had one. But much of my daughters’ love for the great rock and roll of my youth comes from that time we spent every night. As they became toddlers, every weekend I took them to Miz Brown’s diner in Laurel Village. So Judy could get more sleep? Hmm, ok, but not really. It was completely selfish on my part. Want more time? Be the home that welcomes the gathering of the friends. While perhaps not directly involved in your child’s life at that moment, the benefits are extraordinary in what you get to witness, the welcoming environment you’re modeling for your kids, and the lifetime of relationships with your childrens’ friends, who consider you an extra dad. (2019 update - as a result of that, I will be officiating, for the second time, the wedding of one of my extra daughters!)

Next on my list of dad-parenting beliefs is “don’t look for a reason to say yes; assume that’s the answer, and instead force yourself to look for a reason to say no.” It’s simple but at least for me, it was initially uncomfortable and unnatural. But once I grew comfortable with this practice, it was an epiphany! Saying yes to as much as you can say yes to, is so much easier than saying no. And it has such wonderful benefits. Questioning, exploring, learning, experiencing…and you get to be a cool dad! Talking about going on a family camping trip when you’re asked if they can try camping in the house? Say yes, and set up the tent in the living room, light the fire, roast marshmallows, and sleep in sleeping bags. We can all think of valid reasons not to do this and I’m certain my instinctual reaction was “too much time; too much effort, and then I have to clean it all up and put it away.” But saying no wasn’t going to lead to the magnificent shared family memory we now have 20+ years later, and I certainly don’t remember anything about setting it all up or taking it down. “Dad, can I help?” Of course there are reasons to say no; it will certainly take more time. And you may have to watch your language. Unless it’s urgent, so what? Invite your 3-year-old to crawl under the car with you. Rub some dirt on their nose to make it official! And let them help! “Can I go someplace?”; “can someone sleep over?” Yes. And yes. Unless something is a threat to their health and well-being, be quick with the yes! Might some of these yeses have less than ideal implications to you and your free time? Probably, but that’s not what you’re going to remember! Only after saying yes can you then figure out if there is a “no” reason significant enough to change your mind. The more you say yes, the more they will ask you. As school children. As teenagers. And now as adults.

You will recognize my last pearl of wisdom as a modification of the Peter Pan syndrome. Let them be kids as long as possible!  While it may be cliché, as we all know and live every day, once that’s gone, it’s gone forever, and I know that I, and maybe you, wish you could get it back! So don’t take it away from them. Don’t be in such a hurry to “help” them see things as you see them, through adult eyes and perceptions. They are emotionally, physically, and intellectually naïve – it's a wonderful time so don’t rush to take that away from them. In fact, for a truly wonderful relationship, force yourself to see the world as they do! That’s why I once found a pet/fish store open till midnight so I could go out and replace the fish that had died when Lauren was asleep (and yes, I brought the dead fish with me to try to get a match!) Of course she would have to learn to deal with the death of a beloved pet, and eventually beloved humans. But she didn’t have to learn about it that day, and it let her be a kid a little bit longer. 

Don’t try to explain why work is so busy, that you need to do it to pay the bills that benefit them, and thus you don’t have time to play Chutes and Ladders for the 5th time in the past 2 hours. Instead, see it through their filters – why would anyone want to deal with things that are drudgery and frustrating when you can have fun playing a grand game? They didn’t ask to be your child – you decided to make them your child. I hope that decision was made with an appreciation for the fact that this responsibility instantly became the single greatest responsibility you have ever undertaken. The consequences of that decision are literally life changing for all involved. If it’s not your greatest responsibility, then something’s awry and you will miss out on immeasurable joy.

In the summer of 1988, my family of 3 (Lauren was 1) was invited to a swimming party at the home of my then senior VP. He had 4 adult daughters. While everyone was subtly vying for his attention, I spent the greater part of the day with Lauren in the pool. Late in the afternoon, the VP’s wife found me and pulled me aside to tell me that her husband had spent much of the day watching us play in the pool. Why? As she explained, he had been the wonderful corporate soldier. Moved all around the country when he was asked to. Frequently travelling. Successfully moved up to senior VP of one of the world’s largest companies. And she told me that if he had to do it all again, he would rather have spent the time in the pool with his daughters, because now he was here, envying me and the relationship I was already building with my child. Over the course of my career, I was often asked to make those same sacrifices, but by then I had already learned my golden rule – I worked to live; not lived to work. And while I had a satisfying and rewarding career, I never reached for those corporate stars that were dangled in front of me. Because one day I was hoping that I would have the type of relationship with my children that allows me to eat yellow with one of them, and climb a mountain with the other.

Part 2
2017
I want to thank you all for the kind comments I received after last year’s post about my wonderful relationship with my children, a relationship that continues to get better, even now as I close in on the end of my 6th decade of life, and my daughters near the end of their 3rd decade. It is a role that is paramount to me, and I refuse to let time and distance interfere with my efforts to continually improve it. So far, I think I’ve been pretty successful, and the rewards are immeasurable. Certainly it’s a lot easier when they are young, living in your home, and “need” you to be involved in their lives. But the foundation you create early for how you want that relationship to be makes it a lot easier to enable it to grow, flourish and blossom at any stage of life, even now as they establish their own lives, careers, and relationships.

I want to make clear that I have no special training or educational background in this area. What follows are simply my own philosophies about fatherhood; you may disagree with some or all of them. But this is what has worked for me and I cannot really imagine a father with a better relationship with his adult kids than I !

So first an update on my relationship with my daughters. At this time last year, Lauren and I were weeks away from traveling to Tanzania for the challenge of a lifetime. AND WE DID IT!!! We summitted Kilimanjaro on the morning of July 19th, an absolutely grueling climb that took me to the very limits of physical, intellectual, and emotional endurance. In fact, I couldn’t have done it without Lauren’s support, and I was quick to make sure she knew that. We spent two weeks together in very close quarters, most of that time unwashed, extremely sleep deprived, and cold. Summit temperature was 24 below zero! The only cross words that were exchanged were over a misplaced towel (I both misplaced it and spouted those cross words!) I never want to face an ordeal like that again!! At least not until April 2018 when we climb to the base camp on Mt. Everest! See – the relationship just keeps giving!

If you are an avid reader of Nurse Judy’s blog, you may remember that when she was in grade school, Alana ended every night by telling one of us all about her day…in exquisite, and often lengthy, detail! The big, the little; the important and the minutiae. Well, more than 20 years later, I get to do that with her all over again. Every day. And I look forward to it and resent it when another friend has a need for Alana’s time! After obtaining her MSW last June, Alana is now a practicing therapist in a community mental health center in Michigan. She has about a 30-minute commute in each direction and on her car ride home, I get to keep her company!!!! And we talk all about our respective days. The time flies past and she is home before we both know it, but not without each of us learning a little bit more about something in each of our lives. What I have primarily leaned is that her counseling clients are the luckiest people in the world because they have Alana as their therapist. I listen in wonder and respect as I get to share in the progress they make dealing with the issues that brought them to her in the first place. She is changing lives on a daily basis and I get to be the fly on the wall. I am overjoyed that she still wants to spend that time of her day with me. I frequently tell her that I am in awe of what she is doing and remind her that she has to take the time to sit back and reflect on that also, and not just move on to the next client… which brings me to my first point of this year’s father’s day recommendations for building that relationship with your children:

Find reasons to be proud, and praise them whenever you can!

From the first time they can lift their head by themselves, to the first crawl, to standing up, and that first use of the potty, let them hear your voice filled with pride and encouragement. Let it become ingrained in them that you are their number 1 supporter, for both the little and big accomplishments in life. As I mentioned last year, that’s why I took a day off of work to go see a VERY shy 2ndgrade Alana (right now, all her friends are saying “who the heck are you talking about?”) get up on stage just to say one line in a play; it was a grand small accomplishment that deserved to be recognized. When younger, even though they can’t understand the words, they can hear and feel the sentiment in your voice, and for the rest of their lives, that sound will provide great sources of satisfaction and comfort, and it will provide a lifetime of encouragement for future exploration. Now, I am not one of those in favor of participation trophies and I am not saying that everything they do should get this level of exuberance. But be generous with the praise, especially in their formative years.  This brings me to my next recommendation:

Value the efforts too, not just the successes!
There is an old saying that good judgement comes from experience; experience comes from bad judgement! It is a cycle that cannot be completed without falling down. So let them fall down, but don’t bemoan the failure; commend the attempt, and any part of the effort that will help them gain “good judgement” next time. It is quite easy for children to focus on your critical evaluation of whatever it is they are attempting, while underappreciating the praise you may simultaneously be conveying. For example, if you’re trying to teach them to throw a ball, don’t focus on the fact that the ball landed by their feet. Appreciate that there are things they may simply be incapable of at any given age. It’s up to you to understand that, not them, so focus on the things that they can do well (gripping the ball, placing the feet, shifting the weight…) and celebrate these building blocks that will one day end up in those ultimate tasks being that much easier, and enjoyable! Simply focusing on the failure of achieving the end result will certainly lead to frustration, and possibly anger and resentment.

It's ok to be wrong. In fact, it’s good! Admit it, and apologize!  
It is sad when I see a parent who either insists they are never wrong, or twists circumstances to make it seem that they were not wrong in a specific situation. It’s very easy to play that mental game with a child in an effort to demonstrate that you always know what’s best, or think you will be respected because you are always right. Satisfied that you out-strategized a child in this mental arena? Get over it; it’s not that hard. And it’s not that smart. I (and I think my daughters would agree,) created some of our most profoundly important relationship building moments by admitting I was wrong about something, and apologizing for it. Think about it – is there anything more empowering to your young child than having a person in a position of authority implicitly say to them “I not only heard you but I really listened to what you had to say. I thought about it with all my years of advanced experience, education, and knowledge, and I realized that you were right and I was wrong.” Trust, confidence, consideration, kindness, communication…. there are innumerable benefits to acknowledging your own fallibility to your child! And it tells them it’s OK to be fallible too! You don’t expect/need/want perfection, and they don’t have to live up to that standard. And it teaches them that being wrong is a part of life, not something to be defensive about, and can be dealt with responsibly and respectfully.

Tolerance!
I mentioned above that you should “appreciate that there are things they may simply be incapable of at any given age. It’s up to you to understand that, not them…” You must accept very early on that you are incapable of thinking like a child, nor they as an adult. Kind of like the “Men are from Mars, Women are from Venus” paradigm, you and your children speak the same language, live in the same environment, are familiar with the same behavioral mannerisms, yet you have such different frames of reference, experiences, emotions, intellect…that at times it will seem to each of you that the other is speaking a foreign language. And you are!! It is so very easy at those times to get frustrated, and even worse, angry. But it is unrealistic for you to expect them to be able to think, analyze, and express themselves at the level you do. They don’t have your emotional and intellectual development and it is unfair to simply use your advanced capabilities as the measure of their intent. When you feel that coming on, take a break, remind yourself of this, and try your best to see things as they do. You most surely won’t completely succeed, but every little bit of empathy you can muster will bridge that gap just a little. It’s also never a bad idea to voice this self-realization; let them know that you are consciously aware that you are cross communicating and invite them to help think about how each of you can get your respective thoughts out. They’ll develop patience, compassion and problem solving skills!

Establish ground rules for how to disagree!
My girls and I had a very useful rule – we weren’t allowed to go to sleep mad! The rest of the argument or disagreement could proceed along its natural course, but ultimately it had to end at this rule. It was really quite simple in its effectiveness since it forced (encouraged?) us to resolve our differences. There were times long after bedtime that one of them would either come out of their room to say “I’m still mad” or amusingly, would slip notes under our door detailing the issue (Alana was the talker; Lauren the writer!) This led to frequent comical exchanges of notes going back and forth under each other’s doors but it was such an easily understood rule that it almost always worked! The key though is to take it to heart! As my brother-in-law sometimes says “gravity, it’s not just a good idea, it’s the law.” My daughters and I made this a law, and if one of us was “violating” the law by claiming fatigue, or anger, or issue complexity, or…etc., the other party was free to demand that we follow the law, sometimes leading to late nights and missed bedtimes! But always successful resolutions of the issue. And guess what? Most of what I have written about here represents the philosophies that I tried to use to help make sure each day ended on a happy note.

Happy father’s day to all. See you next year when we get back from Everest!

Update 2019
Last year, Sandy had more milestones and amazing experiences with our daughters.

Two weeks after I broke my right arm last winter, Alana decided that she wanted to be just like mom. She slipped on some ice and broke her left arm. Sandy caught a red-eye flight that night so he could be with her for the surgery she would need. He knew she was frightened and that his orthopedic experiences (5 surgeries) would serve her well! The change in her demeanor was instant when she realized daddy would be there. This was a week prior to his scheduled big trek with Lauren.

On April 2nd, my birthday, I got a call from Lauren and Sandy from Everest Base Camp! They had an epic adventure. For those of you considering climbing mountains, the 38 hour summit day on Kilimanjaro was the single most challenging day of either of their lives, while the Everest trek was more difficult on the whole. But they did it! And on Lauren's wedding day, outdoors on a chilly San Francisco August evening, Lauren was quite cold while we walked her down the aisle. So Sandy turned to her and whispered "Just remember, it was 24 below zero on the summit of Kilimanjaro!" Her reply - "Not helping dad!"

And since Alana was returning permanently to San Francisco from Ann Arbor in August, he and she did another cross-country road trip, exploring the Black Hills of South Dakota, the Badlands, Mt. Rushmore, Yellowstone, the Grand Tetons, and more, singing and laughing their whole way across.

Friday, May 31, 2019

Bath Time Tips for all ages

Bath Time Tips for all ages


I can still remember the first time we put my daughter Lauren in the big tub. My husband was in the other room tackling his first solo messy diaper. The episode was a big learning experience that got referred to as 'Poopageddon'. He had neglected to fold over the poopy diaper and Lauren managed to get her feet right in there. Poop was everywhere including the walls.

“Jude? Can you come in here? I need an extra hand”.

There was no way a sponge bath was going to do the trick. Fortunately her cord was off so doing a full bath was an option.
If I remember correctly, at this point Sandy needed a bath as well. He got in first and I handed him the baby. Our bath routine was created. Both of my kids learned to love the bath in the security of daddy’s lap. (If you don't have two willing partners I would usually use a big sink until the babies are good at sitting.)

I have patients who swear by the blooming lotus bath aid

As you bathe them, I would start with the face and head.......then do the body and end with the tush (going from the cleaner areas to the dirtier areas). You can use a warm, wet cotton ball to clean the eyes. I suggest cleaning from the outside of the eyes in towards the tear duct/ nose.

There is not one bath routine that works for everyone. Tub and sink sizes, babies temperament and willing partners will vary from family to family.

Until the cord is off and any circumcision is healed, the babies should not be submerged in a tub. This is usually around 10 days to 2 weeks. Until you can do that first bath, you can simply do some gentle sponging off. Babies are not terribly dirty. As long as you get the face and tush you are fine.

Safety review

Once you are ready to submerge the baby, safety is key.

NEVER LEAVE THE BABY FOR EVEN AN INSTANT

  • Remember that babies can drown in even an inch or two of water

  • Have all supplies at hand (towel, wash cloth, cup for rinsing)

  • Make sure there are no electric cords or tools nearby ( like shavers or hair dryers) that can get pulled into the water

  • Wet babies are squirmy and slippery! Wearing a terry cloth robe will help keep you dry as well as offering traction to a wet slippery baby.

  • Have a rug on any tile surface to keep from slipping.

  • Watch out for faucets. There are faucet covers to keep from getting bumped

As a safety precaution I would have you turn down your hot water heater to 120 degrees. Many hot water heaters come from the factory set to 140 degrees. No one needs it to be quite so high. Check the water temperature in the tub to make sure it isn't too hot. Grandma did just fine by testing with her elbow, but there are all sorts of floating bath thermometers that will take the guesswork out of it.

A good water temperature range would be between 36-38 Celsius or 97-100 Fahrenheit. Some infants have a little trouble regulating their body temperature so water that is either too hot or too cold can make them uncomfortable. The normal body temperature averages 37 or 98.6. Too cold is no good, but too hot is probably worse. Babies have very sensitive skin that can burn easily.

While I don’t ever advocate keeping the bedroom too warm, 68-72 is fine; it is nice to have a cozy environment for drying off right after a bath. Making it a pleasant experience from start to finish will help keep bath time from being an ordeal. Many folks use a little space heater for this. Make sure any appliance is kept well away from the water.

How Often?
Babies don't get too dirty and usually don't need to be fully bathed more than 2-3 times a week.

Faces and diaper areas should be washed at least daily. All skin-folds also need to tended to DAILY as well. Don’t skip this or you will be the one sheepishly calling me to tell me that you discovered some nasty areas on your baby. Common areas are under the arms, in the neck, thighs and groin. The area behind the ears also can get gross. You can proactively avoid this with a routine skin fold check, spread the creases, wipe with cetaphil cleanser (no water needed) and then add a layer of aquaphor or cerave ointment.
If your baby loves the bath and it is part of your routine, it is perfectly fine to do one daily. Make sure you moisturize your kids after the bath. This is especially important for anyone with dry skin.

Other considerations
It isn’t uncommon for kids who used to like their tub time, to become “bath phobic.” One of my patients had an issue when a couple of siblings were having their routine bath time together. The younger one had a large poop in the tub. The older one freaked out. There was no fixing that. He ended up taking showers for a while. In the case of Dr Elizabeth’s son, their tub has some jets. He hit a button, It made a horrid noise and it took a month before he would get in without a struggle.

One slip in the tub, or shampoo in the eyes can make kids who used to like the baths reluctant to get in. Having one parent in the tub is usually my best suggestion.

To protect the eyes, using a cup to rinse the hair usually helps. A sports bottle can work well for this. There are also lots of little specialty bath items with spouts on the market.

Having your child look way up for the hair rinsing can help keep the eyes from getting shampoo in them. If you can, perhaps stick a little sticker or decal on the ceiling of the tub for them to look at.
Some kids feel empowered if they are holding a dry washcloth that they can hold over their eyes for the rinsing.

Find a nice gentle baby soap. There are a lot of good brands. Watch for any rashes or irritation when trying anything new.
It is worth being a careful label reader. There can be ingredients lurking in some products that you want to avoid. Parabens and phthalates can be hidden under the ingredient ”fragrance;” these can potentially disrupt the hormone system.

If you are local, you are safe getting any product from Natural Resources on Valencia. They don’t let any product in the door unless they have carefully vetted all of the active and inactive ingredients. The lines that they like to carry are Earth Mama and Think Baby. EWG is another source to checking on product safety

 
Bubble baths can cause urinary discomfort in some sensitive little girls, so I I avoid them except for very special occasions. Some kids can get irritations from simply sitting in the soapy water so if you have an older baby who enjoys the bath, let them play in the clear water and then do the soaping and rinsing right before they get out.

Things you can add to the bath
Adding a splash of apple cider vinegar to the tub seems to be useful at preventing some rashes. It is hard to give an exact amount since the tub volumes vary so much, but I usually suggest between ½ to 1 cup.

Baking soda is also a popular thing to add. For babies use about 2 tablespoons; for older kids you can add up to a cup. This is a good one for an itchy rash like poison oak. Believe it or not, it can also help with constipation.

Do NOT mix the vinegar and the baking soda unless you are doing a science experiment and want to create a volcano.


Bleach baths are good for eczema or any potentially bacterial rash.
If properly diluted and used as directed, a bleach bath is safe for children and adults and believe it or not, this is a standard recommendation from many dermatologists. The directions are to add ¼ - ½ cup of bleach to a standard tub that is filled. Don’t do this more than 3 times a week, and only soak from the neck down.

Oatmeal - Aveeno makes a nice product that is good for dry itchy skin.

Bath toys are fun, but can get gross! Make sure you clean them regularly. The get quite moldy and slimy

There is nothing quite like the scent of a clean, sweet smelling baby. Enjoy the moment!

Friday, May 10, 2019

Nurse Judy the Mom


How many of us feel inadequate when we look at other parents who appear to be super mom or super dad. These magical beings seem to manage to handle whatever life throws at them with ease? They never ever make a mistake or lose their temper. Their children think they are perfect.

Um, not likely.

What you may see on the outside is not always accurate. As a Mother’s Day gift to you and I going to share an inside look at Nurse Judy the mom, including the story of one of my more epic 'mommy fails'.

For the most part, I am blessed and my kids have made it easy for me to look pretty good. The truth is though, that we all have our moments. If you ask my daughters for the lamest mommy stories, I certainly have my fair share of times that I did something that they didn’t appreciate or a time I embarrassed them.

Lauren recalls an incident at a zoo night when she was around five that still makes her grimace. That evening there were costumed characters roaming around the zoo dressed as animals. Some had instruments.

“Mommy, I dare you to ask that Lion to sing 'The Lion sleeps tonight'”

Dare me? Silly girl.

The Lion’s response was, “Only if you sing with me”

Much to Lauren’s chagrin, the guitar toting Lion and I created a lovely duet of Weem-a-Wopping ‘In the Jungle’ as we wandered all through the zoo.

I think the only time I actually embarrassed Alana was the first time I discovered Lemon Drop Martini's at a friends Bat Mitzvah Party and danced the night away with a large group of tipsy moms. Those things are dangerous!

There was also the time that Lauren and I were practicing our karate moves. She practiced some punches on me and then it was my turn. She had a pillow up to her belly for protection but wasn’t standing properly, I did my move and she went flying across the living room. I was horrified. She was furious. Moral of the story, check your stance.

But the hands down winner is the time I drugged Lauren and then put her on a horse.

We were doing a family vacation up at the Russian River and scheduled a horse back riding session at beautiful Armstrong Redwood state park. My girls and I could count the number of times that we had been up on a horse. Sandy, the New York City boy, was actually an experienced rider. Lauren had a mild cold and her allergies were bugging her, so I gave her a little something to help dry her up and we were off on our adventure.

We were in a guided group along some pretty steep trails. Lauren’s horse had a mind of his own and didn’t want to stay with the others. To compound things, Lauren was feeling really quite out of it and was having a hard time staying awake. Sandy held back on his own horse to make sure she didn’t get left behind.

She managed to keep it together for the several hours, but just barely. She could barely keep her eyes open. I was concerned that she was really coming down with something worse than a cold. When we got back to our cabin, I figured out what the problem was. I had not taken the time to read the box and had grabbed and given her the nighttime cold/ cough medicine instead of the daytime one. The poor girl was sedated! Since fortunately she didn't fall off the horse, we can laugh about it now. I promise that I never did anything so careless moving forward.

Trust me. Most parents have done some dumb stuff, the photos on Instagram are usually just showing the better moments. If you are human, take it easy on yourself as long as you gather wisdom and learn lessons.

We all have fairly different parenting styles. Alana (who I never punched across the room) generously offered to let me share a glimpse of mine. Because I actually kept (and still keep) a journalof milestones, I recently reread the letter that I had written to her as she left for college. She was the baby moving out. This was a big milestone for me as well. I did need to make some mild edits and I have some explanations at the bottom for some of the more cryptic references. Warning This letter is not rated G.

Oh Goodness….Dear little Pooh of mine,
How is it possible that it is time for the ….letter. Just a blink ago you were my sleeping, spitty, very large baby.
First of all, you know (but I will tell you anyway) how very proud I am of you. I must have done something very wonderful and you are my reward. There is no one quite like you. You are a magical person. You never lose a friend, you just keep collecting them. You are fun to be with. You are kind. You are smart. You are wise beyond your years. Of course, no doubt, that is partly due to me (mommy takes a bow.) We will now review the mommy theories of life.
You know the pie theory very well. So we will simply discuss its relevance now.
Your pie is changing more drastically than it ever has before. You have pieces shrinking and other pieces dramatically growing. Brush off that student piece please…it has been fallow. Create a brand new…”let's do some laundry piece”
Just be aware that huge pie shifts are exhausting…if life seems overwhelming for a bit it is perfectly natural as the pieces settle into place and you achieve a new balance.
(My pieces will be shifting as well, but my mommy piece is always available to be a large as you need it to be)
Everything in life causes some amount of stress. Obviously some things have way more stress points than others.
Sometimes, though even the littlest thing can tip the scale and move you from mild stress to moderate stress or to completely stressed out (otherwise known as the straw that broke the camel's back.) Starting anything new is worthy of plenty of stress points. Make sure you get enough sleep, especially at first!!
Sex, Drugs, Rock and Roll

Sex
Make good choices…I do not expect you to remain a virgin until you are 30. That would actually be most unfortunate,
Just make sure that anything you do is something you will feel good about. You are worth a lot. Condoms are an unfortunate fact of life until you are in a committed relationship. Frankly I would insist that an experienced partner be tested before I did anything   *(remember the lollipop story) okay fine…let's quickly move on... Parting words, remember that you can always talk to me about anything and Lauren, I am sure is another fine resource if you want to bounce something off of someone other than your mom (even though she is remarkably cool.)
 
Drugs
easy….just say no,
Actually just be smart and safe. Alcohol is a drug, and lemon drops taste good…be careful. If you do drink a bit too much, the body can get dehydrated as well as hypoglycemic.
Orange juice and graham crackers are good things to eat/drink. Remember:
Vomiting all night…
Not fun!
Know your limit
Rock and Roll
That’s fine, just don’t start liking country or rap
Relationships
Remember that relationships are learning stations.
You will learn what it feels like to dump someone, you will possibly learn what it feels like to be dumped (or at the very least lied to.) You will learn what characteristics you like in a partner and what things you don’t want to put up with.
Never regret anything. Cherish the good memories learn from the bad ones and move on.
And the very new theory…men are like shoes
Some you try on (have them tested first…just kidding; second thought not kidding…do it.)
Some you buy
Some are comfy,
Some just look good,
Some will give you blisters if you wear them too long,
Some get tight but can be stretched out and worn in
(This works doesn’t it!!!)
Happy shopping
QUICK LIST

  • French onion soup on a first date is probably not a good idea if you want to impress
  • Check your blind spot
  • Floss
  • Use sunscreen
  • Take viactiv
  • Don’t get a job where you need to wear a stupid hat
  • No reality shows (sorry I know this is a tough one)
Optical illusions
When you get in a disagreement with someone, remember that life is often like an optical illusion, People see what they see, and know what they know. There are indeed white arrows there, but they can’t see the black arrows as hard as they look. (Or they can only see the young lady and can’t see the old crone) Always try to see both images and feel sorry for those obstinate folks that simply can’t
Honesty
People lie all the time. They think it makes life easier. Lies are heavy to carry around and they often get complicated. It is wonderfully freeing to just tell the truth. It might be difficult for someone to hear, but oh well, they just have to deal. Don’t lie

Psychic stuff
Know the difference between the good spirits (which hover around you), the confused spirits (that you tend to encounter) and really icky things (that hopefully you never need to deal with.) Call upon those good ones to just weave the golden web around you whenever you feel the need. You are fairly powerful, keep learning to control it.
Encounters with the strange and wonderful (real people…not ghosts)
You don’t have a prayer actually. You attract the odd, the strange and yes the wonderful…Both your grandmothers and your mom have passed that lovely gene directly down to you.
May you always have fun, and great stories, but be wise and know that it is better to be safe than to have a good scary adventure story to tell.
Great saying
Love many
Trust Few
Always paddle your own canoe
Easy Mitzvah
Call or email your Grandparents.
Bambi
If the deer discover the magic of Alana (hey all other animals do) don’t feed them, and learn to check your body head to toe for deer ticks. They are tiny and black and look like raised freckles, you can check your scalp by just running your hands through your hair and feeling, you would feel a raised bump
(..I bet lots of moms send their kids with letters, perhaps mine is the only one with tick advice?)
Have a blast
Carpe diem! Seize the day!
You are about to start a great adventure. Enjoy every moment! Stop and look at the sunsets! Never ignore a “good sky”. Savor the gorgeous place you are in, Oceans, Redwoods, Deer, Brunch….How lucky are you?!?!
I love and adore you.
Mommy

************************************************************************************
Here are some further explanations to help make sense of things

Lollipop story
There was a story on the news about a teacher who ultimately was fired for an unorthodox approach to teaching about safe sex. He had started the class licking and sucking on a lollipop. After a few moments of this he told the class he was going to pass it around and have everyone in the class take a few licks and keep passing it around. The students all made expressions of disbelief and disgust. He went on to point out the obvious parallels of unprotected sex. I was happy to share this with my teenage daughters.

Psychic stuff
I come from a family where it is hard to to find rational explanations for the oddities and coincidences that abound. Whatever it is, Alana has it in spades, Lauren has managed to avoid it so far.

Mitzvah
A mitzvah is a good deed and I did my share of nagging to make sure my kids made a point of reaching out to their grandparents. I am proud to say that they were pretty good about it, and probably didn’t need quite the amount of nudging that I did.

Bambi/ Deer
Alana was at UC Santa Cruz, the day we dropped her off, there was a deer standing in front of her dorm as if he was waiting to welcome her. She is an animal magnet; my warning not to pet the deer was necessary.

Ten years after this letter, Alana has still never lost a friend and continues to collect them.

Friday, May 3, 2019

My Mother in-law/The amazing Nanya

My mother in law/the amazing Nanya
May 4th would be my mother in law's 92nd birthday. In honor of that, and with Mother’s Day right around the corner, I decided to take a break from topics like yucky viral syndromes or tick bites, and share some more personal stories about my children’s paternal grandmother.

In Law.
Just the word might make some people shudder and prefer reading about insects. It can make others feel warm and fuzzy. Regardless of who you get dealt in the in-law department, you have choices as to what type of relationship you establish with your partners parents. Some relationships are more challenging than others. Others are easy from the start. My married daughter Lauren couldn’t be luckier with hers.

Even if you are not close at first, bringing a baby into the equation is often an opportunity to deepen the relationship in a meaningful way. Some folks have turbulent relationships with their own parents, so making the assumption that it is only an in-law that presents challenges is flawed. Take a breath and if it is all possible hit the reset button. Having a child in the mix changes everything.

Before the kids came along, my dealings with Sandy’s mom were clearly going to be a bit interesting to say the least. When I met her for the first time, I was only 17 and I was outmatched from the start.

Elaine was the proverbial Jewish mother who was pretty certain that both of her children were perfect. Sandy was her only son. Being the woman worthy of him was something I was clearly going to have to work towards. One of the first battles of the ‘girlfriend versus the mother’ came when Sandy had to have his wisdom teeth out and asked me to come to NY to be with him. Elaine had already made vats of soup, and had purchased a new blender to make soft foods. “I am his mother and I will take care of him.” I did a wise, quick retreat; Mom was going to win this round.

After several years when it became apparent that this relationship wasn’t going away, we got to be more and more comfortable with each other, but it wasn’t until I had my first child (and the first grandchild for my in-laws) that our relationship became set. We united in the mutual love of the kids and ultimately had a close, enduring loving relationship until the end of her life in 2012. She was another mom to me, but without the same baggage that she had with her biological children.

Elaine may have had some challenging traits as a mother, but as a grandmother she was superb. She threw herself into the role with every ounce of her being. As soon as I became pregnant, Elaine started to mull over what she wanted to be called as a new grandparent. She didn’t want to be called something as common as grandma; even the mention of Bubby horrified her. She decided she would be Nanny. Lauren had other ideas and called her Nanya. It stuck and was perfect. Nanya she was.

Nanya belonged to Lauren. These two were soul mates, if you believe in that kind of thing. (Spoiler alert, I do.) When baby sister Alana came along, Lauren had to learn how to share. The first time Elaine held Alana, Lauren took one look and said, “Nanya, you need to put that baby down. Give her to someone else.”

Although Sandy’s parents had moved from NY to south Florida, they made a point of staying connected with visits to San Francisco every several months. It wasn’t always easy to have relatives come often and stay for several weeks, but having the open door policy is a choice I will never regret. My own mom instilled that value in me. When I was growing up, our vacations were based on grandparent visits rather than trips to more exotic locations.

If you are fortunate enough to have grandparents in the mix, make the effort to help foster the relationship that they have with your children. There are so many people out there who would give anything to have their parents alive to share the joy of watching the grandchildren grow up. Don’t waste this. (apologies to any of my readers for whom this might be a trigger.)

There was never a grandparent day at school that Elaine missed. She had a way about her and attracted all of the kids to her orbit. Everyone knew Lauren and Alana’s grandma.

Nanya was a brilliant and fiercely independent woman. When she was in town, she took the car keys, figured out the car seats and took the kids to movies, parks and museums. It was always an adventure. One story that is hard to forget is the time she spent several minutes playing catch with a gorilla at the zoo, until someone pointed out that she didn’t want to be handling the substance that the gorilla was tossing to her!

She gave money to people on the streets. She was quite clear that she didn’t care what folks did with cash. It was her choice to give. It was theirs what they ended up doing with it.

One of the lessons that Lauren cherished the most from her grandmother was that it is okay to crave and insist on some alone time. Lauren also inherited the travel bug. Elaine loved to visit far off countries, often by herself. She would pick a place and spend a couple of years researching and planning what she would see. She loved art and would have a list of museum exhibits to visit. She would also learn some important phrases in the new language. When we were clearing through her apartment after she died, We found a list of some quick translations in Turkish from a trip to Istanbul:

  • Where is the bathroom
  • How much does this cost
  • This is my hotel
  • Chocolate ice cream (Lauren used this phrase personally on her own trip to Istanbul!)

I admire her priorities!
She never took photos. She said that’s what postcards are for. She wanted to see things from her eyes and not behind the lens of a camera.

In 2014, Lauren packed up her sturdy backpack which she still has, and is called “ chocolate Ice cream”, and went to spend a year teaching English in Israel. She took advantage of being in that part of the world to take short trips during her breaks. The first trip she rather randomly planned was to Budapest and Prague.

When we told Uncle Bert, Elaine’s brother, that Lauren was going to those two cities, he paused for a moment and told us that those two places were the next ones on Elaine’s bucket list. We had no idea. She had started doing her research but age got in the way and she wasn’t able to go. We got the chills. Maybe not so random after all.

One of the last but important lessons she left us with was that everyone grieves differently. There is no such thing as a correct way to deal with loss.

Elaine had a framed poem that she treasured:

I’m not Here
Don’t stand by my grave and weep
For I’m not there, I do not sleep
I am a thousand winds that blow
I am the diamonds glint on snow
I am the sunlight on ripened grain
I am the gentle autumn rain

When you awaken in morning’s hush
I am the swift uplifting rush
Of quiet birds in circle flight
I am the soft stars that shine at night
Do not stand at my grave and cry
I am not there, I did not die

Indeed, her lessons and her love live on.