Drowning Prevention: Appoint a Water Guardian!

Drowning Prevention: Appoint a Water Guardian!

Somehow it is already summer. This year feels so different, but many families are figuring out how to do a bit of traveling even in the midst of the Covid virus. As long as you take reasonable precautions, getting a change of scenery can be a wonderful thing. Anytime you are away from home, there are a range of safety issues that can arise. When you get to your vacation destination, do a basic assessment as soon as you arrive. Are there smoke and carbon monoxide detectors? Do you know where the fire extinguisher is? If you are visiting older relatives, are any of their medications safety out of reach? Are any unfamiliar pets comfortable with children? Have you asked to make certain that there are no unsecured firearms?   Think like a toddler. What type of trouble can they get into? Can they open the doors on their own?   Water danger is one of the more essential considerations. If you are going anywhere that has a pool or is near water of any sort, you need to be aware that drowning can happen in just a few inches of water and it can happen quickly!!! According to the CDC drowning is now the most common cause of death in children under the age of four (excluding congenital issues)   Here is a true story from one of my patients. Several adults and children were enjoying a day at a friend's pool in the East bay. They got out of the pool to have some lunch. Some of the oldest kids started to bicker. While the adults turned their attention to the squabble, a one year old got back into the pool unnoticed and submerged. Thank goodness another of the adults looked up, noticed, and was able to get her out and perform CPR. The little girl is perfectly fine, but this was terrifying for everyone.  Just this week my friend Dr. Ted from Oath Pediatrics, fresh from his overnight shift in the hospital, was telling me about a close call, near drowning from a family pool in Walnut Creek. Just a moment of taking their eyes off of the kids almost led to tragedy. Sometimes having a lot of adults around lends a false sense of security. If kids are near a pool, the adults must take turns being on a shift as the designated lifeguard.   It is so important to be aware that a person who is drowning usually does not thrash about and call attention to the fact that they are having trouble. They can slip silently under the water without being noticed until it is too late. Even if your child has proven themselves to be solid swimmers, you need to stay actively focused and engaged on watching them like a hawk while they are in the water.   When I sent this post a couple of years ago, I became aware of Levi's Legacy https://www.levislegacy.com/ and I am going to continue to do my part to spread the word. Many parents are doing a good job of staying on high alert when they are actively at a poolside but the danger doesn’t end when you leave the pool area.   Levi's Legacy tells a heartbreaking story of a child who slipped out of the vacation home, made it out to the pool and drowned as the parents were busy doing some preparation for a family evening outing.   The important message here is that the lifeguard shift does NOT end when you go inside.   If you are staying anywhere with a pool, make certain that your child has absolutely no access to the pool area when there is no adult present. Hotels or apartments with fountains need to be treated with caution as well. If you do have pool access, there are a variety of pool alarms and safety monitors on the market. Some devices are little gadgets that your child wears around their wrist. Alarms and monitors may add a layer of safety but nothing takes the place of direct supervision. Someone needs to be on duty. Take turns. Appoint a water guardian. On duty mean no distractions (that means your cell phone. Put it down, you can do it.)

Decisions about how to ease out of quarantine restrictions

Decisions/ Decisions

Being isolated is HARD! We have been in quarantine for three months, give or take 100 years. With talk about things starting to open up, I have gotten many questions from friends and patients asking for my counsel about how to make a good decision about their personal “opening up”. People need to figure out work, childcare and/or seeing their family and friends. Some schools are reopening. I have some friends who are busting to hold their grandchildren and haven’t been able to. Others have made creative quarantine schedules to allow visits. How and when to normalize is on everyone’s mind. As much as we wish we could wave a magic wand, this virus is not going away anytime soon. Staying inside is not realistic for another year. We need to find the crucial balance. At the same time, watching other states reopen and have numbers surging is an uncomfortable situation. During the past couple of months, many people made individual choices about how much they would actively isolate. Here is an important fact - you can be as careful as can be, but if you are living with someone who is not taking adequate precautions, then you may be wasting your efforts. Some people have created an absolute bubble. They have had no in-person contact with anyone. All of their food is delivered and decontaminated before they touch it. If we are assigning grades, they get an A+. Other people I know have been making more relaxed choices. Folks with a wide social circle, who congregate but keep their masks on are probably a C+. If they go out without a mask, they get an F. (How masks became a political football is beyond me; it is a simple action. It broadcasts that you have an awareness and are taking an action that is in your control.) I will assign myself the grade of an A-. I have been very careful about who I see. I have done some safely distanced walks outside with other friends who are also at least an A-. I have gone into some supermarkets, but not when they were crowded and I did a full scrub when finished. I always have a mask with me and put it on when I am within 6 feet of anyone outside my home. I make a conscious choice to not judge anyone else's decisions. I give full respect to people that will avoid me because I am not an A+. I give my understanding to the people who have a lower grade. Some of those have no options. They have to work or deal with childcare. While I don’t question their choices, I maintain my own boundaries. Being over 60, I have tried hard to keep people out of my orbit unless I am comfortable that they “make the grade.” Understand that these grades are arbitrary and are made up on a scale that is only found in my brain. You all get to create your own scale. Remember, your grade is only as high as the people you are with. Or in other words, you are only as safe as your weakest link. If I spend time with a B-, then my grade goes down to a B-. I am not privy to any special inside scoop, but I am good at problem solving. This is all about risk vs. benefit.  What do I mean by that? Here is an example that my husband Sandy uses. He had to do a personal risk assessment regarding resuming activities after major orthopedic surgery, and his surgeon taught him how to think about it. In 1990 he tore his anterior cruciate ligament playing basketball; he also participated in a variety of other sports, but this was his passion. This was the dark ages of orthopedic surgery and there was no such thing as arthroscopic surgery for this injury back then. So, he had almost 7 hours of surgery, with 4-6 inch scars on both sides of his knee. He was in the hospital for 6 days and non-weight bearing for 8 weeks; This was going on while I was quite pregnant with our second daughter. His rehab was excruciating and took a full year. When his doctor told him he was free to resume an active sports life, he expressed serious reservations, because he never wanted to go through this again, and he was fearful of tearing it again. So the doctor asked him a series of questions – how would he feel if he ended up back in his office after tearing it playing softball? Sandy said he would regret it and believe it to have been a waste. How about if he ended back there after skiing? Sandy said he liked skiing but also would not feel it was worth another surgery and rehab. What about basketball? And here Sandy said yes, it would be ok if he injured it again playing basketball because he loved it that much. So the doctor said – ok, there’s your answer. Go out and play basketball! And he did! But what he first had to do was weigh the consequences of a number of potential activities against the benefit he would derive from each, and only one met that hurdle. Unfortunately, Sandy got a real-world test of his analysis 8 years later when he tore his other ACL. But he had no regrets, even before seeing the same surgeon. As luck would have it, arthroscopic repair had become the standard for this surgery; he was in the hospital one night, weight bearing the day after surgery, and back on the basketball courts in 4 months, where he continued to play for many years. So all of you need to play the risk/ benefit game for your family. No one has the exact same situation. So, how do we approach these very complicated choices that have potential ramifications that go beyond the risk of knee injury. Simplify it as much as you can by marking down all of the important considerations. What are the benefits of the action you're considering? And what price are you willing to pay to do it? Make a list. Writing it all down might help you get clarity. Start with contemplating your risk tolerance. Kids are generally not getting very ill from this, and the young adults are not as safe as once thought, but if someone in your quarantine bubble is over 60 or has any preexisting conditions, that needs to be taken into consideration. Where are you located? That is an incredibly important factor. Keep an eye on the numbers in your city. They are likely changing weekly. Keep your finger on the pulse. In San Francisco, the numbers are relatively low and flat compared to other large cities. Find a database that you trust and keep checking it. I do a daily look at the US and world counts here: https://ncov2019.live/ I check the bay area here: https://projects.sfchronicle.com/2020/coronavirus-map/ Another excellent source are the tweets of Bob Wachter, Chief of Medicine at UCSF: twitter.com/Bob_Wachter Keep in mind that all life activities involve risk. Just getting in a car or crossing the street involves some risk. So, what is it that you want to do? For instance, going to a movie theatre right now would seem like a silly choice right now; you can watch a movie from home. That is an easy one. Pedicure? Paint your own toenails. Questions like childcare are a bit more complicated. Who might be coming into your orbit? What is their grade? Are you contemplating a visit with family or friends who have not been as careful as you are? Have a serious and civil conversation. Perhaps they are willing to do a week of clean living to raise their grade in order to accommodate you. Of course we don’t know if a week is adequate. Two weeks would be safer. Come up with a solution that feels right for all of you. One of my cousins has planned an Air BnB get away with her kids. She has been an A+. Her daughter has been a B, but is going to spend a very careful week or so raising her grade before joining her parents for what will surely be a wonderful getaway. Their son has been going to a lot of protests in NYC. He wears a mask, but is not going to change his lifestyle to get his grade up high enough. He won’t be joining the rest of the family. They all love each other and completely respect each other's choices. While you do your figuring, here are some things we know about contracting the virus. Some of these factors carry more weight than others. It is much more about the air that we share, than catching something from touching something. Outdoors is significantly safer than indoors. >6 ft is safer than <6 ft.  Masks are safer than no masks. Of course the masks also need to be worn properly. Short exposures (<10 min) are safer than longer ones.  Regardless of whether or not you are inside or outside, the risk goes up if you are around people who are coughing or sneezing, but it also goes up if people are shouting or singing. There was a church choir that was severely impacted early on in this pandemic.   If you have wandered outside the safety of your home, washing your hands for at least 20 seconds and avoiding touching your face are the most protective actions that you can take. Hand sanitizer is useful but you need to use at least a dime sized dollop and then after generously spreading it, allow it to dry. Once you get back to a sink, do an extra wash with soap and water. In the unlikely event that the virus has landed somewhere and is actually still alive, shiny surfaces are riskier than rough ones. There was a story in the news this week about toilet seats.. Oy, I am not even going to go there. Just please wash your hands. Looking at the above information, it stands to reason that taking a walk outside while wearing a mask is probably pretty safe. Being inside the corner fruit store for 5 minutes and washing your hands before you touch your face, probably okay too.   Singing duets inside a building for an extended period with someone who is not usually in your bubble, is quite a bit riskier. Whatever happens...accept that you made the best choice you could in the circumstances. Parents it is essential that you work as a team here. There can be no finger pointing if things don’t go as planned. Whatever plan you cobble together, shake on it (and then go wash your hands!) You are in this together. This is all a guessing game. Put thought into the process and do the best you can. No beating yourself up.   This will pass at some point. We will find some kind of new normal that doesn’t feel as restrictive. Scientists are actively working on improving testing, tracking and working on vaccines, but I am not optimistic that we will have true answers this year.  We need to carefully balance safety with the need to resume some normalcy.

Stop feeling guilty for finding moments of joy

Have you ever gone from laughing to crying and then back again in a single breath? I know I have. Emotions don’t follow rules. They jumble in all at once. It is perfectly normal to be able to host more than one emotion at the same time. Why am I paying attention to this now?  Because, these days, when I ask someone how they are doing, the response is usually a protracted sigh. Many people feel guilt or shame if they are among the population that is actually doing somewhat okay during these tumultuous times. People seem reluctant to admit that they are intact. I think I will start changing my question. Instead of the broad, “How are you?”, I will amend it to “How are things in your tiny little corner of the universe?” By no means should we afford ourselves the luxury of ignoring what is happening to the state of the world these days. It is essential to listen, pay attention, learn and support others who are fighting real battles with health and/or racial injustice. If you need to feel some heartache over current events, allow it, but if you can, put some limits on it. As my daughter Alana says about a tricky emotion, “invite it in for tea, but don’t let it stay for too long”.  In order to continue to live well, we also need to invite the joy in. Think of it as your oxygen mask. You need to take care of your mental health so that you can then tend to the needs of others. If your immediate friends and family are intact, then as a family you can reach out further and put positive energy out in the world. It starts with you. Joy is everywhere. You just have to notice it.  I frequently walk up to the top of twin peaks. It is currently closed to cars, I confess that I will have mixed feelings when it opens back up. There is joy in looking at the flowers, hearing the birds, smiling at the children who are busy making chalk drawings on the sidewalks. I give a greeting to all the waggy dogs. There is joy in the sweet clear air when I sneak my mask down below my nose for a few moments. I am thrilled that my body graces me with the ability to get up there without passing out. And then there is the spectacular view which is a reward all by itself. How can I feel contentment when the world is in so much turmoil? How can any of us? Because we must. I had recently been chatting with some patients who had new babies. They were exhausted, but euphoric. The discussion was about how they had mixed feelings of sharing their happiness with others. You don’t need to hide. The world needs that joy!

In memory of Uncle Landshark

In Memory of Uncle Landshark

I do much of my writing at night when I am in bed trying to fall asleep. Words and sentences swirl through my head. This world is hurting so much right now. There is a lot to grapple with. I had several subjects that I was considering writing about this week - big topics, such as talking to your children about race and how to teach them to value differences. Health issues such as the fact that standard vaccinations rates are going down. Or perhaps writing about more tips on keeping sane during the quarantine….but then this weekend my family and I experienced a more personal loss. That is the subject that won the battle. Thank you for indulging me as I put my memories onto paper. We lost our uncle Steve this week. My kids called him uncle Landshark because of a game he played with them when they were children. He was one of the good guys on this planet. Steve was my husband's uncle, but since I have known him since I was 17, we were closely connected. I chatted with him at least every week or so. It wasn’t uncommon for calls to go into voicemail. He took turns ignoring his cell or his landline, depending on which was getting more spam calls that month. It also wasn’t unusual for him to take a few days before calling me back. This past week, after a few days of leaving messages, not hearing back from him, and a “feeling in my gut that something was not okay,” Sandy called the police in his little town in Ohio and asked them to do a welfare check. They broke into the house and found that he had died. I had been nagging him to get one of those life alerts, but he was stubborn. He was just shy of turning 80, and with a 91 year old older brother down in Florida who is doing well, I hadn’t pushed the ‘younger’ uncle on it, beyond bringing it up occasionally. For those of you who like my tales of the “things that are hard to explain” here is one. Steve was married to Aunt Millie. She and I were also very close. Several years ago when I was at work, my phone started to turn off and restart. It continued this cycle repeatedly. Other people watched and witnessed, no one could figure it out. I called Sandy and told him what was going on. He "knew" why this was happening but instead said it might be time for a new phone. He sounded a bit odd and told me that we could figure it out later. The phone continued to be “possessed” for the entire day. When I got home, Sandy broke the news to me that Millie had died, fairly suddenly. The phone stopped acting strangely. The message had been delivered. This week, before we actually knew there was anything wrong, both my phone and my daughter Alana's started acting wonky. Our phones were making calls to each other without any instigation from us. Not butt calls - the phone would be on a surface, not being touched and would start dialing. Also, the Alexa device in our house was randomly having conversations. There was a disturbance in the force. Now we know. The devices are now behaving just fine again. How to capture his essence in just a few words…..   Steve spent most of his life in the air force as a communications expert. For much of his career he was stationed at Cape Kennedy, assigned to NASA. Yes, along with the astronauts, he drove a Corvette while there! He was actively involved with all the Apollo missions. While not officially licensed, since he was already aloft as part of the team, when not busy he would occasionally pilot the converted C130 plane used to communicate with the lunar missions; he just missed seeing this recent launch. Once retired, he volunteered for the Red Cross as a radio and communications expert, assigned to emergency response teams that were sent to different disaster areas to lend a hand. On every birthday Steve and Millie would call family members, armed with pots and pans, whistles and other noise makers. We would get a clanking, cacophonous rendition of a very off-key happy birthday that is hard to describe. He loved all animals and until that last year or so, always had an assortment of rescued animals that found their way to him.  When Steve came to visit he liked to fix and repair things. He also woke up in the middle of the night and baked delicious mandel bread. I remember the first time he did that, I woke up at 3 am to the most amazing aroma, went down to explore and found him busy in the kitchen. The recipe was his secret. As far as we know, he took it with him (maybe he can figure out a way to text it to me.) He hated butter. He was that person who would interview the servers at every restaurant for at least five minutes about the importance of making sure that no butter was involved in the preparation of his food. As much as he hated butter, he loved extremely spicy food and lived for sushi. A good day could include sushi for breakfast, lunch and dinner. I kid you not. I allowed myself a solid day to beat myself up for not acting on my uneasiness that first moment when he didn’t call me back. Of course I know perfectly well that it may well not have made a difference. I am human and had to play the woulda-shoulda-coulda game. I can’t change this story, but I can perhaps change somebody else's. Do you have people in your life who live alone? Quarantine is tricky for people who live by themselves. How long does it take for someone to notice that there might be something wrong? Please institute a daily check-in system with the people in your life.  Do people have “in case of emergency instructions” left in a place where others can find them? Unfortunately, we have now learned that uncle Steve did not. Get that taken care of. It might not be an easy conversation, but it is an important one

How and when to talk to your kids about sex. It might be sooner than you think!

I have been doing this blog for many years. I try to stay fresh with new thoughts and ideas, but I also continually update old posts. Things change, new information emerges, sometimes something will come along making headlines that feels like it is worth addressing. The ‘Talking to your kids about sex post” is one that I have posted several times over the years. I am updating it because there is a new resource that I want you all to know about. I have tacked information and the link to a brilliant playbook option on to the bottom of the post. Comes the moment in every family when it is time to have the talk about sex, but how and when? It varies with every child. There is a story about a young boy visiting his grandparents’ house one summer. He came rushing in from outside where he had been playing with some new friends from the neighborhood. “Grandma, what’s it called when two people are in bed, but one is on top of the other one?” Grandma was taken aback for a moment but sat him down and gave him a matter of fact talk about the birds and the bees, so to speak. The little boy listened carefully with his eyes open wide and then ran back out to join his friends. It wasn’t long before he ran back into the house saying, “Grandma, it’s called BUNK BEDS and Mrs. Wilson wants to talk to you!" The all important moral of this story is to make sure that when your child presents you with a question, you understand what they are actually asking before you launch into any complex explanations. You could start with a statement such as “ I am so glad that you asked me. I am always happy to help you find answers to things. Tell me more about what you are wondering about." My sister Amy has her own tale. She and her husband are National Park rangers and they moved to Utah when her oldest son was in 4th grade. Even when reading the Harry Potter series, my nephew Asher covered his ears when they were reading any scenes that involved kissing, but now that they were living in a new place, he had a question. “Mom, where do babies come from”? Amy paused and then followed up appropriately. “Is there something specific that you are wondering about?” “I heard that babies happen when a mommy and daddy love each other very much and their souls connect.” My sister's family was now living in the heart of Mormon country where most families were quite a bit larger than he was used to seeing. He knew that his mom and dad seemed to love each other a lot, but they just had 2 kids, Asher and his brother Ben. The math wasn’t adding up. Why didn’t their ‘souls connect’ as often as most of the neighbors. Amy went on to let him know that there was a little more to it than that, but it involved some more mechanics including some of that “Kissing stuff”. Nope, this wasn't his moment.There was no need to talk about it that day. Get yourself as comfortable as you can with the discussion. What do you call body parts? Does your family use a nickname (perfectly fine) or is your child able to rattle off the anatomical names for all of their “parts"? Of course having discussions about bodies usually comes long before discussions about sex. Many parents are a little shocked and uncomfortable when infant boys have erections or they notice young boys and girls masturbating. This is incredibly common (the human race is fortunate that masturbation doesn’t actually cause blindness.) While it is usually quite normal, if you notice that your child is constantly touching themselves to excess, I want to make sure there is no irritation or external cause. Maybe their underwear is too tight. Have they been running around in a wet bathing suit? That could be yeast. Itching could even be something like pinworms! If there is no obvious underlying issue, consider having a discussion about that fact that, yes it feels good, but our bodies are delicate and it is important not to touch so much that things can get sore. Some families have a talk about family rules and theirs might be that gentle touching is a private activity. Beware, a true story - one of my families who made a point of having accurate vocabulary was caught off guard one night when their 4 year old son made an announcement at a fairly formal dinner party with mom’s boss. “ I am going to go into my room now so that I can touch my penis in private.” This is also an important time to have a discussion about body ownership. No one should be able to touch any part of your child’s body without permission. Exceptions are parents and doctors (with parents present) and that should never be a secret! Empowering your child about their body early is important. And then they get a little bit older…. I remember driving a van loaded with carpool kids to school many many years ago. I caught a piece of the conversation that was going on in the back seat and my ears perked up a bit as I tuned in. “Yours have done it at least twice." “Yours have done it at least once” "Ours have done it at least twice...Oooh/Yuck” As soon as you feel that your child is curious and is possibly going to be picking up odd or skewed information from their friends or classmates, it is important that you make an opportunity to have a chat. It is essential that your child sees you as the trusted source of correct information and is comfortable asking you questions. Unfortunately in this high tech world, it is becoming increasingly easy for kids to be exposed to all sorts of things with very adult content at a very young age. You may want the help of a book. Amazon and libraries have an enormous amount of books that you can use as a resource. There are many good ones out there. I would suggest that you skim through several until you find one that feels like it is the right comfort level for you. You may want to do this research a little ahead of time. (At the end of this post is a new and worthwhile resource to check out.) Liesel Harris-Boundy from the West Portal Branch of the San Francisco Public Library was kind enough to come up with a list of good books on the subject that she is familiar with. Liesel shared that an ObGyn friend recounted that her 7-year old son asked her, "Mom, what's a vagina?" and though this woman talks about vaginas all day, she was unprepared to tell her son and excused herself from answering! That reserved part of her upbringing came through in spite of all her medical training! This is to remind you that we all have different comfort levels dealing with this, but gather your wits about you, it needs to be done. The following books should all be available through the library. Once the libraries reopen, go in and leaf through a few until you pick one that you like. Talk to Me First: Everything You Need to Know to Become Your Kids' "Go-To" Person about Sex by Deborah Roffman Talking to Your Kids About Sex: turning "the talk" into a conversation for life by Laura Berman Asking About Sex & Growing Up: A Question-and-Answer Book for Kids by Joanna Cole Everything You Never Wanted Your Kids to Know about Sex, (but Were Afraid They'd Ask): The Secrets to Surviving Your Child's Sexual Development from Birth to the Teens by Justin Richardson and Mark A. Schuster Talking to Your Kids About Sex: From Toddlers to Preteens by Lauri Berkenkamp, Steven C. Atkins, Charlie Woglom Sex Is a Funny Word: A Book about Bodies, Relationships, and YOU by Cory Silverberg It's Perfectly Normal: Changing Bodies, Growing Up, Sex, and Sexual Health (20th Anniv. Edition) by Robie H. Harris You want to make sure that the books are geared to the correct age. Some are guides for the parents and some are meant as a resource for the child. ****************************************************************** There are many different kinds of families, it isn’t always mommy plus daddy equals baby. I was happy to find out about the book below. http://corysilverberg.com/what-makes-a-baby/ What Makes a Baby is a children’s picture book about where babies come from that is written and illustrated to include all kinds of kids, adults, and families. Geared to readers from preschool to about 8 years old, it teaches curious kids about conception, gestation, and birth in a way that works regardless of whether or not the child in question was adopted, conceived using reproductive technologies at home or in a clinic, through surrogacy, or the old fashioned way; and regardless of how many people were involved, their orientation, gender and other identity, or family composition. Just as important, the story doesn’t gender identify people or body parts, so most parents and families will find that it leaves room for them to educate their child without having to erase their own experience. Once you do pick the book that you feel comfortable using as a resource, go ahead and buy a copy so that there isn’t a time limit. If your child is embarking on puberty and you are looking for something more interactive than a book, check out the Heart to Heart seminars hosted by Stanford. They hold these in multiple locations. The San Francisco class is held at CPMC on California street: https://www.stanfordchildrens.org/en/classes/community/pre-teen-teen-parent During this Covid quarantine, they are offering classes online! A list of other classes they offer are here: https://www.stanfordchildrens.org/en/classes One mom in our practice who went to the session thought it was very worthwhile, but she wished she had taken it earlier. She thought ten or eleven would have been perfect. So what’s new? Caricia, a local mom with two daughters was reading an article that included some disturbing statistics. Global estimates published by WHO indicate that about 1 in 3 (35%) of women worldwide have experienced either physical and/or sexual intimate-partner violence or non-partner violence in their lifetime. The sad fact is that these are the same statistics that existed 30 years ago. Knowing what we know, why haven’t we been able to improve this? She gathered together a group of other parents to take a deeper look. It turned out that the public school where her children attend does the standard 5th grade sex ed that we all probably remember. They actually still use a VHS tape from 1984. Woe unto them when the VCR breaks. This is perfectly adequate to teach kids about periods and erections, but this is no longer the same world. Kids these days need to learn more about consent and boundaries. They should be aware of gender identity. They need to be given tools that will help them be able to have healthy relationships. They need to be able to navigate the online world safely. Social media is a minefield. This group of parents embraced this project with a gusto. They traveled the world in search of information. The disparities between different countries was notable. The Netherlands is the country with the best health outcomes so they headed there to learn more. One of the successes that the Netherlands has achieved is the lowest incident of teen pregnancies and sexually transmitted diseases. If the data is to be believed, the kids wait. The first sexual intercourse was reported to be the age of 19 and, this is important, it was with someone they cared about. Contrast that with this country where the average age is 16 and the experience is more likely to be casual. Once they returned from their travels, they studied the curricula from leaders in the field here as well. The thinking is that we need to start our education earlier. Perhaps as young as 5 years old. At the very least, young children should be comfortable with their bodies. They should be given the rules that a surprise is okay, but a secret is not. This is a crazy scary world; we do NOT want porn or sexting to be our kids first introduction to sex. Parents need to be the ones to get there first with accurate information. How do we tackle this? You can thank this group of parents for creating a method that will help guide you through this. These educational activities focus on empathy and safety as well as biology. These are broken down into 3 age appropriate segments. 5-8 7-10 9-12 These are rough age ranges because they recognize individual differences in families and children. These are also directed to parental comfort. The books are spiral bound. If there is something a parent wants to avoid, a page can be removed. Hopefully there isn’t anything that you are too uncomfortable to talk about. The goal is normalizing this topic and keeping the conversations safe and open. The website is Bloomscience.org This goes well beyond simply reading a book to get necessary information. What they have is playbooks that include games and activities that can open dialogue opportunities. There is also a robust list of books and resources on the site ( some overlap with the list I have above). Bottom line, honesty and communication are essential. As awkward as this conversation may feel to some of you, you really don’t want your kids to be getting their sex education from the neighborhood kids (or even worse, the internet!) For your teens, you can act as a safe boundary from the nastier places on the internet. Make clear rules that as long as you are paying for the phone plan, you have access to the browsing history whenever you want (but don't abuse that right!) There might be the kid out there who feels saved by this. “Sorry, I can’t sent you a photo of my ‘whoozee whatsis’, my parents check my phone.” Don't force too much information on a younger child who isn't interested. Letting them know that you are always open and willing to talk about "grown up" stuff with them is a great start. These playbooks might be just this thing.   Click  to find more about and/or support this project

The impact of a single sentence

The impact of a single sentence

My Mother-in-Law’s birthday was this week. I have done several posts about her over the years. This week I am rerunning a short one that is always relevant. Social media in general and Facebook in particular have their benefits and drawbacks There is no doubt that it is way easier to reconnect with long lost friends than it used to be.   A few years ago my husband got tagged in a 6th grade class photo from his good old PS 32 in New York City. This started a flurry of conversation between people who hadn’t been in touch for many many (many) years. There is really nothing quite like an old friend who knew you when. I believe he may actually stay reconnected with some of these folks.   With all the catching up that was going on, there was a comment from a girl in his class that caught my attention. She wanted to let Sandy know that after all this time, she still thought about his mother.   It turns out that way back when, after a school performance, my mother-in-law had made a bee-line straight over to this girl just to tell her what a wonderful job she had done. It wasn’t the simple “good for you”; Elaine had told her how moved she had been and that this young lady should be very proud of the performance. Forty eight years later, this woman says that she still remembers how impacted she was by the interaction. Wow!   There are more people out there than we can count for whom a crumb of positive feedback is rare and important. Words, either kind ones or mean ones, are often put out there without much thought and the speaker moves on. This story illustrates how much a message can sometimes stick and make a profound impact. Update: I was taking a walk with Alana and I told her that I was re-running this old post. She thought it was worth mentioning that it isn’t only words that make a difference. As we walk along with our masks on, it is more important than ever to make socially distant but kind and pleasant acknowledgements to the people we pass. You never know when kind words or positive attention are exactly what someone might need to keep moving forward. Folks are so stressed right now. A nod of your head and a smile with your eyes can count. Even better is a “Hi, enjoy this lovely weather" or "Oh what a sweet doggy.” This simple interaction might be the only one that some people are getting these days. Only do this when it seems appropriate. There is no need to engage with someone who makes you feel uncomfortable.

The science of Hair Loss

Quarantine day 200001, or at least that's the way it feels. My hair is getting long. Easy enough to pop it into a ponytail; it will be long enough to donate when all of this is over. Sandy’s hair was driving him crazy and a ponytail was not an option. We actually looked online to see if we could procure a Flowbee. Remember those? It was a hair-cutting tool attached to a vacuum cleaner, a strange but brilliant concept from decades ago. Evidently we weren’t the only one with that idea and they are all sold out. With little option, Sandy trusted me with the scissors and for the first time in 44 year relationship, I gave him a haircut. It came out surprisingly well, but I will stick to writing and giving advice. The scissors will be turned over to more able hands as soon as we move into that phase of looser restrictions. In the meanwhile, health and safety are more important than lovely haircuts. Since hair was on my mind and I have also recently gotten some questions about it from my Juno chat groups, I thought I would address this topic in a post.

This week's topic The science of hair loss

When I was the advice nurse at Noe, I would get the occasional call from a parent who was worried that their kid's hair seemed to be falling out at an alarming rate. They seemed otherwise well. The parents were always surprised when I asked them to think back and see if there had been any stress or illness several months ago. Here is a little hair science to explain why. People typically lose about 100 hairs a day. This usually doesn't cause noticeable thinning of scalp hair because new hair is growing in at the same time. Hair has a growth stage and a resting stage. The growth stage usually lasts about three years. The resting phase ranges from one to six months, but three months is the most typical. During the resting phase, the hair remains in the follicle until the new hair starts to grow in. Roughly 5 to 15 percent of the hair on the scalp is in the resting phase at any one time.It starts to shed when the new growth stage starts. If you want to get technical and impress folks at your next Zoom happy hour, growing hairs are called anagen hair and resting hairs are referred to as telogen hair. If there is some hormonal changes or stress to the system, as many as 70% of the growing hairs become resting hairs which are poised to fall out. Those resting hairs don’t shed until the new hair coming in pushes them out. This happens a full 2 to 4 months after the triggering event. It is usually not something that has long term consequences and most of the time the hair grows back fully. I mentioned stress or illness. Hormones are another common cause. Mommies who recently gave birth, I am talking to you. Even in the throes of exhaustion with all of your shirts covered with spit up, it is hard not to notice all of those hairs on your pillow when you wake up. This is very very normal. Your hair will grow back. Pregnancy isn’t the only culprit. Hormonal changes from getting on or off various birth control methods can also trigger this reactive hair loss. Other common causes could be thyroid issues, certain medications, jet lag, nutritional deficiencies, eating disorders, excessive sun exposure. This list goes on and on. So, if you or your child are experiencing excessive hair shedding, see if you can figure out a cause, relax and give yourself some time for it to grow back. If it remains a mystery and doesn’t show signs of slowing down, it is time to check in with the dermatologist. Let's talk about your baby’s hair. Babies are born with their complete set of hair follicles. They just have wide variations in when the hair will actually grow in. Remember that babies are exposed to huge hormone fluctuations, so even those who are born with a full head of thick hair are likely to lose it within a few months. Interestingly, often the hair that grows back can be an entirely different color and texture. This is all normal. If there is only one area that seems to be thinning, that is often positional. Little ones who get plunked down on their backs (following the guidelines) often have a patch that has less hair. Aside from infants, if you or your older child has a distinct patch of hair loss, rather than general shedding, make sure it isn’t from something as obvious as tight ponytails or barrettes. If that isn’t the cause, it is worth checking with your doctor or dermatologist to make sure there isn’t an underlying issue. If the patch is scaly and circular, that could be ringworm.Dr Lawrence Cheung, my 'go to' dermatologist says that there is lots of clinical research going on that will hopefully help with future treatment for more serious hair loss conditions. If your child is pulling their hair out this might be because they are itchy! Check the scalp to make sure you don’t see any irritation. While you are there, check for nits. ( I know you hate me now and many of you are scratching your heads) If the head looks clean, hair pulling can be a simple habit ( blog post) . It could also be a condition called Trichotillomania (pronounced trik-o-till-o-MAY-nee-uh), or something that is stress related. It is worth talking to your doctor if this persists. Interesting Hair trivia Your hair can grow up to 0.5mm per day – that’s 6 inches per year!  When wet, a healthy strand of hair can stretch an additional 30% of its original length. Goosebumps from cold or fear are the result of hair follicles contracting, causing the hair and surrounding skin to bunch up. Balding only begins to become visible once you’ve lost over 50 percent of the hairs from your scalp. Anything that’s been in your bloodstream, including drugs, alcohol and minerals can be detected in your hair, which is why hair is most commonly used as forensic evidence. The only thing that cannot be identified by your hair is your gender – both men’s and women’s hair is identical in structure. Stress diagnostics can measure cortisol levels in hair. There are fascinating future implications for this that I will discuss in a future post.